Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf

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Attached to
Hazardous Detection Equipment, Accessories and Preventive Maintenance Services
Solicitation number
IFB-26-0111
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This document 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 contract work. The form requires dual certification—one affidavit completed by the prime contractor and a separate affidavit executed by the Disadvantaged Business Enterprise (DBE) firm—confirming that full payment, including all retention amounts, has been made for materials and work performed on a specific project. Both the contractor and DBE firm must certify the total amount paid and declare under penalty of perjury that all statements are true and complete. Supporting documentation for all payments must be retained for a minimum of three years from the project acceptance date, and in cases where the DBE was not paid in accordance with submitted affidavits, the contractor must provide documentation supporting any delayed or withheld payment positions. The form includes blank fields for project identification, DBE firm name, total amount paid, and authorized signatures with printed names and titles from both parties.

This certification form is directly applicable to the City of Phoenix Fire Department's IFB-26-0111 solicitation for hazardous detection equipment and preventive maintenance services, which mandates DBE participation compliance under 49 CFR Part 26. Contractors awarded the five-year contract (commencing June 1, 2026) must submit an initial DBE/Small Business Participation Plan within 30 days of award and provide annual updates, with monthly reporting through the City's Certification and Compliance System. The contract requires contractors to demonstrate good faith efforts to promote DBE participation through documented outreach activities, solicitation letters to DBE suppliers, and engagement with certified disadvantaged and small businesses identified through the Arizona Department of Transportation UTRACS database. Sealed offers are due March 10, 2026, with a non-mandatory pre-offer conference scheduled for March 3, 2026, and written inquiries due by March 6, 2026.

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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 .