Difference between revisions of "Category:101 Standard Forms"
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* [https://epg.modot.org/forms/CM/Contractor_Performance_Evaluation_Letter.pdf Contractor Performance Evaluation Letter] | * [https://epg.modot.org/forms/CM/Contractor_Performance_Evaluation_Letter.pdf Contractor Performance Evaluation Letter] | ||
* [https://epg.modot.org/forms/CM/Contractor_Performance_Evaluation_Signature_Page.pdf Contractor Performance Evaluation Signature Page] | * [https://epg.modot.org/forms/CM/Contractor_Performance_Evaluation_Signature_Page.pdf Contractor Performance Evaluation Signature Page] | ||
| + | * [https://epg.modot.org/forms/CM/Contractors_Affidavit_C-242.pdf Contractor Affidavit Regarding Settlement of Claims] | ||
* [https://epg.modot.org/forms/CM/Contractors_Affidavit_C-242_With_Exceptions.pdf Contractor's Affidavit Regarding Settlement of Claims (C-242) with Exceptions] | * [https://epg.modot.org/forms/CM/Contractors_Affidavit_C-242_With_Exceptions.pdf Contractor's Affidavit Regarding Settlement of Claims (C-242) with Exceptions] | ||
* [https://epg.modot.org/forms/CM/C9_Daily_Utility_Report.pdf Daily Utility Report (C-9)] | * [https://epg.modot.org/forms/CM/C9_Daily_Utility_Report.pdf Daily Utility Report (C-9)] | ||
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* [https://epg.modot.org/forms/CM/Form%20M-45%20Bitumin%20Distributor%20Calibration.doc Form M-45 Bitumin Distributor Calibration] | * [https://epg.modot.org/forms/CM/Form%20M-45%20Bitumin%20Distributor%20Calibration.doc Form M-45 Bitumin Distributor Calibration] | ||
* [https://epg.modot.org/forms/CM/Inspectors_Pay_Qty_Report_IPQR.pdf Inspectors Pay Qty Report (IPQR)] | * [https://epg.modot.org/forms/CM/Inspectors_Pay_Qty_Report_IPQR.pdf Inspectors Pay Qty Report (IPQR)] | ||
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* [https://epg.modot.org/forms/CM/IRI_Inertial_Profiler_Report_with_Bonus.xlsm IRI Inertial Profiler Report with Bonus] | * [https://epg.modot.org/forms/CM/IRI_Inertial_Profiler_Report_with_Bonus.xlsm IRI Inertial Profiler Report with Bonus] | ||
* [https://epg.modot.org/forms/CM/Job_Site_Bulletin_Board_Checklist_fillable.pdf Job Site Bulletin Board Checklist] | * [https://epg.modot.org/forms/CM/Job_Site_Bulletin_Board_Checklist_fillable.pdf Job Site Bulletin Board Checklist] | ||
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| − | + | <div class="mw-customtoggle-CM5a" style="font-size:1.15em; margin-left:15px; margin-bottom:5px; cursor:pointer; color:black; background-color: #EBEBEB;"> [+/-] Ready Mix Forms</div> | |
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* [https://epg.modot.org/forms/CM/RM_Aggregate_Scale_Calibration_200.dotx RM Aggregate Scale Calibration - 200] | * [https://epg.modot.org/forms/CM/RM_Aggregate_Scale_Calibration_200.dotx RM Aggregate Scale Calibration - 200] | ||
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</div> | </div> | ||
| − | + | * [https://epg.modot.org/forms/CM/Concrete%20Daily%20Inspection%20Report%20C-681.xls Concrete Daily Inspection Report, C-681] | |
| + | * [https://epg.modot.org/forms/CM/Concrete_Cylinder_Sample_Sent_to_Central_Lab.doc Concrete Cylinder Sample Sent to Central Lab] | ||
| + | * [http://eprojects/Templates/AWP_CIW_Mainline_Paving.xlsm Concrete Inspection Worksheet – Mainline QC/QA Paving] | ||
| + | * [https://epg.modot.org/forms/CM/Concrete_Roadway_Report.pdf Concrete Roadway Report] | ||
| + | </div> | ||
| + | </div> | ||
===Forms for Contractor Use === | ===Forms for Contractor Use === | ||
| + | <!-- NOTE: FORMS FOR CONTRACTOR USE SHOULD MATCH WHAT IS OUT ON https://www.modot.org/forms-contractor-use --> | ||
<div class="mw-customtoggle-CM7" style="font-size:1.25em; margin-bottom:5px; cursor:pointer; color:black; background-color: #EBEBEB;">[+/-] Construction and Contract Administration Forms</div> | <div class="mw-customtoggle-CM7" style="font-size:1.25em; margin-bottom:5px; cursor:pointer; color:black; background-color: #EBEBEB;">[+/-] Construction and Contract Administration Forms</div> | ||
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Revision as of 09:58, 8 September 2023
Contents
EPG articles are not referenced as "sections" but as EPG XXX.X (example: EPG 401.3) to avoid confusion with MoDOT specs (which are contractually binding).
