Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
PDF 142 KB Posted
- Attached to
- Environmental Lab Services State and local contract opportunity
- Solicitation number
- RFP GGS-26-0363
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Final Payment form for the Disadvantaged Business Enterprise - Neutral (DBE-N) Program administered by the Public Transit Department in connection with a City of Phoenix environmental lab services contract. The document serves as an official certification mechanism to document full and final payment from prime contractors to small business subcontractors upon completion of work. The form requires dual attestations: one from the prime contractor affirming that all payments, including retention amounts, have been made to the identified small business firm, and a corresponding affidavit from the small business confirming receipt of contracted payments for materials and work performed. Both parties must declare under penalty of perjury that all statements are true and complete. Supporting documentation for all payments must be retained for a minimum of three years from the project acceptance date, and any instances of delayed or withheld payments must be accompanied by supporting documentation explaining the contractor's position.
This certification form is applicable to the City of Phoenix's seven-year environmental lab services contract commencing October 1, 2026, or upon final signature and recording by the City Clerk's department, whichever is later. The document establishes accountability mechanisms within the DBE-N program to ensure transparent subcontractor payment practices and compliance with federal and state regulations governing small business participation. The form requires identification of the specific small business firm receiving payment and the total amount paid, with both the prime contractor's authorized agent and the small business's authorized agent providing signatures and printed names and titles. The certification process is subject to audit and serves as a critical compliance tool for monitoring adherence to disadvantaged business enterprise program requirements throughout the contract performance period.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Environmental_Lab_Services.pdf | ||
| Acceptance_of_Offer_Form_2026.pdf | ||
| Addendum_Form.docx | DOCX document | |
| Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf | ||
| SAP_OCI_5_1.pdf | ||
| DBE-N_Annual_SBPP.pdf | ||
| Supplemental-Terms-And-Conditions-To-All-Airport-Contracts_Rev_4-29-26.pdf | ||
| Aviation_Only_-_Sensitive_Security_Information_Acknowledgement_Form.docx | DOCX document |
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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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