Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
PDF 142 KB Posted
- Attached to
- Operations Control Center & Data Collection Services State and local contract opportunity
- Solicitation number
- PTD26-003
- 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 for Project 02_26-IFR PTD. The document serves as a mutual certification between prime contractors and small business subcontractors upon completion of contracted work or material provision. The form requires the contractor to certify that full payment, including all retention amounts, has been made to the small business firm(s) involved in the project, while the small business must verify receipt of payment and confirm the accuracy of the payment amount. Both parties execute the certification under penalty of perjury in accordance with applicable Federal and State laws.
The certification document establishes recordkeeping requirements mandating that supporting payment documentation be retained for a minimum of three years from the project acceptance date. In cases where small businesses were not paid in accordance with bidder affidavits, contractors must submit documentation supporting their position regarding any delayed or withheld payments. This form functions as a compliance mechanism within the DBE-N Program framework, ensuring accountability and verification of subcontractor payments on state and local transit projects. No specific pricing, set-aside percentages, or funding source information is detailed within this certification template, as it is designed as a standardized form to be completed upon project conclusion.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Operations_Control_Center_&_Data_Collection_Services_(Addendum_#1_Revision).pdf | ||
| Operations_Control_Center_&_Data_Collection_Services.pdf | ||
| Exhibit_A_-_Incumbent_OCC_Job_Descriptions_&_Wages.pdf | ||
| Exhibit_B_-_OCC_Site_Plan.pdf | ||
| Exhibit_C_-_OCC_Warm_Site_Plan.pdf | ||
| Exhibit_-_D_-_Facility_Incident-Repair_Request_Procedure_04.22.26.pdf | ||
| Exhibit_G_-_Security_Access_&_Control.pdf | ||
| Exhibit_E_-_Technical_Requirements.pdf | ||
| Exhibit_F_-_Exhibit_-_A.R._4.45.pdf | ||
| Exhibit_H_-_A.R._2.324_Substance_Abuse_Policy.pdf | ||
| DBE-N_Annual_SBPP.pdf | ||
| Addendum_Form.docx | DOCX document | |
| Supplemental-Terms-And-Conditions-To-All-Airport-Contracts_Rev_4-29-26.pdf | ||
| SAP_OCI_5_1.pdf | ||
| Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx | DOCX document | |
| Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf |
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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:
File details come from the government source that posted it. Updated .