HomeMy Public PortalAboutJoint 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)