Form 2228 "Disadvantaged Business Enterprise (Dbe) Program Termination/Substitution Request Form" - Texas

What Is Form 2228?

This is a legal form that was released by the Texas Department of Transportation - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2016;
  • The latest edition provided by the Texas Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 2228 by clicking the link below or browse more documents and templates provided by the Texas Department of Transportation.

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Download Form 2228 "Disadvantaged Business Enterprise (Dbe) Program Termination/Substitution Request Form" - Texas

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Form 2228
Disadvantaged Business Enterprise (DBE) Program
(Rev. 10/16)
Termination/Substitution Request Form
Page 1 of 1
Prior to submitting this form to TxDOT you must notify the DBE in writing of your intent and allow the DBE five(5) days to respond.
Project #:
County:
Contract-CSJ:
Request Date:
Prime Contractor:
Date Prime determined DBE unwilling, unable or ineligible:
List Previous Approved Subcontractor:
Proposed Subcontractor:
Committed
Remaining
Dollar
Bid Item
Work Description
Bid Item
Work Description
Dollar Amount
Dollar Amount
Amount
Total $
Total $
No If so, how much?
Will termination/substitution result in a goal shortfall?
Yes
Projected date Proposed Subcontractor will commence work?
Reason(s) for termination/substitution. Check Appropriate Block.
The listed DBE requested removal.
The listed DBE is no longer in business.
Other issues not listed:
The listed DBE failed or refused to perform the
contract or furnish the listed materials.
The work performed by the listed DBE was
unsatisfactory and was not in accordance with the
scheduled plans and specifications.
Provide copy(s) of: Letter to terminate, DBE termination agreement statement or if applicable, DBE letter of
voluntary removal request.
Contractor Signature:
Date:
Approved
Rejected
Reason:
District DBE Coordinator Signature:
Date:
Use TxDOT Form 2603 if good faith effort is applicable.
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 Sections 552.021 and 552.023 of the Government Code, you also are entitled to receive and review this information. Under Section
559.004 of the Government Code, you are also entitled to have us correct information about you that is incorrect.
Form 2228
Disadvantaged Business Enterprise (DBE) Program
(Rev. 10/16)
Termination/Substitution Request Form
Page 1 of 1
Prior to submitting this form to TxDOT you must notify the DBE in writing of your intent and allow the DBE five(5) days to respond.
Project #:
County:
Contract-CSJ:
Request Date:
Prime Contractor:
Date Prime determined DBE unwilling, unable or ineligible:
List Previous Approved Subcontractor:
Proposed Subcontractor:
Committed
Remaining
Dollar
Bid Item
Work Description
Bid Item
Work Description
Dollar Amount
Dollar Amount
Amount
Total $
Total $
No If so, how much?
Will termination/substitution result in a goal shortfall?
Yes
Projected date Proposed Subcontractor will commence work?
Reason(s) for termination/substitution. Check Appropriate Block.
The listed DBE requested removal.
The listed DBE is no longer in business.
Other issues not listed:
The listed DBE failed or refused to perform the
contract or furnish the listed materials.
The work performed by the listed DBE was
unsatisfactory and was not in accordance with the
scheduled plans and specifications.
Provide copy(s) of: Letter to terminate, DBE termination agreement statement or if applicable, DBE letter of
voluntary removal request.
Contractor Signature:
Date:
Approved
Rejected
Reason:
District DBE Coordinator Signature:
Date:
Use TxDOT Form 2603 if good faith effort is applicable.
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 Sections 552.021 and 552.023 of the Government Code, you also are entitled to receive and review this information. Under Section
559.004 of the Government Code, you are also entitled to have us correct information about you that is incorrect.