ATTN: Due to #SFFD activity near 18th and Eureka the 33 will reroute via Market btwn Douglass and Castro in both directions. (More: 22 in last 48 hours)

Payment Plan & Community Service Application


Contact Information










(e.g. driver's license, passport, State ID, City ID, etc.)
Citation(s)

Please list all the citations you would like to include in your Payment or Community Service Plan.
You can lookup citation payment information


Household Size / Annual Income
  • 1- $25,520
  • 2 - $34,480
  • 3 - $43,440
  • 4 - $52,400
  • 5 - $61,360
  • 6 - $70,320
Proof of Income

Upload one of the following proofs of income here.
  • Medi-Cal card 
  • SNAP or EBT card
  • Women, Infants & Children (WIC) Supplemental Nutrition Program (screenshot of your phone app)
  • San Francisco Department of Homelessness and Supportive Housing (HSH) Coordinated Entry eligibility letter
  • Lifeline card
  • Unemployment Benefits letter from EDD letter stating you have applied for or are receiving benefits. Letter must be issued in the current year. 


*Uploaded file must be less than 20 MB. File types are restricted to Microsoft Office file type, jpg, png, and pdf.
Check this box if you do not have one of the above items, but still qualify based on income. If requested, you will be required to provide documentation proving income level. Failure to respond will result in termination from the program and/or administrative fines.  
                   
Community Service Program Rules and Conditions
1. I agree to perform and complete my community service hours in San Francisco at a non-profit site approved by SFMTA Community Service Program.
2. I am not an employee or affiliated with the community service/non-profit site in any way, nor do I have any relationship with the individuals/organization that will be approving the community service credit.
3. I agree to perform community service on a schedule to be arranged with my program site supervisor and not to exceed eight (8) hours a day.
4. I will not consume alcohol or use drugs before or during service hours.
5. I agree to inform JBR immediately and request reassignment, if I find I cannot perform the community service selected due to a medical condition or physical limitation.
6. I understand that, if they are available, a minimum of fifty-percent of community service hours must be performed with San Francisco Public Works or SFMTA Potrero Division, unless a waiver has been granted due to health reasons. Any hours performed at third-parties above the fifty-percent requirement will not be counted towards service credit. 
7. A change in community service site/sites must be approved by a JBR representative. Without approval, any hours completed may not be accepted.
8. I understand that because I am not an employee of the SFMTA Community Service Program or of the community service site, I will not be covered by insurance for any injury/injuries received on this assignment. I understand I have not right to claim compensation for any accident and/or injury from SFMTA Community Service Program service site I am assigned to, or any of their officers, agents, or employees. I waive all claims against the SFMTA Community Service Program, JBR Partners, Inc., its officers and employees for any injury, loss or damage that may result in my participation within the program.  
Community Service Program Release and Waiver of Liability

I acknowledge that I am a participant with San Francisco Public Works or SFMTA Potrero Division via San Francisco Municipal Transportation Agency's Community Service Program. I desire to participate in volunteer "activities" that my involve physical/manual labor in inclement weather. 

Physical Activities may include:
  •  Standing prolonged periods, twisting, bending, kneeling, pulling, lifting heavy objects, handling of non-hazardous/hazardous waste
  • Washing buses, sweeping facility or dumping trash. I recognize that there may be risks or hazards directly or inherently involved in this activity. The above-mentioned activities may expose me to certain unforeseeable risks of damage and/or bodily injury, including serious bodily injury, where I may need to be hospitalized. With full knowledge of the facts and circumstances surrounding this activity, I voluntarily undertake this duty and assume all responsibility and risk arising from my participation in this activity. Participation in this activity is NOT covered by worker's compensation, and that in the event of an injury I will not be eligible to file a worker's compensation claim. I recognize that should I incur a physical injury as a result of my participation, my health insurance coverage will be my resort for covering any cost related to injury. 
I assure San Francisco Public Works or SFMTA Potrero Division that I have no health-related reasons or problems, including but not limited to emotional sensitivities, that would preclude or restrict my participation in this activity or that could be aggravated by my participation.

I hereby release San Francisco Public Works and SFMTA Potrero Division from any and all liability arising out of my participation in the above mentioned activities and hereby waive my rights herein to assert any claim(s) for damages, bodily injury or serious bodily injury to the fullest extent allowed by law. I further agree that I will hold harmless JBR Partners, Inc. against any and all claim(s) for damages, bodily injury or serious bodily injury arising out of or in connection with my participation in the above mentioned activities whether cause by negligence or otherwise.

I, the PARTICIPANT, affirm that:
  1. I have read and do presently understand the meaning, nature, and consequences of consenting to the terms and conditions of this Release and Waiver of Liability ("Release");
  2. I sign this Release in full recognition and appreciation of the risks of the above indicated activity;
  3. I am fully competent to sign this Release;
  4. I agree to the terms and conditions contained in this Release, and
  5. Therefore, I execute this Release for full, adequate, and complete consideration, fully intending for myself, the PARTICIPANT'S family, estate, heirs, administrators, personal representatives, or assigns to be bound by the terms of this Release.
THIS IS A RELEASE OF LEGAL RIGHTS, READ BEFORE CHECKING THE BOX BELOW.
Requirements


By submitting this form you (1) attest the information provided is true and accurate and (2) understand the SFMTA may conduct audits, and (3) if requested, you will be required to provide documentation proving income level.


Failure to respond will result in termination from the program and/or administrative fines.