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Clear FormMDOT 0166B (10/11)Page 4 of 14SECTION 4: CONTROLA. IDENTIFY YOUR FIRM’S OFFICERS & BOARD OF DIRECTORS (if additional space is required, attach a separate sheet)NAMETITLEDATEAPPOINTEDETHNICITYGENDERa.b.(1) OFFICERSOFc.THECOMPANY d.e.a.b.(2) BOARD OFc.DIRECTORSd.e.(3) DO ANY OF THE PERSONS LISTED IN (1) AND/OR (2) ABOVE PERFORM A MANAGEMENT OR SUPERVISORY FUNCTION FOR ANYOTHER BUSINESS?NOYES PERSON TITLEBUSINESS FUNCTION(4) DO ANY OF THE PERSONS LISTED (1) AND/OR (2) ABOVE OWN OR WORK FOR ANY OTHER FIRM(S) THAT HAS A RELATIONSHIP WITHTHIS FIRM? (e.g., ownership interest, shared office space, financial investments, equipment, leases, personnel sharing, etc)NOYES FIRM NAME PERSONNATURE OF BUSINESS RELATIONSHIPB. IDENTIFY YOUR FIRM’S MANAGEMENT PERSONNEL WHO CONTROL YOUR FIRM IN THE FOLLOWING AREAS(if more than two persons, attach a separate sheet)NAME(1) FINANCIAL DECISIONS (Responsiibilityfor acquisition of lines of credit, surety, bonding, supplies, etc.)a.(2) ESTIMATING AND BIDDINGa.b.b.(3) NEGOTIATING AND CONTRACT EXECUTIONa.b.(4) HIRING/FIRING OF MANAGEMENTPERSONNELa.b.(5) FIELD/PRODUCTIONOPERATIONS SUPERVISORa.b.(6) OFFICE MANAGEMENTa.b.TITLEETHNICITYGENDER

Clear FormMDOT 0166B (10/11)Page 5 of 14B. IDENTIFY YOUR FIRM’S MANAGEMENT PERSONNEL WHO CONTROL YOUR FIRM IN THE FOLLOWING AREAS(if more than two persons, attach a separate sheet)NAME(7) MARKETING/SALESTITLEETHNICITYGENDERa.b.(8) PURCHASING OF MAJOREQUIPMENTa.b.(9) AUTHORIZED TO SIGN COMPANYCHECKS (for any purpose)a.b.(10) AUTHORIZED TO MAKEFINANCIAL TRANSACTIONSa.b.(11) DO ANY OF THE PERSONS LISTED IN (1) THROUGH (10) ABOVE PERFORM A MANAGEMENT OR SUPERVISORY FUNCTION FOR ANYOTHER BUSINESS?NOYES PERSON TITLEBUSINESS FUNCTION(12) DO ANY OF THE PERSONS LISTED (1) THROUGH (10) ABOVE OWN OR WORK FOR ANY OTHER FIRM(S) THAT HAS A RELATIONSHIPWITH THIS FIRM? (e.g., ownership interest, shared office space, financial investments, equipment, leases, personnel sharing, etc)NOYES FIRM NAME PERSONNATURE OF BUSINESS RELATIONSHIP4. STORAGESPACE3. OFFICESPACE2. VEHICLES1. EQUIP ENTC. INDICATE YOUR FIRM’S INVENTORY IN THE FOLLOWING CATEGORIES (attach additional sheets if needed)TYPE OF EQUIPMENTMAKE/MODELCURRENT VALUEOWNED OR LEASED?TYPE OF VEHICLEMAKE/MODELCURRENT VALUEOWNED OR LEASED?a.b.c.a.b.c.STREET ADDRESSOWNED OR LEASED?CURRENT VALUE OF PROPERTY OR LEASESTREET ADDRESSOWNED OR LEASED?CURRENT VALUE OF PROPERTY OR LEASEa.b.a.b.D. DOES YOUR FIRM RELY ON ANY OTHER FIRM FOR MANAGEMENT FUNCTIONS OR EMPLOYEE PAYROLL?NOYES EXPLAIN:

