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Disadvantaged Business Enterprise DBE Program Trucking Commitment Agreement Form Form SMS.4901-T Rev. 8/2007 GSD-EPC Page 1 of 2 This commitment is subject to the award and receipt of a signed contract from the Texas Department of Transportation for the subject project. Dollar Amount of Contract/Agreement Name of Trucking Company Number of Dump Trucks The Contractor shall inform the District the dates when the subcontractor starts and completes all work under the subcontract. Estimated Beginning Date Estimated Completion Date Mo Yr / Prime Contractor Address Phone E-mail IMPORTANT The signatures of the prime contractor and the DBE and the total commitment amount must always be on the same page. Name/Title please print Signature Fax DBE Vendor No. Subcontractor if the DBE will be a second tier sub Date The Texas Department of Transportation maintains the information collected through this form. With few exceptions you are entitled on request to be informed about the information that we collect about you. DBE s must be certified at time of submittal* Project County Contract-CSJ All Trucking quantities and units of measure should match the bid tab item whenever possible. If listing items by hours or by lump sum amounts please provide calculations to substantiate the quantities listed* Bid Item Item Description Unit of Measure Unit Price Quantity Total Per Item Total Commitment Amount including attachments TO BE COMPLETED BY THE DBE TRUCKING FIRM 1. Number of hours contracted or quantities to be hauled Tractor/trailers 2. Number of fully operational trucks to be used 2a* Specify vehicle identification information on page 2. Dump trucks 4. If Owner Operators or additional trucking companies are to be used answer the following and provide a copy of lease agreement s including specific information asked on page 2. Dollar Amount of Contract/Agreement Name of Trucking Company Number of Dump Trucks The Contractor shall inform the District the dates when the subcontractor starts and completes all work under the subcontract. Estimated Beginning Date Estimated Completion Date Mo Yr / Prime Contractor Address Phone E-mail IMPORTANT The signatures of the prime contractor and the DBE and the total commitment amount must always be on the same page. Name/Title please print Signature Fax DBE Vendor No* Subcontractor if the DBE will be a second tier sub Date The Texas Department of Transportation maintains the information collected through this form* With few exceptions you are entitled on request to be informed about the information that we collect about you. Under 552. 021 and 552. 023 of the Texas Government Code you also are entitled to receive and review the information* Under 559. 004 of the Government Code you are also entitled to have us correct information about you that is incorrect. To ensure prompt and efficient handling of your project file we are requesting that all commitments to be presented to the Business Opportunity Programs Office using this basic format.

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