Emergency Worksfunding Application

Emergency WorksFunding Application

NZTA Region Name: / Network Manager Name: / Net Mgr Phone No:
NOC Name: / Application Date:
Click here to enter a date. / AMIAdvisedDate:
Click here to enter a date.

1. ELIGIBILITY FOR EMERGENCY work funding:

EventName / SAP Project Name: / Event Start Date:
Click here to enter a date. / SAP Project Number:
Qualifying Event:
Description - Location, and Asset(s) OR reason for requesting additional funds:

1. SUPPORTING detail REQUIRED FOR EMERGENCY work:

Is there a Schedule of Activitiesattached?
Yes ☐ / Are Supporting Details attached?
Yes ☐

1. funding requested:

Current Yr Year2 Year 3 Totals

Original Approval:
Total of previous increases:
This Application:
New Total:

1. ASSET MANAGER INTEGRATOR ASSIGNED STATUS:

Approved ☐ / orAlternate ☐
Specify other Work Category: /
/ or Declined ☐
If yes, provide a reason below

1. ASSET MANAGER INTEGRATOR - ALTERNATE / DECLINE Decision:

Reason for suggesting an alternate funding code, or declining the funding:

1. ASSET MANAGER INTEGRATOR Approval:

Asset Manager Integrator (1)
Name: Date: Click here to enter a date. / Asset Manager Integrator (2)
Name: Date:Click here to enter a date.

1. ASSET MANAGER INTEGRATOR Comment:

Commentary supporting the decision to recommend approval:

1. Confirmation of recommendation from the project sponsor: .

Project sponsor confirmation of endorsement of recommendation:
Name: Date:Click here to enter a date.

1. FUNDING APPROVAL and ADMINISTRATION:

Snr Mgr Op Policy, Planning & Perf (SD&D)/Snr Mgr System Mgmt (SD&D)/Snr Mgr Journey Mgmt
Yes ☐ No ☐
Regional P&I Representative Approval
N / A ☐ Yes ☐ No ☐
Is the funding in SAP?
Yes ☐ / Is the funding in TIO?
Yes ☐ / Network Manager advised
Yes ☐
Legend: / Network Manager to complete / Asset Integrator to complete / Sponsor to complete / Funder to complete