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Local Assistance Procedures Manuals (LAPM) Forms (PDF)

The following files comprise the Exhibits portion of the most recent LAPM chapters, including all updates issued in Local Programs Procedures (LPPs).
 
CHAPTER 2 ROLES AND RESPONSIBILITIES
  Exhibit 2-A Caltrans District Boundary Map
  Exhibit 2-B Federal-Aid Local Assistance Responsibilities
  Exhibit 2-C SAFETEA-LU Major Project Flowchart
CHAPTER 3 PROJECT AUTHORIZATION
  Exhibit 3-A REQUEST FOR AUTHORIZATION TO PROCEED WITH PRELIMINARY ENGINEERING (PE)
  Exhibit 3-B REQUEST FOR AUTHORIZATION TO PROCEED WITH RIGHT OF WAY
  Exhibit 3-C REQUEST FOR AUTHORIZATION TO PROCEED WITH UTILITY RELOCATION
  Exhibit 3-D REQUEST FOR AUTHORIZATION TO PROCEED WITH CONSTRUCTION
  Exhibit 3-E REQUEST FOR AUTHORIZATION TO PROCEED DATA SHEET(S)
  Exhibit 3-F INSTRUCTIONS FOR REQUEST FOR AUTHORIZATION DATA SHEET(S)
  Exhibit 3-G FEDERAL PROJECT LOG SHEET (MINIMUM REQUIREMENTS)
  Exhibit 3-H REQUEST FOR  CAPITAL SUBVENTION REIMBURSEMENT ALLOCATION
  Exhibit 3-I REQUEST FOR LOCAL ADVANCE CONSTRUCTION AUTHORIZATION
  Exhibit 3-J REQUEST FOR TRANSFER OF FEDERAL FUNDS TO THE FEDERAL TRANSIT
  Exhibit 3-K Administrative Procedures for Transfer of Local Federal-aid Funds to FTA
  Exhibit 3-L LOCAL ASSISTANCE PROJECT PREFIXES
  Exhibit 3-M FEDERAL HIGHWAY TRANSPORTATION PROGRAMS
  Exhibit 3-N FEDERAL HIGHWAY DISCRETIONARY PROGRAMS
  Exhibit 3-O SAMPLE LOCAL FEDERAL-AID PROJECT FINANCE LETTER
  Exhibit 3-P SAMPLE “STATE-AUTHORIZED PROJECT AUTHORIZATION
CHAPTER 4 AGREEMENTS
  Exhibit 4-A LOCAL AGENCY AGREEMENT CHECKLIST
  Exhibit 4-B LOCAL AGENCY AGREEMENT EXECUTION CHECKLIST
  Exhibit 4-C Master Agreement - Sample
  Exhibit 4-D Sample- Program Supplement Agreement
CHAPTER 5 ACCOUNTING/INVOICES
  Exhibit 5-A Sample Federal-aid Invoice (Except for TEA and STIP Projects)
  Exhibit 5-B Sample Federal-aid Invoice With Two Appropriations & Different Reimbursement Rates
  Exhibit 5-C SAMPLE OF STATE PROJECT INVOICES
  Exhibit 5-D SAMPLE RIGHT OF WAY INVOICE
  Exhibit 5-E SAMPLE OF "STIP PROJECT" FEDERAL INVOICE
  Exhibit 5-F SAMPLE OF "STIP PROJECT" STATE INVOICE
  Exhibit 5-G Alternative Payment Procedure Sample
  Exhibit 5-H Cognizant Federal Agencies
  Exhibit 5-I Sample Indirect Cost Rate Proposal
CHAPTER 6 ENVIRONMENTAL PROCEDURES
  Exhibit 6-A PRELIMINARY ENVIRONMENTAL STUDY (PES) FORM
  Exhibit 6-B INSTRUCTIONS FOR COMPLETING THE PRELIMINARY ENVIRONMENTAL STUDY (PES) FORM
  Exhibit 6-C Table 2- Exempt Projects
  Exhibit 6-D Table 3- Exempt Projects
  Exhibit 6-E Categorical Exclusion Checklist
  Exhibit 6-F Categorical Exemption/Categorical Exclusion Determination Form
  Exhibit 6-G NEPA/CEQA Revalidation Form
  Exhibit 6-H External Certifications Environmental Document Quality Control Reviews
  Exhibit 6-I Instructions for Completing the External Certifications
CHAPTER 7 FIELD REVIEW
  Exhibit 7-A INSTRUCTIONS FOR FIELD REVIEW FORM
  Exhibit 7-B FIELD REVIEW FORM
  Exhibit 7-C ROADWAY DATA
  Exhibit 7-D MAJOR STRUCTURE DATA
  Exhibit 7-E RAILROAD GRADE CROSSING DATA
  Exhibit 7-F AIRPORT DATA
  Exhibit 7-G FIELD REVIEW ATTENDANCE ROSTER
  Exhibit 7-H STATE TSM MATCH (Exhibit Deleted)
  Exhibit 7-I SYSTEMS ENGINEERING REVIEW FORM
CHAPTER 8 PUBLIC HEARINGS
  Exhibit 8-A Sample Notice of Public Hearing
