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APPLICATION <br /> We have reviewed the Project Description and the Intent to <br /> Participate. We intend to participate in the Hazard <br /> Elimination Safety Program for local roads. It is understood <br /> that reimbursement will be 90% of the total eligible costs <br /> attributed to a comprehensive sign/device inventory*, <br /> materials and installation. Although no submittal deadline <br /> is indicated, we understand that the funds are limited and <br /> available on a "First Come, First Served" ' basis. <br /> (* Those counties and cities who previously received Federal <br /> Aid for sign inventories are not eligible for re-inventory <br /> reimbursement under this program. ) <br /> Sign/device inventory will be conducted oy: Circle response <br /> COUNTY ENGINEER or CONTRACT <br /> Furnish/install phase will be conducted by; Circle res_ onse <br /> COUNTY ENGINEER or CONTRACT or OTHER <br /> sp cify <br /> We understand that the sign/device inventory will not begin <br /> until we receive authorization from MnDOT to proceed. <br /> Instructions for the inventory phase will accompany the <br /> authorization to proceed. <br /> Upon approval of the O ventory, the project manager may <br /> proceed with the project. <br /> We understand that reimbursement is contingent on approval of <br /> the field inspection , the materials certification and <br /> satisfactory review of claims documents. <br /> Estimated mileage to be inventoried: ____ ___ -----------_ <br /> Estimated inventory start date <br /> ---- - -- 4_ d -- - <br /> -------- <br /> ----------------=-- <br /> Name of Couhty. Municipality or Township <br /> e = -----------------------�= I=g <br /> Of icial signaturre Date signed <br /> ---------------MN' <br /> Address City Zip Code <br /> Mail the Intent to Particieatg and the Aeglication to: <br /> Nancy Mahle, Manager • <br /> -09 Transportation Building , St. Paul , MN 55155 <br /> Page 11 Henn. Co. Agrmt. No. PW 13-10-91 <br /> Exhibit "A" ; Sheet 2 of 2 <br />