+---------------+------------------------------------------------------+
| ![](media/ima | **Site Access Department**                           |
| ge1.wmf){widt |                                                      |
| h="1.26875in" | Lawrence Berkeley National Laboratory                |
| heig          |                                                      |
| ht="0.875in"} | **1 Cyclotron Road, MS 65, Berkeley, CA 94720**      |
|               |                                                      |
|               | #                                                    |
|               | #### Questions: JMTabata@lbl.gov Fax: (510) 495-2700 |
+---------------+------------------------------------------------------+

# 

# PUBLIC TRANSPORTATION VALUE PACK APPLICATION

+-----------+---+-----------+---+---+----+-----------------------------------+
| ##        | # | **Name    |   |   |    |                                   |
|  Official | # | (last,    |   |   |    |                                   |
|  Use Only |   | first,    |   |   |    |                                   |
|           |   | middle    |   |   |    |                                   |
|           |   | in        |   |   |    |                                   |
|           |   | itial):** |   |   |    |                                   |
+-----------+---+-----------+---+---+----+-----------------------------------+
| **Status: |   | *         |   |   |    |                                   |
| \_\_\_\_\ |   | *Employee |   |   |    |                                   |
| _\_\_\_\_ |   | ID        |   |   |    |                                   |
| \_\_\_\_\ |   | Number:** |   |   |    |                                   |
| _\_\_\_** |   |           |   |   |    |                                   |
+-----------+---+-----------+---+---+----+-----------------------------------+
| *         |   | **Divi    |   |   |    |                                   |
| *Payroll: |   | sion/Depa |   |   |    |                                   |
| \_\_\_\   |   | rtment:** |   |   |    |                                   |
| _\_\_\_\_ |   |           |   |   |    |                                   |
| \_\_\_\_\ |   |           |   |   |    |                                   |
| _\_\_\_** |   |           |   |   |    |                                   |
+-----------+---+-----------+---+---+----+-----------------------------------+
| ## Ber    |   | **Lo      |   |   |    |                                   |
| keley Tri |   | cation/Ma |   |   |    |                                   |
| p: \_\_\_ |   | ilstop:** |   |   |    |                                   |
| \_\_\_\_\ |   |           |   |   |    |                                   |
| _\_\_\_\_ |   |           |   |   |    |                                   |
+-----------+---+-----------+---+---+----+-----------------------------------+
| #####     |   | **Lab     |   |   |    |                                   |
| # Email:  |   | Phone     |   |   |    |                                   |
| \_\_\_\_\ |   | Number:** |   |   |    |                                   |
| _\_\_\_\_ |   |           |   |   |    |                                   |
| \_\_\_\_\ |   |           |   |   |    |                                   |
| _\_\_\_\_ |   |           |   |   |    |                                   |
|           |   |           |   |   |    |                                   |
| ##        |   |           |   |   |    |                                   |
+-----------+---+-----------+---+---+----+-----------------------------------+
| ## Pr     |   | **E-mail  |   |   |    |                                   |
| ocessed b |   | A         |   |   |    |                                   |
| y: \_\_\_ |   | ddress:** |   |   |    |                                   |
| \_\_\_\_\ |   |           |   |   |    |                                   |
| _\_\_\_\_ |   |           |   |   |    |                                   |
+-----------+---+-----------+---+---+----+-----------------------------------+

