Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
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- Solicitation number
- IFB-26-0111
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This file is a Certification of Full/Final Payment to DBE Firms form issued by the City of Phoenix Public Transit Department. The form serves as an official affidavit to be completed jointly by contractors and Disadvantaged Business Enterprise (DBE) firms upon completion of work on City projects. The document requires the contractor to certify that full payment, including all retention amounts, has been made to the designated DBE firm, with the total value of payments documented for materials and/or work performed. Similarly, the DBE firm must execute a corresponding affidavit confirming receipt of the documented payment amount and acknowledging the contract entered into with the prime contractor. Both parties declare under penalty of perjury in the second degree that all statements are true and complete to the best of their knowledge. Supporting documentation for the certified payments is subject to audit and must be retained for a minimum of three years from the project acceptance date.
The certification form includes provisions requiring contractors to submit detailed documentation of delayed or withheld payments if the DBE was not paid in accordance with affidavits previously submitted by the successful bidder. The form references related exhibits including the Initial SBPP Plan, DBE Annual SBPP Plan, DBE Request for Substitution or Exemption, and the Certification of Final Payment itself. This document is integral to the City of Phoenix's compliance with federal Disadvantaged Business Enterprise requirements under 49 CFR Part 26 and supports the City's monitoring and verification that DBE participation goals and payment obligations are fulfilled throughout contract performance and upon project completion.
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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 .