Project No. PCN
SS-2-038(030)280 12345
Page North to Jct 32
1804
Prepared by
NORTH DAKOTA DEPARTMENT OF TRANSPORTATION
BISMARCK, NORTH DAKOTA
http://www.dot.nd.gov/
DIRECTOR
Thomas K. Sorel
PROJECT DEVELOPMENT DIRECTOR
Robert A. Fode, P.E.
Principal Author: (Engineering Firm or NDDOT Designer)
January 2010
PROJECT NAME
PROJECT LOCATION
CERTIFICATION
I hereby certify that this report was prepared by me or under my direct supervision and that I am a duly registered professional engineer under the laws of the State of North Dakota. This document was originally issued and sealed by NAME, Registration number PENUMBER on MM/DD/YY and the original document is stored at the NorthDakota Department ofTransportation.
______
Name, P.E. Date
A. Project Description
Highway: District: Projects:
From:
Project Current ADT Forecast ADT
B. Project Schedule
Project Plans Complete Bid Opening
C. Purpose of Project
D. Need for Project
Existing Conditions:
Deficiencies:
E. Scope of Work (The original Scope of work versus the proposed scope in the ECL. Include original investment strategy and cost estimate for the STIP, Scoping Report, and ECL, as well as any investment strategy changes.)
20xx STIP:
20xx Scoping Report:
20xx ECL:
Notes:
F. Alternatives
Alternative A: No Build
Alternative B:
Optional Work Items:
Engineering Issues:
Environmental Issues:
Comparison of Alternatives:
G. Comments from the Draft Decision Document
Recommendations Table
1. Do you concur with the project concepts as proposed? / 2. Which alternative should proceed with the project?Office of Project Development
Office of Transportation Programs
Office of Operations
Bridge Division
Construction Services Division
Design Division
District
Environmental and Transportation Services Division
Local Government Division
Maintenance Division
Materials and Research Division
Programming Division
Planning/Asset Management Division
City
FHWA
H. Executive Decisions
1. Do you concur with the project concepts as proposed?
_____ Yes
_____ No
2. Which alternate should proceed with the project?
_____ Alternative A – No-Build Alternative
_____ Alternative B – Proposed Build Alternatives
Amendments/Comments for Project No. XXX:
______Ronald J. Henke, P.E., Deputy Director for Engineering Date
Project Title Page 3
Project No. XXXXX PCN XXXXX
Month year Draft Decision Document
Attachments