Department of Transportation /
/ State of Georgia /
J. TOM COLEMAN, JR. / HAROLD E. LINNENKOHL /
COMMISSIONER / #2 Capitol Square, S.W. / DEPUTY COMMISSIONER /
(404) 656-5206 / (404) 656-5212 /
/ Atlanta, Georgia 30334-1002 /
FRANK L. DANCHETZ / EARL MAHFUZ /
CHIEF ENGINEER / TREASURER /
(404) 656-5277 / (404) 656-5224 /

Date, 2004

Name

Address

City, GA Zip

RE: PI: ###### Project No.: STP-####-00(###), Description

Dear Project Sponsor:

As part of your Transportation Enhancement (TE) Agreement with the Georgia Department of Transportation (GDOT), the above referenced TE project must be inspected and certified that it is being maintained and used according to the project scope that was originally submitted and approved by GDOT.

In order to meet this requirement, a Maintenance Inspection Sponsor Certification must be completed for each project on an annual basis. You will receive the enclosed form from our office each year. Please complete and return to GDOT no later than May 31, 2004. Please refer to the project plans approved by GDOT as you complete this Maintenance Inspection Certification form. Each Maintenance report may be completed by a staff member but the certification must be signed by the Mayor, County Commissioner, or City / County Manager. Failure to complete this Certification may effect future TE funding for your projects.

Once you have completed the form, please fold, seal and return to the address printed on the back cover. This is a self-mailer and the return address is pre-printed for your added convenience. In addition, please send photos of your TE project either electronically or in print that we may use for presentations and other materials. You may want to send these under separate cover to the same address as shown on the back cover. If you have any questions, please contact Ronda Britt, TE Program Coordinator, at 404-657-6914.

Sincerely,

Joseph P. Palladi, P.E.

State Transportation Planning Administrator

JPP: rjb

TRANSPORTATION ENHANCEMENT PROJECT
MAINTENANCE INSPECTION SPONSOR CERTIFICATION
Fill in by TE Program Coordinator Fill in by TE Program Coordinator Fill in by TE Program Coordinator
Date Inspection Requested:
Federal Project No.: / P.I. No.:
Project Name/Description:
Location:
City: / County:
Date Project Completed: / Economic Life of Project: /

Years

Fill in below by Sponsor Fill in below by Sponsor Fill in below by Sponsor Fill in below by Sponsor
Date of Inspection: / Date of Report:
Person(s)/Agency Conducting Inspection:
NAME / TITLE / Office / Phone No.
Features of Project Reviewed and Condition of each:
FEATURES- (Attributes to review) / CONDITION / Definition:
Good:
No visible damage or missing items, landscape, or pavement sections
Fair:
Faults >1/4”< 1” cracks, damaged items or vegetation
Poor:
Missing items, missing or major damage to pavement sections, items not working as intended
GOOD / FAIR / POOR

Streetscapes

Sidewalks – Faulting, cracking, missing sections

Curb Ramps – Cracking, missing

Landscaping – Damaged, dead, missing

Street Furniture – Damaged, missing

Street Lights – Missing, working

Landscaping – Damaged, dead, missing

Multi-use trails – Pavement cracked or
faulted, signs missing or damaged,
erosion, evidence of poor drainage,
vegetation within user clearances
Buildings – Water and/or insect damage,
windows and doors intact,
condition of inside and outside
surfaces, evidence of settlement
Buildings – Still serving project intended use? / Yes / No
Other Structures – Overall condition and
appearance / GOOD / FAIR / POOR
Other Structures – Still serving project
intended use?
Yes / No
Scenic Preservation/Easements – Do the scenic
qualities remain intact?
Yes / No
ROW Acquisition: Is the property still in the ownership of the Government Entity and still being used for the original intent as outlined in the application and TE Agreement? / Yes / No
Overall Condition of Project: / GOOD / FAIR / POOR
(Check one)
Describe deficiencies:
Schedule to develop and implement a maintenance plan to correct deficiencies: Must be completed within 60 days
Comments:

Is this a follow up review?

/ Yes / No
If yes, what were the deficiencies needing correction and are the corrections satisfactory?
Brief Description of Deficiency / Correction Satisfactory?
Yes / No
Yes / No
Yes / No
Yes / No
Sponsor Certification
I certify that the information included in this report is accurate and complete. As per the TE Agreement, I understand that GDOT maintains the right to conduct periodic site inspections for the purpose of confirming proper operation and maintenance of the Project.
City/County Official Signature: /

City / County

Print Name:
Title:
Report Distribution:
R. Britt, TE Program Coordinator, #2 Capitol Square, RM 349, Atlanta, GA 30334
GDOT District Ofc:______

Tiim Meyer

TE Program Coordinator

Ga. Department of Transportation

#2 Capitol Square

Room 349

Atlanta, GA 30334