U.S. Department of Transportation
Federal Highway Administration
1200 New Jersey Avenue, SE
Washington, DC 20590
202-366-4000


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Bridges & Structures

NBIS Framework

Certification of Bridge Safety Inspection To the Commissioner of Transportation

On behalf of ________________________________ (Agency) , I hereby certify that the Annual Bridge Safety Inspections for the year 2001 have been completed as required by MN. STAT. 165.03 SUBD.3 and Minnesota Rule 8810.9000 to 8810.9700 and that reports of these inspections have been filed with the County Auditor, Township Clerk or governing body of the Municipality in those cities which do not employ an Engineer to perform such inspections.

I further certify that at least one of the following qualified team leaders was present at all times during each inspection:

__________________________ meets the following qualifications *________
Team Leader   (enter 1, 2, 3, or 4)
__________________________meets the following qualifications *________
Team Leader   (enter 1, 2, 3, or 4)

Team Leaders were assisted by the following staff:

____________________with ______ years of bridge safety inspection experience.
Inspector  
____________________with ______ years of bridge safety inspection experience.
Inspector  
____________________with ______ years of bridge safety inspection experience.
Inspector  
Certified by: _______________________________ _________ _____________
  Inspection Project Manager Date PE Registration No.

*Qualification requirements as listed in Minnesota Rules 8810.9300 Subp. 2:

  1. is registered in Minnesota as a professional engineer:
  2. has a minimum of five years experience in bridge inspection assignments in a responsible capacity and has completed a comprehensive training course based on the Bridge Inspector’s Training Manual developed by a joint federal-state task force;
  3. has current certification as a Level III or IV Bridge Safety Inspector under the National Society of Professional Engineer’s program for National Certification in Engineering Technologies; or,
  4. is certified by the Commissioner of Transportation as a Level II Bridge Safety Inspector.
_________________
Initial (Mn/DOT Bridge)
The information supplied above has been reviewed and (does) (does not) comply with NBIS requirements For those certifications that do not comply with NBIS requirements or do not have sufficient information to make such a determination, additional information or applicable accountability will be promptly pursued with the bridge owner.
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Updated: 09/04/2013
Federal Highway Administration | 1200 New Jersey Avenue, SE | Washington, DC 20590 | 202-366-4000