Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
PDF 106 KB Posted
- Attached to
- HVAC Filter Maintenance and Repair
- Solicitation number
- 27-FMD-007
- 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, applicable to the HVAC Filter Maintenance and Repair contract. The form serves as an affidavit to be completed by contractors and Disadvantaged Business Enterprise (DBE) firms upon project completion to verify that full payment, including all retention amounts, has been made to DBE subcontractors. The three-year HVAC filter maintenance and repair contract commences September 1, 2026, with two optional one-year extension periods. The City of Phoenix solicitation requires sealed offers submitted electronically through the City's Procurement Portal, with a pre-offer conference scheduled for February 18, 2026, at 9:00 a.m. via Microsoft Teams, a written inquiry deadline of March 25, 2026, at 9:00 a.m., and sealed offers due April 8, 2026, at 11:00 a.m. Services include full-service HVAC filter maintenance and repair across approximately 120 municipal facilities, including fire stations, police precincts, public works buildings, libraries, and cultural institutions.
The certification form requires both the prime contractor and DBE firm to declare under penalty of perjury in the second degree that all payments are accurate and complete, with supporting documentation subject to audit and retention for a minimum of three years from the project acceptance date. This form is one of several required exhibits under the City's comprehensive DBE participation plan, which mandates compliance with 49 C.F.R. Part 26 and requires successful contractors to submit initial and annual DBE participation plans, maintain documentation of good faith efforts to engage DBE-certified suppliers through the Arizona UTRACS database, and provide monthly reporting of all DBE and small business expenditures. Offerors must demonstrate a minimum of five years in operation with equivalent experience, maintain all required licenses and certifications, provide appropriate insurance coverage within 14 calendar days of notification of recommended award, and register with both the City's Procurement Portal and procurePHX Self-Registration System prior to contract execution.
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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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