Form SMS.4906-T "Small Business Enterprise (Sbe) Program Trucking Commitment Agreement Form" - Texas

What Is Form SMS.4906-T?

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 December 1, 2015;
  • 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;
  • Fill out the form in our online filing application.

Download a fillable version of Form SMS.4906-T by clicking the link below or browse more documents and templates provided by the Texas Department of Transportation.

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Download Form SMS.4906-T "Small Business Enterprise (Sbe) Program Trucking Commitment Agreement Form" - Texas

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Small Business Enterprise (SBE) Program
Form SMS.4906-T
(Rev. 12/15)
Trucking Commitment Agreement Form
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. SBE’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?
Dump trucks:
2a. Specify vehicle identification information on page 2.
3. Number of fully operational trucks owned by DBE?
Dump trucks:
Tractors/trailers:
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
Number of Dump Trucks,
Name of Trucking Company
Contract/Agreement
Tractors/Trailers (specify)
$
$
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)
(Mo & Yr)
IMPORTANT! The signatures of the prime contractor and the SBE,
and the total commitment amount must always be on the same page.
Prime Contractor:
Name/Title (please print):
Address:
Signature:
Phone:
Fax:
E-mail:
Date:
*Prime Contractor's SBE Representative:
Name/Title (please print):
Address:
E-mail:
Phone:
Fax:
SBE:
Name/Title (please print):
Vendor No.:
Address:
Signature:
Phone:
Fax:
E-mail:
Date:
Subcontractor, if the SBE will be a second tier sub.
Name/Title (please print):
Subcontractor:
Address:
Signature:
Phone:
Fax:
E-mail:
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.
*The SBE representative is responsible for submitting reports, maintaining records, and documenting good faith efforts to use SBEs.
To ensure prompt and efficient handling of your project file we are requesting that all commitments be presented to the Office of Civil Rights
at OCR_DBE_Compliance@txdot.gov, using this basic format.
Small Business Enterprise (SBE) Program
Form SMS.4906-T
(Rev. 12/15)
Trucking Commitment Agreement Form
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. SBE’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?
Dump trucks:
2a. Specify vehicle identification information on page 2.
3. Number of fully operational trucks owned by DBE?
Dump trucks:
Tractors/trailers:
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
Number of Dump Trucks,
Name of Trucking Company
Contract/Agreement
Tractors/Trailers (specify)
$
$
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)
(Mo & Yr)
IMPORTANT! The signatures of the prime contractor and the SBE,
and the total commitment amount must always be on the same page.
Prime Contractor:
Name/Title (please print):
Address:
Signature:
Phone:
Fax:
E-mail:
Date:
*Prime Contractor's SBE Representative:
Name/Title (please print):
Address:
E-mail:
Phone:
Fax:
SBE:
Name/Title (please print):
Vendor No.:
Address:
Signature:
Phone:
Fax:
E-mail:
Date:
Subcontractor, if the SBE will be a second tier sub.
Name/Title (please print):
Subcontractor:
Address:
Signature:
Phone:
Fax:
E-mail:
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.
*The SBE representative is responsible for submitting reports, maintaining records, and documenting good faith efforts to use SBEs.
To ensure prompt and efficient handling of your project file we are requesting that all commitments be presented to the Office of Civil Rights
at OCR_DBE_Compliance@txdot.gov, using this basic format.
Form SMS.4906-T
SBE Truck Unit Listing
(Rev. 12/15)
Page 2 of 2
Company Name:
Contract-CSJ #
Unit #
Year/Make
VIN #
Plate #
I hereby certify that the information presented above is correct. I agree to inform the District Area
Engineer in writing of any changes within 10 days of the change(s).
SBE Company:
SBE Principal:
Page of 2