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Joint Venture Pre-Qualification Application for a Single ProjectMetropolitan St. Louis Sewer District 2350 Market Street St. Louis, Missouri 63103 JOINT VENTURE PRE-QUALIFICATION APPLICATION FOR A SINGLE PROJECT Page 1 March 5, 2012 (Applications must be submitted at least three (3) business days prior to the bid date to allow time for District review.) TO BE COMPLETED BY APPLICANT  Page 2 – Contract Letting Number  Page 2 – Joint Venture Information and Applicant Signature  Page 2 – Date of Incorporation of Joint Venture  Page 2 – Bonding Information  Page 3 – Joint Venture Composition  Page 4 – Affidavit with Notary Seal of Joint Venture  Attached proof that Joint Venture has registered with the Office of the Secretary of the State of Missouri. TO BE COMPLETED BY MSD Contract Letting No. __________________ Bid Date: ________________ Date Application Received: _________________ Project Work Category(s): _________________________ All Parties to Joint Venture are Pre-Qualified in this Work Category (or in at least one category if two or more are named in the bid documents): Yes ______ No ______ Joint Venture Bonding Capacity Exceeds Project Engineer’s Estimate: Yes ______ No ______ Joint Venture ________ Approved ________ Disapproved By____________________________________ Date: ___________ Metropolitan St. Louis Sewer District 2350 Market Street St. Louis, Missouri 63103 JOINT VENTURE PRE-QUALIFICATION APPLICATION FOR A SINGLE PROJECT Page 2 March 5, 2012 CONTRACT LETTING NUMBER__________ The undersigned hereby applies to the Executive Director of the Metropolitan St. Louis Sewer District for a Certificate of Qualification to bid the above referenced Contract Letting as a Joint Venture. ________________________________ (Joint Venture Name) ________________________________ (Joint Venture Address) ________________________________________________________________________ (Joint Venture City, State, Zip Code) By _______________________________ Title _____________________________________ (Print Name) ______________________________________ (Signature) Date of Incorporation as a Joint Venture: _______________________ (Please attach proof of registration of this business entity with the Office of the Secretary of State) Name of Bonding Company: ___________________________________________________ Total Bonding Capacity of Joint Venture: ________________________________________ THE SIGNATORY OF THIS QUESTIONNAIRE GUARANTEES THE TRUTH AND ACCURACY OF ALL STATEMENTS AND OF ALL ANSWERS TO INTERROGATORIES HEREINAFTER MADE Metropolitan St. Louis Sewer District 2350 Market Street St. Louis, Missouri 63103 JOINT VENTURE PRE-QUALIFICATION APPLICATION FOR A SINGLE PROJECT Page 3 March 5, 2012 Please list the individual companies that comprise the Joint Venture Name Individual Participant or Company to the Joint Venture: _____________________________ ( ) MWBE (Minority or Woman Business Enterprise (Please attach a copy of your MWBE certification document to this application) Name of Company Representative to Joint Venture:________________________________________ Contact Number:________________________ Email Address: ______________________________ Name Individual Participant or Company to the Joint Venture: _____________________________ ( ) MWBE (Minority or Woman Business Enterprise (Please attach a copy of your MWBE certification document to this application) Name of Company Representative to Joint Venture:________________________________________ Contact Number:________________________ Email Address: ______________________________ Name Individual Participant or Company to the Joint Venture: _____________________________ ( ) MWBE (Minority or Woman Business Enterprise (Please attach a copy of your MWBE certification document to this application) Name of Company Representative to Joint Venture:________________________________________ Contact Number:________________________ Email Address: ______________________________ Name Individual Participant or Company to the Joint Venture: _____________________________ ( ) MWBE (Minority or Woman Business Enterprise (Please attach a copy of your MWBE certification document to this application) Name of Company Representative to Joint Venture:________________________________________ Contact Number:________________________ Email Address: ______________________________ NOTE: In order for the District to grant a Certificate of Qualification through this application process, ALL parties to the Joint Venture must be individually pre-qualified in the category specified in the Notice to Contractor, Paragraph 1.3.A for the Contract Letting Number referenced above. A joint venture consisting of MWBE and majority business e nterprises will be credited with MWBE participation based upon the information provided on Form A as specified in the Contract Documents. Metropolitan St. Louis Sewer District 2350 Market Street St. Louis, Missouri 63103 JOINT VENTURE PRE-QUALIFICATION APPLICATION FOR A SINGLE PROJECT Page 4 March 5, 2012 AFFIDAVIT FOR JOINT VENTURE State of ________________________________) ) ss. County of: ______________________________) ______________________________________, being duly sworn, deposed and says that he/she is _____________________________________________________________ of the __________________________________________, the Joint Venture described herein and which executed the foregoing statement that that he/she is familiar with the books of said Joint Venture, showing its financial condition; and that the answers of the foregoing interrogatories are true, and that any depository, vendor or other agency herein named is authorized to supply The Metropolitan St. Louis Sewer District with any information necessary to verify this statement. ________________________________ ________________________________ (Title) ________________________________ ________________________________ (Title) Sworn to before me, this ___________ day of ___________________________, 2011. ________________________________ Notary Public (seal)