Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf
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- Attached to
- Cooling Tower Water Treatment Services
- Solicitation number
- IFB 27-FMD-013
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution or Exemption form issued by the City of Phoenix Public Transit Department for the Disadvantaged Business Enterprise-Neutral (DBE-N) Program. The form must be submitted to the City of Phoenix Public Transit Department Compliance Section for approval prior to making any modifications to the proposed Statement of Small Business Utilization or the Contractor's Monthly Statement of Small Business Utilization Form. The form applies to the Cooling Tower Water Treatment Services contract, which has an effective date upon final signature and recording by the City Clerk's department, with a commencement date on or about October 1, 2026. The contract term is three years from the commencement date, with two optional one-year extensions that may be exercised at the City's sole discretion. The agreement will terminate upon reaching the end of the term, including any extensions, or upon termination pursuant to the contract provisions.
This form permits prime contractors to request exemptions for four categories of changes: releasing a proposed small business subcontractor, substituting a small business subcontractor, changing the scope of work for a small business subcontractor, or reducing the amount originally proposed for a small business subcontractor. No small business subcontractor shall be substituted, terminated, have their scope of work reduced, or have their proposed amount changed without written approval from the Contract Compliance Section. Prime contractors must provide detailed justification and documentation of good faith efforts to identify additional small business participation when requesting exemptions. Contract compliance specialists review and approve or deny requests, with approved requests resulting in revised small business utilization commitments.
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Text version
Disadvantaged Business Enterprise - Neutral (DBE-N) Program AGENCY: Public Transit Department
02_26-IFR - PTD
REQUEST FOR SUBSTITUTION/EXEMPTION
THIS FORM MUST BE SUBMITTED TO THE CITY OF PHOENIX, PUBLIC TRANSIT DEPARTMENT COMPLIANCE SECTION, FOR APPROVAL PRIOR TO MAKING ANY CHANGES TO THE PROPOSED STATEMENT OF SMALL BUSINESS (SB) UTILIZATION OR CONTRACTOR’S MONTHLY STATEMENT OF SMALL BUSINESS UTILIZATION FORM. NO SMALL BUSINESS SHALL BE SUBSTITUTED OR TERMINATED, NOR SHALL THEIR SCOPE OF WORK
BE REDUCED OR PROPOSED AMOUNT CHANGED WITHOUT THE APPROVAL OF THE CONTRACT
COMPLIANCE SECTION.
Prime Contractor: Contract Number:
Project Number and Description:
Affected Small Business Subcontractor(s):
Scope of Work to be Performed by Affected Small Business Subcontractors(s):
1. I am the duly authorized representative of the above-listed Prime Contractor and am authorized to request this exemption on behalf of the Prime Contractor.
2. I hereby request that an exemption be granted to the above-mentioned Prime Contractor to (circle those that apply);
A. Release a proposed SB subcontractor C. Substitute a SB subcontractor B. Change the scope of work to be performed by an SB subcontractor D. Reduce the amount originally proposed for a
SB subcontractor
3. I have summarized the Prime Contractor's request for an exemption and the good faith efforts required in finding additional Small Business participation on the above-mentioned contract as follows: (Attach additional pages and supporting documentation as necessary.)
Authorized Signature: ________________________________________________ Date: ___________________ Prime Contractor's Representative
Name and Title: _____________________________________________________ Phone: __________________
FOR CONTRACT COMPLIANCE USE ONLY
Request Approved: YES NO Revised Small Business Commitment: $
REVISED SMALL BUSINESS UTILIZATION
Contract Compliance Specialist: Date:
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