Tification of Payments to DBE Firms - Arizona Department of 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Contract No. and Prime Consultant details at the top of the form.
3. Fill in the Project Description, followed by the DBE Firm name and their Certification number.
4. Indicate the DBE Contract Commitment and the amount paid to the DBE firm in the respective fields.
5. Enter both the DBE Goal Percentage and Actual DBE Percentage, ensuring accuracy for compliance.
6. Provide a brief description of the work completed by the DBE firm in the Work Description section.
7. The prime consultant must sign and date the document, certifying that all information is true under penalty of perjury.
8. The DBE subconsultant should also complete their section, confirming receipt of payment and signing accordingly.

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