### PUBLIC TRANSIT (More than one option may be selected, but the maximum pretax benefit is \$100.00)

+---+--------------------+----+----+----+---+----------------------------+
|   | **31-Day AC        | #  | ## |    |   | ***One 31-day pass valid   |
|   | Transit Pass:**    | ## | ## |    |   | on AC Transit buses.       |
|   |                    | #  |  [ |    |   | 31-day valid period starts |
|   |                    | [C | Pr |    |   | the first time you use the |
|   |                    | os | e- |    |   | pass.***                   |
|   |                    | t] | ta |    |   |                            |
|   |                    | {. | x] |    |   |                            |
|   |                    | un | {. |    |   |                            |
|   |                    | de | un |    |   |                            |
|   |                    | rl | de |    |   |                            |
|   |                    | in | rl |    |   |                            |
|   |                    | e} | in |    |   |                            |
|   |                    |    | e} |    |   |                            |
|   |                    | *  |    |    |   |                            |
|   |                    | *\ | *  |    |   |                            |
|   |                    | $4 | *\ |    |   |                            |
|   |                    | 9. | $4 |    |   |                            |
|   |                    | 00 | 9. |    |   |                            |
|   |                    | ** | 00 |    |   |                            |
|   |                    |    | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **AC Transit       | #  | ## |    |   | ***Four booklets of ten    |
|   | ticket booklets:** | ## | ## |    |   | tickets each. Use one      |
|   |                    | #  |  [ |    |   | ticket per ride on AC      |
|   |                    | [C | Pr |    |   | Transit buses. Tickets do  |
|   |                    | os | e- |    |   | not expire.***             |
|   |                    | t] | ta |    |   |                            |
|   |                    | {. | x] |    |   |                            |
|   |                    | un | {. |    |   |                            |
|   |                    | de | un |    |   |                            |
|   |                    | rl | de |    |   |                            |
|   |                    | in | rl |    |   |                            |
|   |                    | e} | in |    |   |                            |
|   |                    |    | e} |    |   |                            |
|   |                    | *  |    |    |   |                            |
|   |                    | *\ | *  |    |   |                            |
|   |                    | $4 | *\ |    |   |                            |
|   |                    | 6. | $4 |    |   |                            |
|   |                    | 00 | 6. |    |   |                            |
|   |                    | ** | 00 |    |   |                            |
|   |                    |    | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **1 (\$45) BART    | #  | ## |    |   | ***Each BART ticket has a  |
|   | ticket:**          | ## | ## |    |   | \$48 value, but the actual |
|   |                    | #  |  [ |    |   | cost is \$45. If two       |
|   |                    | [C | Pr |    |   | tickets are purchased,     |
|   |                    | os | e- |    |   | \$90 is valid as           |
|   |                    | t] | ta |    |   | pretax.***                 |
|   |                    | {. | x] |    |   |                            |
|   |                    | un | {. |    |   |                            |
|   |                    | de | un |    |   |                            |
|   |                    | rl | de |    |   |                            |
|   |                    | in | rl |    |   |                            |
|   |                    | e} | in |    |   |                            |
|   |                    |    | e} |    |   |                            |
|   |                    | *  |    |    |   |                            |
|   |                    | *\ | *  |    |   |                            |
|   |                    | $4 | *\ |    |   |                            |
|   |                    | 5. | $4 |    |   |                            |
|   |                    | 00 | 5. |    |   |                            |
|   |                    | ** | 00 |    |   |                            |
|   |                    |    | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **2 (\$45) BART    | #  | ## | #  |   | ####                       |
|   | tickets:**         | ## | ## | ## |   |                            |
|   |                    | #  |  [ | #  |   |                            |
|   |                    | [C | Pr |    |   |                            |
|   |                    | os | e- |    |   |                            |
|   |                    | t] | ta |    |   |                            |
|   |                    | {. | x] |    |   |                            |
|   |                    | un | {. |    |   |                            |
|   |                    | de | un |    |   |                            |
|   |                    | rl | de |    |   |                            |
|   |                    | in | rl |    |   |                            |
|   |                    | e} | in |    |   |                            |
|   |                    |    | e} |    |   |                            |
|   |                    | *  |    |    |   |                            |
|   |                    | *\ | *  |    |   |                            |
|   |                    | $9 | *\ |    |   |                            |
|   |                    | 0. | $9 |    |   |                            |
|   |                    | 00 | 0. |    |   |                            |
|   |                    | ** | 00 |    |   |                            |
|   |                    |    | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **1 (\$30) BART    | #  | ## | #  |   | #### *Each BART ti         |
|   | ticket:**          | ## | ## | ## |   | cket has a \$32 value, but |
|   |                    | #  |  [ | #  |   |  the actual cost is \$30.* |
|   |                    | [C | Pr |    |   |                            |
|   |                    | os | e- |    |   |                            |
|   |                    | t] | ta |    |   |                            |
|   |                    | {. | x] |    |   |                            |
|   |                    | un | {. |    |   |                            |
|   |                    | de | un |    |   |                            |
