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BLR FORMS
Last updated: July 11, 2014

If you have questions regarding this conversion, please e-mail Rhonda.Leinberger@illinois.gov.
 

In order to provide continuity and simplicity in the administration and expenditure of funds, the Department has provided a number of pre-printed forms for local agency use. These forms have been reproduced in an electronic format to be readily accessible and more easily used.
The Files below are MS Word templates. If you do not have MS Word to read these files, see Tips and Tools for a free copy of WordViewer.

Notice: The BLR Forms have been renumbered to correspond with chapters in the new BLR Manual. Please use the Cross Reference Sheet listing Old to New BLR Forms, or the Cross Reference Sheet listing New to Old BLR Forms to reference the appropriate form. The first two numbers refer to chapter. The third number refers to section. The last two numbers are sequential. For example, BLR 05610: Chapter = 05, Section = 6 and Sequence = 10.
Use of the new forms is effective July 1, 2005, but old forms will be accepted until July 31, 2005. Old forms received after July 31, 2005 will be returned.

Usage Key: C = County, R = Road District, M = Municipality
 

Form

Revised

Description

Usage

BLR 00300 1/13/2009 Directory of County Officials C
BLR 00400 1/13/2009 Directory of Municipal Officials M

BLR 02110

5/19/2009

Resolution Certifying Names to Take the Examination for County Engineer

C

BLR 02111

5/19/2009

Resolution Certifying Names to take the Examination for Co. Eng. & Requesting the Consent of IDOT to the Reappointment of the incumbent

C

BLR 02120

5/28/2009

Resolution Requesting Consent of IDOT to the Reappointment of the Incumbent as County Engineer

C

BLR 02121

5/28/2009

Resolution Reappointing County Engineer

C

BLR 02122

5/28/2009

Resolution Appointing County Engineer (Fixed Salary)

C

BLR 02123

5/28/2009

Resolution Appointing County Engineer

C

BLR 02124

5/28/2009

Resolution Concurring in the Joint Appointment of a County Engineer

C

BLR 02125

5/28/2009

Resolution Appointing a County Engineer Jointly with  County

C

BLR 02130

5/28/2009

Resolution Requesting Consent of the IDOT to the Appointment of an Acting County Engineer

C

BLR 03210

6/10/2009

Resolution Establishing a Class II or Class III Designated Truck Route

C, M
BLR 03211 1/28/2009 Local Agency Truck Route Designation Update  
BLR 04100 12/13/2011 Project Application for Local Rail-Highway Crossing Safety Program  

BLR 04310

6/10/2009

Ordinance for Municipal Census

M

BLR 04311

5/19/2009

Affidavit for Municipal Census

M

BLR 04312

3/30/2010

Affidavit for Municipal Annexation

M

BLR 05210

4/8/2008 Local Agency-State Jurisdictional Transfer C,R,M

BLR 05211

4/8/2008

Local Agency-State Agreement for Jurisdictional Transfer

C,R,M

BLR 05212

4/8/2008

Local Agency Agreement for Jurisdictional Transfer

C,R,M

BLR 05310

07/11/14

Local Agency Agreement for Federal Participation

C,M
BLR 05311 07/11/14 Local Agency Amendment for Federal Participation C,M

BLR 05320

07/11/14

Economic Development Program Agreement

C,M

BLR 05321

07/11/14

Truck Access Route Program (TARP) Agreement

C,M
BLR 05322 07/11/14 Economic Development/TARP Agreement C,M
BLR 05323 07/11/14 Local Agency/State Agreement (Non-Federal)  

BLR 05510

11/1/2006

Preliminary Engineering Services Agreement for Motor Fuel Tax Funds

C,M

BLR 05511

11/1/2006

Preliminary Engineering and Construction Guidance Agreement for MFT Funds

C,M
BLR 05512 1/10/2012

Preliminary Construction Engineering Services Agreement for MFT Funds

C,M

BLR 05520

12/6/2011

Maintenance Engineering to be Performed by a Consulting Engineer

C,M
BLR 05610 11/21/2013 Preliminary Engineering Service Agreement for Federal Participation C,M

BLR 05611

1/10/2012

Construction Engineering Services Agreement for Federal Participation

C,M

BLR 05612

3/30/2012

Request for Construction Engineering Services Performed by Local Forces

C,M
BLR 05613 11/21/2013 Engineering Payment Record C,M

BLR 05620

11/1/2006

Invoice

C,R,M

BLR 06310

4/16/2010

Bridge Record

C,M

BLR 06510

6/1/2007

Local Agency Load Rating Request

C,R,M

BLR 09110

7/15/2013

Resolution for Improvement by County Under the Illinois Highway Code

C

BLR 09111

11/1/2006

Resolution for Improvement by Municipality Under the Illinois Highway Code

M
BLR 09112 3/15/2010 Local Agency Resolution of Intent MFT/G.O. Bond  
BLR 09113 3/15/2010 Municipal Resolution of Intent for Special Assessment M

BLR 09120

11/1/2006

Statement of Proposed Road Improvement

C,R

BLR 09130

6/1/2007

Co. Request for Rd. Dist. Motor Fuel Tax Funds to be Used to Retire Indebtedness

C

BLR 09140

7/1/2005

Statement of Financing of Local Improvement Project

M

BLR 09150

11/1/2006

Request for Expenditure/Authorization of Motor Fuel Tax Funds

C,R,M
BLR 09210 9/28/2007 Township Bridge Program C
BLR 09215 3/9/2012 Resolution for the Anticipation of Township Bridge Funds  

