Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
PDF 142 KB Posted
- Attached to
- Custodial Services for Fire Department
- Solicitation number
- RFP GGS-26-0368
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This document is a Certification of Final Payment form issued by the Public Transit Department under the Disadvantaged Business Enterprise - Neutral (DBE-N) Program. The form serves as an affidavit to be completed jointly by the prime contractor and small business subcontractor upon completion of work on a project contract. The certification confirms that full payment, including all retention funds, has been made to the small business firm for materials and/or work performed. Both the contractor and small business must declare under penalty of perjury that all statements made on the form are true and complete to the best of their knowledge.
Supporting documentation for all payments must be retained for a minimum of three years from the project acceptance date and is subject to audit. In cases where a small business was not paid in accordance with affidavits submitted by the successful bidder, all documentation supporting the bidder's position regarding delayed or withheld payments must be submitted. The form requires the contractor to provide the small business firm name and total amount paid, with authorized signatures and dates from both parties. This certification is made under Federal and State laws concerning false statements and serves as evidence of compliance with small business payment obligations on public transit projects.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .