Ocr 485 Lpa Mississippi Department Of Transportation
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1LPA PROJECT
OCR-485-LPA
REV. 04/09
LIST OF FIRMS SUBMITTING QUOTES
I/we received quotes from the following firms on Project No: _________________________
County: _______________________________
Disadvantaged Business Enterprise (DBE) Regulations as stated in 49 CFR 26.11 require the
Mississippi Department of Transportation (MDOT) to create and maintain a comprehensive list
of all firms quoting/bidding subcontracts on prime contracts and quoting/bidding subcontracts
on federally-funded transportation projects. For every firm, we require the following
information:
Firm Name:
_________________________________________________________
Contact Name/Title: _________________________________________________________
Firm Mailing Address _________________________________________________________
Phone Number:
_________________________________________________________
_____ DBE Firm
_____ Non-DBE Firm
Firm Name:
_________________________________________________________
Contact Name/Title: _________________________________________________________
Firm Mailing Address _________________________________________________________
Phone Number:
_________________________________________________________
_____ DBE Firm
_____ Non-DBE Firm
Firm Name:
_________________________________________________________
Contact Name/Title: _________________________________________________________
Firm Mailing Address _________________________________________________________
Phone Number:
_________________________________________________________
_____ DBE Firm
_____ Non-DBE Firm
Firm Name:
_________________________________________________________
Contact Name/Title: _________________________________________________________
Firm Mailing Address _________________________________________________________
Phone Number:
_________________________________________________________
_____ DBE Firm
_____ Non-DBE Firm
Firm Name:
_________________________________________________________
Contact Name/Title: _________________________________________________________
Firm Mailing Address _________________________________________________________
Phone Number:
_________________________________________________________
_____ DBE Firm
_____ Non-DBE Firm
______________________________________
SUBMITTED BY (Signature)
______________________________________
FIRM NAME
Submit this form to the LPA as a part of your bid package. If this form is not included as
part of the bid packet, your bid will be deemed irregular. For further information about this
form, call Mississippi DOT’s Office of Civil Rights at (601) 359-7466; FAX (601) 576-4504.
Please make copies of this form when needed and also add those copies to the bid package.
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