Download a Word version of this application: ibrd2011appl.docx, 22 KB
State:
State's Priority Ranking: # _____ of _____
Project type: (new construction, replacement, rehabilitation, or repair)
NBI structure number:
County:
Congressional District:
Name of Congressional Representative:
Structure Name and/or Identifying Description (e.g., Number/Name of Route on the Bridge and Feature Crossed):
Structure description (e.g., bridge type, number of spans, length, width, material):
Innovative designs, materials and construction methods (describe the designs, materials, and/or construction methods; and how they are used and how the project meets one or more of the program goals). Each application (proposal) shall include and address the following items:
Schedule for start of work (month/year):
Total project cost (P):
Preliminary engineering cost, if requested (A):
Cost of "innovative material/method" portion of the construction (B):
Cost of documenting construction practice evaluation and lessons learned (C):
Cost of post-construction evaluation, if warranted (D):
PE costs + construction costs + evaluation costs = (A + B + C + D) = T
Total Federal Program Funds Requested:
Commitment of Other Funds:
Name:
Title:
Agency:
Ph:
Fax:
E-mail:
Name:
Title:
Agency:
Ph:
Fax:
E-mail:
Name:
Title:
Agency:
Ph:
Fax:
E-mail: