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June 2023 MDOT Electronic Forms Update
Michigan DOT sent this bulletin at 07/05/2023 12:49 PM EDT|
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All MDOT forms can be located at the MDOT Forms homepage located at: MDOT - WebForms (state.mi.us)
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 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:
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REVISIED |
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Form Number |
Form Name |
Division Name |
Form Revision Date |
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0193 |
Disadvantaged Business Enterprise (DBE) Supplier Participation Affidavit |
Office of Business Development |
6/8/23 |
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0204 |
General Computation |
BFS-Construction Field Services |
6/14/23 |
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0371 |
Continuing Education Activity Request for Professional Engineers and Surveyors |
Design Division |
6/8/23 |
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0397 |
Work Zone Audit Report |
BFS-Construction Field Services |
6/2/2023 |
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0426 |
Quotation Request for Services or Equipment |
BFS-Transportation Systems Management Operations |
6/8/23 |
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0501 |
Materials Source List |
BFS-Construction Field Services |
6/7/23 |
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0561 |
MDOT Lane Closure Notification/ Request Form |
BFS-Construction Field Services |
6/14/23 |
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0565 |
Work Zone Enforcement Agreement with Local Agency Police and MDOT |
BFS-Construction Field Services |
6/28/23 |
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0612D |
Restricted Appraisal Report for Non-Condemnation Related Valuation |
DSD-Appraisal |
6/5/23 |
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0633A |
Noncompensable Items of Damage in Eminent Domain Proceedings and Michigan Law Regarding Benefits |
DSD-Appraisal |
6/5/23 |
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1100A |
Extension of Contract Time-Request Number |
BFS-Construction Field Services |
6/2/2023 |
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1105A |
Final Estimate Submittal Form |
BFS-Construction Field Services |
6/8/23 |
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1107 |
Daily Weight Record |
BFS-Construction Field Services |
6/2/2023 |
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1013S |
Inspector's Checklist for Inspection for Solar Boards |
BFS-Construction Field Services |
6/7/23 |
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1122B |
Inspector's Daily Report |
BFS-Construction Field Services |
6/22/23 |
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1122C |
Inspector's Daily Report Worksheet |
BFS-Construction Field Services |
6/7/23 |
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1126 |
National Pollutant Discharge Elimination System (NPDES) and Soil Erosion and Sedimentation Control (SESC) Inspection Report |
BFS-Construction Field Services |
6/13/23 |
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1130 |
Progress Schedule |
BFS-Construction Field Services |
6/7/23 |
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1130A |
Progress Schedule - 2020 Spec Book |
BFS-Construction Field Services |
6/22/23 |
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1156-T1 |
Minimum Wage Rate Interview Sheet Tier 1 |
BFS-Construction Field Services |
6/2/2023 |
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1156-T2 |
Minimum Wage Rate Interview Sheet Tier 2 |
BFS-Construction Field Services |
6/6/23 |
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1160A |
Concrete Cylinder/Core Compression Test Results |
BFS-Construction Field Services |
6/8/23 |
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1165 |
Notice of Non-Compliance with Contract Requirements |
BFS-Construction Field Services |
6/5/2023 |
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1302-FED |
Subcontract - FED |
BFS-Construction Field Services |
6/8/23 |
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1302-State |
Subcontract- State |
BFS-Construction Field Services |
6/8/23 |
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1366 |
Contractor's Affidavit of Indebtedness |
Contract Services Division |
6/8/23 |
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1367 |
Consent of Surety for Payment to Contractor |
Contract Services Division |
6/8/23 |
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1585 |
Pavement Marking Material Verification Checklist |
BFS-Transportation Systems Management Operations |
6/13/23 |
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1903 |
Daily Report of Bituminous Plant Inspection |
BFS-Construction Field Services |
6/22/23 |
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1907 |
Report of Compacted Bituminous Mixture Core Density & Percent Compaction |
BFS-Construction Field Services |
6/22/23 |
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1907J |
Report of Compacted Longitudinal Joint Core Density & Percent Compaction |
BFS-Construction Field Services |
6/22/23 |
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1994 |
Stake Request Form |
BFS-Construction Field Services |
6/2/2023 |
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1967 |
Jobsite Poster Inspection Checklist |
BFS-Construction Field Services |
6/6/23 |
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2620 |
Operation of New Public Transportation Service |
Transportation Planning |
6/22/23 |
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2071 |
Funding Application for Local Agency Highway-Railroad Grade Crossing Surface Improvement Projects |
Office of Rail |
6/8/23 |
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2142 |
Category B: Community Service Infrastructure Fund Application |
Office of Economic Development |
6/8/23 |
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2217 |
Notice and Order to Remove Encroachment |
DSD-Permits-Construction |
6/13/23 |
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2224 |
Notice and Order to Comply |
DSD-Permits-Construction |
6/13/23 |
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2480 |
Letter Requesting Utility Information at Base Plan Stage |
DSD-Permits-Utility Coordination |
6/13/23 |
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2481 |
Letter to Public/Private Utilities at Preliminary Plan Stage |
DSD-Permits-Utility Coordination |
6/13/23 |
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2482 |
Letter to Municipal Utilities at Preliminary Plan Stage |
DSD-Permits-Utility Coordination |
6/13/23 |
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2492 |
Non-Holiday Coffee Break Permit Application Return Letter |
DSD-Permits-Construction |
6/13/23 |
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3757 |
Affidavit of Notification |
DSD-Permits-Construction |
6/13/23 |
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3764D |
Temporary Closing Order for ORV Connector Route on State Highway |
DSD-Permits-Construction |
6/13/23 |
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3765 |
Authorization to Re-Open ORV Connector Route on State Highways |
DSD-Permits-Construction |
6/13/23 |
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3766 |
Order to Close ORV Connector route on State Highway |
DSD-Permits-Construction |
6/13/23 |
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4106 |
Small Business Program Application |
Office of Business Development |
6/21/23 |
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5022 |
Request for Payment |
Office of Economic Development |
6/30/23 |
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5105 |
Contract Request |
Contract Services Division |
6/15/23 |
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5601 |
MDOT Core Log and Chain of Custody |
BFS-Construction Field Services |
6/6/23 |
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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 |
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3536 |
Compliance Certification Form for LAP Projects With Federal Aid Highway Program (FAHP) Funding |
DSD-Local Agency Program |
6/14/23 |
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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 |
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1174S – Inspector's Report of concrete Placed - Structure 1031 - Request for Electronics Equipment Repair |
Transfer from CFS to BOBS-Bridge Construction |
Obsolete Forms:
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0072 - Employer Inquiry for Special Placement in the Transportation Maintenance Work Element Program |
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0434 - Emergency Information Form |
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1886 - Life Cycle Cost Analyst Assumption Sheet |