VENDOR'S LIST APPLICATION

Company's Name: ____________________________

Date _______________________________

Address: ____________________________

____________________________

____________________________

Phone # _________________________________________________

Fax # ___________________________________________________

E-mail address ____________________________

Federal ID # ___________________________

New York State Department of Economic Development Certification:

___ Minority Business Enterprises

___ Women Business Enterprises

Nature of Business: (Please use the code list. If you do not see a code, please attach information explaining your company's nature of business).

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Individual(s) authorized to execute procurements for your company.

Name ______________________________ Title ________________

Signature ___________________________

Name ______________________________ Title ________________

Signature ___________________________

Be sure to include any descriptive material including catalogues, line cards, etc., for items you are offering. Any materials included become property of the Triborough Bridge and Tunnel Authority and cannot be returned. Persons or firms wishing to be added to or retained on the TBTA's bidders' mailing list for goods or services must complete and sign this form and mail it to:

Triborough Bridge and Tunnel Authority
2 Broadway, 24 Floor
New York, NY 10004
Attn: Bid Administration Manager

In order to be valid, the application must be signed by a principal of the firm; it cannot be signed by an agent.

The receipt of this application form is in no way binding upon the Triborough Bridge and Tunnel Authority.

The inclusion of bidders on the appropriate lists will be done solely at the discretion of the Triborough Bridge and Tunnel Authority.

CERTIFICATION

I certify that information supplied herein (including all pages attached) is correct and that neither the applicant nor any person (or firm) in any connection with the applicant as a principal or officer, is now debarred or otherwise declared ineligible by any agency of New York City from bidding for furnishing materials, supplies or services to New York City or any agency thereof.

Person Signing: ___________________________________________________________________
(Name and Title)

__________________________________________________________________
(Signature)

INFORMATION AND INSTRUCTIONS

Persons or firms wishing to be added to or retained on the TBTA's bidders mailing list for goods or services must complete and sign the Contracts Division's Questionnaire and mail it to the Contracts Division. In order to be valid, the application must be signed by a principal of the firm; it cannot be signed by an agent.

Definitions of Types of Ownership

1. "Minority Business" means a small business concern: (a) which is at least 51 percent owned by one or more socially and economically disadvantaged individuals, or in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more socially and economically disadvantaged individuals; and (b) whose management and daily business operations are controlled by one or more of the socially and economically disadvantaged individuals who own it.

2. "Socially and economically disadvantaged individuals" means those individuals who are citizens of the United States (or lawfully admitted permanent residents) and who are Black Americans, Hispanic Americans, Native Americans, Asian-Pacific Americans, or Asian-Indian Americans and any other minorities or individuals found to be disadvantaged by the Small Business Administration pursuant to Section 8(a) of the Small Business Act. As provided by USDOT, TBTA will make a rebuttable presumption that individuals in the following groups are socially and economically disadvantaged. (TBTA also reserves the right to determine on a case-by-case basis, that individuals who are not a member of one of the following groups are socially and economically disadvantaged.

3. In making such determinations, TBTA will utilize USDOT guidelines in 49 CFR Part 23.)

   a) "Black Americans" which includes persons having origins in any of the Black racial groups of Africa;

   b) "Hispanic Americans" which includes persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race;

   c) "Native Americans" which includes persons who are American Indians, Eskimos, Aleuts, or Native Hawaiians;

   d) "Asian-Pacific Americans" which includes persons whose origins are from Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Phillipines, Samoa, Guam, the U.S. Trust Territories of the Pacific, and the Northern Marianas; and

   e) "Asian-Indian Americans" which includes persons whose origins are from India, Pakistan, and Bangladesh.

   f) "Portuguese" (a member of Portuguese, Brazilian or other culture or origin regardless of race).

   (Bona fide minority group membership shall be established on the basis of the individual's claim that he or she is a member of a minority group and is so regarded by the particular minority community. TBTA reserves the right to request all appropriate documentation, i.e., tribal roll number, birth certificate, visa, passport, etc., necessary to clearly support an individual's claim of "minority" status.)

4. "Women-owned business" means a small business concern: (a) which is at least 51 percent owned by women, or in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and (b) whose management and daily business operations are controlled by one or more of the women who own it.