Form BLR 17100 Local Public Agency Multi-Year Program Project Request - Illinois

Form BLR17100 or the "Local Public Agency Multi-year Program Project Request" is a form issued by the Illinois Department of Transportation.

Download a PDF version of the Form BLR17100 down below or find it on the Illinois Department of Transportation Forms website.

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Local Public Agency Multi-Year
Program Project Request
Local Public Agency
County
Section Number
Date
Metropolitan Planning Organization (MPO)
For Construction Projects
In MPO Boundary
MPO Name
MPO TIP Number
Anticipated Letting Date
Letting Type
Yes
No
Project Location
Street / Road Name
Local Route Name
Beginning Termini
Ending Termini
Key Route
Stationing
Type
Number
From
To
Length
Functional Class
Structures - for Projects that include Rehabilitation, Replacement or New Structure also complete
Over
Existing Structure Number
Structure Cost
Sufficiency Rating
Each project/location requires submittal of a map with the location indicated
Estimated Cost
State Job #
SFY
FHWA Funding
State Funding
LPA Funding
Total
Fed
Fund Source
Amount
%
Fund Source
Amount
Amount
Fund Source
+
P-
-
+
D-
-
+
R-
-
+
C-
-
+
CE
-
Total
Additional Information
Local Public Agency Contact Information
Email
Name
Phone Number
CMAP USE ONLY
Email
Planning Liaison Name
Phone Number
Printed 06/05/19
Page 1 of 1
BLR 17100 (10/04/17)
Local Public Agency Multi-Year
Program Project Request
Local Public Agency
County
Section Number
Date
Metropolitan Planning Organization (MPO)
For Construction Projects
In MPO Boundary
MPO Name
MPO TIP Number
Anticipated Letting Date
Letting Type
Yes
No
Project Location
Street / Road Name
Local Route Name
Beginning Termini
Ending Termini
Key Route
Stationing
Type
Number
From
To
Length
Functional Class
Structures - for Projects that include Rehabilitation, Replacement or New Structure also complete
Over
Existing Structure Number
Structure Cost
Sufficiency Rating
Each project/location requires submittal of a map with the location indicated
Estimated Cost
State Job #
SFY
FHWA Funding
State Funding
LPA Funding
Total
Fed
Fund Source
Amount
%
Fund Source
Amount
Amount
Fund Source
+
P-
-
+
D-
-
+
R-
-
+
C-
-
+
CE
-
Total
Additional Information
Local Public Agency Contact Information
Email
Name
Phone Number
CMAP USE ONLY
Email
Planning Liaison Name
Phone Number
Printed 06/05/19
Page 1 of 1
BLR 17100 (10/04/17)
Instructions for BLR 17100
This form is to be used by a Local Public Agency (LPA) to submit a project for IDOT's Multi-Year Program. For additional information
please refer to the Bureau of Local Roads and Streets (BLRS) manual Chapter 17.
Local Public Agency
Insert the name of the LPA for who the project is for.
County
Insert the County in which the LPA is located.
Section Number
Insert the section number assigned to this project.
Date
Insert the preparation date of this document.
MPO (Metropolitan Planning Organization)
In MPO Boundary
If this project is within an MPO’s planning boundaries, check yes, if not check no.
MPO Name
From the drop down choose the MPO in which the project is. Types to choose from are:
Bi-State
Bi-State Regional Commission
CMAP
Chicago Metropolitan Planning Organization
CUUATS
Champaign/Urbana Urban Area Transportation Study
DATS
Danville Area Transportation Study
DMATS
Dubuque Metropolitan Area Transportation Study
DSATS
DeKalb/Sycamore Area Transportation Study
DUATS
Decatur Urbanized Area Transportation Study
EWGCG
East-West Gateway Council of Governments
KATS
Kankakee Area Transportation Study
MCRPC
McLean County Regional Planning Commission
PPUATS
Peoria/Pekin Urban Area Transportation Study
RMAP
Rockford Metro Agency for Planning
SATS
Springfield Area Transportation Study
SEMPO
South East Metropolitan Planning Organization
SIMPO
Southern Illinois Metropolitan Planning Organization
SLATS
State Line Area Transportation Study
MPO TIP Number
Insert the TIP number assigned to this project by the MPO.
For Construction Projects:
Anticipated Letting Date
Insert the anticipated letting date for construction of this project. If submittal is not for
construction, this is not applicable.
Letting Type
From the drop down choose, Day Labor, State Let, Local Let.
Project Location
Street/Road Name
Insert the name of the Street/Road the project is located on. For additional streets/roadways,
use the add location button to add information for the additional roadways. If there are more
than five (5) locations included with the project, please insert the word "Various" instead of
listing all the locations.
Local Route Name
Insert the local route name (common name) of the roadway.
Beginning Termini
Insert the beginning termini for the street/roadway listed above.
Ending Termini
Insert the ending termini for the street/roadway listed above.
Key Route
Type
From the drop down select type as it relates to the roadway/street listed above. Types to
choose from are:
CH
County Highway
FAI
Federal Aid Interstate
FAP
Federal Aid Primary
FAS
Federal Aid Secondary
FAU
Federal Aid Urban
HSB
House/Senate Bill
MS
Municipal Street System
OR
Other Road
SBI
State Bond Issue
Printed 06/05/19
BLR 17100 (10/04/17)
TR
Township Route
UNK
Unknown
VAR
Various
Number
Insert the roadway number as it relates to the type chosen.
Stationing
