Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
PDF 106 KB Posted
- Attached to
- Lutron Lighting Systems
- Solicitation number
- IFB PCC-26-0101
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Full/Final Payment to DBE Firms form issued by the City of Phoenix Public Transit Department for use upon completion of contracted work. The form serves as a dual-affidavit document requiring certification from both the prime contractor and the Disadvantaged Business Enterprise (DBE) firm regarding payment completion on state and local contract projects. The certification confirms that full payment, including all retention amounts, has been made to the DBE firm for materials and/or work performed, with supporting documentation subject to audit and retention for a minimum of three years from the project acceptance date. Both the contractor and DBE firm must declare under penalty of perjury in the second degree that all statements made on the document are true and complete to the best of their knowledge.
The form requires the contractor to provide the DBE firm name and total amount paid, along with signature and printed name and title of an authorized agent. Similarly, the DBE firm must provide its name and certify that a contract was entered into with the named contractor and that the total payment received is accurate and unchallenged. The document functions as part of the City of Phoenix's Small Business and Purchasing Program (SBPP) compliance framework, with exhibits referencing initial SBPP plans, DBE annual SBPP plans, DBE requests for substitution or exemption, and this certification of final payment. This documentation requirement ensures accountability and transparency in DBE subcontracting participation, particularly relevant to the five-year Lutron Lighting Systems contract for the Phoenix Convention Center commencing March 1, 2026, which mandates significant DBE and small business participation through monthly compliance 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: |
File details come from the government source that posted it. Updated .