Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
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- Solicitation number
- RFP PTD26-004
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Final Payment document for the Disadvantaged Business Enterprise - Neutral (DBE-N) Program administered by the Public Transit Department for the City of Phoenix, Arizona, in connection with fixed-route transit operations and facility support services. The document serves as a certification form to be completed by prime contractors and small business subcontractors upon completion of work to verify that full payment, including all retention amounts, has been made for materials and services performed on the project contract. The form requires both the contractor and small business firm to execute affidavits under penalty of perjury certifying the accuracy of payment amounts and that work obligations have been fulfilled. 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 require submission of supporting documentation explaining the contractor's position.
The certification process is a compliance mechanism designed to ensure accountability and proper distribution of contract funds to small business subcontractors participating in city procurement. The document does not contain specific pricing information but establishes the framework for documenting payment transactions between prime contractors and small business entities. This certification requirement aligns with federal and state regulations governing false statements and ensures that small businesses receive timely and full compensation for their contracted work. The form applies to the North and South Transit Facilities Fixed Route Services contract, which is a five-year agreement with one two-year renewal option commencing July 1, 2027, for transit operations, maintenance, and facility support services in Phoenix.
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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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