Standard forms organized by functional unit are accessible from this page.
The files accessible by the links below are identical to those accessed through Word, Excel or other software application by MoDOT employees.
Many of these file links are also contained in Engineering Policy Guide articles that refer to the forms.
Bridge
[+/-] Bridge Forms
- Bridge Division Memo
- Bridge Hydraulics Report
- Change Order
- Constructability Questionnaire
- Culvert Hydraulics Report
- Design Exception Information
- Design Except to District
- Design Layout (Box)
- Design Layout (Grade)
- Design Layout (Stream)
- Design Layout (Wall)
- Floodplain Development Permit/Application
- Floodplain Development Permit To District Cover Letter
- Layout to FHWA
- Layout to Railroad
- Missouri-Illinois Border Bridge Clearinghouse Form
- No-Rise Certificate
- Request for Final Soundings for Structures Form
- Telefax
- Transmittal Letter
- Vertical Clearance Design Exception Coordination with SDDCTEA
Construction and Materials
Forms for MoDOT Use
[+/-] General Forms
[+/-] Project Closeout and As-Built Plans
- As Built Plans Checklist - SL District
- Bridge Clearance Report (C-239A)
- Final Acceptance Report (C-239), pdf version
- Final Plans Certification
- Final Plans Checklist
- Final Plans Memo
- Final Utility Report (C-13)
- Preparing As-Built (Final) Plans in Construction Using Bluebeam Revu
- Semi-Final Inspection (C-236)
- 30 Day Reminder Final Invoice Letter
- 60 Day Final Acceptance Letter
- ADA Checklist (PDF)
- ADA Checklist (MS Word)
- Aggregate Base Random Locations
- Asbestos Bulk Sample Bridge CL EL 5
- Asbestos Bulk Sample Parcel CL EL 5
- Asbestos Survey Report - All Suspect ACM (Form T746), Nonfriable ACM (Form T747) and All Materials (Form T748)
- Bluebeam Revu Training Manual
- Bridge Bearings
- Bridge Fabrication Report
- Change Order
- Commercially Useful Function (CUF) Determination Form
- Commercially Useful Function (CUF) Determination Form (for contracts let after March 2021)
- Compressive Strength for Forney
- Contingent Item Price Check
- Contractor Performance Evaluation Letter
- Contractor Performance Evaluation Signature Page
- Contractor Affidavit Regarding Settlement of Claims
- Contractor's Affidavit Regarding Settlement of Claims (C-242) with Exceptions
- Daily Utility Report (C-9)
- Dimensions To Tons Converter
- Documentation Record
- EEO Checklist
- Fence Removal Notice
- Force Account Spreadsheet
- Form M-45 Bitumin Distributor Calibration
- Inspectors Pay Qty Report (IPQR)
- IRI Inertial Profiler Report with Bonus
- Job Site Bulletin Board Checklist
- Milestone Memo
- Milestone Worksheet
- Mobile Mixer Calibration
- Mobile Mixer Verification Sheet
- Nonconformance Report (NCR)
- Nuclear Density (C-709ND)
- Nuclear Density of Plastic Portland Cement Concrete (C-710ND)
- Order Record (C-259)
- Outlier Analysis
- Pavement Type Selection Submittal Information (PTS Submittal Form)
- Payroll Log Form
- Pile Driving Chart
- Pile Driving Data
- Pile Driving Data PDA
- PODI Bridge Deck Pour Checklist
- Pore Pressure Report - Type A
- Pore Pressure Report - Type B
- PreCon Letter - Federal
- PreCon Letter - State
