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• Instructions for BLR 09110-Page 1 of 2 <br /> NOTE: Form instructions should not be included when the form is submitted. <br /> This form shall be used when a Local Public Agency(LPA)wants to construct an improvement using Motor Fuel Tax(MFT)funds. Refer to <br /> Chapter 9 of the Bureau of Local Roads and Streets Manual(BLRS Manual)for more detailed information.For signature requirements <br /> refer to Chapter 2, Section 3.05(b)of the BLRS Manual. <br /> When filling out this form electronically,once a field is initially completed,fields requiring the same information will be auto-populated. <br /> Is this project a bondable capital <br /> improvement? Check Yes if the project was a bondable capital improvement,check no if it is not. An <br /> example of a bondable capital project may include,but is not limited to:project development, <br /> design,land acquisition,demolition when done in preparation for additional bondable <br /> construction,construction engineering,reconstruction of a roadway,designed overlay <br /> extension or new construction of roads, bridges,ramps,overpasses and underpasses,bridge <br /> replacement and/or major bridge rehabilitation. Permanent ADA sidewalk/ramp <br /> improvements and seeding/sodding are eligible expenditures if part of a larger capital <br /> bondable project. A bondable capital improvement project does not mean the LPA was <br /> required to sell bonds to fund the project, however the project did meet the criteria to be <br /> bondable. <br /> Resolution Number Enter the resolution number as assigned by the LPA,if applicable. <br /> Resolution Type From the drop down box choose the type of resolution: <br /> -Original would be used when passing a resolution for the first time for this project. <br /> -Supplemental would be used when passing a resolution increasing appropriation above <br /> previously passed resolutions. <br /> -Amended would be used when a previously passed resolution is being amended. <br /> Section Number Insert the section number of the improvement the resolution covers. <br /> Governing Body Type From the drop down box choose the type of administrative body. Choose Board for County; <br /> Council for a City or Town; President and Board of Trustees for a Village or Town. <br /> LPA Type From the drop down box choose the LPA body type. Types to choose from are: County, <br /> City,Town or Village. <br /> Name of LPA Insert the name of the LPA. <br /> Contract or Day Labor From the drop down choose either Contract or Day Labor. <br /> Roadway/Street Improvements: <br /> Name Street/Road Insert the name of the Street/Road to be improved. For additional locations use the Add <br /> button. <br /> Length Insert the length of this segment of roadway being improved in miles. <br /> Route Insert the Route Number of the road/street to be improved if applicable. <br /> From Insert the beginning point of the improvement as it relates to the Street/Road listed to the left. <br /> To Insert the ending point of the improvement as it relates to the Street/Road listed to the left. <br /> Structures: <br /> Name Street/Road Insert the name of the Street/Road on which the structure is located. For additional locations <br /> use the Add button. <br /> Existing Structure No. Insert the existing structure number this resolution covers, if no current structure insert n/a. <br /> Route Insert the Route number on which the structure is located. <br /> Location Insert the location of the structure. <br /> Feature Crossed Insert the feature the structure crosses. <br /> 1 Insert a description of the major items of work of the proposed improvement. <br /> 2 Insert the dollar value of the resolution for the proposed improvement to be paid for with MFT <br /> funds in words followed by in the same amount in numerical format in the(). <br /> Printed 03/15/22 BLR 09110(Rev.05/08/20) <br />