Chapter 17: Forms and Documents

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Section 1: Forms and Guidance Documents

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List of Forms

This manual references the following forms and examples of forms.

Anchor: #t160001Contract Administration Forms and Examples

Name of Form/Example

Link (on-line only) or Contact

No. of Pages

TxDOT Administrative documents, including Administrative Orders and Circulars

Administrative Documents Currency List**

N/A

TxDOT Form 168, Pile Record

Form168**

1

TxDOT Form 181, Test Pile Data

Form181**

1

TxDOT Form 599, Traffic Control Devices Inspection Checklist

Form599

2

TxDOT Form 1276, Drilled Shaft Record

Form1276**

1

TxDOT Form 269, Monthly Record of Material Received

Form269

1

TxDOT Form 316, Daily Report of Force Account Work

Form316 (instructions included)

2

TxDOT Form 1257, Work Report

Form1257

1

TxDOT Form 1258, Summary of Work Performed

Form1258

1

TxDOT Form 202, Identification of Material Samples

Form202

2

TxDOT Form 517, Sample Tag

Contact CST-Materials & Pavements Section

1

TxDOT Form 2118, Construction Storm Water Pollution Prevention Plan Field Inspection & Maintenance Report

2118

2

*FHWA-47, Statement of Materials and Labor used by Contractors on Highway Construction involving Federal Funds

http://www.fhwa.dot.gov/programadmin/contracts/fhwa47.pdf

FHWA-47 (instructions included)

4

*FHWA-1273, Required Contract Provisions Federal-aid Construction Contracts

http://www.fhwa.dot.gov/programadmin/contracts/1273.htm

FHWA1273

21

*FHWA-1391, Federal-aid Highway Construction Contractors Annual EEO Report

FHWA1391

1

*FHWA-1392, Federal-aid Highway Construction

FHWA1392 (instructions included)

2

*Form 2235, Final Inspection of Federal-Aid Project (replacing Form FHWA-1446C)

Form 2235

1

*FHWA-1494, For Projects Subject to the Davis Bacon and Related Acts

FHWA1494 (instructions included)

2

WH-347, Payroll (DOL)

WH-347

5

TCEQ Form 20022, Notice of Intent (NOI) for Storm Water Discharges Associated with Industrial Activity Under a TPDES Permit

NOI-TCEQ Form 20022

Electronic submittal

2

TCEQ Form 20023, Notice of Termination (NOT) of Coverage Under a TPDES General Permit for Storm Water Discharges Associated with Industrial Activity

NOT-TCEQ Form 20023

Electronic submittal

2

Temporary Suspension of Work Letter (Example)

Suspend

1

Resumption of Work Letter (Example)

Resume

1

Supplemental Agreement (SA) Form

SAForm

1

Example of Supplemental Agreement

Example

2

Change Orders:

  • Change Order Form
  • Tables A & B
  • Advance Funding (Third Party)

Form 2146, Change Order

Form 2146, Change Order (Contract Items pg 5, pg 6)

Form 2146, Change Order (pg 7)

1

2

1

Change Order Reason(s) Code Chart

Form 2146, Change Order (Code Chart, pg 3)

1

Change Order Checklist

Form 2146, Change Order (CO Checklist, pg 2)

1

TxDOT Form 2201, Contractor OJT Enrollment Request Form

Form 2201

1

TxDOT Form 2202, OJT Weekly Reporting Form

Form 2202

1

Time Extension Letter (Example)

Time

1

Certification of Materials Used Letter (Example)

Material

1

TxDOT Form 2220, Labor Standards Review

Form 2220

1

Ten (10) Days Warning Letter (Example)

Warning

1

Surety Letter (Example)

Surety

1

No Surety Letter (Example)

NoSurety

1

Additional Classification and Wage Rate Request

Wage

1

Example of Statement of Contingencies & Force Account Items

Items

1

Final Acceptance Letter (Example)

Final

1

Public Interest Determination Letter (Example)

Public

1

Contractor’s Assurance

Assure

1

TDLR Request for Inspection Form

TDLR

1

FHWA & TxDOT Oversight Project Review Plan

Oversght

1

ENV – Cultural Resource Management Emergency Discovery Guidelines

EmerDisc

2

ENV – Hazardous Materials Management Technical Guidelines for Removal of UST’s Encountered During Construction

USTs

4

ENV - Environmental Commitment Checklist for Construction, Maintenance and Facilities Projects

DEQCKLST

5

Subcontracting & Payroll Requirements

SubCont

1

2004 Construction Specification Required Shop/Working Drawing Submittal (for pre-construction meeting use)

ShopDraw

2

Shop/Working Drawing Submittal Form

ShopSub

2

Shop Drawing Flow Diagrams

Flow

-

*Required by FHWA for federally funded projects.

**Available through the TxDOT intranet only.



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