(Replace all items in italics or symbols with appropriate information in non-italic font)
(Email a PDF and Microsoft Word file of the completed request to teprojects@maai.net)
Revised June 9, 2015
PLACE ON CONSULTANT LETTERHEAD
GDOT PI: #######, ####### County
CSTEE-####-00(###) (if assigned; delete sentence if CSTEE project # would not apply)
GDOT project description (match GDOT’s program project name)
DATE: Current date of request submittal
FROM: Consultant Engineer/Landscape Architect of Record name
Consultant firm name
TO:
Brent Story, P.E.
State Design Policy Engineer
SUBJECT Request for Design Exception (or Variance) for (list criteria here; ex: shoulder Width,
Lateral Offset, etc.)
Approval of a Design Exception (or Variance) is requested for this project.
PROJECT DESCRIPTION
Provide a general description of the project including the length of the project, the general location of the
project including any city and county limits or proximity thereto, city and street location, speed design,
posted speed limit, scope of work, and existing/proposed typical sections, amount of TE funds awarded,
and other improvements to be constructed. Recommend using approved concept report location and
description.
FEATURE(S) REQUIRING A DESIGN EXCEPTION/VARIANCE
Describe the feature(s) requiring a design exception or a design variance. Give the values of the current
standard criteria and the values that are proposed to be used. For example, “based on the GDOT Design
Policy Manual, section xx, table xx, ## mph speed limit, page ## or AASHTO Roadside Design Guide, 4th
Edition, 2011, Chapter 10, the minimum lateral offset is ##. The item is/are located less than the
required minimum lateral offset from face of curb to the face of pole/center of tree.” Include the value of
the beginning and the ending stationing for the design feature. (Add a statement describing what kind of
utilities are on the pole: Cable, T.V., Phone, etc.)
The existing/proposed items to remain in place is/are located at the following stations: (list all items
requiring a design exception or variance)
Recommend including a chart such as:
Item Number
Station
Side
Distance from Face of Curb to Item feature
1
##+##
X
##
2
##+##
X
##
GDOT PI: #######, ####### County
CSTEE-####-00(###) (if assigned; delete sentence if CSTEE project # would not apply)
Design Variance/Exception
CURRENT AND FUTURE TRAFFIC DATA
Describe current and future traffic volumes with any other pertinent traffic data. For example: Current
Average Daily Traffic (ADT) is ###. Future traffic volume is expected to increase by #%. Future traffic
volume analysis is beyond the scope of this project.
CRASH DATA
Describe the crash history within the project limits for the last three years. In particular, address and
summarize the crash history related to the feature requiring a design exception or variance request.
Recommend including a chart such as:
Year
Angle
Rear End Side Swipe
Total
201#
#
#
#
#
201#
#
#
#
#
201#
#
#
#
#
Total
#
#
#
#
WHY THE CURRENT STANDARD CRITERIA CANNOT BE MET
Summarize why the current AASHTO Standard Controlling Criteria (Design Exception)/GDOT Standard
Criteria (Design Variance) cannot be met. For example, low traffic volume, cost of relocation/ROW
acquisition is beyond the scope of this work, community plan for aesthetic appearance of downtown area
with trees or lighting or citizens enjoy old trees and shade provide by the trees, etc.
COST TO MEET STANDARD CRITERIA
Summarize the cost estimate for construction and right-of-way and other associated costs for constructing
or reconstructing the design feature to meet current standards.
MITIGATION PROPOSED
Describe any mitigation proposed to lessen the impact of not meeting current standard criteria. (FHWA
publication Mitigation Strategies for Design Exceptions is a good reference. It is available at
http://safety.fhwa.dot.gov/geometric/pubs/ should be reviewed and, as a minimum, the strategies
presented in the report are to be considered and discussed in the Design Exception or Design Variance
request). If mitigation or other additional enhancement costs are significant, summarize these costs at
this point.
RECOMMENDATION
The Engineer/Designer of Record must make a recommendation to the approving authority for action.
Any conditions to the approval of this exception should be clearly stated. Include name and contact
number. For example add “Based on the information presented herein, I, as the Engineer/Landscape
Architect of Record recommend approval of the design exception (or variance) for the referenced project.
Should you have any questions please feel free to contact me at (contact information - email address and
telephone number).”
GDOT PI: #######, ####### County
CSTEE-####-00(###) (if assigned; delete sentence if CSTEE project # would not apply)
Design Variance/Exception
The signature block for approval will take one or the other of the following forms. This section is required
for each type of design exception or variance, ex. Utility pole or trees. Typically TE projects are NOT
classified as Full Oversight or Project of Division Interest (PoDI).

For projects NOT classified as Full Oversight (FOS) or Project of Division Interest (PoDI):
Recommend: (Include this line for consultant designed projects only)
Engineer/Landscape Architect of Record
Date
Concur:
GDOT Director of Engineering
Date
GDOT Chief Engineer
Date
Approve:

For projects classified as Full Oversight (FOS) or Project of Division Interest (PoDI):
Recommend: (Include this line for consultant designed projects only)
Engineer/Landscape Architect of Record
Date
Concur:
GDOT Director of Engineering
Date
GDOT Chief Engineer
Date
FHWA Division Administrator
Date
Approve:
Approve:
Attachments:
a. Project Location Map (Clearly indicate project location. Include PI#, county, programmed name on
the page.)
b. Typical Sections (Clearly indicate each item which requires design exception or variance approval.
Range of widths or offsets is acceptable. Include PI#, county, programmed name on the page.)
c. Project Layouts/plan/profile sheets (Indicate each item in plan view with item number, offset, and
side, which requires design exception or variance approval corresponding to stations. Include PI#,
county, and programmed name on page.)
d. Photo image of item location (Include item description as appropriate, PI#, county, and
programmed name on page.)
e. Any other documentation pertinent to request. (Include PI#, county, and programmed name on
page.)