Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
PDF 142 KB Posted
- Attached to
- Membrane Diffusers State and local contract opportunity
- Solicitation number
- IFB-26-0382
- 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, applicable to the City of Phoenix, Arizona. The form serves as an attestation document to be completed upon conclusion of work on project contracts involving small business firms. The contractor and small business must jointly certify that all payments, including retention amounts, have been rendered for materials and services provided. The contract term for the related Membrane Diffusers procurement is five years commencing on or around September 23, 2026, with no options to extend. The agreement will terminate upon the earliest occurrence of reaching the end of the term or pursuant to other termination provisions outlined in the contract.
The certification process requires both the prime contractor and small business to execute affidavits under penalty of perjury affirming payment accuracy and contract compliance. Supporting documentation for all payments must be retained for a minimum of three years from the project acceptance date. In instances where the small business was not paid in accordance with affidavits submitted by the successful bidder, comprehensive documentation supporting the bidder's position regarding delayed or withheld payments must be submitted. The related procurement is being conducted through the City's Procurement Portal with no stated contract value, and responses should be submitted in accordance with specifications and provisions contained in the solicitation materials.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Membrane_Diffusers.pdf | ||
| Acceptance_of_Offer_Form_2026.pdf | ||
| Addendum_Form.docx | DOCX document | |
| SAP_Open_Catalog_Interface_5_1.pdf | ||
| Supplemental-Terms-And-Conditions-To-All-Airport-Contracts_Rev_4-29-26.pdf | ||
| DBE-N_Annual_SBPP.pdf | ||
| Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf | ||
| 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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