Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
PDF 106 KB Posted
- Attached to
- Youth Crime Prevention Program
- Solicitation number
- HSD-RFP-26-0074
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This document is a Certification of Full/Final Payment to Disadvantaged Business Enterprise (DBE) Firms form issued by the City of Phoenix Public Transit Department. The certification form establishes the process by which contractors and DBE firms document the completion of contracted work and full payment for materials and services rendered on City of Phoenix projects. The form requires dual affidavits—one from the prime contractor and one from the DBE firm—confirming that payment has been made in accordance with the original contract terms. Both parties must declare under penalty of perjury that all statements are true and complete, and supporting documentation for all payments must be retained for a minimum of three years from the project acceptance date. The form is designed to ensure compliance with federal and state laws regarding false statements and to create an auditable record of DBE participation and compensation.
The certification serves as a compliance mechanism within the City of Phoenix's Disadvantaged Business Enterprise program framework and is particularly relevant to the Youth Crime Prevention Program (HSD-RFP-26-0074), which includes specific DBE participation requirements and mandatory tracking through the City's Certification and Compliance System. Contractors responding to this and other City solicitations must demonstrate good faith efforts in engaging DBE firms and document all subcontracting arrangements using forms such as this. The document functions as both a contractual safeguard and an audit trail, ensuring that prime contractors fulfill their obligations to DBE subcontractors and that the City can verify compliance with its small business and disadvantaged business participation mandates.
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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 .