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] ]
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.
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:
*REVISIED*
*Form*
*Number*
*Form Name*
*Division*
*Name*
*Form*
* Revision*
*Date*
0167A
Disadvantaged Business Enterprise (DBE) - Annual Declaration of Eligibility (DOE)
Office of Business Development
4/15/25
0749
Possession and Use Agreement
DSD-Acquisition
4/28/25
0976
MDOT - Human Resources Onboarding Checklist
Human Resources
4/22/25
1039
Interstate Certification Declaration of Eligibility (DOE)
Office of Business Development
4/15/25
2142
Category B: Community Service Infrastructure Fund Application
Office of Economic Development
4/11/25
3119
Report of New Equipment
BFS-Transportation Systems Management Operations
4/18/25
3146
Cost Analysis for A&E Services
Passenger Transportation-Procurement Forms
4/17/25
*NEW*
*Form*
*Number*
*Form Name*
*Division*
*Name*
*New Form*
*Create*
*Date*
1033-BywaysWP
Pure Michigan Byways Annual Work Plan
Michele Klein
4/29/25
*_Obsolete Forms:_*
1561 - Project Information Sheet for Horizontal and Vertical Map
1561-ATC - Project Information Sheet for Horizontal and Vertical Map (Alternative Technical Concepts)
2913 - Plan Review Material Submittal Order
0213 - Letter of Transmittal
0377- Certification & Acceptance - Type 4
*_ADA Compliant Updated Forms:_*
0096 - Out-of-State Applicant Affidavit of Certification
0103E - Equal Opportunity Contract Compliance Data Form
0103F - MDOT EEO Officer Notification
0112 - Title VI - Complaint Form
0112A - Title VI - Complaint Consent Forms (Arabic)
0112B - Title VI - Complaint Consent Forms (Bengali)
0112S - Title VI - Complaint Consent Forms (Spanish)
0113 - Title VI Complaint Procedure & Investigation Guidelines
0113A - Title VI Complaint Procedure & Investigation Guidelines - Arabic
0113S - Procedimiento Para Levantar Una Queja Y Guia De Investigacion Por Titulo VI
0125 - Trainee Monthly Report, On-the-Job Training (OJT) Program
0147 - Work Classification Request
0148 - Work Experience Resume (Template)
0156 - DBE Educational/Training Program Application
0156A - DBE Reimbursement Request
0162 - Consultant Services Program Application
0163 - Consultant Services Program Reimbursement Request
0166A - Additional - DBE Certification Additional Information Required (Use if sending to MDOT)
0167A - Disadvantaged Business Enterprise (DBE) - Annual Declaration of Eligibility (DOE)
0168 - MDOT Vendor Availability Questionnaire
0170 - DBE Program Association Membership Program
0171 - DBE Association Membership Reimbursement Request
0172 - DBE Program Subscription Services Program Application
0173 - DBE Program Subscription Services Reimbursement Request
0179 - Title VI Sub-Recipient Annual Certification Form
0181 - On-The-Job Training (OJT) Program Contractor Yearly Training Plan
0182 - Disadvantaged Business Enterprise (DBE) Participation (Service)
0183 - Application to Use Joint Checks
0190 - Request for On-the-Job Trainee Approval, On-the-Job Training (OJT) Program
0191 - On-The-Job Training (OJT) Program Trainee Interview Form
0192 - Petroleum Company Account(s) Information and Liquid Asphalt Cement Tractors and Trailers
Information
0193 - Disadvantaged Business Enterprise (DBE) Supplier Participation Affidavit
0194 - Final Quantities of Liquid Asphalt Cement Supplied
0196 - Disadvantaged Business Enterprise (DBE) Removal/Substitution Request
0197 - Project Worker Interview Form
0198 - MDOT Complaint Consent/Release Form
0198A - MDOT Complaint Consent/Release Form (Arabic)
0198B - MDOT Complaint Consent/Release Form (Bengali)
0198S - MDOT Complaint Consent/Release Form (Spanish)
0203 - Engineer's Estimate
0204 - General Computation
0205 - Engineering Calculations
0222 - Survey Notes Receipt & Transmittal
0222P - Photogrammetric Information: Receipts & Transmittal
0223 - Utility Charge Estimate
0226 - Survey / Mapping Action Request
0258 - Program Application for Local Agency Projects - Bridge Projects
0259 - Program Application for Local Agency Projects Transportation Alternative Funds
Enhancement and Safe Routes to Schools
0260 - Program Application for Local Agency Projects - Road and Safety Projects
0268 - Project Cost Estimating Checklist
0291 - Revision of Plans
0304 - Proprietary Item Certification (PIC) and Public Interest Finding (PIF)
0333 - Michigan Interstate Vertical Clearance
0343 - Contractor Allocation Waiver Request, On-the-Job Training (OJT) Program
0344 - On-The-Job Training (OJT) Program - Trainee Warehouse Order Form
0345 - Commercially Useful Function Issue Report
0347 - Training or Event Reimbursement, On-The-Job Training (OJT) Program
0348 - Mitigation Follow-up Summary Form for EA/EIS Project Contract
0349 - Mitigation Follow-up Sign-Off Form for EA/EIS Project Contract
0363 - Local Contracting Certification & Conditions for Local Contract Development &
Administration
0364 - Proposal Certification
0365 - Request to Advertise
0366 - Certification of Contractor Selection & Request to Award
0369 - Local Agency Work Zone Safety & Mobility Determination Worksheet
0370 - ADA Statement of Accessibility Constraints
0372 - FUSP Request Form
________________________________________________________________________
"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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