- Prestress Deficiency Report (1029-01)
- Price Verification
- Railroad Crossing Inspection
- RE Letterhead
- RE Letterhead – Word Format
- Retroreflectivity Payment Adjustment
- Retroreflectometer Request
- RoCap Test Form - Long Bolts
- RoCap Test Form - Short Bolts
- Semi-annual Labor Compliance Report
- Contractor Payment Schedule
- Standard Compaction Test Blank
- Survey Calculator
- Tank Capacity
- Tension Log Form
- Wage Interview (Form CR-1)
- Work Zone Inspection Form
[+/-] Job Order Forms
- JOC 2020 Asphalt Pavement Repair
- JOC 2021 Asphalt Pavement Repair
- JOC 2022 Asphalt Pavement Repair
- JOC 2023 Asphalt Pavement Repair
- JOC 2021 Bridge Repair Spreadsheet
- JOC 2022 Bridge Repair Spreadsheet
- JOC 2023 Bridge Repair Spreadsheet
- JOC 2021 Concrete Pavement Repair
- JOC 2022 Concrete Pavement Repair
- JOC 2023 Concrete Pavement Repair
- JOC 2022 Fence Repair Spreadsheet
- JOC 2023 Fence Repair Spreadsheet
- JOC 2020 Rail Cable Fence Spreadsheet
- JOC 2021 Rail Cable Fence Spreadsheet
- JOC 2022 Rail Cable Fence Spreadsheet
- JOC 2023 Rail Cable Fence Spreadsheet
- JOC Lighting Repair
- JOC Microsurfacing Spreadsheet
- JOC Signal and Lighting Repair
[+/-] AC Index Price and Fuel Adjustment Forms
[+/-] Asphalt Inspection Forms
[+/-] Concrete Inspection Forms
[+/-] Ready Mix Forms
- RM Aggregate Scale Calibration - 200
- RM Aggregate Scale Calibration - 300
- RM Aggregate Scale Calibration - 350
- RM Air Dispenser Calibration
- RM Cement Scale Calibration - 150
- RM Cement Scale Calibration - 175
- RM Cement Scale Calibration - 200
- RM Concrete Systems Form
- RM Equipment Calibrated and Verified Form
- RM Truck Mixer Information Form
- RM Water Calibration
Forms for Contractor Use
[+/-] Construction and Contract Administration Forms
- 2AA Sheet-Blank
- 2AA Sheet-Example
- ADA Checklist - PDF
- ADA Checklist - Word Document
- Affidavit for Compliance with Prevailing Wage
- Contractor Affidavit Regarding Settlement of Claims
- Contractor Performance Questionnaire
- Contractor Questionnaire
- CUF Determination Form
- Lead Abatement MoDOT Contractor Informational
- Lead Abatement MoDOT FA Project Notification Must be Filled out by RE
- Lead Abatement MoDOT Project Notification
- Lead Abatement MoDOT Project Re-Notification
- Lead Abatement Program Contact Info
- Pile Driving Set Calculator
- Prequalification Questionnaire
- Request to Subcontract Work (C-220)
- Request to Subcontract Work (C-220), Excel
- Sign Certification of Destruction (PDF)
- Sign Delivery Certification (PDF)
- Subcontractor Certification Regarding Affirmative Action
- Tension Log Form
- Value Engineering Change Proposal (C-104)
- Wage Flowchart for Federal Jobs-Precon
- Wage Flowchart for State Jobs-Precon
- Waste Disposal Agreement
[+/-] Materials Forms
- Asphalt Mix Design Submittal
- Buy America Materials of Origin
- Buy America Materials of Origin Non-Iron/Steel (PDF)
- Concrete Mix Design Submittal Form
- Corelok Aggregate Workbook
- Durable Aggregate Calculation
- Illinois Flexibility Index Test
- New Product Evaluation Form
- PAL Program Inclusion Certifications and Guarantee Statement
- PAL Fabricators Receival Form
- PAL Shippers Transmittal Form
