DOT - Special Road Fund Program Application

SPECIAL ROAD FUND PROGRAM APPLICATION
North Dakota Department of Transportation, Local Government
SFN 62528
If you have questions on filling out the application or the program, please contact: specialroadfund@nd.gov
Local Public Agency Type*
City, County, or State Agency Name*
LPA Contact Information
Name*

First NameLast Name
Title*
Phone Number*
Email*
example@example.com
Engineering Firm Information (If Applicable)
Name

First NameLast Name
Title
Phone Number
Email
example@example.com
Project Information
Project Name
What SRF category best fits your project*
Who prepared the cost estimate?*
Total Project Cost*
Upload Project Estimate (pdf)*

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SRF Funds Requested*
Matching Funding Source*

LocalStateFederalOther LPAPrivateNone
Source of Local Funds*
Source of State Funds*
Source of Federal Funds*
Source of Other LPA Funds*
Source of Private Funds*
Project Location*
Upload Project Map (pdf)*

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Project Length*
in Miles
Is the project ready to be advertised for bid (shovel ready)?*
Proposed construction year*
Proposed surface type*
Average daily traffic*
vehicles per day
Speed limit on roadway*
miles per hour
Design speed*
miles per hour
Please describe the overall scope of the project*
Please describe the need for the project*
Is this project on County Major Collector Route? *
What is the CMC route number?*
Who will provide maintenance?*
Will all ROW be acquired with local funds prior to construction? *
Please attach the following documents in PDF format:
- Map showing project location
- Cost estimate (for construction only)
- Other Supporting documents
  - Letters of support
  - Traffic studies
  - Photos
Attach supporting pdf documents here:*

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LPA Signature
LPA Signature Date

MonthDayYear
Date
Should be Empty:

Project Information