Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
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- Attached to
- Volunteer and Guest Services Management
- Solicitation number
- RFP 26-0367
- 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 for a project in Arizona. The form serves as an official affidavit to be completed jointly by the prime contractor and small business subcontractor upon completion of work, certifying that full payment, including all retention amounts, has been made for materials and services rendered on the project contract. The document requires the contractor to document the total value of all payments made to the small business firm and mandates that supporting documentation be retained for a minimum of three years from the project acceptance date.
Both the contractor and small business must execute separate affidavits under penalty of perjury in the second degree, attesting to the accuracy and completeness of payment information and confirming that all work was performed as contracted. The certification process is subject to audit, and in cases where payment disputes exist, the contractor must submit documentation supporting any delayed or withheld payments to reconcile discrepancies between affidavits initially submitted by the successful bidder.
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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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