CDOT Construction Manual APPENDIX B EXAMPLE LETTERS, NOTICES, AND FORMS March 2014 . [Page Intentionally Blank] . Example Letters, Notices, and Forms March 2014 APPENDIX B EXAMPLE LETTERS, NOTICES, AND FORMS Appendix B presents examples of the most common letters, notices, and forms (i.e., CDOT Forms, FHWA Forms) Project Engineers and Project Inspectors will be involved with on a day-to-day basis. The Contractor may be responsible for submitting some items. The completion of other items will be the responsibility of either the Project Inspector or the Project Engineer. Regardless, the Project Engineer is responsible for ensuring the items are properly reviewed and distributed. Completion instructions are provided for each form example presented in Appendix B. See Appendix C for guidance on preparing change orders (i.e., Form 90 and Form 94). Most of the forms are self-explanatory. Computer generated forms will be accepted if they contain the exact verbiage and statute references. CDOT Forms are available at Forms Management on the Intranet Web Site, and FHWA Forms are available at http://www.fhwa.dot.gov/programadmin/contracts/index.htm. Consultants may obtain forms from their CDOT contact. Document Page Sample Final Acceptance Letter B-3 Sample Buy America Certification B-4 Sample Stockpiled Material Letter of Vested Interest B-6 Sample Prompt Payment Notice B-7 Sample Prompt Payment Law Notice B-8 Form 7 – Weekly Report on Miscellaneous Pay Items B-9 Form 10 – Inspector’s Report for Force Account Work (Prime & Sub) B-13 Form 10 (Prime Contractor) B-15 Form 10 (Subcontractor) B-16 Billing Example Contractor Bill to CDOT B-17 Billing Example Subcontractor Bill to Contractor B-18 Form 17 – Contractor DBE Payment Certification B-19 . B-1 July 2016 Example Letters, Notices, and Forms Document Page Form 46 – Concrete Truck Mixer Inspection Certification B-21 Form 103 – Project Diary B-23 Form 105 – Speed Memo B-26 Form 200 – OJT Training Questionnaire B-29 Form 205B – Sublet Permit Application B-31 Form 262 – Weekly Time Count Report – Work Days B-39 Form 263 – Weekly Time Count Report – Calendar Days B-43 Form 266 – Inspector’s Progress Report B-47 Form 279 – Inspector’s Report of Reinforcing Steel Placed B-51 Form 280 – EEO and Labor Compliance Verification B-54 Form 282 – Asphalt Paving Inspector’s Daily Report B-57 Form 568 – Authorization and Declaration of Temporary Speed Limits B-61 Form 580 – Equipment Rental Rate Determination Request B-66 Form 713 – Contractor DBE Subcontractor, Supply and Service Contract Statement B-70 Form 715 – Certificate of Proposed Underutilized DBE (UDBE) Participation B-72 Form 832 – Trainee Status and Evaluation B-75 Form 838 – OJT Trainee/Apprentice Record B-78 Form 859 – Project Control Data B-81 Form 1186 – Contract Funding Increase/Decrease and Approval Letter B-91 Form 1212 – Final Acceptance Report B-94 Form 1318 – Dispute and Claim Status Report B-97 FHWA Form 1391 – Federal-Aid Highway Construction Contractors Annual EEO Report B-101 Form 1401 – Block Faced MSE Wall Submittal Checklist B-103 Form 1402 – Panel Faced MSE Wall Submittal Checklist B-105 Piling Form B-107 Traffic Control Review Form B-110 Project Final Submittal Checklist B-119 Final Materials Submittal Checklist B-122 . B-2 Example Letters, Notices, and Forms March 2014 . B-3 December 2014 Example Letters, Notices, and Forms Buy America Certification Sample The specification requires the Contractor to certify that he has obtained all the correct certifications from the manufacturers and suppliers. These Buy America certifications are to be received and approved by CDOT before the materials are incorporated into the project. Once the Contractor receives the Buy America certification from manufacturers and suppliers, the Contractor provides CDOT with a Buy America certification such as the example below. CDOT does not accept blanket Buy America letters covering all materials. . B-4 Example Letters, Notices, and Forms December 2014 . B-5 December 2014 Example Letters, Notices, and Forms Summary of Buy America Quantities This is a suggested format for the reconciliation of the Buy America Certification quantities with Installed Quantities. The Contractor shall submit this summary on a monthly basis to the Project Engineer for material incorporated during the previous month. The Project Engineer will verify the information in the Summary and all Buy America certifications provided by the Contractor. Before approving a progress payment, the Resident Engineer will verify that the quantities in the Contractor’s summary document match the quantities in the progress payment. . B-5b Example Letters, Notices, and Forms December 2014 . B-5c December 2014 Example Letters, Notices, and Forms Example of Exceptions The specification requires the Contractor to document the project delivered costs of any foreign steel or iron permanently incorporated into the project. This is an example of the requirement. . B-5d