  Exhibit 8-B Sample Notice of Opportunity for Public Hearing
CHAPTER 9 CIVIL RIGHTS AND DISADVANTAGED BUSINESS ENTERPRISES
  Exhibit 9-A DBE Race-Neutral Implementation Agreement for Local Agencies
  Exhibit 9-B Local Agency DBE Annual Submittal Form
CHAPTER 10 CONSULTANT SELECTION
  Exhibit 10-A PRE-AWARD AUDIT REQUEST LETTER AND CHECKLIST
  Exhibit 10-B Suggested Evaluation Sheet
  Exhibit 10-C CONSULTANT AGREEMENT REVIEWERS CHECKLIST
  Exhibit 10-D CONSULTANT AGREEMENT OUTLINE
  Exhibit 10-E SAMPLE PAYMENT CLAUSES
  Exhibit 10-F Certification of Consultant, Commissions & Fees
  Exhibit 10-G Certification of Local Agency
  Exhibit 10-H Sample Cost Proposal
  Exhibit 10-I Notice to Bidders/Proposers Disadvantaged Business Enterprise information
  Exhibit 10-J Standard Agreement for Subcontractor/DBE Participation
  Exhibit 10-K AUDIT DISPOSITION
  Exhibit 10-L Pre-award Audit Notification Letter
  Exhibit 10-M Standard Audit Program Procedures
  Exhibit 10-N Accounting & Auditing Guidelines for Contracts with Caltrans
  Exhibit 10-O Local Agency Proposer/Bidder-DBE (Consultant Contracts)-Information
  Exhibit 10-P Nonlobbying Certification For Federal-Aid Contracts
  Exhibit 10-Q Disclosure of Lobbying Activities
  Exhibit 10-R A&E Sample Contract Language
  Exhibit 10-S Consultant Performance Evaluation
CHAPTER 11 DESIGN STANDARDS
  Exhibit 11-A Geometric Design Standards for Local 3R Projects
  Exhibit 11-B EXHIBIT DELETED
  Exhibit 11-C FOUNDATION INVESTIGATION FOR DESIGN
  Exhibit 11-D PRELIMINARY HYDROLOGIC/HYDRAULIC REVIEW SUMMARY
  Exhibit 11-E CHECKLIST FOR DRAINAGE STUDIES AND REPORTS
  Exhibit 11-F DESIGN EXCEPTION FACT SHEET
CHAPTER 12 PLANS, SPECIFICATIONS & ESTIMATE
  Exhibit 12-A Preliminary Estimate of Cost
  Exhibit 12-B SCOPE OF WORK - CMAQ/TE Projects
  Exhibit 12-C PS&E CERTIFICATION
  Exhibit 12-D PS&E CHECKLIST
  Exhibit 12-E PS&E CHECKLIST INSTRUCTIONS
  Exhibit 12-F Request for Approval For Cost-Effectiveness/Public Interest Finding
  Exhibit 12-G Bidder's List of Subcontractors (DBE and NON-DBE) Part I and Part II
CHAPTER 13 RIGHT OF WAY
  Exhibit 13-A No Right of Way Certification Local Assistance Project (Off State Highway System)
  Exhibit 13-B Right of Way Certification Local Assistance Project (Off State Highway System)
  Exhibit 13-C CONSULTANT SELECTION CRITERIA AND GUIDE
  Exhibit 13-D UNIFORM RELOCATION ACT BENEFITS SUMMARY
  Flow Chart 13-1 FLOW CHART OF RIGHT OF WAY PROCEDURES
CHAPTER 14 UTILITY RELOCATIONS
  Exhibit 14-A Local Agency Submittal Requirements for Federal Participation in Utility Relocations
  Exhibit 14-B Local Agency Utility Agreement Provisions for Federal Participation
  Exhibit 14-C FHWA Specific Authorization/Approval of Utility Agreement
  Exhibit 14-D Notice to Owner
  Exhibit 14-E Report of Investigation
  Exhibit 14-F Utility Agreements
  Exhibit 14-G Utility Agreement Clauses
  Exhibit 14-H Stages of R/W Utilities Through Stages of Project Development
CHAPTER 15 ADVERTISE AND AWARD PROJECT
  Exhibit 15-A Local Agency Construction Contract Administration Checklist
  Exhibit 15-B Resident Engineer's Construction Contract Administration Checklist
  Exhibit 15-C LOCAL AGENCY PROJECT ADVERTISING CHECKLIST
  Exhibit 15-D Sample Bid Tabulation Summary Sheet
  Exhibit 15-E National Highway System Bid Tabulation Data
