Fillable Project Request Form printable pdf download

Project Request Form

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Public Works Department / Rural Services Division

520 Fifth Avenue, First Floor, Suite D, PO Box 71267

Fairbanks, AK 99707

(907)459-1223

Fax (907)459-1499

Project Request Form

Service Areas are encouraged to breakup projects having an estimated cost in excess of $500,000 into multiple projects

(Phase 1, Phase 2) with costs below the grant limit.

Service Areas are also encouraged to combine small projects with similar improvements into larger projects. Projects with

an estimated cost of less than $20,000 will not be considered.

Do not include general maintenance items, such as brushing, ditch cleaning, etc., in this project submittal.

If necessary, attach additional pages to explain important details and the Service Area Commissions priority selection for

this project request.

All areas of information are necessary for project submittals. Incomplete submittals may not be considered.

1) Service Area:

2) District:

3) Road:

4) Provide a brief, but adequate, description of what the Service Area Commission believes this project should

entail.

5) Has this project been discussed at a publicly noticed service area meeting? ___ Yes

___ No

6) Do the minutes of the meeting above reflect an understanding of this project by the residents in attendance

that is consistent with the description of the project provided above? ___ Yes

___ No

7) This project is:

a new project or

a previous project being resubmitted. (Select one.)

8) Length of Improvement is:

entire road

portion of road of ________ approximate length.

Funds for individual projects are limited to $500,000. If this project is selected and exceeds this amount, is

the Service Area willing to provide or secure the additional funds? ___ Yes

___ No

10)

Existing Road Conditions

11)

Issues Concerning Road

___ paved, drivable year round

___ steep approach grades to intersection

___ gravel, drivable year round

___ poor/limited sight visibility at intersection

___ dirt, drivable year round

___ bus route

___ 4 wheel only, year round

___ dust control

___ 4 wheel drive only during breakup

___ accessibility

___ not drivable during breakup

___ spring breakup

___ no existing road

___ other

12)

PRIORITY of this project compared to ALL projects, both existing and new, submitted by the Service Area.

___ First (1st) priority

___ Second (2nd) priority

Page 1 of 3

Form Revised June 2015

Project Request Form

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