Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
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- Attached to
- Evidence Bags
- Solicitation number
- IFB-26-0116
- 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, designed to document payment completion to Disadvantaged Business Enterprise (DBE) firms upon project completion. The form serves as a dual affidavit requiring execution by both the prime contractor and the DBE firm, with the contractor certifying that full payment—including all retention amounts—has been made to the subcontracting DBE firm for materials and work performed. The DBE firm must countersign to verify receipt of the stated payment amount and confirm the accuracy of all compensation received under the prime contract. Both parties declare under penalty of perjury in the second degree and applicable state and federal laws 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, with all records subject to audit. The form includes reference exhibits for Initial SBPP Plans, DBE Annual SBPP Plans, DBE Requests for Substitution or Exemption, and prior Certification of Final Payments.
This certification document is a compliance mechanism for the City of Phoenix's Disadvantaged Business Enterprise program requirements, which are mandated under 49 CFR Part 26 for Federal Transit Administration-assisted projects. The form requires contractors to demonstrate good faith efforts in identifying, soliciting, and tracking DBE-certified firm participation across all procurement activities. The certification must be completed upon project completion and any delays or withheld payments require supporting documentation to justify the contractor's position. This instrument ensures accountability and transparency in the distribution of contract dollars to certified minority and women-owned business enterprises participating as subcontractors on City of Phoenix transit projects.
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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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