Fillable Form M-203 - Oversized/overweight Transporting Company Agreement printable pdf download

Form M-203

Indiana Department of Revenue

State Form 25415

Oversized/Overweight Transporting Company

(R6 / 2-16)

Agreement

This application is made and offered ________________________ , 20 __________ , to and between the State of Indiana, acting by

and through the Indiana Department of Revenue, (hereinafter referred to as the "State") and

Legal Company Name: _____________________________________________________________________________________

(Hereinafter referred to as the “Transporting Company”).

Doing Business As (if applicable): _____________________________________________________________________________

Company Type: (ex. Corporation, etc.) _________________________________________________________________________

Physical Address: _________________________________________________________________________________________

Mailing Address: __________________________________________________________________________________________

(Include City, State, Zip and County)

Federal Identification Number (Social Security Number if sole proprietor): ______________________________________________

US DOT Number: _________________________________________________________________________________________

(If the vehicle has a gross vehicle weight or gross combined vehicle weight of 10,001 lbs. or more.)

Federal Motor Carrier (MC) Number: __________________________________________________________________________

(A company that provides truck transportation of cargo belonging to others and is paid for doing so is required to obtain an MC number

to operate as an interstate for-hire carrier.)

The Transporting Company shall:

1. Request a permit for all oversize and/or overweight vehicular movements.

2. Indemnify, defend, exculpate, and hold harmless the State, its officials and employees from any liability due to loss, damage,

injuries, or other casualties of whatsoever kind, or by whomsoever caused, to the person or property of anyone on or off the right-

of-way arising out of, or resulting from the issuance of permits, as herein provided, or the work connected herewith, or from the

installation, existence, use, maintenance, condition, repairs, alterations, or removal of any equipment or material, whether due

in whole or in part to the negligent acts or omissions (1) of the State, its officials, agents or employees; or (2) of the Transporting

Company, its agents, or employees, or other persons engaged in the performance of the work; or (3) the joint negligence of any

of them; including any claims arising out of the Workmen's Compensation Act or any other law, ordinance, order or decree. The

Transporting Company also agrees to pay all reasonable expenses and attorney's fees incurred by or imposed on the State in

connection herewith in the event that the Transporting Company shall default under the provisions of this paragraph.

3. Have valid insurance coverage on the vehicle for at least the minimum value required by the statutes of the State. The insurance

must be valid for the time this agreement is in force.

4. Be responsible for the validity of all checks and instruments used in the payment of permit fees which must be paid as required.

5. Agree to the recording of all telephone conversations for the purpose of ordering and issuing permits.

6. Order future permits by using the Company Number. The number will be used to identify the Transporting Company.

7. Use only the permit application forms which will be prescribed by the State.

8. If a permit must be sent to a driver, Form M-233 or other Department approved form must be completed and sent in a format

and by a method previously approved by the State.

9. Use only the State's telephone lines to call in permit application data.

10. Certify that the permit form will be completed properly, including the starting and expiration date, describing accurately the truck

when loaded with the object to be hauled, giving the origin of the load, the destination of the load, and only the state routes by title

and number, which will be used to move the load.

11. Check the routes to be requested for restrictions, detours, and especially overhead clearances for high loads.

Form M-203 - Oversized/overweight Transporting Company Agreement

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