Clear FormMDOT 0166B (10/11)Page 6 of 14E. FINANCIAL INFORMATION(1) BANKING INFORMATIONNAME OF BANKPHONE NO.ADDRESSCITY(2) BONDING INFORMATION: If you have bonding capacity, identify:STATEZIP CODESTATEZIP CODEBINDER NO.NAME OF AGENT/BROKERPHONE NO.ADDRESSCITYBONDING LIMIT: AGGREGATE LIMIT PROJECT LIMIT F. IDENTIFY ALL SOURCES, AMOUNTS, AND PURPOSES OF MONEY LOANED TO YOUR FIRM, INCLUDING THENAMES OF ANY PERSONS OR FIRMS SECURING THE LOAN, IF OTHER THAN THE LISTED OWNERNAME OF SOURCEADDRESS OF SOURCENAME OF PERSON SECURITYTHE LOANORIGINALAMOUNTCURRENTBALANCEPURPOSEOF LOAN1.2.3.G. LIST ALL CONTRIBUTIONS OR TRANSFERS OF ASSETS TO/FROM YOUR FIRM AND TO/FROM ANY OF ITSOWNERS OVER THE PAST TWO YEARS. (Attach additional sheets if needed)CONTRIBUTION/ASSETDOLLAR VALUEFROM WHOMTRANSFERREDTO WHOMTRANSFERREDRELATIONSHIPDATE OFTRANSFER1.2.3.H. LIST CURRENT LICENSES/PERMITS HELD BY ANY OWNER AND/OR EMPLOYEE OF YOUR FIRM (e.g.,contractor, engineer, architect, etc.) (Attach additional sheets if needed)NAME OF LICENSE/PERMIT HOLDERTYPE OF LICENSE/PERMITEXPIRATIONDATELICENSE NUMBER ANDSTATE1.2.3.I. LIST THE THREE LARGEST CONTRACTS COMPELTED BY YOUR FIRM IN THE PAST THREE YEARS, IF ANY:NAME OF OWNER/CONTRACTOR1.2.3.NAME/LOCATIONOF PROJECTTYPE OF WORK PERFORMEDDOLLAR VALUE OFCONTRACT

Clear FormMDOT 0166B (10/11)Page 7 of 14J. LIST THE THREE LARGEST ACTIVE JOBS ON WHICH YOUR FIRM IS CURRENTLY WORKING:NAME OF PRIME CONTRACTOR ANDPROJECT NUMBER1.2.3.LOCATION OFPROJECTTYPE OF WORKPROJECT STARTDATEANTICIPATEDCOMPLETIONDATEDOLLAR VALUEOF CONTRACT

Clear FormMDOT 0166B (10/11)Page 8 of 14AFFIDAVIT OF CERTIFICATIONThis form must be signed and notarized for each owner upon which disadvantaged status is relied.A MATERIAL OR FALSE STATEMENT OR OMISSION MADE IN CONNECTION WITH THIS APPLICATIONIS SUFFICIENT CAUSE FOR DENIAL OF CERTIFICATION, REVOCATION OF A PRIOR APPROVAL,INITIATION OF SUSPENSION OR DEBARMENT PROCEEDINGS, AND MAY SUBJECT THE PERSONAND/OR ENTITY MAKING THE FALSE STATEMENT TO ANY AND ALL CIVIL AND CRIMINAL PEALTIESAVAILABLE PURSUANT TO APPLICABLE FEDERAL AND STATE LAW.I (full name printed), swear or affirm under penalty of law that I am(title) of applicant firm (firm name) and that I have read andunderstood all of the questions in this application and that all of the foregoing information and statements submittedin this application and its attachments and supporting documents are true and correct to the best of my knowledge,and that all responses to the questions are full and complete, omitting no material information. The responsesinclude all material information necessary to fully and accurately identify and explain the operations, capabilitiesand pertinent history of the named firm as well as the ownership, control, and affiliations thereof.I recognize that the information submitted in this application is for the purpose of inducing certification approval bya government agency. I understand that a government agency may, by means it deems appropriate, determine theaccuracy and truth of the statements in the application, and I authorize such agency to contact any entity named inthe application, and the named firm’s bonding companies, banking institutions, credit agencies, contractors, clients,and other certifying agencies for the purpose of verifying the information supplied and determining the namedfirm’s eligibility.I agree to submit to government audit, examination and review of books, records, documents and files, in whateverform they exist, of the named firm and its affiliates, inspection of its places(s) of business and equipment, and topermit interviews of its principals, agents, and employees. I understand that refusal to permit such inquiries shallbe grounds for denial of certification.If awarded a contract or subcontract, I agree to promptly and directly provide the prime contractor, if any, and theDepartment, recipient agency, or federal funding agency on an ongoing basis, current, complete and accurateinformation regarding (1) work performed on the project; (2) payments; and (3) proposed changes, if any, to theforegoing arrangements.I agree to provide written notice to the recipient agency or Unified Certification Program (UCP) of any materialchange in the information contained in the original application within 30 calendar days of such change (e.g.,ownership, address, telephone number, etc.).I acknowledge and agree that any misrepresentations in this application or in records pertaining to a contract orsubcontract will be grounds for terminating any contract or subcontract which may be awarded; denial orrevocation of certification; suspension and debarment; and for initiating action under federal and/or state lawconcerning false statement, fraud or other applicable offenses.I hereby certify that I am a (circle all that apply):FemaleBlack AmericanHispanic AmericanAsian- Pacific AmericanSubcontinent Asian AmericanOther (specify) .Native AmericanI have held myself out as a member of that group and have acted as a member of that group. I certify that I am anowner of the company seeking DBE certification and that I have been subjected to racial or ethnic prejudice orcultural bias within American society because of my identity as a member of the above circled group.

