Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
PDF 106 KB Posted
- Attached to
- Portland Cement (Bulk)
- Solicitation number
- IFB-26-0033A
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Full/Final Payment to DBE Firms form issued by the City of Phoenix Public Transit Department for use upon completion of work on state and local contracts. The form serves as a dual affidavit document requiring certification from both the prime contractor and the Disadvantaged Business Enterprise (DBE) subcontractor that all payments, including retention amounts, have been made in full. The contractor must document the total value of all payments made to the DBE firm for materials and/or work performed, while the DBE firm must confirm receipt of payments and verify that no payment disputes exist. Supporting documentation for all payments must be retained for a minimum of three years from the project acceptance date. Both parties execute the certification under penalty of perjury in the second degree and under applicable state and federal laws.
The form is directly applicable to the City of Phoenix's Portland Cement (Bulk) procurement (IFB-26-0033A), a five-year contract for the Street Transportation Department with an estimated annual requirement of 300 tons of ASTM C-150, Type II Low Alkali cement. This solicitation emphasizes significant DBE and small business participation, requiring contractors to submit annual participation plans, conduct good faith outreach to DBE-certified suppliers, maintain detailed interaction documentation, and report monthly through the City's Certification and Compliance System. The procurement timeline includes a non-mandatory pre-offer conference on November 4, 2025, written inquiries due by November 19, 2025, and final offer submissions due on November 24, 2025, at 2:00 pm local time, with contract commencement targeted for July 1, 2026. Pricing will be firm and fixed for the initial two years with potential annual adjustments thereafter, subject to Chief Procurement Officer approval. Delivery requirements specify drop-off at the Street Transportation Preventive Maintenance facility between 7:00 am and 2:00 pm, Monday through Friday, excluding city holidays, with contractors required to maintain sufficient local inventory to support daily city requirements.
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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: |
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