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 is a Certification of Full/Final Payment to Disadvantaged Business Enterprise (DBE) Firms form issued by the City of Phoenix Public Transit Department for use upon completion of contracted work. The document requires dual certification from both the prime contractor and the DBE firm to verify that full payment, including all retention amounts, has been made for materials and work performed on designated projects. The form mandates that supporting documentation for all payments be retained for a minimum of three years from the project acceptance date. Both the contractor and DBE firm must execute the certification under penalty of perjury in the second degree and in accordance with applicable federal and state laws. The document references related exhibits including the Initial SBPP Plan, DBE Annual SBPP Plan, DBE Request for Substitution or Exemption, and this certification form itself.
The certification form serves as a compliance mechanism for the City of Phoenix's obligations under 49 CFR Part 26 regarding Disadvantaged Business Enterprise participation requirements on federally-assisted projects. The related acquisition and relocation real estate services contract opportunity (RFQu-26-0091) requires contractors to submit an initial DBE plan within 30 calendar days of award and annual updates thereafter, with monthly tracking and reporting of all DBE and small business participation through the City's Certification and Compliance System. Contractors must maintain comprehensive documentation of all participating vendors including certification status and payment amounts. The City reserves discretionary authority over contract awards and may award multiple contracts, conduct interviews, request best and final offers, or reject any proposals. The initial contract term is five years with potential extensions, with pricing expected to remain firm and fixed during the first year and subject to potential annual adjustments thereafter upon written request with supporting documentation.
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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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