Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
PDF 106 KB Posted
- Solicitation number
- IFB-26-0111
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Full/Final Payment to Disadvantaged Business Enterprise (DBE) Firms form developed by the City of Phoenix Public Transit Department for use on public transit projects. The document serves as a dual affidavit mechanism requiring completion by both the prime contractor and the DBE firm upon project completion. The contractor must certify that full payment, including all retention amounts, has been made to the cited DBE firm and must document the total value of all payments for materials and work performed. Similarly, the DBE firm must certify that a contract was entered into with the prime contractor and confirm that the total payment amount received is accurate and unchallenged. Both parties execute the certification under penalty of perjury in the second degree and applicable state or federal law. Supporting documentation for all payments must be retained for a minimum of three years from the project acceptance date, and the form requires submission of detailed documentation in cases where DBE firms were not paid in accordance with affidavits submitted by the successful bidder, including evidence supporting any delayed or withheld payments.
This certification document directly relates to the City of Phoenix Fire Department's Hazardous Detection Equipment, Accessories and Preventive Maintenance Services solicitation (IFB-26-0111), which requires all contractors to comply with DBE participation requirements under 49 CFR Part 26. Contractors bidding on the five-year contract commencing June 1, 2026, must submit an initial DBE participation plan within 30 days of contract award and provide annual updates thereafter, along with monthly reporting of all DBE and small business participation through the City's Certification and Compliance System. The use of this certification form ensures accountability and documented compliance with federal DBE requirements, protecting both the City and participating disadvantaged businesses by creating an auditable record of payment fulfillment on public contracts.
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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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