Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
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- Solicitation number
- IFB-26-0107
- 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 contracted work with Disadvantaged Business Enterprise (DBE) firms. The document serves as a dual affidavit requiring certification from both the prime contractor and the DBE subcontractor 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 that the total payment amount received is accurate and unchallenged. All supporting documentation for payments is subject to audit and must be retained for a minimum of three years from the project acceptance date. In cases where the DBE was not paid in accordance with previously submitted affidavits, the contractor must provide all documentation supporting their position regarding delayed or withheld payments.
Both the contractor and DBE firm must execute the certification under penalty of perjury in the second degree and any other applicable state or federal laws, with authorized agents providing signatures, printed names, and titles. This form is part of the City's broader Small Business Participation Program (SBPP) compliance framework and works in conjunction with initial SBPP plans, annual DBE SBPP plans, and requests for substitution or exemption. The certification requirement ensures accountability in federal and state-funded projects by creating a formal record of DBE payment compliance and establishing a verifiable audit trail for procurement oversight and regulatory compliance purposes.
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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 .