Attachment_-_Certification_of_Full_-_Final_Payments_to_DBE_Firms.pdf
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- Solicitation number
- RFP GGS-26-0117
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Full/Final Payment to DBE (Disadvantaged Business Enterprise) Firms form issued by the City of Phoenix Public Transit Department for use upon completion of contracted work. The form serves as an official affidavit process requiring both the prime contractor and the DBE firm to certify that full payment, including all retention amounts, has been made for materials and/or work performed on project contracts. The document establishes a binding certification made under penalty of perjury in the second degree and applicable state or federal laws, with supporting documentation subject to audit and retention for a minimum of three years from the project acceptance date. The form includes separate affidavit sections for authorized agents of both the contractor and the DBE firm to sign and print their names and titles, along with blank fields for project identification, DBE firm name, and total amount paid.
The certification process requires detailed documentation of all payments made to DBE firms and serves as a compliance mechanism for federal and state requirements governing contractor payments to disadvantaged business subcontractors. In cases where a DBE was not paid according to affidavits submitted by the successful bidder, the contractor must submit all supporting documentation regarding any delayed or withheld payments. The form is part of the City of Phoenix's broader small business and payment plan (SBPP) requirements, with cross-references to initial SBPP plans, annual SBPP plans, and requests for substitution or exemption. This certification document is a standard administrative requirement for projects involving DBE participation under City of Phoenix contracts.
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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 .