Clear FormMDOT 0166B (10/11)Page 9 of 14I further certify that my personal net worth does not exceed 1.32 million, and that my ability to compete in the freeenterprise system has been impaired due to diminished capital and credit opportunities as compared to others in thesame or similar line of business who are not socially and economically disadvantaged.I declare, under penalty of perjury, that the information provided in this application and supporting documentsrelating to my disadvantaged status and me is true and correct.Signature: Date:NOTARY CERTIFICATE:

Clear FormOMB APPROVAL NO. 3245-0188EXPIRATION DATE:11/30/2004PERSONAL FINANCIAL STATEMENTAs of,U.S. SMALL BUSINESS ADMINISTRATIONComplete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan.NameBusiness PhoneResidence AddressResidence PhoneCity, State, & Zip CodeBusiness Name of Applicant/BorrowerASSETSCash on hand & in BanksSavings AccountsIRA or Other Retirement AccountAccounts & Notes ReceivableLife Insurance-Cash Surrender Value Only(Complete Section 8) Stocks and Bonds(Describe in Section 3) Real Estate(Describe in Section 4) Automobile-Present ValueOther Personal Property(Describe in Section 5) Other Assets(Describe in Section 5) TotalSource of Income(Omit Cents) Accounts PayableNotes Payable to Banks and Others(Describe in Section 2)Installment Account (Auto)Mo. Payments Installment Account (Other)Mo. Payments Loan on Life InsuranceMortgages on Real Estate(Describe in Section 4)Unpaid Taxes(Describe in Section 6)Other Liabilities(Describe in Section 7)Total LiabilitiesNet Worth TotalSection 1.LIABILITIES(Omit Cents)Contingent Liabilities SalaryNet Investment IncomeReal Estate IncomeOther Income (Describe below)* As Endorser or Co-MakerLegal Claims & JudgmentsProvision for Federal Income TaxOther Special Debt Description of Other Income in Section 1.*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.Section 2. Notes Payable to Banks and Others.(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)Name and Address of Noteholder(s)OriginalBalanceCurrentBalanceSBA Form 413 (3-00) Previous Editions ObsoleteThis form was electronically produced by Elite Federal Forms, Inc.PaymentAmountFrequency(monthly,etc.)How Secured or EndorsedType of Collateral(tumble)Page 10 of 14

Clear FormSection 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed).Market ValueDate ofNumber of SharesName of SecuritiesCostTotal ValueQuotation/Exchange Quotation/Exchange(List each parcel separately. Use attachment if necessary. Each attachment must be identified as a partof this statement and signed.)Property AProperty BProperty CSection 4. Real Estate Owned.Type of PropertyAddressDate PurchasedOriginal CostPresent Market ValueName &Address of Mortgage HolderMortgage Account NumberMortgage BalanceAmount of Payment per Month/YearStatus of MortgageSection 5. Other Personal Property and Other Assets.(Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, termsof payment and if delinquent, describe delinquency)Section 6.Unpaid Taxes.(Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)Section 7.Other Liabilities.(Describe in detail.)Section 8.Life Insurance Held.(Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the aboveand the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaininga loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General(Reference 18 U.S.C. 1001).Signature:Date:Social Security Number:Signature:Date:Social Security Number:PLEASE NOTE:Last 4 digits onlyLast 4 digits onlyThe estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or commentsconcerning this estimate or any other aspect of this information, please contact Chief, Administrative Branch, U.S. Small BusinessAdministration, Washington, D.C. 20416, and Clearance Officer, Paper Reduction Project (3245-0188), Office of Management and Budget,Washington, D.C. 20503. PLEASE DO NOT SEND FORMS TO OMB.Page 11 of 14

