? MDOT E-mail
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All MDOT forms can be located at the MDOT Forms homepage located at: MDOT - WebForms (state.mi.us) [ [link removed] ]
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MDOT users can view a listing of all forms that have been updated for the last 3 months by going to the MDOT Sharepoint Forms [ [link removed] ]?Intranet webpage and clicking on New/Revised Forms on the left side of the screen in the navigational bar.?
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The following forms were created, modified, or made fillable last month.? All forms are available electronically at Inside MDOT Forms Management Page and the public website as appropriate:
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*REVISIED*
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*Form*
*Number*
*Form Name*
*Division*
*Name*
*Form*
* Revision*
*Date*
0193
Disadvantaged Business Enterprise (DBE) Supplier Participation Affidavit
Office of Business Development
6/8/23
0204
General Computation
BFS-Construction Field Services
6/14/23
0371
Continuing Education Activity Request for Professional Engineers and Surveyors
Design Division
6/8/23
0397
Work Zone Audit Report
BFS-Construction Field Services
6/2/2023
0426
Quotation Request for Services or Equipment
BFS-Transportation Systems Management Operations
6/8/23
0501
Materials Source List
BFS-Construction Field Services
6/7/23
0561
MDOT Lane Closure Notification/ Request Form
BFS-Construction Field Services
6/14/23
0565
Work Zone Enforcement Agreement with Local Agency Police and MDOT
BFS-Construction Field Services
6/28/23
0612D
Restricted Appraisal Report for Non-Condemnation Related Valuation
DSD-Appraisal
6/5/23
0633A
Noncompensable Items of Damage in Eminent Domain Proceedings and Michigan Law Regarding Benefits
DSD-Appraisal
6/5/23
1100A
Extension of Contract Time-Request Number
BFS-Construction Field Services
6/2/2023
1105A
Final Estimate Submittal Form
BFS-Construction Field Services
6/8/23
1107
Daily Weight Record
BFS-Construction Field Services
6/2/2023
1013S
Inspector's Checklist for Inspection for Solar Boards
BFS-Construction Field Services
6/7/23
1122B
Inspector's Daily Report
BFS-Construction Field Services
6/22/23
1122C
Inspector's Daily Report Worksheet
BFS-Construction Field Services
6/7/23
1126
National Pollutant Discharge Elimination System (NPDES) and Soil Erosion and Sedimentation Control (SESC) Inspection Report
BFS-Construction Field Services
6/13/23
1130
Progress Schedule
BFS-Construction Field Services
6/7/23
1130A
Progress Schedule - 2020 Spec Book
BFS-Construction Field Services
6/22/23
1156-T1
Minimum Wage Rate Interview Sheet Tier 1
BFS-Construction Field Services
6/2/2023
1156-T2
Minimum Wage Rate Interview Sheet Tier 2
BFS-Construction Field Services
6/6/23
1160A
Concrete Cylinder/Core Compression Test Results
BFS-Construction Field Services
6/8/23
1165
Notice of Non-Compliance with Contract Requirements
BFS-Construction Field Services
6/5/2023
1302-FED
Subcontract - FED
BFS-Construction Field Services
6/8/23
1302-State
Subcontract- State
BFS-Construction Field Services
6/8/23
1366
Contractor's Affidavit of Indebtedness
Contract Services Division
6/8/23
1367
Consent of Surety for Payment to Contractor
Contract Services Division
6/8/23
1585
Pavement Marking Material Verification Checklist
BFS-Transportation Systems Management Operations
6/13/23
1903
Daily Report of Bituminous Plant Inspection
BFS-Construction Field Services
6/22/23
1907
Report of Compacted Bituminous Mixture Core Density & Percent Compaction
BFS-Construction Field Services
6/22/23
1907J
Report of Compacted Longitudinal Joint Core Density & Percent Compaction
BFS-Construction Field Services
6/22/23
1994
Stake Request Form
BFS-Construction Field Services
6/2/2023
1967
Jobsite Poster Inspection Checklist
BFS-Construction Field Services
6/6/23
2620
Operation of New Public Transportation Service
Transportation Planning
6/22/23
2071
Funding Application for Local Agency Highway-Railroad Grade Crossing Surface Improvement Projects
Office of Rail
6/8/23
2142
Category B: Community Service Infrastructure Fund Application
Office of Economic Development
6/8/23
2217
Notice and Order to Remove Encroachment
DSD-Permits-Construction
6/13/23
2224
Notice and Order to Comply
DSD-Permits-Construction
6/13/23
2480
Letter Requesting Utility Information at Base Plan Stage
DSD-Permits-Utility Coordination
6/13/23
2481
Letter to Public/Private Utilities at Preliminary Plan Stage
DSD-Permits-Utility Coordination
6/13/23
2482
Letter to Municipal Utilities at Preliminary Plan Stage
DSD-Permits-Utility Coordination
6/13/23
2492
Non-Holiday Coffee Break Permit Application Return Letter
DSD-Permits-Construction
6/13/23
3757
Affidavit of Notification
DSD-Permits-Construction
6/13/23
3764D
Temporary Closing Order for ORV Connector Route on State Highway
DSD-Permits-Construction
6/13/23
3765
Authorization to Re-Open ORV Connector Route on State Highways
DSD-Permits-Construction
6/13/23
3766
Order to Close ORV Connector route on State Highway
DSD-Permits-Construction
6/13/23
4106
Small Business Program Application
Office of Business Development
6/21/23
5022
Request for Payment
Office of Economic Development
6/30/23
5105
Contract Request
Contract Services Division
6/15/23
5601
MDOT Core Log and Chain of Custody
BFS-Construction Field Services
6/6/23
UP-67
Parade Event Permit Application
DSD-Permits-Construction
6/8/23
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*NEW*
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*Form*
*Number*
*Form Name*
*Division*
*Name*
*New Form*
*Create*
*Date*
3536
Compliance Certification Form for LAP Projects With Federal Aid Highway Program (FAHP) Funding
DSD-Local Agency Program
6/14/23
3593
Lane Closure and Oversize/Over Width Restriction Request
BFS-Construction Field Services
6/28/23
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1861C - Transverse Shear Test Data ? Worksheet
Transfer from CFS to
BOBS-Geotechnical Services Section
1174S ? Inspector's Report of concrete Placed - Structure
1031 - Request for Electronics Equipment Repair
Transfer from CFS to
BOBS-Bridge Construction
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*_Obsolete Forms:_*
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0072 - Employer Inquiry for Special Placement in the Transportation Maintenance Work Element Program
0434 - Emergency Information Form
1886 - Life Cycle Cost Analyst Assumption Sheet
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________________________________________________________________________
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"The Michigan Department of Transportation:?"
"Providing the highest quality integrated transportation services for economic benefit and improved quality of life.?"
"www.michigan.gov/mdot [ [link removed] ]??| ?www.michigan.gov/drive [ [link removed] ]? | ?contact MDOT [ [link removed] ]?
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