U.S. Department of Transportation
Office of the Secretary
of Transportation

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This form is a SAMPLE ONLY. For a working copy of the Project Summary, please download the solicitation.
TO BE FILLED OUT BY THE PROPOSER: Project Title ________________________________________________ __________________________________________________________ TO BE FILLED OUT BY THE DEPARTMENT OF TRANSPORTATION: Date Received ___________________ Proposal No. _______________
The form for acknowledging receipt of proposal appears above. Please include it in the same package with the proposal submitted to DOT and provide your address on the reverse side.