MDOT E-mail

Having trouble viewing this email? View it as a Web page [ [link removed] ].

Bookmark and Share [ [link removed] ]



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*



0380



Request for Payment Exhibit-A

Local Agency Programs



DSD-Local Agency Program



8/20/25



0381



Project Cost Reporting and Certification Exhibit-B Local Agency Programs



DSD-Local Agency Program



8/28/25



0633T



Application for Approval to Provide Real Estate Appraisal & Appraisal Review Services



DSD-Contracts



8/20/25



2067



Annual Certification of Employee-related Conditions - County Road Agency



FOD-Act 51



8/21/25



3071



FY 20__ Coordination Plan for Local Bus Operating Assistance



Passenger Transportation



8/5/25



3174



MDOT Review of Procurements



Passenger Transportation-Procurement Forms



8/21/25



3078



FY 20__ Resolution of Intent



Passenger Transportation



8/6/25



3182



Procurement Guidelines-For Grantees Receiving Federal Transit Funds and/or State Funds Via MDOT



Passenger Transportation-Procurement Forms



8/21/25



5027



Development Information Form



Office of Economic Development



8/21/25



5105



Consultant Contract Request



Contract Services Division



8/20/25



5108



Certification of Overhead Rate



Contract Services Division



8/4/25



5635



Official Entry Form - MDOT ACEC Partnership Charter Award



Office of Organizational Development (OOD)



8/21/25



 

*NEW*



 



*Form*

*Number*



*Form Name*



*Division*

*Name*



*New Form*

*Create*

*Date*



0573



County Firm Unit Prices



BFS-Transportation Systems Management Operations



8/14/25



1095



Disposal of Hazardous Material



BFS-Construction Field Services



8/19/25



1096



Disposal of Non-Hazardous Material



BFS-Construction Field Services



8/19/25



1993



Onsite Group Meal Request



Contract Services Division



8/20/25



 

*_Obsolete Forms:_*

0976 - MDOT - Human Resources Onboarding Checklist



1580 - Vehicle Purchase Specification Certification



5108L - Certificate of Overhead Cost Rate

   

 

*_ADA Compliant Updated Forms:_*

1905 - Testing of Bituminous Mixtures (Centrifuge Worksheet)



1907 - MDOT Report of Compacted HMA Core Density & Percent Compaction



1907J - Report of Compacted Longitudinal Joint Core Density & Percent Compaction



1911 - Job Mix Formula (JMF) HMA Field Communication



1912 - Testing of Bituminous Mixtures Ignition Furnace Worksheet



1920 - Field Report for Concrete Pipe



1920A - Field Report for Precast Drainage Items



1923 - Sample Identification



1923B - Sample Identification (Bituminous Materials)



1927 - Mechanical Anchoring System Proof Test



1928 - Adhesive Anchoring System Proof Test



1934 - Daily Bituminous Plant & Street Communication Worksheet



1937 - Tensile Strength Ratio (TSR) Worksheet



1940 - Soil Erosion and Sedimentation Control (SESC) Quality Assurance Review Checklist-Project Delivery



1941 - Inspector's Daily Report for Bridge Painting



1942 - Fabrication Inspection File Checklist



1944 - Bid Requests Fax Transmission



1945 - Report of Test



1946 - CPM-HMA Ultra-Thin Overlay (Worksheet)



1947 - CPM-HMA Ultra-Thin Overlay (Cursory Inspection)



1948 - CPM-Paver Placed Surface Seal (Cursory Inspection)



1949 - CPM-Paver Placed Surface Seal (Worksheets)



1951 - Prevailing Wage Claim Form



1953 - Claim Content and Certification



1954 - Certified Payroll Status Log



1956 - LRFD Pile and Driving Equipment Data



1959 - Technical Report Documentation Page



1960 - Checklist for Constructability Review Project Development Phase



1961 - Checklist for Constructability Review Early Project Scoping



1962 - Value Engineering Change Proposal



1963 - Interim Project File Review



1964 - Local Agency Project Field Review



1965 - Prevailing Wage Quality Assurance Review Checklist



1967 - Jobsite Poster Inspection Checklist



1968 - Receipt of Required Claimant Information



1969 - Engineer Certification and Final Project Reviews Contract and Related Documents Checklist



1970 - Engineer Certification and Final Project Reviews Construction Item/IDR Checklist



1971 - Engineer Certification and Final Project Reviews - HMA Items Checklist



1972 - Engineer Certification and Final Project Reviews - Material Review Checklist



1973 - Engineer Certification and Final Project Reviews -Concrete Items Review Checklist



1976 - Job Mix Formula (JMF) Concrete Field Communication



1978 - Proposed Ride Quality Excluded Areas



1981 - Repair Observation Report



1985 - Bar Reinforcement Report



1988-20 - Drilled Shaft Inspection Record for Ancillary Freeway Structures, Highway Signs, Luminaires, and Traffic Signal Foundations



1989 - Micropile Installation Record



1990 - Cofferdam Installation, Piling Placement, and Tremie Pour Inspector's Checklist



