"Project Status Report Card - Local Bridge Program" - Connecticut

Project Status Report Card - Local Bridge Program is a legal document that was released by the Connecticut Department of Transportation - a government authority operating within Connecticut.

Form Details:

  • Released on April 1, 2014;
  • The latest edition currently provided by the Connecticut Department of Transportation;
  • Ready to use and print;
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  • Fill out the form in our online filing application.

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Download "Project Status Report Card - Local Bridge Program" - Connecticut

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CONNECTICUT DEPARTMENT OF TRANSPORTATION
LOCAL BRIDGE PROGRAM
Project Status Report Card
Project Number: _____________ Bridge Number: _________ Municipality: _____________________
Bridge Location: _____________________________________________________________________
Current Project Phase: ____________________
Change in Project Scope? ___ Yes ___ No If yes, please provide description of new proposed scope:
Describe work performed to date (at least in the past 3 months) or since the last status update:
Please describe the work that will be performed in the next 3 months:
Project Schedule:
(mm/dd/yyyy)
Final Design (Accepted by the Municipality)
_____________
Public Hearing
_____________
Submit Supplemental Application
_____________
Note: If a time extension for submittal
Construction Advertising
_____________
of the Supplemental Application is
needed, please visit the LBP webpage
Construction Contract Award
_____________
at www.ct.gov/dot/localbridge to
retrieve the appropriate form.
Construction Start
_____________
Construction Complete
_____________
Any changes in Project costs? ___ Yes ___ No If yes, please enter costs information below:
Preliminary
Updated
Preliminary Engineering Fees
$ _______________
$ _______________
Rights-of-Way Cost
$ _______________
$ _______________
Municipal Utility Relocation
$ _______________
$ _______________
Estimated Construction Costs
$ _______________
$ _______________
Construction Engineering
$ _______________
$ _______________
Contingencies
$ _______________
$ _______________
(10% of Construction Costs Only)
Total Estimated Project Costs
$ _______________
$ _______________
Submitted by: ____________________________________, __________________________________
(Name: First MI Last)
(Title)
Telephone: ________________ Ext: ______ Email: _________________________________________
CLICK TO SUBMIT BY EMAIL
Signature: ___________________________ Date Submitted: _______________
(Digital signature is acceptable)
Rev 4/2014
If by mail, send to: Francisco T. Fadul, Local Bridge Program, CT DOT, PO Box 317546, Newington, CT 06131-7546
CONNECTICUT DEPARTMENT OF TRANSPORTATION
LOCAL BRIDGE PROGRAM
Project Status Report Card
Project Number: _____________ Bridge Number: _________ Municipality: _____________________
Bridge Location: _____________________________________________________________________
Current Project Phase: ____________________
Change in Project Scope? ___ Yes ___ No If yes, please provide description of new proposed scope:
Describe work performed to date (at least in the past 3 months) or since the last status update:
Please describe the work that will be performed in the next 3 months:
Project Schedule:
(mm/dd/yyyy)
Final Design (Accepted by the Municipality)
_____________
Public Hearing
_____________
Submit Supplemental Application
_____________
Note: If a time extension for submittal
Construction Advertising
_____________
of the Supplemental Application is
needed, please visit the LBP webpage
Construction Contract Award
_____________
at www.ct.gov/dot/localbridge to
retrieve the appropriate form.
Construction Start
_____________
Construction Complete
_____________
Any changes in Project costs? ___ Yes ___ No If yes, please enter costs information below:
Preliminary
Updated
Preliminary Engineering Fees
$ _______________
$ _______________
Rights-of-Way Cost
$ _______________
$ _______________
Municipal Utility Relocation
$ _______________
$ _______________
Estimated Construction Costs
$ _______________
$ _______________
Construction Engineering
$ _______________
$ _______________
Contingencies
$ _______________
$ _______________
(10% of Construction Costs Only)
Total Estimated Project Costs
$ _______________
$ _______________
Submitted by: ____________________________________, __________________________________
(Name: First MI Last)
(Title)
Telephone: ________________ Ext: ______ Email: _________________________________________
CLICK TO SUBMIT BY EMAIL
Signature: ___________________________ Date Submitted: _______________
(Digital signature is acceptable)
Rev 4/2014
If by mail, send to: Francisco T. Fadul, Local Bridge Program, CT DOT, PO Box 317546, Newington, CT 06131-7546