ATTACHMENT D.pdf
PDF 12 KB Posted
- Attached to
- Grease Interceptor Services
- Solicitation number
- OP137196(3)
- Issued by
- California
About this file
This is a Payment Certification form for Metro, a state or local transportation agency, used to validate contractor payment requests under executed contracts. The form serves as the primary mechanism through which contractors certify the accuracy and compliance of work performed and payment requests submitted. Contractors must affirm that payment requests represent true and correct statements of completed work, that all work conforms to contract terms, and that all subcontractors and suppliers have been paid their proportionate shares from previous Metro payments. The certification applies to all work completed through the closing date of the prior payment request period.
The form emphasizes contractor liability under both federal and California False Claims Acts, establishing that knowingly submitting false claims for payment constitutes a violation subject to significant penalties. The certification defines "knowingly" broadly to include actual knowledge, deliberate ignorance, or reckless disregard of information truthfulness, and specifies that proof of fraudulent intent is not required for violation. Contractors executing the form must do so under penalty of perjury under California law, with signature authority vested in designated certifying officials who provide their name, title, firm identification, and execution date on the document.
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Text version
ATTACHMENT D
PAYMENT CERTIFICATION
1. I hereby certify to the best of my knowledge and belief that:
A. This Payment Request represents a true and correct statement of the Work performed;
B. The Work completed to date under this Contract is in full accordance with the terms of the Contract; and
C. All Subcontractors and/or Suppliers who have performed Work on the project through the closing date of the prior Payment Request have been paid their proportionate share of all previous payments from Metro.
2. I understand that it is a violation of both the federal and California False Claims Acts to knowingly present or cause to be presented to Metro a false claim for payment or approval.
A claim includes a demand or request for money. It is also a violation of the False Claims Acts to knowingly make use of a false Record or statement to get a false claim paid. The term "knowingly" includes either actual knowledge of the information, deliberate ignorance of the truth or falsity of the information, or reckless disregard for the truth or falsity of the information. Proof of specific intent to defraud is not necessary under the False Claims Acts. I understand that the penalties under the Federal False Claims Act and State of California False Claims Act are non-exclusive, and are in addition to any other criminal and/or civil remedies which Metro may have either under contract or law.
I certify under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct
Firm:
Signature:
Name of Certifying Official:
Title:
Date of Execution:
File details come from the government source that posted it. Updated .