1994 - Stake Request Form



1995 - Work Zone Monitoring Report Form



1997 - Air Meter Calibration Sheets



1997D - Air Meter Calibration Sheets



1999 - Concrete Field Cylinders Test Results



2000 - Mix Design Review Checklist



2001 - Fabrication Inspection File Checklist



2008A - Request for Change in the Major Street System



2008B - Additions and Deletions to City or Village Local Street System



2008D - Request for Change in County Primary Road System



2008E - Additions and Deletions to County Local Road Systems



2012 - Resolution for Designation of Street Administration



2044 - Engineering Reimbursement



2047 - Project Agreement Checklist



2066 - Alternate Overnight Parking Request



2067 - Annual Certification of Employee-related Conditions - County Road Agency



2068 - Annual Certification of Employee-related Conditions - City or Village



2072 - Application for Extension of Time to Complete Ordered Work Issued by the Michigan  Department of Transportation Office of Rail, Rail Safety Section



2073 - Railroad Contact Form



2074 -MDOT Office of Railroad Authority Contact Form



2075 - Notice of Trespassing Railroad Property



2075A - Notice of Trespassing



2076 - Notice of Encroachment



2077 - Owned and Leased Fleet Equipment for DBE Credit



2078 - On-The-Job Training (OJT) Program - Dependent Child Care Reimbursement



2079 - ADA Complaint Form



2080 - ADA Complaint Appeal Form Request



2081 - MDOT Bridge Painting Project Office Checklist



2082 - MDOT Bridge Deck Construction Inspection Checklist



2083 - MDOT Bridge Deck Overlay Construction Inspection Checklist



2084 - Stop Work Order - Notice of Violation



2085A - Guidelines for Establishing a Golf Cart Connector Routes (GCCR) on State Trunkline Highways



2085B - Special Conditions for Golf Cart Connector Routes (GCCR) on State Trunkline Highways



2122 - MDOT Digital Signature Certificate Request Form



2124A - Prime Contractor Bi-Weekly Statement of Subcontractor/Supplier Payments



2142 - Category B: Community Service Infrastructure Fund Application



2169 - Use of Photo Release



2200 - Adopt A Highway Individual App. for Use of State Trunkline



2205-1 - General Conditions and Supplemental Specifications



2207A - Performance and Indemnification Commitment



2207B - Performance Resolution for Municipalities



2207C - Performance & Indemnification Resolution for Public School Districts



2207D - Performance Resolution for Tribal Governments



2207E - Performance Resolution for Universities or Colleges



2207F - Resolution to Request Authorization to Adopt an Off-Road Vehicle Ordinance



2207G - Collateral Assignment of Certificate of Deposit



2209 - Certificate of Agency



2213 - Permit Inspection Report



2223G - Notice of Violation- Billboards



2225 - Michigan Rail Enhancement Grant Program



2235 - Construction Permit Fee Schedule



2240 - Special Conditions for Tree Removal, Tree Trimming & Herbicide Application



2241 - Permit To Establish, Expand And/or Maintain a Junkyard



2242 - Environmental Review



2243 - Standard Conditions for Serving Refreshments in Rest Areas on Non-Holidays



2251 - Special Conditions for Seismic Explorations



2252 - Special Conditions for Discharge of Treated Effluent



2253 - Special Conditions for Monitoring Wells



2254 - Special Conditions for Private Utility-Type Facilities Transverse Crossings



2255 - Application for Approval to Provide Real Estate Acquisition & Relocation Services



2271 - Water Meter Letter



2279 - Special Conditions for Mowing and Brush Cutting



2280 - Trunkline Usage Review Sheet



2286 - Utilities Status Report



2289 - Consent to Access Highway via Joint Driveway System



2292 - Special Conditions for Closure of a State Highway by Local Governmental Agency



2410 - Protective Maintenance Use Permit



2411 - Technician's Work Sheet



2432 - Special Conditions for Traffic Signal Installation



2433 - Special Conditions for Sidewalk Cafe Permits



2445 - Non-Residential Building Rental Agreement



2446 - Residential Building Rental Agreement



2457 - Special Conditions for Wildflower Seed Collection



2458 - Special Conditions for Distribution of Travel Related Information



2459 - Special Conditions for Harvesting Hay



2464 - L-CAR/MITRIP Construction Restriction Request



2465 - Route Survey Certification



2475 - Special Conditions for Alternative Environmental Cleanup Methods



2480 - Letter Requesting Utility Information at Base Plan Stage



2481 - Letter to Public/Private Utilities at Preliminary Plan Stage



 

 

 
________________________________________________________________________

 

"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] ] 
"

 

Manage Subscriptions [ [link removed] ]  |  Subscriber Help [ [link removed] ]  |  Having trouble viewing this email? View it as a Web page [ [link removed] ].
________________________________________________________________________

This email was sent to [email protected] using GovDelivery Communications Cloud on behalf of: Michigan DOT · 425 W. Ottawa St. · Lansing, MI 48909 · 517-241-2400