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Deferred Maintenance

Project Information Form

Person Initiating Project:


Fill out as much information as possible.

Project Name:
Is this to be a phased project: Yes No Director Approval ___________________
If yes, how many years:

Project Requestor:
Project Driver or Contacts:

Project Goal:

Attach any documents that may help provide background information or specific information on
preferred venders or estimates by others.

Project Scope (be specific):

Earliest Desired Start Date:

Signature: _______________________ Date: ________________

Assistant Director:

Project ID #: __________________ TMA Project Number: ________________

Signature:________________________ Date: _________________

Estimator:

Initial Project Estimated Cost: _________________________

Basis of Estimate: _____________________________

Signature: _______________________ Date: _________________

Director:

Review Completed:

Signature: _______________________ Date: _________________

Planning Design and Construction:

Proposed Project Manager: __________________________

Planning / Design/ Estimated Start Date: ________________

Bid Date: ________________

Construction Date: from:__________ to:_______________

Signature: _______________________ Date: _________________

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