  Exhibit 15-F Bid Price Data
  Exhibit 15-G LOCAL AGENCY BIDDER DBE INFORMATION
  Exhibit 15-H Blank - For Future Use
  Exhibit 15-I LOCAL AGENCY BID OPENING CHECKLIST
  Exhibit 15-L LOCAL AGENCY CONTRACT AWARD CHECKLIST
  Exhibit 15-M DETAIL ESTIMATE
  Exhibit 15-N FINANCE LETTER
CHAPTER 16 ADMINISTER CONSTRUCTION CONTRACTS
  Exhibit 16-A WEEKLY STATEMENT OF WORKING DAYS
  Exhibit 16-B SUBCONTRACTING REQUEST
  Exhibit 16-C Resident and Assistant Engineer's Daily Report
  Exhibit 16-D CERTIFICATE OF PROFICIENCY
  Exhibit 16-E Independent Assurance Sampling and Testing (Form MR-0102)
  Exhibit 16-F Report of Witness Tests (Form MR-0103)
  Exhibit 16-G Corroboration Report (Form MR-0104)
  Exhibit 16-H Independent Assurance Sampling and Testing Log Summary (Form MR-0110)
  Exhibit 16-I Notice of Materials To Be Used (Form CEM-3101)
  Exhibit 16-J Notice of Materials To Be Furnished (Form MR-0608)
  Exhibit 16-K Report of Inspection of Material (Form MR-0029)
  Exhibit 16-L Sample Federal-Aid Advice Invoice
  Exhibit 16-M Notice of Materials to be Inspected (MR-0028)
  Exhibit 16-N Employee Interview: Labor Compliance/EEO
  Exhibit 16-O Federal Highway Construction Contractor’s Annual EEO Report
  Exhibit 16-Q U.S. Department of Labor, Office of Federal Contract Compliance Programs
  Exhibit 16-R Size, Frequency and Location of Sampling and Testing Tables
  Exhibit 16-S Caltrans Test Method - ASTM Test Method Conversion Chart
  Exhibit 16-T Materials Typically Accepted by a Certificate of Compliance
  Exhibit 16-U Notice of Potential Claim
  Exhibit 16-V Source Inspection Request from Local Agency to Caltrans District Local Assistance Engineer
  Exhibit 16-W Source Inspection Request from Local Agency to Caltrans' Office Materials Engineering and Testing Services
  Exhibit 16-X Blank for future Use (Exhibit Deleted)
  Exhibit 16-Z Monthly DBE Trucking Verification
CHAPTER 17 PROJECT COMPLETION
  Exhibit 17-A Sample Cover Letter and Federal Report of Expenditures Checklist
  Exhibit 17-B Final Inspection of Federal-Aid Project (FHWA Form 1446C)
  Exhibit 17-C FINAL INSPECTION FORM
  Exhibit 17-D Sample Federal-Aid Final Invoice
  Exhibit 17-E Sample Change Order Summary
  Exhibit 17-F Final Report of Utilization of Disadvantaged Businesses
  Exhibit 17-G Materials Certificate
  Exhibit 17-H Statement of Materials and Labor Used by Contractors Highway Construction involving Federal Funds (Form FHWA-47)
  Exhibit 17-I Sample Cover Letter for Report of Completion of Structures
  Exhibit 17-J REPORT OF COMPLETION OF STRUCTURES
  Exhibit 17-K Sample Report of Completion of Right of Way Expenditure
  Exhibit 17-L Sample Report of Expenditures for Force Account Projects
  Exhibit 17-M Final Project Expenditure Report
  Exhibit 17-N EEM Program Final Report of Right of Way Expenditures
  Exhibit 17-O Disadvantaged Business Enterprises (DBE) Certification Status Change
CHAPTER 18 MAINTENANCE
  Exhibit 18-A Maintenance Reriew Checklist
  Exhibit 18-B Sample Resolution
  Exhibit 18-C City-County Road System EDP Input Form HCC 342
  Exhibit 18-D Mileage of Maintained Roads
   
  If you have any problems downloading files or questions, please read Tech Support & Related Information or email to FormsPLUS@dot.ca.gov for help. Page last updated: 06/16/2008 at 11:30 p.m.