SAN FRANCISCO BAY AREA RAPID TRANSIT DISTRICT

INFORMATION FORM FOR DETERMINING JOINT VENTURE ELIGIBILITY

(this form need not be filled in if all
joint venture firms are minority owned.)



1. Name of joint venturer _________________________________________

2. Address of joint venturer ______________________________________

3. Phone number of joint venturer _________________________________

4. Identify the firms whichcomprise the joint venture. (DBE partners must complete theDisadvantaged Business Enterprise Certification Form)

_____________________________________________________________________

_____________________________________________________________________

(a) Describe the role of each DBE firm in the joint venture:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

(b) Describe very briefly the experience and businessqualifications of each non DBE joint venturer:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

5. Nature of the joint venturer's business

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

6. Provide a copy of the joint venture agreement and ifapplicable, a copy of the joint venture license.

7. What is the claimed percentage of DBE ownership? ___________________

8. Ownership of joint venture:(This need not be filled in if described in the joint ventureagreement, provided by questions 6.)

_____________________________________________________________________

_____________________________________________________________________

9. Control of and participation in this contract. Identifyby name, race, and sex, those individuals (and their titles)who are responsible for day-to-day management and policy decisionmaking, including, but not limited to those with primeresponsibility for:

(a) Financial decisions

_____________________________________________________________________

(b) Management decisions, such as:

(1) Estimating _____________________________________________________________
(2) Marketing and sales _____________________________________________________________
(3) Hiring and firing of management personnel_____________________________________________________________
(4) Purchasing of major items or supplies _____________________________________________________________


(c) Supervision of field operations._____________________________________________________________

Note: If, after filing this form and before the completionof the joint venture's work on the contract, there is anysignificant change in the information submitted, the jointventure must inform the District either directly or throughthe prime contractor, if the joint venture is a subcontractor.

Affidavit

The undersigned swear that the foregoing statements are correctand include all material information necessary to identify andexplain the terms and operation of our joint venture and theintended participation by each joint venturer in the undertaking.Further, the undersigned does covenant and agree to provide tothe District current, complete and accurate information regardingactual joint venture work and the payment therefor and anyproposed changes in any of the joint ventures, or those ofeach joint venturer relevant to the joint venture, orauthorized representative of the District of the Federal fundingagency. Any material misrepresentation will be grounds forterminating any contract which may be awarded and for initiatingaction under Federal or State laws concerning false statements.



Name of Firm_____________________________________________________________

Signature_____________________________________________________________

Title_____________________________________________________________

Date_____________________________________________________________

State of __________________________

County of _________________________

On this day of___________, 19__, before me appeared _____________________________________________________________

(name) to me personally known,who, being duly sworn, did execute the foregoing affidavit, anddid state that he or she was properly authorized by (name offirm) to execute the affidavit and did so as his or her free actand deed.



Notary Public

_____________________________________________________________________

Commission Expires

_____________________________________________________________________

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