MISSOURI/ILLINOIS BORDER BRIDGE CLEARINGHOUSE FORM

This form is to be used to approve all activities planned to be accomplished by contract or whenever non-contract activities exceed $50,000.

This form serves as an agreement for contract projects of $50,000 or less. Contract projects exceeding $50,000 require a separate bi-state agreement. All contract projects also require advertisement approval and concurrence of award.

Lead State:	Date:

Completed By:	Phone:

PROJECT DESCRIPTION

Route:	Location

Missouri Bridge No	Illinois Bridge No:

Missouri Job No:	Illinois Job No:

Type of Activity Planned:

Total Estimated Cost (100%):	($ each state)	Start Date: Letting

MISSOURI	ILLINOIS

Fund Type:	State	State

Federal	Federal

Fund Source:	Maintenance	Maintenance

Contract Maintenance	Contract Maintenance

Transportation	Highway Improvement Program

Improvement Program

Coordinated/Approved By: (signatures required)

MISSOURI	ILLINOIS

District Engineer	Regional/Operations Engineer

Jeff Keirn

Date

State Bridge Engineer	Bridge Engineer

Carl Puzey

Date

Assistant Chief Engineer	Director, Office of

Approved	__________	Planning and Programming Charles J. Ingersoll

Date

Date__________________	Director of Highways/Chief Engineer

_____________________ Date____________

Omer Osman, P.E.

Secretary of Transportation

Date

Ann L. Schneider

Exhibit B