- CMP, RCP, Pipe Shipping Submittal Form: Precast Drainage Unit and Precast Box Culvert Shipping Report Form
- Pipe Shipping Submittal Form: Thermoplastic
- Producer Supplier Listing Form
- Recycle Binder Contribution v2.12
- Recycle Binder Contribution v2.20
- Section 1040, 1043 and 1044 Inclusion Certification Statement
- Section 1040, 1043 and 1044 Shipping Report Form
- Transfer Request of Inspected Material
[+/-] Civil Rights Related Forms and Posters
[+/-] DBE Forms
- DBE and non DBE Subcontractor Reporting Form
- DBE Change Form
- DBE Contractor/Subcontractor Project Trucker and Equipment List
- DBE Contractor/Subcontractor Project Trucker and Equipment List - Instructions
- DBE Identification Submittal Form (Excel)
- DBE Identification Submittal Form (PDF)
- DBE Termination Form
[+/-] On the Job Training Forms
[+/-] Workforce Diversity Forms
[+/-] Federal Aid Job Site Posters
- Please refer to EPG 110.2 Federal-Aid Projects, Required Notices and Posters.
[+/-] State Aid Job Site Posters
- Please refer to EPG 110.2 Federal-Aid Projects, Required Notices and Posters.
[+/-] Permit Forms for Working on Right of Way
Quick Reference Guides (QRGs)
[+/-] AASHTOWare Project
- AWP QRG Revision Dates
- AWP CM AASHTOWARE Project Terminology
- AWP CM Certified Testers
- AWP CM Filters
- AWP CM Filters for Sample Records or Acceptance
- AWP CM Test Equipment
- AWP CO 1 Change Order Overview
- AWP CO 2 Change Order Adding New Item or Overrun/Underrun of Existing Items
- AWP CO 3 Change Order Time Extension
- AWP CO 4 Change Order Value Engineering
- AWP CO 5 Change Order, No Cost Contract Modification
- AWP CO 6 Change Order, Mobilization and Contract Bond
- AWP CO 7 Change Order Approval
- AWP CO Change Order Codes
- AWP CO Change Order Reports
- AWP CO Commercially Useful Function (CUF) Review Date Entry
- Commercially Useful Function (CUF) Determination Form (for contracts awarded after March 2021)
- AWP CO Construction Stockpiles
- AWP CO Contract Payment Estimate Exception Override
- AWP CO Contract Vendor Assets
- AWP CO Contract Adjustments
- AWP CO Contract Times
- AWP CO Daily Diary
- AWP CO Daily Diary Adjustments
- AWP CO Daily Work Report
- AWP CO Daily Work Report, Deleting DWR Postings and Acceptance Records
- AWP CO Disposition Remarks for PAL Material
- AWP CO Documentation Records
- AWP CO Emergency Contacts
- AWP CO Estimate
- AWP CO Estimate Final
- AWP CO Item Adjustments
- AWP CO Milestones
- AWP CO Signal Maintenance
- AWP CO SL District Reason Codes for Time Extension Change Orders
- AWP CO Subcontract
- AWP Guide for Creating QA Sample Records Using E20 Spreadsheets (Internal Use Only)
- AWP MA Adding Contract Lines For Acceptance Actions
- AWP MA Adding New Concrete Mix Design
- AWP MA Associating Material to Source
- AWP MA Checking For Unauthorized Sample Records
- AWP MA DEC Sample Record
- AWP MA Deleting materials From Acceptance
- AWP MA Editing Contract Acceptance Actions and Action Relationships
- AWP MA Generating Contract Sample Checklist
- AWP MA I.A.S. Lab Audit
- AWP MA PAL Plant Inspection Record
- AWP MA Regenerating Contract Lines for Original Materials and Acceptance Actions
