Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
PDF 106 KB Posted
- Attached to
- 35-65-95 Gallon Containers
- Solicitation number
- RFP 27-SW-001
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Full/Final Payment to DBE Firms form used by the City of Phoenix Public Transit Department to document completion of payments to Disadvantaged Business Enterprise firms upon project completion. The form requires dual certification from both the prime contractor and the DBE firm, with each party attesting under penalty of perjury that full payment, including all retention funds, has been made for materials and work performed. The contractor must document the total amount paid to each DBE firm, while the DBE firm must confirm receipt of payments and acknowledge that the amounts are accurate and unchallenged. 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 by the City.
The certification form serves as critical documentation for the City of Phoenix's compliance with federal and state requirements governing DBE participation in transit-related contracts. The form includes designated exhibits for the Initial SBPP (Small Business Participation Plan), DBE Annual SBPP Plan, DBE Request for Substitution or Exemption, and this certification itself. Both the contractor and DBE firm must provide authorized signatures with printed names and titles, establishing accountability for the accuracy of payment information submitted. This document is essential for contractors working on the 35-65-95 Gallon Containers procurement and other City of Phoenix Public Works projects that incorporate federal transit funding and mandate DBE participation requirements, ensuring transparent tracking and verification of small business expenditures throughout contract performance.
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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 .