Clear FormMDOT 0166B (10/11)Page 12 of 14(Exhibit A)WORK EXPERIENCE RESUMEA COPY OF THIS FORM MUST BE COMPLETED BY EACH OWNER, OFFICER, DIRECTOR AND OTHER PERSONNEL OF THE FIRM IDENTIFIED IN THE APPLICATION. PLEASE TYPE OR PRINT. DO NOT LEAVE ANYTHING BLANK. MAKE ADDITIONAL COPEIS OF THIS FORM ASNEEDED.NAME OF APPLICANT’S COMPANYYOUR NAME/TITLENAME AND LOCATION OF SCHOOLSATTENDEDYEARSATTENDEDDIPLOMA/DEGREECOURSES OF STUDY/MAJOREDUCATIONALOR VOCATIONALTRAININGCOLLEGES ANDUNIVERSITIESOTHER TRAININGEMPLOYMENT RECORDPLEASE LIST ALL OF YOUR WORK EXPERIENCE. START WITH YOUR MOST RECENT EMPLOYMENT AND WORK BACKWARDS.PROVIDE A DETAILED DESCRIPTION OF REGULARLY ASSIGNED, ONGOING DUTIES, FOR EACH JOB. ATTACH ADDITIONAL SHEETS IFNECESSARY.EMPLOYERJOB TITLESTREET ADDRESSCITYDATE OF EMPLOYMENTSUPERVISOR’S NAMEDESCRIPTION OF YOUR DUTIESLIST UNION LICENSES, PROFESSIONAL REGISTRATIONS, ETC. WHICH ARE IN YOUR NAMESTATEZIP CODEAVERAGE HOURS PER WEEK

Clear FormMDOT 0166B (10/11)Page 13 of 14EMPLOYERJOB TITLESTREET ADDRESSCITYDATES OF EMPLOYMENTSUPERVISOR’S NAMESTATEZIP CODEAVERAGE HOURS PER WEEKDESCRIPTION OF YOUR DUTIESEMPLOYERJOB TITLESTREET ADDRESSCITYDATES OF EMPLOYMENTSUPERVISOR’S NAMESTATEZIP CODEAVERAGE HOURS PER WEEKDESCRIPTION OF YOUR DUTIESLIST ANY ADDITIONAL EXPERIENCE/INFORMATION YOU FEEL MAY BE HELPFUL TO US IN CONSIDERING YOUR APPLICATION:CERTIFICATION: I certify that all information on this and all attached pages is true, correct, and complete to the best of myknowledge and contains no willful falsifications or misrepresentations.RESUME ATTACHED?YESNOSIGNATURESOCIAL SECURITY NO. (Last 4 digits only)DATE

Clear FormMDOT 0166B (10/11)Page 14 of 14DBE UNIFORM CERTIFICATION APPLICATION SUPPORTING DOCUMENTS CHECKLISTIn order to complete your application for DBE certification, you must attach copies of all of the followingdocuments as they apply to you and your firm.All ApplicantsWork experience resumes (that include places of ownership/employment with corresponding dates),for all owners and officers of your firmPersonal Financial Statement (form available with this application)Personal tax returns for the past three years, if applicable, for each owner claiming disadvantagedstatusYour firm’s tax returns (gross receipts) and all related schedules for the past three yearsDocumented proof of contributions used to acquire ownership for each owner (e.g. both sides ofcancelled checks)Your firm’s signed loan agreements, security agreements, and bonding formsDescriptions of all real estate (including office/storage space, etc.) owned/leased by your firm anddocumented proof of ownership/signed leasesList of equipment leased and signed lease agreementsList of construction equipment and/or vehicles owned and titles/proof of ownershipDocumented proof of any transfers of assets to/from your firm and/or to/from any of its owners overthe past two yearsYear-end balance sheets and income statements for the past three years (or life of firm, if less thanthree years); a new business must provide a current balance sheetAll relevant licenses, license renewal forms, permits, and haul authority formsDBE and SBA 8(a) or SDB certifications, denials, and/or decertifications, if applicableBank authorization and signatory cardsSchedule of salaries (or other compensation or remuneration) paid to all officers, managers, owners,and/or directors of the firmTrust agreements held by any owner claiming disadvantaged status, if anyPartnership or Joint VentureOriginal and any amended Partnership or Joint Venture AgreementsCorporation or LLCOfficial Articles of Incorporation (signed by the state official)Both sides of all corporate stock certificates and your firm’s stock transfer ledgerShareholders’ AgreementMinutes of all stockholders and board of directors meetingsCorporate by-laws and any amendmentsCorporate bank resolution and bank signature cardsOfficial Certificate of Formation and Operating Agreement with any amendments (for LLCs)Trucking CompanyDocumented proof of ownership of the companyInsurance agreements for each truck owned or operated by your firmTitle(s) and registration certificate(s) for each truck owned or operated by your firmList of U.S. DOT numbers for each truck owned or operated by your firmRegular DealerProof of warehouse ownership or leaseList of product lines carriedList of distribution equipment owned and/or leasedNOTE: The specific state UCP to which you are applying may have additional requireddocuments that you must also supply with your application. Contact the appropriatecertifying agency to which you are applying to find out if more is required.

DISADVANTAGED BUSINESS ENTERPRISE PROGRAM 49 C.F.R. PART 26 UNIFORM CERTIFICATION APPLICATION ROADMAP FOR APPLICANTS Should I apply? o Is your firm at least 51%-owned by a socially and economically disadvantaged individual(s) who also controls the firm? o Is the disadvantaged owner a U.S. citizen or lawfully admitted permanent