ADDITIONAL STATEMENT – Local Agency Program

No Additional Right of Way Required

R/W ITEM/SEGMENT NO.:	Enter if applicable	STATE ROAD:
CONST. ITEM SEGMENT NO.:	Enter FDOT FM #	DESCRIPTION:
F.A.P. NO.:	Enter Fed'l project #
PREFERRED LETTING DATE:	LOCAL AGENCY:

The following interests in land (Right of Way) will NOT be required for the construction of this project.

☒	Fee Title – land on which a permanent improvement is to be placed and maintained.

☒	Perpetual Easement – may be used when permanent improvement is to be constructed and maintained on a parcel for which acquisition of fee title is impractical.

☒	Temporary Easement – used when it is necessary to temporarily occupy a parcel. No improvement that is a permanent part of the transportation facility or that requires maintenance beyond the term of the easement will be constructed on the temporary easement.

Execution below acknowledges that the following applies:

If the project requires one or more right of way related permits that are revocable by the permitting entity and the permitting entity's needs require the removal of the project facility or any portion of it, either:

The facility would be reconstructed or relocated in such a way as to continue serving the same need (e.g., connectivity for pedestrians) at the Agency’s expense and a funding source would be made available; or

Federal funds would be repaid, again at the Agency’s expense. The useful life of the facility would be determined and a schedule for repayment developed (i.e., the amount of repayment necessary for each year of the remaining useful life of the facility at the time of its removal).

The Agency is in possession of all rights necessary for the construction and maintenance of improvements upon property that is not owned by the Agency in fee.

The right of way limits as depicted on the plans have been verified by the Agency.

The right of way maps/sketches have been compared to the construction plans and the right of way, as shown, will accommodate the planned construction. The construction activities will be performed in the existing right of way. The contractor will not be required to temporarily enter upon property not owned by ENTER NAME OF LOCAL AGENCY for the purpose of restoration and harmonization. There are no encroachments within existing right of way that impact the construction project.

SIGNATURE	DATE

Enter Name of Person with Signature Authority

NAME (Printed)

Title: Enter Title of Person Signing

Agency: Enter Name of Local Agency