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GOMDOT.com > Divisions > Consulting Services > Click LPA
All Consultant Services Division (CSU) Local Public Agency (LPA) Selection, Special Match Credit & Contract Templates
Parcel File Review Checklist
Parcel # and Contact Information
Title Certificate
Donation Documentation
Appraisal Report
Review Appraisal Report
Any X‐deed or Q‐Deed appraisals and review appraisals
Signed and dated Waiver Valuation
Signed and dated LPAs Establishment of Just Compensation form or LPA Board authorization
Verification that Acquisition Guide and/or Relocation Guide was provided to the property owner
Signed and dated Fair Market Value Offer
Signed Contact Records for Acquisition and/or Relocation
Documentation on counter‐offers and/or Administrative Adjustments
Copies of RECORDED deeds, easements, q‐deeds, x‐deeds, transfer documents
Copies of recorded Partial Releases and/or Cancellations of D/T, UCCs, tax liens, etc.
Signed and dated appropriate relocation notices – 30 day, 90 day
Relocation offers reviewed
All relocation documents
Recommendation for Condemnation Form
Condemnation approval by LPA
Copies of any and all cancelled checks paid to property owners for acquisition and/or relocation
Closing costs sheets
If condemned, need copy of recorded Order Granting Right of Entry or Agreed Order
Copy of court deposits
LPA-ROW-EZ Form Rev 08/21
RIGHT OF WAY CERTIFICATION REPORT Name of LPA: Project Termini: FMS Project No.: External Project No.__________________________________ County: Date:
Yes No
(1) The LPA certifies that all project activities will take place on existing ROW and noadditional ROW is required.
(2) The LPA certifies that based on a site inspection of the right of way for the projectthe right of way is clear of encroachments.
(3) The LPA certifies that there are no improvements that remain within the projectright of way limits.
(4) The LPA certifies that the project has been inspected and there are no visibleindications of potentially contaminated sites within the proposed right of way.
(5) The LPA certifies that the project right of way does not contain structures thatrequired asbestos abatement.
(6) The LPA certifies that there are no utilities in conflict with the project.
(7) The LPA certifies that there are no railroads facilities affected by the abovereferenced project.
If the project requires any additional ROW, or the LPA cannot certify yes to any of the seven certifications listed above, then the LPA must complete the appropriate status report found in the MDOT-LPA Project Development Manual's (PDM) Chapter 5, section 11 and include with this Report. Any errors to this certification will be the responsibility of the certifying LPA.
The LPA certifies that the LPA will accept full financial responsibility for any damage caused, or delay claims that arise, in whole or in part, due to the failure of the LPA to remove, relocate or adjust, or clear any encroachment, utility, or contaminated site. Any additional construction costs incurred as a result of working around any encroachment, utility, or contaminated site will be paid by the LPA as a non-reimbursable expense.
LPA Project Director (Print)
_________________ Signature Date
__________________________ __________________ MDOT District Utility Coordinator Date (For verification of Utilities only)
Revised 4/1/2011
MONTHLY PROJECT STATUS REPORTReporting Period:
LPA Consultant Project No.
Project Description:
I. Work completed (Brief Summary of work completed during reporting period)
II. Work Planned (Brief Summary of work planned for next reporting period)
III. Request for MDOT Response (Information required from MDOT to continue project development)
Revised 10/28/2013 TGW
LPA:External Project No:
FMS Project No:Proj. Description:
IV. Project Status Log
A B C D
Original Anticipated
Date for each Item
Current Revised
Anticipated Date
Actual Date Submitted
ActualDate
Approved
1 MOU2 PE Consultant Selection (LPA may select CEI at same time)
3 Kick-off Meeting4 ENV Action Decided (same as date for Kick-off Mtg)
5 PE Contract6 ENV Document7 LPA-1008 LPA-700/8009 Field Review Plans (allow 21 calendar days for MDOT Review)
10 Field Review Meeting11 Office Review PS&E (allow 21 calendar days for MDOT Review)
12 Office Review Meeting13 DBE Goal (Assigned by MDOT based on O.R. constr est.)
14 STIP Rechecked/Amended (for Non-Grouped Projects Only)
15 ROW Status Reports (14 calendar days prior to PSE Submittal)
16 CE&I Consultant Selection (if not simultaneous with PE selection)
17 CE&I Contract (14 calendar days prior to PSE Submittal)
18 Sampling & Testing Proposal (14 calendar days prior to PSE Submittal)
19 PS&E Assembly20 Final PS&E Assembly21 Authority to Advertise Letter from MDOT (approved PS&E) MOU Obligation Deadline:
Instructions to LPA/Consultant
Column A: Original Anticipated Date -- These are target dates for project design
Column B: Current Revised Anticipated Dates
Column C: Actual Date Submitted
Column D: Actual Date Approved
Signature of LPA Consultant/Professional: Date:
Signature of LPA Project Director: Date:
Note: The LPA/consultant is responsible for submitting this signed form to the District LPA Coordinator by the 7th of each month (via email).
These dates are to be filled in as the LPA/Consultant receives responses from MDOT. Please note any item submitted and awaiting a response from MDOT on Page 1, Section C of this report
Item No. Status/RemarksItem
Dates in this column should be reviewed and updated monthly. The fields in this column can be changed throughout the development of the project depending on the delays/challenges that may arise. Provide an explanation for the revised date under the Status/Remarks.
ALL fields in this column should be filled out once at the beginning of the project. These dates in this column should not be modified after the initial submittal of this form.
These dates should be filled in as the LPA/Consultant submits each item.
Form
CSD
-612
LPA
Rev.
8/2
020
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160
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