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Submit this form to in accordance with section 1-02.9 of the Contract. <br /> Instruction to Bidder: The Bidder shall complete and submit the Disadvantaged Business Enterprise (DBE)Trucking Credit <br /> Form in accordance with Section 1-02.9 of the Contract. <br /> INSTRUCTIONS <br /> Please note—All Fields are required <br /> PART A: TO BE COMPLETED BY THE BIDDER <br /> Federal Aid: Include the project federal-aid number. <br /> County: Specify the County where the project will take place. <br /> Contract#: Specify the Project Contract Number which can be found in the Engineer's estimate bid check report. I <br /> Bid Item: Provide the Bid Item Number(as it appears in the engineer's estimate bid check report)for which trucking <br /> services will be utilized. <br /> Item Description: Provide description of the bid item (as it appears in the engineer's estimate bid check report)for which <br /> trucking will be utilized. <br /> Bidder: In this section, provide the bidder's legal name, title, Business address, Phone and email. <br /> The bidder's representative signature is required in addition to the date the form was signed. <br /> 1 <br /> PART B: TO BE COMPLETED BY THE DBE TRUCKING FIRM <br /> Question 1: Specify type of material that will be hauled (i.e. Sand, HMA, gravel) I <br /> Question 2: Specify the total number of operational trucks that will be used on the project. <br /> Question 3: Specify the total number of operational trucks and trailers owned by the DBE that will be used on the project. <br /> Question 4: Specify the total number of operational trucks and trailers leased by the DBE that will be used on the project. <br /> DBE Firm: In this section, provide the DBE Firm's legal name, DBE Firm's representative legal name and title, certification <br /> Number(Found in the firm's OMWBE Profile page in the OMWBE directory), Business address, Phone, fax and email. <br /> The DBE Firm's representative signature is required in addition to the date the form was signed. 1 <br /> 1 <br /> 1 <br /> 1 <br /> r <br /> 1 <br /> I <br /> DOT Form 272-058 <br /> Revised 09/2020 <br /> Page 18 of 30 <br />