STATE AID FOR LOCAL TRANSPORTATION Rev. June 2015
REQUEST FOR CONTRACTING AUTHORITY (DCP 01)
DATE: month day, year
TO: DSAE
FROM: Local Agency Name
& Address
SUBJECT: SP _____ - _____ - _____, Minn Proj No _____ _____ ( )
Project Location: __________________________________
We hereby request to be approved by MnDOT to receive delegation of its duties for construction of a federal-aid project as documented in the Agency Agreement relevant to the above referenced project.
Our agency will comply with all Federal requirements, and is adequately staffed and suitably equipped to undertake and satisfactorily complete the work, and has either employed a full-time, licensed engineer to be in responsible charge of the project, or has hired consultants for engineering services and will provide a qualified, full-time employee of the agency to be in responsible charge of the project.
Signed: _____________________________________________
City/County Engineer Date
Approved: _____________________________________________
District State Aid Engineer Date
__Delegated Contract Process requirements have been reviewed.
__ Agency Agreement is needed.
Special Conditions:
For Non governmental Agencies only:
Approved: _____________________________________________
State Aid Engineer Date