This information will need to be obtained from IDOT.
From
Insert the beginning station number as it relates to the beginning termini.
To
Insert the ending station number as it relates to the ending termini.
Length
Insert the length of the project in miles. For projects that involve only a structure this will be
0.01.
Roadway Functional Class
From the drop down select the functional class of the roadway. Types to choose from are:
1- Interstate
2- Freeway/express
3 -Other Principal Art.
4-Minor Arterial
5-Major Collector
6-Minor Collector
7-Local
Structures
For a project that includes the rehabilitation, replacement or a new structure the following
must be completed.
Over
Insert the feature the structure crosses.
Existing Structure Number Insert the existing NBIS structure number, if applicable.
Structure Cost
Insert the estimated total cost of construction of this structure. Do not include CE.
Sufficiency Rating
Insert the sufficiency rating of the current structure, if applicable. This information can be
obtained from the master report for the current structure.
Add Location
Click on this button if another project location box is needed to insert information on
additional locations.
Estimated Cost
State Job Number
Insert the state job number assigned to the project. This number can be obtained from IDOT.
This number is required for projects programmed in the annual year (current year or
upcoming state fiscal year), and optional for projects programmed in the out(not the current
or upcoming) years.
SFY
State Fiscal Year. Insert the state fiscal year in which this phase of the project is to be
started. The state's fiscal year is from July 1 to June 30. If a project is anticipated to start in
August of 2017, this would be SFY 18.
FHWA Funding
Fund Source
Insert the fund source for the Federal Funds being used for this phase. If type other is chosen
in the additional information below, indicate what "other" federal funds are being used. Types
to choose from are:
CMAQ
Congestion Mitigation and Air Quality Improvement
DEMO (ISTEA)
Specific Earmark Funds
ER - Federal
Emergency Relief
Ferry Boat Disc
Ferry Boat Discretionary
FLAP
Federal Lands Access Program
HPD (TEA-21)
Specific Earmark Funds
HPP-STLU
Highway Propriety Project, SAFETEA-LU Transportation Bill
HSIP
Highway Safety Improvement Program
HSR
High Speed Rail
ITEP
Illinois Transportation Enhancement Program
ITS
Intelligent Transportation Systems
MBR
Major Bridge Program
Other
Printed 06/05/19
BLR 17100 (10/04/17)
RRP
Rail Safety Program
Scenic Byways
Scenic Byways
Sec Hwy DEMO Specific Earmark Funds
SRTS
Safe Routes to Schools
STP-Br
Surface Transportation Program Bridge
STR
Surface Transportation Rural
STU
Surface Transportation Urban
TIGER
Transportation Investment Generating Economic Recovery
Amount
Insert the amount of federal dollars being used for this phase of the project.
Fed %
Insert the percentage of federal dollars being used on this phase of the project.
State Funding
Fund Source
From the drop down select the type of state funds being used on this phase of the project, if
applicable. If type other is chosen, under additional information insert the type of other state
funds .Types to choose from are:
EDP
Economic Development Program
GCPF
Grade Crossing Protection Fund
IJN
Illinois Jobs Now
Jump Start Pgm Jump Start Program
Other
Road Fund
Road Fund
SMA
State Match Assistance
State Match
State Match
State Only
State Only
TARP
Truck Access Route Program
TBP
Township Bridge
Amount
Insert the amount of state funds being used for this phase of the project.
LPA Funding
Fund Source
Insert the fund source for the local funds being used to fund this phase of the project, i.e.
General Funds, Motor Fuel Tax funds, etc.
Amount
Insert the amount of local funds being used for this phase of the project.
Total
This is a calculated field no entry necessary. This is the sum of amounts listed under FHWA
funding, State Funding and LPA funding for this phase of the project.
Total
This line contains calculated fields no entry necessary. This will be the sum of the totals for
each funding type. For example under FHWA funding it will sum the total of the FHWA funds
listed.
Additional Information
Insert any necessary additional information. For example if type other was used in the
estimated cost table, explain what type other is. Additionally if the project is an ITEP or
SRTS project insert the number assigned upon award for this project.
Local Public Agency Contact Information
Name
Insert the name of the contact person at the LPA who can provide additional information on
this project if needed.
Email
Insert the email of the LPA contact person.
Phone Number
Insert the phone number of the LPA contact person.
CMAP use only
The information below will only need to be completed for projects located within the Chicago
Metropolitan Planning Area.
Planning Liaison Name
Insert the name of the planning liaison.
Email
Insert the planning liaison's email.
Phone Number
Insert the planning liaison's phone number.
All project submittal's must include a location map of the project.
Distribution will be as follows:
Local Public Agency
District File
Printed 06/05/19
BLR 17100 (10/04/17)

Download Form BLR 17100 Local Public Agency Multi-Year Program Project Request - Illinois

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