|   |                    | rl | de |    |   |                            |
|   |                    | in | rl |    |   |                            |
|   |                    | e} | in |    |   |                            |
|   |                    |    | e} |    |   |                            |
|   |                    | ## |    |    |   |                            |
|   |                    | ## | ## |    |   |                            |
|   |                    |  \ | ## |    |   |                            |
|   |                    | $3 |  \ |    |   |                            |
|   |                    | 0. | $3 |    |   |                            |
|   |                    | 00 | 0. |    |   |                            |
|   |                    |    | 00 |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
| * |                    | #  | ## | #  |   | ***Two half-* *monthly     |
| * |                    | ## | ## | ## |   | tickets to be used on BART |
| B |                    | #  |  [ | #  |   | and Bay Area buses.***     |
| A |                    | [C | Pr | [P |   |                            |
| R |                    | os | e- | os |   | ***Ticket "A" valid from   |
| T |                    | t] | ta | t- |   | 1^st^ through 15^th^,      |
| P |                    | {. | x] | ta |   | ticket "B" valid from      |
| l |                    | un | {. | x] |   | 16^th^ through the end of  |
| u |                    | de | un | {. |   | the month. Various values  |
| s |                    | rl | de | un |   | available.***              |
| t |                    | in | rl | de |   |                            |
| i |                    | e} | in | rl |   |                            |
| c |                    |    | e} | in |   |                            |
| k |                    |    |    | e} |   |                            |
| e |                    |    |    |    |   |                            |
| t |                    |    |    |    |   |                            |
| s |                    |    |    |    |   |                            |
| ( |                    |    |    |    |   |                            |
| A |                    |    |    |    |   |                            |
| & |                    |    |    |    |   |                            |
| B |                    |    |    |    |   |                            |
| ) |                    |    |    |    |   |                            |
| : |                    |    |    |    |   |                            |
| * |                    |    |    |    |   |                            |
| * |                    |    |    |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **each ticket      | *  | *  | #  |   |                            |
|   | contains \$15 BART | *\ | *\ | ## |   |                            |
|   | value**            | $5 | $5 | #  |   |                            |
|   |                    | 6. | 6. |    |   |                            |
|   |                    | 00 | 00 |    |   |                            |
|   |                    | ** | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **each ticket      | *  | *  |    |   |                            |
|   | contains \$20 BART | *\ | *\ |    |   |                            |
|   | value**            | $6 | $6 |    |   |                            |
|   |                    | 6. | 6. |    |   |                            |
|   |                    | 00 | 00 |    |   |                            |
|   |                    | ** | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **each ticket      | *  | *  |    |   |                            |
|   | contains \$25 BART | *\ | *\ |    |   |                            |
|   | value**            | $7 | $7 |    |   |                            |
|   |                    | 4. | 4. |    |   |                            |
|   |                    | 00 | 00 |    |   |                            |
|   |                    | ** | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **each ticket      | *  | *  |    |   |                            |
|   | contains \$30 BART | *\ | *\ |    |   |                            |
|   | value**            | $8 | $8 |    |   |                            |
|   |                    | 4. | 4. |    |   |                            |
|   |                    | 00 | 00 |    |   |                            |
|   |                    | ** | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **each ticket      | *  | *  |    |   |                            |
|   | contains \$35 BART | *\ | *\ |    |   |                            |
|   | value**            | $9 | $9 |    |   |                            |
|   |                    | 4. | 4. |    |   |                            |
|   |                    | 00 | 00 |    |   |                            |
|   |                    | ** | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **each ticket      | ** | ** | ** |   |                            |
|   | contains \$40 BART | \$ | \$ | \$ |   |                            |
|   | value**            | 10 | 10 | 4. |   |                            |
|   |                    | 4. | 0. | 00 |   |                            |
|   |                    | 00 | 00 | ** |   |                            |
|   |                    | ** | ** |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **each ticket      | ** | ** | *  |   |                            |
|   | contains \$45 BART | \$ | \$ | *\ |   |                            |
|   | value**            | 11 | 10 | $1 |   |                            |
|   |                    | 2. | 0. | 2. |   |                            |
|   |                    | 00 | 00 | 00 |   |                            |
|   |                    | ** | ** | ** |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **each ticket      | ** | ** | *  |   |                            |
|   | contains \$50 BART | \$ | \$ | *\ |   |                            |
|   | value**            | 12 | 10 | $2 |   |                            |
|   |                    | 2. | 0. | 2. |   |                            |
|   |                    | 00 | 00 | 00 |   |                            |
|   |                    | ** | ** | ** |   |                            |
+---+--------------------+----+----+----+---+----------------------------+
|   | **Other ticket     |    |    |    |   | ***(NOTE: Muni tickets not |
|   | packages: contact  |    |    |    |   | available.)***             |
|   | <J                 |    |    |    |   |                            |
|   | MTabata@lbl.gov>** |    |    |    |   |                            |
+---+--------------------+----+----+----+---+----------------------------+

