____________________________________________
Joint Venture Request Form
(Project Specific)
Name of Joint Venture: Date: _________________________
Name of JV Partner: Name of JV Partner:
Address: Address:
City: State: Zip: City: State: Zip:
Lead Contact: Phone: Email:______________________________
Please submit the following:
A letter from each proposed Joint Venture Partner designating lead entity and percentage of participation and if needed,
requesting a waiver on behalf of the Joint Venture
A completed Joint Venture Agreement
A certified Power of Attorney from each Joint Venture Partner
An original Surety Letter from each Joint Venture Partner
Class of Work
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Project Number
City / Town
Bid Opening Date Project Value
Scope of Work
Please Email Form to: prequal.r109@dot.state.ma.uss
Phone: (857) 368 – 8660
FOR INTERNAL USE ONLY:
Approved Denied
Comments __________________________________
Per Regulations:
(1) Are the Contractors prequalified with MassDOT? Yes No
(2) Is at least one Contractor prequalified in the Class of Work? Yes No
(3) Class of Work Single Contract Limit: Combined = $__________________ = JV1 $_____________ + JV2 $____________
(4) Single Bond Limits: Combined Single = $__________________________ = JV1 $_____________ + JV2 $____________
(5) Aggregate Bond Limits: Combined Aggregate = $____________________= JV1 $_____________ + JV2 $____________
Rev. 12/2018
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