Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
PDF 106 KB Posted
- Attached to
- Alco-Sensor Equipment, Parts and Supplies
- Solicitation number
- IFB-26-0123
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Full/Final Payment to DBE (Disadvantaged Business Enterprise) Firms form issued by the City of Phoenix Public Transit Department for use upon completion of contract work. The document serves as a dual affidavit requiring both the prime contractor and the DBE subcontractor to certify that full payment, including all retention amounts, has been made for materials and work performed on designated projects. The form requires the contractor to document the total value of all payments made to the DBE firm and be signed under penalty of perjury in the second degree, with supporting documentation subject to audit and retention for a minimum of three years from the project acceptance date. The DBE firm must similarly certify receipt of accurate payment amounts and confirm the validity of the contract entered into with the prime contractor.
This certification document is directly applicable to the City of Phoenix's Alco-Sensor Equipment, Parts and Supplies procurement (IFB-26-0123), which is subject to DBE and Small Business Participation Plan requirements under 49 CFR Parts 26 and 23. Contractors awarded this five-year contract commencing November 1, 2026, must submit an initial Small Business Participation Plan within thirty calendar days after contract award and track all DBE and small business expenditures monthly through the City's Certification and Compliance System. Upon completion of work or delivery of goods under this procurement, both the prime contractor and any DBE subcontractors must execute this certification form to document full and final payment compliance, ensuring accountability in the utilization of disadvantaged business enterprises as required by federal regulations and City of Phoenix policy.
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Text version
By:
Date:
City of Phoenix
PUBLIC TRANSIT DEPARTMENT
CERTIFICATION OF FULL/FINAL PAYMENT TO DBE FIRMS
(TO BE COMPLETED BY THE CONTRACTOR & DBE FIRM UPON COMPLETION OF WORK)
CONTRACTOR AFFIDAVIT:
The undersigned, having contracted as the Contractor on Project _________________ (Project Number and Name) hereby certifies that full payment (including all retention) has been made to the DBE firm cited below. The total value of all payments made to the DBE firm for materials and/or work performed on this project contract is as follows:
DBE Firm:
Total Amount Paid:
This certification is made under Federal and State laws concerning false statement.
Supporting documentation for this payment is subject to audit and should be retained for a minimum of three (3) years from the project acceptance date. In the event the DBE was not paid in accordance with affidavits submitted by the Successful Bidder, all documentation supporting the Successful Bidder 's position with regards to delayed or withheld payment(s) should be submitted.
I DECLARE UNDER PENALTY OF PERJURY IN THE SECOND DEGREE, AND ANY
OTHER APPLICABLE STATE OR FEDERAL LAW, THE STATEMENTS MADE ON
THIS DOCUMENT ARE TRUE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE.
Signature of Authorized Agent for Contractor
Printed Name and Title
By:
Date:
DBE FIRM AFFIDAVIT:
(Name of DBE)
The undersigned DBE firm hereby certifies that a contract was entered into with the above named Contractor to perform work or provide materials on the project cited in this document. I further certify that the total amount of payments received as provided herein by the prime contract is accurate and unchallenged.
I DECLARE UNDER PENALTY OF PERJURY IN THE SECOND DEGREE, AND ANY
OTHER APPLICABLE STATE OF FEDERAL LAWS, THE STATEMENTS MADE ON
THIS DOCUMENT ARE TRUE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE.
Signature of Authorized Agent for DBE Firm
Printed Name and Title
| Exhibit - Initial SBPP Plan |
| Exhibit - DBE Annual SBPP Plan |
| Exhibit - DBE Request for Substitution or Exemption |
| Exhibit - DBE Certification of Final Payment |
| CONTRACTOR AFFIDAVIT: |
| DBE Firm: |
| Total Amount Paid: |
| Printed Name and Title: |
| Text57: |
| Name of DBE: |
| Printed Name and Title_2: |
File details come from the government source that posted it. Updated .