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C'`J'~' O~ SAi~d'I'A Al~?A • PROJECT NO. OS-3195 IV/A PROPOSAL AND CONTRACT AGREEMENT - ~'E3)E I~E~Ui~EM~I~'~'S F®R F'E~E -AST) C~1~S'~'~~1CTI®N PR~C'I'S ~-Thy work h~zin Pik uallbe 1>rmx,~ecl in wl~le or in put with (This form need not be filled in if all j oint ventuue funs are minority Federate fiuxis, argh tl~efore. all of the sfatr~.s, roles aril mei ~l~ .om pian~il~1 by owned.) fl~ Federal Govr~~ arxi applicable to wrnic fir~xed in wl~le or in part wrote FedEC-al furxls apply to slicl~ wodc. The `~tegi>IIed ContractProvisions, Fed.~ah- 1. Naive of j oint venhu-e Aid Cor~shl~tian Corrtiac`sc , `F'aun FHWA 1273, ale incltx~d na this Section 14. _ Wl~rer in aid rec~mzd contract provisions refeterxxs uz made tQ "SHA Car~actuig office "SHA resida~ eiTir,~,-," ar "auThoii~~cl izlnz~-~ative of the 2. Address of join venhu-e S~IA," soh izf - shall be conshueclto rr~ "Ei~ga~" as defn~d nl Section 1-1.18 ofthe Standuti Spevifirations. P~FtORMANCE OF I'Ft>EVIOIJS COiol'TiRACT - In addition to d~ 3. Phone number of joust venture provisions pl Section II, `Nrnxliscairrm>adon," uxi Section VII, "S1~blettnag a1 the Corrtiaci;" of the r~zd canhact provisirn~s, th:. Ccx>hacmr shall ~Iywidi the follow 4. Identify the fines which comprise the joint venture. (The DBE partner must complete Schedule A) The bides shall execute tl~ CERTIFICATION WITH RF~GARD TO THE PERFORMANCE OF PREVIOUS CONTRACTS OR SUBCONIRACIS SLIBJECI' TO THE EQUAL OPPORTtJN1TI' CLAUSE AND THE FILING OF REQUIRID REPORTS loc~zd ni die a. Descnbe the role of the DBE t3rm in this joint venture. pi~a1 No request for subletting ar assigning airy portion of the cor~ract nl excess of$10,000 un31 be oonsideizdurxlerthe provisions ofSection VII ofthe • rzquired contract piavisiar~s unless such rzquesi is accrnnpazied by the CERTIFICATION refeuzd to above, executed by the pmlxased b. Descnbe very briefly flee experience and business qualifications of st~bconhacta. each non-MBE joint venture: P~'Ol~i-COLI~USIOIV P~OVIlSIIONS -The provisions in this ~tirnl ar applicabletoaIlcor>haclsexceptcar~ractsforFedaalAidSe-cor~yprojarts. 5. Nature of the joint venture'sbusuless Tide 23, Ur~d States Code, Section 112, requires as a condition pizcedei~T to approval by d~ FecJL-ial Highway Adnmrishator of the conhact for this tiva~ic that each bidder file a swam stat~„~r,r executed by, ar an beYnlf o~ the meson, ffina, association, or cprporation to worn such oor~act is in be au~rrled, certifying that 6. Provide a copy of the j oint venture agreement soh pe<soi~, iim~ association, ar crnpoiarion has nor; eitlxz ditzcdy or ffi dnzc-dy, entered into arty ag~eenr-r~ partic~ated in any colhisian or otheiwi~ taken arty 7. What is the claimed percentage of DBE ownership? actirniinr~strairrtoffizecon-~eiitivebiddn~incrnn~ecdonumhtl~subn~it~dbid A faun to nuke the noncoih~sion affidavit siafen~Z~t required by Section 112 as a eeitificariontnxlerp;=~~aliy ofpegtuy ratl~ den as a swam statEa~a~t as IZ-m~tecl by 28, USC, Sec.174b, is inchuied inthepropoal. 8. Otivnership of joint venhire: (This need not be filled in if described PARTICII'A'IION BI' DLSADVAPIT'AGED BUSIl~S.S 'n the joint venture agreement, provided by question (6). EI~1T'EI~PRiS'1~ 5 IIaI 5`IJBCOI~~ACTIPdG -Put 26, Tide 49, Cad of a. Profit and loss sharing Federal Regu]atiom supplies to this Fe~a1-aid project Pertir~nrt seciians of said b. Capital con~7buiions, including equipment Cale arz incorprnated in part or in its a>mzty u~i oar szctia~ of theme sp~ial c. Other applicable provisiam. ownership interests SclreduleB-Infom-ationforl?eteum~m>ing7oirrtVer>tiuz Eligbility. Attaclrn~~3t • F.~d~3~atA-FRl ~7-97 TO BE INCL UDED IN BID PACKAGE BP (4 of 26