Fillable Form M-203 - Oversized/overweight Transporting Company Agreement (Page 2 of 2) in pdf

12. Explain the General Provisions and any Special Provisions to the driver and any escorts. Any Special Provisions provided over

the telephone must be written on the application in the appropriate blank. Have the driver read and sign at the bottom of the form.

13. Give written notice to the State in order to cancel this agreement, effective upon expiration of any outstanding permit.The

Transporting Company will also give notice and complete a new agreement if any ownership or corporate change occurs. This

agreement is valid until canceled for cause, or until an ownership or corporate change occur, whichever occurs first.

The State will:

1. Give written notice to the Transporting Company in order to cancel this agreement on the effective date stated in the written notice.

2. Provide to the Transporting Company information on routes, load dimension limits and all other matters pertaining to the issuance

of permits for oversize and/or overweight loads.

3. Provide Special Provisions as required.

4. Make every effort to assure that the Company Number is not compromised. If either party is aware of any compromise, a new

number will be issued.

The Transporting Company understands and agrees that:

Review of bridge clearances is for height only from shoulder to shoulder (travel lanes only). It is the company/driver’s responsibility

to make sure there is enough height clearance to use the shoulder, or beyond, due to obstruction or an accident.

All permits cover only travel on interstates, U.S. routes, and state highways. Permits issued do not cover any city streets or county

roads. You must contact the city or municipality for approval to travel on their maintained roads.

The undersigned warrants that he is the applicant, or that he is the authorized representative, agent, member, or responsible officer of

the applicant, that he has not, nor has any other member, employee, representative, agent or officer of the firm, company, corporation

or partnership represented by him, directly or indirectly, entered into or offered to enter into any combination, collusion or agreement to

receive or pay, and that he has not received or paid, any sum of money or other consideration for the execution of the annexed contract

other than that which appears upon the face of the contract.

Under penalties of perjury, I declare that I have examined this document and to the best of my knowledge and belief, it is true, correct,

and complete.

_________________________________________________________

________________________________

Written Signature

Date

Daytime Phone Number

_________________________________________________________

________________________________

Printed or Typed Name and Title

Fax Number

________________________________

Email Address

Mail this form to:

Indiana Department of Revenue

7811 Milhouse Rd, Suite M

Indianapolis, IN 46241-9612

Form M-203 - Oversized/overweight Transporting Company Agreement Page 2