EXHIBIT E-1 - PAYMENT CERTIFICATION (CONTINUOUS).pdf

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Attached to
FSP Light Duty Tow Service - General Purpose Lanes and ExpressLanes
Solicitation number
FS135771
Issued by
California

About this file

This is a Payment Certification form for continuous services under a contract with the Los Angeles County Metropolitan Transportation Authority (LACMTA). The document serves as a certification by the contractor that services performed align with contract terms and conditions. The certifying official must confirm that all work completed to date represents accurate and compliant performance, and that all subcontractors and suppliers involved in the project through the prior payment period have received their proportionate share of previous LACMTA payments. The certification explicitly states that no amounts are being withheld or retained from subcontractors or suppliers beyond what is permitted under their respective subcontract agreements.

The payment certification requires the contractor to affirm its eligibility and compliance status, including representations that neither the contractor nor its principals are subject to debarment, suspension, or exclusion by any governmental entity. The contractor must also confirm it has not experienced termination for cause or default on public transactions within the past three years, nor been convicted of or had civil judgment rendered for fraud, criminal offenses, antitrust violations, embezzlement, theft, forgery, bribery, or related crimes in connection with public contracts. The certification includes acknowledgment of penalties under both federal and California False Claims Acts, with the understanding that knowingly submitting false claims—including false records or statements—constitutes a violation regardless of specific intent to defraud. The document requires execution under penalty of perjury under California law and must include the firm name, certifying official signature, title, date, and contract number.

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EXHIBIT E-1 - PAYMENT CERTIFICATION (CONTINUOUS)

A. I hereby certify to the best of my knowledge and belief that:

1. This Payment Certification represents a true and correct statement of the Services performed;

2. The Services completed to date under this Contract are in full accordance with the terms of the Contract Documents;

3. All Subcontractors and/or Suppliers who have performed Services on the project through the closing date of the prior Payment Request have been paid their proportionate share of all previous payments from LACMTA;

4. This Payment Certification does not include any amounts which the Contractor intends to withhold or retain from a Subcontractor or Supplier in accordance with the terms and conditions of the subcontract; and

5. The Contractor and its principals, (i) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any governmental department or agency (federal, state, or local); (ii) have not in the past three years had one or more public transactions (federal, state, or local) terminated for cause or default; (iii) have not within the past three years been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, local) transaction or contract under a public transaction, violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and (iv) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, local) with commission of any of the offenses listed in Section (A)(5)(iii) above.

B. This Payment Certification is not to be construed as final Acceptance of the Contractor's, and any Subcontractor's or Supplier's performance.

C. I understand that it is a violation of both the federal and California False Claims Acts to knowingly present or cause to be presented to LACMTA a false claim for payment or approval. A claim includes a demand or request for money. It is also a violation of the False Claims Acts to knowingly make use of a false Record or statement to get a false claim paid. The term "knowingly" includes either actual knowledge of the information, deliberate ignorance of the truth or falsity of the information, or reckless disregard for the truth or falsity of the information. Proof of specific intent to defraud is not necessary under the False Claims Acts. I understand that the penalties under the Federal False Claims Act and State of California False Claims Act are non-exclusive, and are in addition to any other criminal and/or civil remedies which LACMTA may have either under contract or law.

I certify under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct

Firm:

Signature:

Name of Certifying Official:

Title:

Date of Execution:

Firm:
Name of Certifying Official:
Title:
Date of Execution:
Contract Number: Contract Number
Project Name: Project Name

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