Notice of Intent

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Jefferson City, MO 65102
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Notice of Intent

Notice of Intent to Perform Work Process
(This Notice of Intent does not elimate the excavator's responsibility under Missouri law to request locates from Missouri One Call).

There are three methods to inform MoDOT of your intent to perform work on MoDOT Right of Way: (Missouri One Call locate sheets are not a substitute. Please fill out the appropriate fields below.) Although MoDOT is a member of Missouri One Call, the information in the form below is required in order to track work zones, lane drops, shoulder work, traffic control plans, etc.

1) Preferred - Fill out the fields below and click “Submit” at the bottom. The form will automatically be sent to the correct District Office for processing.

2) Fax - Print out the form (click here for form), complete and fax to the correct district fax number shown on the form.

3) Phone - Call 888-275-6636 (ASK MoDOT) or call the district office number shown below and provide the information on the form to the Customer Service Representative.

The documents are provided in Acrobat Reader format. Free Acrobat Reader download

*Notification should be submitted a minimum of 2 working days and a maximum of 10 working days prior to commencement of work.

*If the form is not filled out correctly it will be returned to you by E-mail or Fax for corrections.

*MoDOT underground utility facilities are governed under the law for Underground Facility Safety and Damage Prevention RSMO Chapter 319.015 thru 319.050

Date:		*Excavator Name:
*Sender's Name (first & last):		*Excavator Address:
*Email Address:		Cellular Number:
*Telephone:		*Field Contact Name:
Fax:		*Field Contact Phone Number:

*Please enter MoDOT permit #:

or MoDOT Job No.:

One Call Ticket No. (if available):

*County:

*Work Location Route/Street:

*Start Date/Time:

Time:

*Town/Nearest Town:

*Type of Work:

Length of Work:

*Location of work on State Highway right of way along the : side. from

(State Highway, County Road, City street, or County line)

Type of Equipment:

Depth:

Tunnel:

Yes No

Horizontal Boring:

Yes No

Explosive:

Yes No

Is a meeting requested? :

Yes No

If Yes, mark lines at time of meeting? :

Yes No

Date/Time of meeting requested:

Call to Confirm? :

Yes No

Best Time to call Excavator:

(Between 7:30am and 4:00pm)

Comments:

*Is this a Lane or Shoulder Closure? :

Yes No

If Yes, complete the following.

Lane:

#Lanes Closed:

Lane Type:

Closure Location:

Start Date:

Time: Day or Night:

End Date:

Time: Weekend Work:

*Lane Closures Require a 24/7 Point of Contact while work is being conducted.

* Denotes Required Fields

Fill out form and fax to appropriate district. (file size 288kb)