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BUYERS’ PARTICIPATION FORM
Please complete this form and return it to SFMTA Taxi Services, One South Van Ness Avenue, 7th Floor, San Francisco, CA, 94103, FAX 415-701-5437, sftaxis@sfmta.com.
THIS FORM MUST BE RECEIVED BY THE SFMTA NO LATER THAN 5:00 P.M., MAY 14, 2010
to ensure your eligibility to purchase a San Francisco taxi medallion through the Taxi Medallion Sales Pilot Program (“Pilot Program”).
In addition to filling out and completing this form, the buyer will have to demonstrate that he or she spent at least 4 out of 5 years as a full-time driver in San Francisco, and will have to qualify for a loan for any part of the purchase amount that is financed. Available medallions will be offered to qualified buyers in their order of seniority on the waiting list, and then in order of A-Card seniority. The decision to buy a medallion is voluntary. A driver may also elect to continue to wait on the waiting list for a medallion under the current Prop-K waiting list system. If you already own a medallion, you are not eligible to purchase another medallion. By signing this form you are not required to purchase a medallion, but if you do not return this form within the deadline you will have no further right to purchase a medallion as part of the Pilot Program.
- First Name: _________________________
Last Name: ________________________________
- Mailing Address: ________________________________________________________________
- Telephone Number(s): ___________________________(home) ___________________(mobile)
- In what year did you first receive a San Francisco Taxi Driver permit (A-Card)? ___________
- Driver permit (A-Card or badge) number: __________________________________
- Is this your original badge number?
[checkbox] Yes
[checkbox] No - If not, what was your original Driver permit (badge) number and what year was it issued to you?
Badge number: _________ Date of Issue: ________
- Are you on the waiting list for a medallion?
[checkbox] Yes - number on the waiting list: ___________
[checkbox] No
- If the medallion sale price is $250,000 how would you purchase the medallion?
[checkbox] I would purchase the medallion with cash.
[checkbox] I would need a loan to purchase a medallion.
A loan to purchase a medallion will require a down payment.
How much will you put down to obtain the loan? $______________
I, _____________________________________, (print name) have read and understood the Notice & Opportunity to Participate in Taxi Medallion Sales Pilot Program. I understand that by signing this Buyers’ Participation Form:
- I am notifying the SFMTA that I am interested in purchasing a San Francisco taxi medallion at the price that is fixed by the SFMTA and in accordance with the requirements of the San Francisco Transportation Code.
- I am not required to buy a medallion.
- I will have to obtain a loan for the purchase of a medallion if I cannot pay the full purchase price, and that I will have to make a down payment in order to obtain a commercial loan.
- I cannot qualify to purchase a medallion unless I can demonstrate that I was a full-time driver for four out of the last five years, or if I already hold a medallion.
- The right to purchase a medallion will be offered to San Francisco taxi drivers in the order of waiting list seniority, and then by A-Card seniority.
- I am not affecting my right to remain on the waiting list to receive a medallion under the Proposition K system.
Signed: ________________________________________
Date: ______________________
SELLERS’ PARTICIPATION FORM
Please complete this form and return it to SFMTA Taxi Services, One South Van Ness Avenue, 7th Floor, San Francisco, CA, 94103, FAX 415-701-5437, sftaxis@sfmta.com. THIS FORM MUST BE RECEIVED BY THE SFMTA NO LATER THAN 5:00 P.M., MAY 14, 2010 to ensure your eligibility to sell your San Francisco taxi medallion through the SFMTA’s Taxi Medallion Sales Pilot Program.
- Medallion number(s) to be offered for sale: ______________________________________________
- First Name: ________________________________
Last Name: __________________________
- Mailing Address: ____________________________________________________________________
- Telephone Number(s): ____________________________(home) ______________________(mobile)
- Date of birth: __________________________________
SSN: ______________________________
- Eligibility based on disability: If your age will be less than 70 years old as of December 31, 2010, and if you received your medallion after June 30, 1978, do you have a disability that permanently prevents you from meeting the full‑time driving requirement?
[checkbox] Yes (Sellers claiming eligibility to sell based on a permanent disability will be required to provide medical documentation of their qualifying condition at a later time)
[checkbox] No (A person who is not 70 years old as of December 31, 2010 and who is not permanently prevented from fulfilling the full-time driving requirement by a physical disability is not eligible to sell their medallion(s) under this Pilot Program.)
- In the event that the medallion holder is temporarily or permanently incapacitated for any reason during the purchase and sale transaction, who is authorized to act as the agent of the medallion holder? (An appropriate Power of Attorney must be attached to make this delegation effective.)
- First Name: ________________________________ Last Name: _________________________
- Mailing Address: ___________________________________________________________________
- Telephone Number(s): ____________________________(home) _____________________(mobile)
- Date of birth: __________________________________ SSN: _____________________________
- Relationship to medallion holder: __________________________________________________________________________________
- If you ever held a San Francisco Taxi Driver permit (A-Card), in what year did you first receive it? _____________________
- If you currently hold a San Francisco Taxi Driver permit, what is the permit (badge) number: ______________________
14.A Is this your original badge number?
[checkbox] Yes
[checkbox] No
14.B If not, what was your first badge number? ___________
I, _____________________________________, (print name) have read and understood the Notice & Opportunity to Participate in the Taxi Medallion Sales Pilot Program. I understand that by signing this Sellers’ Participation Form:
- I am notifying the SFMTA that I am interested in selling my medallion(s) at the price that is fixed by the SFMTA in accordance with the requirements of the San Francisco Transportation Code.
- I will not be required to sell my medallion.
- If I sell my medallion I will be responsible for paying, and authorize the SFMTA to withhold, a 20 percent transfer fee out of the money that I receive from the sale.
- In addition to the transfer fee, as a condition of being able to participate in the Pilot Program I will be required to withhold up to 15 percent of the total sale price in an interest-bearing certificate of deposit in my name until there is 20 percent equity in the loan made to purchase my medallion.
- I authorize the person named above and designated in the attached Power of Attorney to act on my behalf during the purchase and sale transaction if I become temporarily or permanently incapacitated.
Signed: ________________________________________
Date: ______________________
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