Memorandum

To:	[Name], P.E. [Choose proper title] Engineer

From:	[Name], P.E. [Choose proper title] Engineer

Date:	Date Submitted to Engineer

Subject:	[Project Number]
[Project Name]
UPN [UPN]
Work Type [Work Type]

Please approve the attached Baseline Variance Report for the subject project.

Approved	Date
[Name]
[Choose proper title] Engineer

Distribution:

[Choose District Administrator] District Administrator	Doug McBroom, Statewide Planning & Modal Operations Manager
Dave Holien, Highways Engineer	Tom Martin, Environmental Services Bureau Chief
Andy Cullison, Bridge Engineer	Jeff Jackson, Geotechnical and Pavement Bureau Chief
Gabe Priebe, Traffic and Safety Engineer	Joe Green, Construction Bureau – VA Engineer
Bob Heiser, Right-of-Way Bureau Chief Ed Ereth, Asset Strategy Program Manager	Jon Swartz, Asset Strategy, Operations & Maintenance Manager Steve Felix, Maintenance Division Administrator
[Choose a name], FHWA - Operations Engineer (PODI)

cc:

Located at the end of this document

Use this report to document design variances from baseline or approved context specific geometric design criteria that are not otherwise approved in the project Scope of Work (SOW), combined SOW, SOW approval, or SOW addendum/revision report. See the Baseline Criteria Practitioner’s Guide for applicability of features requiring a variance.

Proposed Scope of Work

This section should provide a very brief description of the proposed scope of work for the project and/or the project intent. For example, "The proposed project has been nominated to provide an overlay and roadside safety enhancements." Also include a brief discussion explaining the reason(s) why the proposed scope of work was selected.

Purpose and Need

If a purpose and need statement was developed prior to PFR, include it here. Otherwise discuss the project purpose and needs during the field review and provide preliminary language here.

Context Specific Criteria

Identify any Context Specific Criteria that have been documented and approved for this project in the signed SOW report.

Scope Specific Considerations

Identify any Scope Specific Considerations that have been documented and approved for this project in the signed SOW report.

Project Location and Limits

county name

city/town name

Indian reservation

route number

functional classification

begin and ending reference points

project length

crossing routes and/or local streets

distances from major bridges on the route

distance and direction from nearby towns/cities

as-built project numbers

adjacent project numbers

direction of the proposed project

Where the stationing proceeds in the opposite direction from the reference points (e.g., stationing increases from south to north while the reference points increase from north to south), note this in the report.

Physical Characteristics

year when the existing road/bridge was built or reconstructed and when it was last overlaid or rehabilitated

pavement width and number of lanes

surface types and thicknesses

number and thickness of previous overlays

the Pavement Management System’s pavement condition and treatment recommendations

general terrain of the area

rural or urban location

general description of the existing horizontal and vertical alignment, including all features which do not meet the proposed design criteria

number of locations where the existing grade exceeds the proposed design maximum

maximum gradient on the project

general description of the existing fill and cut slopes, including slope rates, fill heights and cut depths

lengths and widths of existing bridges

any other unique physical characteristics related to the project

special features within the project limits (e.g., National Forest, State Parks, etc.).

Traffic Data

RP X.X. to RP X.X.
Year AADT	# – Present
Year AADT	# – Letting Year
Year AADT	# – Design Year
DHV	#
T	#%
EAL	#
AGR	#%

Crash Analysis

As requested, a safety analysis was completed on a portion of System and Route # from reference posts X.X to X.X for the X-year period Date to Date. Copy and Paste the Summary or Executive Summary from Safety Managements Memo.

Design Speed and Posted Speed

This section should list the design speed that has been chosen for the project. Discuss the posted speed limits, speed zone studies and approved speed zones.

Proposed Design Criteria

List all proposed variances applicable to the project work type with a brief justification.

Controlling Element	Existing Condition	Standard	Standard Reference	Proposed Criteria	Location
Lane Width
Justification:
Shoulder Width
Justification:
Travel Lane Cross Slope
Justification:
Clear Zone
Justification:
ISD
Justification:
Median Width
Justification:

Justification:

Document the baseline or approved context specific criteria to which the variance applies, the proposed criteria, why the variance is preferred or necessary, and how the proposed criteria are consistent with the project purpose and need.

cc:

[EPSProjectManager], EPS Project Manager
MDT Headquarters Milestone Report Distribution <mdthqmilestonereport@mt.gov>
[Choose a District Distribution]
[Choose a Maintenance Chief]

Optional (remove if not used)

Vacant, Eng. Manager, Bridge Management System [if there are structures on the project]
Vacant, Secondary Roads Engineer [project is on or crosses a secondary route]
Jeremy Terry, Road Design Engineer [Road involvement]
Shelby Clark, Bicycle/Pedestrian Coordinator [omit if is obviously no bike/ped involvement]
County Officials [secondary program, any route that is county maintained, or involves a county agreement]
Tribal Government Officials [on or adjacent to a reservation]
City/Municipal Officials [projects within city/urban limits: MDT Urban Maps | Montana Department of Transportation (MDT) (mt.gov)]
STREET, JOHN THOMAS A CIV USAF AFGSC 341 CES/CEMD, Malmstrom Air Force Base <john_thomas.street@us.af.mil> [USAF access routes: \\state\mdt\prd\GreatFalls\GTF\ALL_STAFF\T_and_E_Routes]