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SIIMS

Bridge owner form

* Required information

I. Bridge owner contact information

First name:*

Last name:*

Email address:*

Phone number:*

(e.g. 555-123-4567)

Cell phone number:

(e.g. 555-123-4567)

Organization / agency / company:*

Address 1:*

Address 2:

City:*

State:*

ZIP code:*

II. Program manager

Bridge Owners are required to provide a bridge inspection program manager for the structures under the Local Public Agencies (LPA) jurisdiction. The individual listed as the bridge inspection program manager must have completed the following criteria:

Have completed and submitted the PROGRAM MANAGERS BRIDGE INSPECTOR FORM or CHANGE INSPECTOR ROLE FORM
Be certified by the Iowa DOT as a qualified National Bridge Inspection Standards (NBIS) program manager.

Program manager's first name:*

Program manager's last name:*

Organization / agency / company:*

Email address:*

Phone number:*

Questions/Comments:

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SIIMS

Bridge owner form

I. Bridge owner contact information

(e.g. 555-123-4567)

(e.g. 555-123-4567)

II. Program manager

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