Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
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- Solicitation number
- RFQu-26-0091
- 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 work on projects involving Disadvantaged Business Enterprise (DBE) subcontractors. The form requires dual certification—one affidavit from the prime contractor and one from the DBE firm—confirming that full payment, including all retention amounts, has been made for materials and work performed. The contractor must identify the DBE firm name, total amount paid, and declare under penalty of perjury that all statements are true and complete. The DBE firm must similarly certify that a contract was entered into with the prime contractor, that payment received matches the amount stated, and that the payment is accurate and unchallenged. All supporting documentation for payments must be retained for a minimum of three years from the project acceptance date, and in cases of delayed or withheld payments, the contractor must submit documentation supporting its position. The form includes reference exhibits for the Initial SBPP Plan, DBE Annual SBPP Plan, DBE Request for Substitution or Exemption, and this Certification of Final Payment.
This certification form is a compliance document tied to the City of Phoenix's Federal Transit Administration (FTA)-assisted projects, which mandate adherence to 49 CFR Part 26 regarding DBE participation requirements. The form serves as an audit trail and enforcement mechanism to ensure that prime contractors honor their commitments to pay DBE subcontractors in full and on time, with federal and state penalties for false statements. Contractors are required to submit this certification upon project completion as part of their ongoing compliance obligations, making it essential documentation for projects involving federal funding or FTA assistance where DBE participation goals must be tracked and reported through the City's Certification and Compliance System.
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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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