**PAYMENT AUTHORIZATION**

+---+-------------------+------------+---+--------------------------------+
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+---+-------------------+------------+---+--------------------------------+
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| * |                   |            | * |                                |
| * |                   |            | * |                                |
+---+-------------------+------------+---+--------------------------------+
|   | **Signature of    | **Date**   |   | #### Signature of participant  |
|   | participant**     |            |   |                                |
+---+-------------------+------------+---+--------------------------------+

*Updated 04/03/02*

**Commuter Incentive Programs**

LBNL offers a pretax transportation program to all eligible employees.
Beginning January 1, 2002, **up to \$100** of your transportation costs
can be deducted from your paycheck **before** taxes. The range of
savings will vary, depending on your tax bracket and FICA coverage.

**The following 2 options are available to employees:**

+---+-------------------------------------------------------------------+
| * | ##### Public Transit Option                                       |
| * |                                                                   |
| ( |                                                                   |
| 1 |                                                                   |
| ) |                                                                   |
| * |                                                                   |
| * |                                                                   |
+---+-------------------------------------------------------------------+
|   | LBNL and Berkeley Trip offer a number of public transit packages. |
|   | Payment for the selected package is made through payroll          |
|   | deduction (pretax or post-tax). You can pick up your BART/AC      |
|   | transit tickets from Berkeley Trip, 2033 Center Street, Berkeley; |
|   | Satellite office located in the UCB Parking Permit Office, 2543   |
|   | Channing, Berkeley; or the Tripmobile, which comes to the Lab on  |
|   | the 1^st^ Monday of the month.                                    |
+---+-------------------------------------------------------------------+

+-------------+---------------------------------------+----------------+
|             | **Transit packages:**                 |                |
|             |                                       |                |
|             | 1\) BART tickets (\$30 and \$45       |                |
|             | high-value tickets)                   |                |
|             |                                       |                |
|             | 2\) 31-day AC Transit Pass (\$49)     |                |
|             |                                       |                |
|             | 3\) BART Plus tickets (\$56 to \$122) |                |
|             |                                       |                |
|             | 4\) AC Transit ticket booklets (\$46) |                |
+-------------+---------------------------------------+----------------+

Ticket details can be found at
[[www.bart.org]{.underline}](http://www.bart.org/) and
[[www.actransit.org]{.underline}](http://www.actransit.org/) or by
calling the Berkeley Trip Commute Store at (510) 643-8552.

Applications are available at the Site Access web site at
[http://www.lbl.gov/Workplace/site-access/]{.underline} or the Site
Access office at Building 65, lower level.

+---+-------------------------------------------------------------------+
| * | ##### Vanpool Option                                              |
| * |                                                                   |
| ( |                                                                   |
| 2 |                                                                   |
| ) |                                                                   |
| * |                                                                   |
| * |                                                                   |
+---+-------------------------------------------------------------------+
|   | LBNL and Enterprise Vanpool would like to offer you an enjoyable  |
|   | and cost-effective alternative to commuting alone, namely         |
|   | commuter vanpooling. Our vanpool program features:                |
+---+-------------------------------------------------------------------+

+---+------------------------------------------------------+-----------+
|   | -   vehicles in a variety of sizes and seating       |           |
|   |     options                                          |           |
|   |                                                      |           |
|   | -   full insurance program                           |           |
|   |                                                      |           |
|   | -   full maintenance                                 |           |
|   |                                                      |           |
|   | -   24-hr. roadside assistance                       |           |
|   |                                                      |           |
|   | -   replacement vans                                 |           |
|   |                                                      |           |
|   | -   variety of lease options including a 30-day      |           |
|   |     release                                          |           |
+---+------------------------------------------------------+-----------+

+---+-------------------------------------------------------------------+
|   | We can arrange a vanpool package that best fits your needs and    |
|   | your budget!                                                      |
|   |                                                                   |
|   | If you commute at least 20 miles one-way, park your car and join  |
|   | a vanpool!                                                        |
|   |                                                                   |
|   | Payment for the vanpool will be made through payroll deduction    |
|   | (pretax or post-tax).                                             |
+---+-------------------------------------------------------------------+

For more information, contact:

Maki Tabata at 510-486-7572 / [JMTabata@lbl.gov]{.underline} or visit
the Enterprise web site at [www.vanpool.com]{.underline}

##### Eligibility 

All employees on Laboratory payroll are eligible for the pretax
incentive except:

1.  Graduate Student Research Assistants and Student Assistants

2.  Participating guests

Employees currently ineligible for the pretax savings may still
participate in either program. Their full transportation costs will be
deducted from their **post-tax** paycheck.

**Complete the application form on the reverse side and**

**mail or drop it off at the Site Access Office, MS 65**