MHTC Agenda Item Checklist

Complete this form for all MHTC agenda items except employee grievances and recurring reports not requiring MHTC approval. The following individuals must concur with this item prior to submitting it to the Commission Secretary’s Office: (1) District Engineer (if a district item), (2) Division leader, and (3) Respective organizational team leader (Director, Chief Engineer, Chief Financial Officer, Assistant Chief Engineer, Chief Administrative Officer, or Chief Safety and Operations Officer).

Send links to the completed form and backup electronically to the MHTCAgenda email group.

See the Commission Secretary’s Office SharePoint site for due dates and additional information.

Reviewed by: (begin with originator)	Concur No Comments	Concur With Comments	Do Not Concur Comments Mandatory
Place comments in Reviewers’ Comments section at bottom of page or in the document(s) in SharePoint in track changes mode.
Checklist and Backup Due to Commission Secretary’s Office

SECTION A

Meeting Date:

Agenda Type:

MHTC AGENDA ITEM TITLE: Include title, brief description, and name and title of individual(s) making the presentation as it will appear on the Commission agenda for public distribution. Respective District Engineer should be listed for items originating in the districts.

Originating or Coordinating Central Office Division / Unit:

District (if applicable):

Person initiating this form:

Title:

Phone:

CONTRACTS: Does the transaction require a contract(s) other than a (1) Contract and Bond for roadwork (lowest responsible bidder under state statute) or (2) purchase of equipment or materials by purchase order or other contract under MoDOT procurement rules? If yes, complete Section B, for each contract contemplated by this agenda item.

Yes	No

CONFLICT OF INTEREST: Is there the appearance of or an actual conflict of interest involving a member of the Commission? If yes, complete Section C.

Yes	No

REVIEWERS’ COMMENTS: Comments, if any, of those listed in the review box above. Comments may also be made on the actual documents in SharePoint in track changes mode.

SECTION B - Contracts (to be completed for ALL items requiring a contract other than exceptions noted on page #1):

Contracting Party:

Does the contract require expenditure of MHTC funds? Yes	No

If yes, how was the contracting party selected?

Engineering, land surveying and architectural services under Chapter 8 RSMo

Professional, technical, or other non-engineering services based on lowest and best bid process

Emergency roadwork (lowest responsible bidder under Chapter 227 RSMo)

Sole source professional services contract (generally not recommended)

Insurance, banking, or financial services through broker

Government agency master contract/task order

Other:

If in addition to stated monetary consideration in the contract MHTC/MoDOT may incur potential liability, is there compliance with MoDOT’s acceptance of liability policy?

Yes	No	Not applicable

Have you checked the MHTC Policies to assure that MHTC authority to execute the contract is necessary?

Yes	No

Has the contract been signed by all other parties than MHTC?	Yes	No

If not, you must justify why MHTC approval of the contract is necessary before the contract is signed by all parties other than MHTC and approved as to form by the Chief Counsel or his designated assistant counsel. If MoDOT management approves your justification, your backup material must indicate the contract is “subject to approval as to form by CCO counsel.”

Justification:

Has the contract been signed and approved as to form by CCO counsel?	Yes	No

Name of CCO attorney who worked with you on this contract.

SECTION C – Conflict of Interest (to be completed only where there is an actual conflict of interest or appearance of a conflict of interest (hereinafter, C/I) involving a member of the Commission)

Commission Member’s Name:

Date of Disclosure Report:

Describe the C/I:

Commission member’s real property interest is one mile or less from the MoDOT activity that is the subject of the agenda item:

Bid Call No. (if any):	Closest real property interest is located at :
Route:
County (if any):
Job/Claim No. (if any):

Project Manager / Appropriate District Staff:

Project Location (city, county, route, etc):

Job description:

Other C/I (explain nature of C/I other than a member’s real property interest):