Certification_of_Final_Payment_PTD_02_2026_(DBE-N).pdf
PDF 142 KB Posted
- Solicitation number
- RFP PS-27-0005
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Certification of Final Payment document related to the City of Phoenix's Worker's Compensation Third Party Administration (TPA) Claims Management Services contract. The document pertains to the final payment certification process for this procurement, which was established to solicit sealed offers for comprehensive third-party administration and claims management services for worker's compensation. The agreement became effective upon final signature and recording by the City Clerk's department, with a commencement date of July 1, 2027, or the effective date, whichever is later. The contract term is five years from the commencement date with no options to extend, and the agreement will terminate upon the earliest occurrence of either reaching the end of the five-year term or termination pursuant to the contract's provisions.
The certification document serves as the formal authorization for final payment disbursement related to the contract performance. This document would typically include verification that all contractual obligations have been fulfilled, services have been rendered satisfactorily, and that the contractor is entitled to final payment. As this is a worker's compensation TPA claims management procurement for the City of Phoenix, Arizona, the contract represents a significant municipal service requirement for administering and managing worker's compensation claims on behalf of the city.
View the file
Other files
Show all 12
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 .