Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
PDF 106 KB Posted
- Attached to
- Concrete Flatwork Services
- Solicitation number
- IFB 26-0078
- 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 (DBE) firms upon project completion. The form serves as a dual affidavit document requiring certification from both the prime contractor and the DBE subcontractor, confirming that full payment—including all retention amounts—has been made for materials and work performed on the specified contract. The certification must identify the DBE firm name, total amount paid, and include supporting documentation that is subject to audit and must be retained for a minimum of three years from the project acceptance date. Both the contractor and DBE firm authorized representatives must sign the document under penalty of perjury in the second degree and applicable state or federal laws, confirming the accuracy and completeness of payment information.
The form is integrated into the City of Phoenix's broader DBE compliance framework for the Concrete Flatwork Services contract (IFB 26-0078), a five-year solicitation commencing June 1, 2026. This document represents a critical compliance mechanism requiring contractors to demonstrate fulfillment of their DBE participation commitments made through initial and annual Small Business Participation Plans. The certification process ensures accountability in federal and local funding requirements related to disadvantaged business engagement, with contractors obligated to document and report monthly DBE expenditures through the City's Certification and Compliance System. Any discrepancies between affidavits and actual payments, including delayed or withheld payments to DBE firms, require supporting documentation and explanation, maintaining transparency in subcontractor payment practices throughout the project lifecycle.
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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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