Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
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- Attached to
- Emergency Plan Portfolio Support Services
- Solicitation number
- RFP GGS-26-0364
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Final Payment form issued by the Public Transit Department under the Disadvantaged Business Enterprise - Neutral (DBE-N) Program. The document serves as an official certification mechanism for contractors to confirm full payment, including all retention funds, has been made to small business subcontractors upon completion of work on a project contract. The form requires completion by both the prime contractor and the small business firm, with each party providing an authorized signature and attestation under penalty of perjury in the second degree that all statements are true and complete. The certification mandates that supporting documentation for payments be retained for a minimum of three years from the project acceptance date, and requires submission of documentation explaining any delayed or withheld payments if the small business was not compensated in accordance with affidavits submitted by the successful bidder.
The form contains fields for recording the small business firm name and total amount paid but does not establish specific payment amounts, timelines, or contract terms within the certification document itself. This certification applies to the related City of Phoenix emergency planning support services contract, a five-year engagement commencing November 1, 2026, with no extension options. The document emphasizes compliance with Federal and State laws governing false statements and establishes audit rights over payment documentation, reflecting the program's focus on ensuring equitable payment practices to disadvantaged and small business enterprises participating in public transit and municipal projects.
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Text version
Disadvantaged Business Enterprise - Neutral (DBE-N) Program AGENCY: Public Transit Department
02_26-IFR PTD
CERTIFICATION OF FULL/FINAL PAYMENT TO SMALL BUSINESS FIRMS
(TO BE COMPLETED BY THE CONTRACTOR & SMALL BUSINESS UPON COMPLETION OF WORK)
CONTRACTOR AFFIDAVIT:
The undersigned, having contracted as the Contractor on Project NUMBER and Name hereby certifies that full payment (including all retention) has been made to the Small Business cited below. The total value of all payments made to the Small Business for materials and/or work performed on this project contract is as follows:
Small Business 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 Small Business 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.
By:
Authorized Agent for Contractor (Print Name and Title)
Date:
SMALL BUSINESS AFFIDAVIT: Insert Name of Small Business
The undersigned Small Business 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.
By: ______________________________ _____________________________________ Authorized Agent for Small Business (Print Name and Title)
Date:
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