BLR 09220

7/7/2005

Agreement for County Engineer's Salary

C
BLR 09221 11/21/2013 Resolution Appropriating Funds for the Payment of the County Engineer's Salary  
BLR 10100 10/8/2008 Motor Fuel Tax Certification/Project Status  

BLR 10210

11/1/2006

Preliminary Bridge and Hydraulic Report

C,M

BLR 10220

7/1/2005

Asbestos Determination Certification for Local Highway Bridges

C,M

BLR 11310

7/1/2005

Special Provisions

C,M

BLR 11510

7/1/2005

Estimate of Cost

C,R,M
BLR 12110 2/3/2010 Equipment Rental Schedule  
BLR 12200 1/8/2014 Local Public Agency Formal Contract Proposal  
BLR 12200a 1/8/2014 Schedule of Prices  

BLR 12230

7/1/2005

Local Agency Proposal Bid Bond

C,R,M

BLR 12240

1/9/2014

Local Public Agency Material Proposal or Deliver & Install Proposal

C,R,M

BLR 12241

7/1/2005

Material Proposal Schedule of Prices

C,R,M

BLR 12250

7/1/2005

Request for Quotations

C,R,M

BLR 12310

6/3/2008

Computer Data for Contractors Bulletin

C,M
BLR 12315 7/16/2013 Tabulation of Bids C,R,M

BLR 12320

1/9/2014

Local Public Agency Formal Contract

C,R,M

BLR 12321

7/1/2005

Contract Bond

C,R,M
BLR 12325 4/1/2007 Apprenticeship or Training Program Certification  
BLR 12326 1/8/2014 Affidavit of Illinois Business Office  

BLR 12330

2/8/2014

Acceptance of Proposal to Furnish Materials and Approval of Award

C,R,M

BLR 13210

2/18/2014

Request for Approval of Change in Plans

C,R,M

BLR 13220

7/21/2008

Local Agency/Contractor Trust Agreement

C,R,M

BLR 13230

9/24/2012

Engineer's Payment Estimate

C,R,M

BLR 13231

1/1/2006

Engineer's Final Payment Estimate

C,R,M

BLR 13310

7/1/2005

Certification of Local Agency Material Test Procedures

C,M

BLR 13311

7/1/2005

Local Agency Report of Certified/Approved Asphalt

C,R,M
BLR 13312 4/1/2007 Contractor's Report of Source of Materials  

BLR 13510

2/18/2014

Final Report, Notice of Completion and Acceptance of Improvement Constructed Under the Illinois

C,R,M

BLR 14210

7/1/2005

Special Assessments - Public Benefit Retirement Schedule

M

BLR 14220

7/15/2013

County Maintenance Resolution

C

BLR 14221

2/18/2014

County or Township Estimate of Maintenance Costs

C,R

BLR 14230

7/15/2013

Resolution for Maintenance of Streets and Highways by Municipality

M

BLR 14231

2/18/2014

Municipal Estimate of Maintenance Costs

M

BLR 14232

7/1/2005

Municipal Maintenance Operations

M

BLR 14310

7/16/2013

Municipal Maintenance Expenditure Statement

M

BLR 14320

7/16/2013

MFT Maintenance Expenditure Statement

C,R

BLR 15110

7/1/2005

Credit Transaction for Motor Fuel Tax Account

C,R,M

BLR 15310

7/1/2005

General Improvement Bond Issues-Description, Ordinance, Election and Bond Data

C,M

BLR 15311

7/1/2005

General Improvement or Refunding Bond Issues - Tax Levy and Bond Retirement Schedule

C,M

BLR 15312

7/1/2005

Refunding or Refinancing Bond Issues-Issued to Retire General Improvement Bonds or Public Benefits

C,M

BLR 15313

7/1/2005

Refunding or Refinancing Bond Issues Schedule  

 

BLR 15314

7/1/2005

Certification Cancellation of Tax Levy

R,M

BLR 15410

7/1/2005

Special Assessments-Description Court, Legal, and Financial Data

M

BLR 15411

7/1/2005

Obligation Retirement Resolution

C,M
BLR 19100 8/26/2013 Categorical Exclusion Group I C.M

BLR 22120

11/1/2006

Approval of Design Variance

C,M
BLR 22210 11/20/2013 Local Project Development Report for Group II Categorical Exclusions and Design Approval  C,M
BLR 22211 11/20/2013 Local Project Development Report for Group I Categorical Exclusions and Design Approval C,M

BLR 22410

5/8/2009

Initial Coordination Meeting Data

C,M

BLR 24110

7/1/2005

Certification/Project Status

 
BLR 24310 1/12/2010 Unit Prices Agreement C,R,M
BLR 45300 11/21/2011 Pavement Preservation Program Participation  
BLR 45310 11/21/2011 Estimate of Pavement Preservation Costs Approval   
BLR 45320 11/21/2011 Estimate of Pavement Preservation Costs  
BLR 46300 09/24/2012 Local Agency Pavement Preservation or Functional Overlay Approval C,M

If you are unable to utilize these files and need further information, please e-mail Rhonda.Leinberger@illinois.gov

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