- AWP MA Sample Record Acceptance By Certification
- AWP MA Sample Record Changing Material Code Source or Sample Type
- AWP MA Sample Record, General
- AWP MA Sample Record, General IAS Audit Record
- AWP MA Sampling and Testing Status Report
- AWP MA Using the Find Sample Function
- AWP QA Asphalt
[+/-] Digital Signatures
[+/-] Storm Water Database
- How to Fill Out Land Disturbance Inspection Record
- Land Disturbance Deficiencies
- Land Disturbance Storm Water Database Closeout Procedure
- Land Disturbance Storm Water Database Initial Setup for Construction Projects
- Land Disturbance Storm Water Database Initial Setup for Maintenance Projects
- Land Disturbance Storm Water Database 7-Day Reviews
- Storm Water Land Disturbance Erosion Reporting
Design
[+/-] Bridge
[+/-] Checklist
[+/-] Contracts
[+/-] Design
- 3R Conceptual Study Report
- 4R Pavement Rehabilitation Analysis Data and Conceptual Study Report
- Commission Backup Form Blank
- Commission Backup Form Instructions
- Conceptual Study Report
- Consultant Rating Form
- D-28 Sign Design Order Form
- Design Exception Information
- Equipment and Materials List
- Form 806.8.2, Project-Specific SWPPP Information
- Highway Lighting Warrants D21
- Location Study Report
- M-40 Request for Drilling Services
- Pavement Distress Log Form - Asphalt - 11x17
- Pavement Distress Log Form - Concrete 11x17
- Pavement Repair Log
- Preliminary Plans Proposal Review
- Project Data for BAMS
- Project Initialization Estimate Form
- Roadway Job Special Provision Formatting Guide
- Roadway Job Special Provision Instructions
- Roadway Job Special Provision Template
- Submittal to Professional Services Committee
- Suggested Revision to a CADD Standard
- Test-Cultural Resource Assessment Letter
- Traffic Signal Warrants, Form D22
- Utility Print Submittal Letter
- Utility Print Submittal Letter, Revised Plans
- Work Day Study
[+/-] Environmental and Cultural
[+/-] Materials
[+/-] Planning
[+/-] Public Involvement
- Public Hearing Statement Form
- Sample Letter Advertising a Public Hearing
- Sample Notice 4F
- Sample Notice of Public Hearing
- Sample Opportunity for a Public Hearing/Meeting Notice
- Sample Public Involvement Plan or Communication Plan
- Sample Request for Approval of Location and/or Design of Highways to State Design Engineer
- Sample Request for Approval of Location to the Commission
- Sample Transcript
[+/-] Scoping
[+/-] Survey
Financial Services
[+/-] Financial Services Forms
Highway Safety & Traffic
[+/-] Highway Safety & Traffic Forms
Maintenance
[+/-] Bridge Maintenance
[+/-] Chip Seal Forms
[+/-] Commuter Lots
[+/-] Disasters
[+/-] Miscellaneous Forms
[+/-] Rest Areas
[+/-] Snow and Ice Control
Motor Carrier Services
[+/-] Bridge Maintenance
- Hazardous Waste Transport Forms
- Household Goods Transport Forms, Tariff Information, Moving in Missouri brochure
- International Fuel Tax Agreement Forms
- International Registration Plan Forms
- Missouri Operating Authority Forms
- Oversize Overweight Permitting Forms
- Missouri Intrastate Skill Performance Evaluation for Medical Exemption Forms
- Waste Tire Transporter Forms
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