Wisconsin Dept of Transportation	WS2503 DESIGN ISSUE NOTICE (DIN)
Region Address	Phone:	(xxx) xxx-xxxx
Region City, State, ZipCode	Fax:	(xxx) xxx-xxxx
SECTION 1 – DESIGN ISSUE
DIN:	XXX
Date:	Potential Changes:
Project:	Project ID	Quantity:
Highway	Plan:
Limits

To:	Design Firm	Method Sent:	Contract ID:
Attn: Design Firm Representative	FAX
Design Firm Address	E-Mail
Design Firm City, State, Zip Code	Mail	Date Response Required:
Phone: (XXX) XXX-XXXX	Fax: (XXX) XXX-XXXX

DESCRIPTION OF DESIGN ISSUE:
Additional Documents :	Are Attached	Are Not Necessary
Construction Oversight Firm/Agency:	Date:
Construction Oversight Representative:	Title:

BASIS OF PAYMENT:
No Additional Compensation (Incidental to Design Contract)
Compensation

SECTION 2 – WISDOT PROJECT MANAGER APPROVAL OF REQUEST

WisDOT Project Manager Comments	Additional Comments
Date Issue Received:
Request Appropriate:	Yes	No
Agree with Basis of Payment:	Yes	No
WisDOT Project Manager:	Date:
Wisconsin Dept of Transportation	WS2503 DESIGN ISSUE NOTICE (DIN)
Region Address	Phone:	(xxx) xxx-xxxx
Region City, State, ZipCode	Fax:	(xxx) xxx-xxxx

SECTION 3 – DESIGNER RESPONSE TO DESIGN ISSUE

DESIGNER RESPONSE TO ISSUE
Additional Documents :	Are Attached	Are Not Necessary
DESIGNER RESPONSE TO COMPENSATION DETERMINATION
Please check one box, provide comments if desired, and return to WisDOT Project Manager
I agree with the Basis of Payment	I disagree with the Basis of Payment
Designer Firm Name:	Date:
Designer Representative:	Title:

SECTION 4 – WISDOT PROJECT MANAGER APPROVAL OF RESPONSE

WisDOT Project Manager Comments	Additional Comments
Date Response Received:
Response Adequate:	Yes	No
Agree with Basis of Payment:	Yes	No
WisDOT Project Manager:	Date: