Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
PDF 142 KB Posted
- Attached to
- Heavy Duty Truck Brake Services
- Solicitation number
- IFB-26-FSD-0412-2
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Final Payment form for the Disadvantaged Business Enterprise - Neutral (DBE-N) Program administered by the Public Transit Department, related to a Heavy Duty Truck Brake Services contract with the City of Phoenix, Arizona. The form serves as a dual affidavit document completed upon project completion, requiring certification from both the prime contractor and the small business subcontractor that full payment, including all retainage, has been made for materials and/or work performed. The related contract opportunity is for heavy duty brake services with an effective date upon final signature and recording by the City Clerk, a commencement date on or about January 1, 2027, and a term of three years with two one-year renewal options exercisable at the City's sole discretion.
The certification form requires documentation of total payments made to small business firms and is subject to audit with supporting documentation to be retained for a minimum of three years from project acceptance. Both the contractor and small business must execute the affidavit under penalty of perjury in the second degree. The file establishes the DBE-N program as a set-aside, indicating the contract includes provisions for utilization of disadvantaged business enterprises. All statements must be made under Federal and State laws concerning false statements, and any instances of delayed or withheld payments require supporting documentation from 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:
File details come from the government source that posted it. Updated .