Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
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- Attached to
- Transit Vehicle Decommissioning Services
- Solicitation number
- IFB PTD26-009
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Final Payment form issued by the Public Transit Department for the Disadvantaged Business Enterprise - Neutral (DBE-N) Program, applicable to state and local contracts in Arizona, specifically related to the City of Phoenix's Transit Vehicle Decommissioning Services solicitation. The form serves as documentation that prime contractors and small business subcontractors have completed their contractual obligations and received full payment, including all retention amounts. The certification process applies to work performed or materials provided on project contracts, with the form requiring completion and signatures from both the prime contractor and the small business firm upon project completion. The contract opportunity itself is a five-year agreement with one optional two-year extension, commencing on or about February 1, 2027, for transit vehicle decommissioning services through the City of Phoenix.
The certification form requires contractors and small businesses to declare under penalty of perjury that all payments have been made accurately and completely, with supporting documentation subject to audit and retention for a minimum of three years from the project acceptance date. In the event of delayed or withheld payments, contractors must submit documentation supporting their position regarding payment discrepancies. This form is essential for compliance with federal and state laws governing disadvantaged business enterprise programs and ensures transparency and accountability in subcontractor payment practices on public transit department projects. The form does not specify pricing, funding amounts, or set-aside percentages, as it functions as a completion and payment certification document rather than a solicitation or budgetary instrument.
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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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