4-Affidavit of Joint Venture Form.pdf

CITY OF LITTLE ROCK

500 West Markham Street

Little Rock, Arkansas 72201

AFFIDAVIT OF JOINT VENTURE

This form must be submitted with all Joint Venture proposals. A written joint venture agreement among the companies must be submitted along with this form. All information requested must be answered in the spaces provided. Do not refer to your Joint Venture Agreement except to expand on answers provided on this form. If additional space is required, additional sheets may be attached.

A Joint Venture is two or more parties which join to carry out a single, for-profit business enterprise, for which each party contributes property, capital, efforts, skills, and knowledge. Each party is responsible for a distinct, clearly defined portion of the work in the contract between them and each shares in the capital contribution, control, management, risks, and profits of the joint venture which are commensurate with its ownership interest.

Joint Ventures apply to Request for Qualifications (RFQ), Request for Proposals (RFP), and Statement of Qualifications

(SOQ).

The City of Little Rock encourages minority and/or women-owned business partnerships. Minority-Owned Business is defined by Act 554 of 1977 (codified, as amended, at Ark. Code Ann. 15-4-303) and Women-Owned Business is defined by Act 1080 of 2017 (codified, as amended, at Arkansas Code Annotated § 15-4-303).

JOINT VENTURE

Joint Venture Name:

COMPANY SUBMITTING RESPONSE

Company Name:

Address:

Contact Name:

Phone Number:

Email Address:

A. Identify each party to the joint venture:

Party #1

Address:

Contact Name:

a. Role in the Joint Venture:

b. Ownership in the Joint Venture (%):

c. Are you a Minority / Women-Owned Business: (Yes) (No)

Classification:

Are you certified by a third-party? (Yes) (No) Certified by: Certification Number:

Party #2

Address:

Contact Name:

Classification:

Party #3

Address:

Contact Name:

Classification:

Party #4

Address:

Contact Name:

Classification:

B. Attach a copy of the Joint Venture Agreement. To demonstrate the party’s share in the ownership, control, management responsibilities, risks, and profits of the joint venture, the proposed Joint Venture Agreement must include specific details related to: (1) the contributions of capital and equipment; (up (2) work items to be performed by each party; and (3) the commitment of management, supervisory, and operative personnel employed by each party to be dedicated to the performance of the project.

C. Please state any material facts of additional information pertinent to the control and structure of this joint venture.

Signatures

The undersigned affirms that the foregoing statements are correct and include all material information necessary to identify and explain the terms and operations of our joint venture and the intended participation of each party to the joint venture in the undertaking. Further, the undersigned covenant and agree to provide the City of Little Rock current, complete, and accurate information regarding actual joint venture work and payment therefore, and any proposed changes in any provision of the joint venture agreement, and to permit the audit and examination of the books, records, and files of the joint venture, or those of each party relevant to the joint venture by authorized representatives of the City or the Federal funding agency.

Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under federal or state laws concerning false statements.

Note: If, after submitting this Affidavit of Joint Venture and before the completion on the joint venture’s work on the project, there is any change in the information submitted, the joint venture must inform the City of Little Rock, either directly or through the prime contractor if the joint venture is a subcontractor.

Party #1 Party #2

Name of Business Entity Name of Business Entity

Signature of Affiant Signature of Affiant

Name and Title of Affiant Name and Title of Affiant

Date Date

Party #3 Party #4

Name of Business Entity Name of Business Entity

Signature of Affiant Signature of Affiant

Name and Title of Affiant Name and Title of Affiant

Date Date

On this day of , 20 , the above-signed officers (names of affiants), personally appeared and, known to me be the persons described in the foregoing Affidavit, acknowledged that they executed the same in the capacity therein stated and for the purpose therein contained.

IN WITNESS WHEREOF, I hereunto set my hand and official seal.

Signature of Notary Public (SEAL)

My Commission Expires: