BLR FORMS
Last updated:
January 13, 2012
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| 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
|
|
BLR 00300 |
|
Directory of County Officials |
C |
|
BLR 00400 |
|
Directory of Municipal Officials |
M |
|
BLR 02110 |
5/19/09 |
Resolution
Certifying Names to Take the Examination for County Engineer |
C |
|
BLR 02111 |
5/19/09 |
Resolution Certifying Names to take the Examination for Co. Eng. & Requesting
the Consent of IDOT to the Reappointment of the incumbent |
C |
|
BLR 02120 |
5/28/09 |
Resolution
Requesting Consent of IDOT to the Reappointment of the Incumbent as County
Engineer |
C |
|
BLR 02121 |
5/28/09 |
Resolution Reappointing County Engineer |
C |
|
BLR 02122 |
5/28/09 |
Resolution
Appointing County Engineer (Fixed Salary) |
C |
|
BLR 02123 |
5/28/09 |
Resolution Appointing County Engineer |
C |
|
BLR 02124 |
5/28/09 |
Resolution
Concurring in the Joint Appointment of a County Engineer
|
C |
|
BLR 02125 |
5/28/09 |
Resolution Appointing a County Engineer Jointly with County
|
C |
|
BLR 02130 |
5/28/09 |
Resolution
Requesting Consent of the IDOT to the Appointment of an Acting County Engineer |
C |
|
BLR 03210
|
01/07 |
Resolution Establishing a Class II or Class III
Designated Truck Route
|
C, M |
|
BLR 03211 |
|
Local Agency Truck
Route Designation Update |
|
|
BLR 04100 |
12/14/11 |
Project Application
for Local Rail-Highway Crossing Safety Program |
|
| BLR 04310
|
05/19/09 |
Ordinance for
Municipal Census |
M |
| BLR 04311
|
05/19/09 |
Affidavit
for Municipal Census |
M |
|
BLR 04312
|
03/30/10 |
Affidavit for
Municipal Annexation |
M |
|
BLR 05210
|
04/08/08 |
Local Agency-State
Jurisdictional Transfer |
C,R,M |
|
BLR 05211 |
04/08/08 |
Local Agency-State
Agreement for Jurisdictional Transfer
|
C,R,M |
|
BLR 05212
|
04/08/08 |
Local
Agency Agreement for Jurisdictional Transfer
|
C,R,M |
|
BLR 05310
|
01/06/12 |
Local
Agency Agreement for Federal Participation
| C,M
|
|
BLR 05311 |
01/06/12 |
Local Agency Amendment
for Federal Participation |
C,M |
|
BLR 05320
|
01/06/12 |
Economic Development
Program Agreement |
C,M |
|
BLR 05321
|
01/06/12 |
Truck Access Route Program (TARP) Agreement |
C,M |
|
BLR 05322 |
01/06/12 |
Economic
Development/TARP Agreement |
C,M |
|
BLR 05323 |
01/06/12 |
Local Agency/State Agreement (Non-Federal) |
|
|
BLR 05510
|
11/06 |
Preliminary Engineering Services Agreement for
Motor Fuel Tax Funds
|
C,M |
|
BLR 05511
|
11/06 |
Preliminary Engineering and Construction Guidance
Agreement for MFT Funds
|
C,M |
|
BLR 05512
|
01/10/12 |
Preliminary Construction Engineering Services
Agreement for MFT Funds
|
C,M |
|
BLR 05520
|
12/06/11 |
Maintenance Engineering to be Performed by a
Consulting Engineer
|
C,M |
| BLR 05610 |
09/06 |
Preliminary
Engineering Service Agreement for Federal Participation |
C,M |
|
BLR 05611
|
01/10/12 |
Construction Engineering Services Agreement for
Federal Participation
|
C,M |
|
BLR 05612
|
03/30/10 |
Request for Construction Engineering Services
Performed by Local Forces |
C,M |
|
BLR 05613 |
03/30/10 |
Engineering Payment
Record |
C,M |
|
BLR 05620 |
11/06 |
Invoice |
C,R,M |
|
BLR 06310
|
04/16/10 |
Bridge Record
|
C,M |
|
BLR 06510
|
06/07 |
Local Agency Load Rating Request
|
C,R,M |
|
BLR 09110 |
11/06 |
Resolution for Improvement by County Under the Illinois Highway Code |
C |
|
BLR 09111 |
11/06 |
Resolution for Improvement by Municipality Under the Illinois Highway Code |
M |
|
BLR 09112 |
03/15/10 |
Local Agency
Resolution of Intent MFT/G.O. Bond |
|
|
BLR 09113 |
03/15/10 |
Municipal Resolution
of Intent for Special Assessment |
M |
|
BLR 09120 |
11/06 |
Statement of
Proposed Road Improvement |
C,R |
|
BLR 09130 |
06/07 |
Co.
Request for Rd. Dist. Motor Fuel Tax Funds to be Used to Retire Indebtedness |
C |
|
BLR 09140 |
07/05 |
Statement of
Financing of Local Improvement Project |
M |
|
BLR 09150 |
11/06 |
Request
for Expenditure/Authorization of Motor Fuel Tax Funds
|
C,R,M |
|
BLR 09210 |
9/28/07 |
Township
Bridge Program |
C |
| BLR 09220
|
07/05 |
Agreement for County Engineer's Salary |
C |
|
BLR 09221 |
12/04/09 |
Resolution Appropriating Funds for the Payment of
the County Engineer's Salary |
|
|
BLR 10100 |
10/9/08 |
Motor Fuel Tax Certification/Project Status |
|
|
BLR 10210
|
11/06 |
Preliminary Bridge and Hydraulic Report
|
C,M |
|
BLR 10220
|
07/05 |
Asbestos Determination Certification for Local
Highway Bridges
|
C,M |
|
BLR 11310
|
07/05 |
Special Provisions
|
C,M |
|
BLR 11510 |
07/05 |
Estimate of Cost
|
C,R,M |
|
BLR 12110 |
02/26/10 |
Rental Schedule of
Privately Owned Equipment |
C,R,M |
|
BLR 12210
|
12/08/08 |
Proposal / Contract Cover
|
C,R,M |
|
BLR 12220
|
01/09/08 |
Notice to Bidders
|
C,R,M |
|
BLR 12221
|
07/05 |
Proposal
|
C,R,M |
|
BLR 12222
|
4/1/09 |
Schedule of Prices
|
C,R,M |
|
BLR 12223 |
07/05 |
Signatures
|
C,R,M |
|
BLR 12230 |
07/05 |
Local Agency Proposal Bid Bond
|
C,R,M |
|
BLR 12240
|
12/06 |
Notice of Material Letting
|
C,R,M |
|
BLR 12241
|
07/05 |
Material Proposal Schedule of Prices
|
C,R,M |
|
BLR 12250 |
07/05 |
Request for Quotations
|
C,R,M |
|
BLR 12310 |
6/3/08 |
Computer Data for Contractors Bulletin
|
C,M |
|
BLR 12315 |
07/09/10 |
Tabulation of Bids |
C,R,M |
|
BLR 12320 |
07/05 |
Contract
|
C,R,M |
|
BLR 12321
|
07/05 |
Contract Bond
|
C,R,M |
|
BLR 12325 |
04/07 |
Apprenticeship or Training Program Certification
|
|
|
BLR 12330
|
07/05 |
Acceptance of Proposal to Furnish Materials and
Approval of Award
|
C,R,M |
|
BLR 13210
|
02/04/10 |
Request for Approval of Change in Plans
|
C,R,M |
|
BLR 13220
|
7/21/08 |
Local Agency/Contractor Trust Agreement
|
C,R,M |
|
BLR 13230 |
07/05 |
Engineer's Payment Estimate
|
C,R,M |
|
BLR 13231
|
01/06 |
Engineer's Final Payment Estimate
|
C,R,M |
|
BLR 13310
|
07/05 |
Certification of Local Agency Material Test
Procedures
|
C,M |
|
BLR 13311
|
07/05 |
Local Agency Report of Certified/Approved Asphalt
|
C,R,M |
|
BLR 13312 |
4/07 |
Contractor's Report of Source of Materials |
|
|
BLR 13510
|
02/04/10 |
Final Report, Notice of Completion and Acceptance
of Improvement Constructed Under the Illinois
|
C,R,M |
|
BLR 14210 |
1/4/06 |
Special
Assessments - Public Benefit Retirement Schedule |
M |
|
BLR 14220 |
11/06 |
County Maintenance
Resolution |
C |
|
BLR 14221
|
02/03/10 |
County or Township Estimate of Maintenance Costs
|
C,R |
|
BLR 14230 |
11/06 |
Resolution for Maintenance of Streets and Highways by Municipality
|
M |
|
BLR 14231
|
02/06 |
Municipal Estimate of Maintenance Costs
|
M |
|
BLR 14232
|
07/05 |
Municipal Maintenance Operations
|
M |
|
BLR 14310
|
12/05 |
Municipal Maintenance Expenditure Statement
|
M |
|
BLR 14320
|
08/05 |
MFT Maintenance Expenditure Statement
|
C,R |
|
BLR 15110 |
07/05 |
Credit Transaction
for Motor Fuel Tax Account |
C,R,M |
|
BLR 15310 |
07/05 |
General Improvement
Bond Issues-Description, Ordinance, Election and Bond Data |
C,M |
|
BLR 15311 |
7/18/08 |
General
Improvement or Refunding Bond Issues - Tax Levy and Bond Retirement Schedule |
C,M |
|
BLR 15312 |
07/05 |
Refunding or
Refinancing Bond Issues-Issued to Retire General Improvement Bonds or Public
Benefits |
C,M |
|
BLR 15313 |
07/05 |
Refunding
or Refinancing Bond Issues Schedule |
|
|
BLR 15314 |
07/05 |
Certification
Cancellation of Tax Levy |
R,M |
|
BLR 15410 |
07/05 |
Special
Assessments-Description Court, Legal, and Financial Data |
M |
|
BLR 15411 |
07/05 |
Obligation
Retirement Resolution |
C,M |
|
BLR 19100 |
03/09 |
Categorical Exclusion Group I |
C.M |
|
BLR 22120
|
11/06 |
Approval of Design Variance
|
C,M |
|
BLR 22210 |
3/5/09 |
Local Project Development Report for Group II
Categorical Exclusions and Design Approval
|
C,M |
|
BLR 22211 |
5/5/09 |
Local Project Development Report for Group I
Categorical Exclusions and Design Approval
|
C,M |
|
BLR 22410
|
5/8/09 |
Initial Coordination Meeting Data
|
C,M |
|
BLR 24110
|
07/05 |
Certification/Project Status
|
|
|
BLR 24310 |
01/12/10 |
Unit Prices Agreement |
C,R,M |
|
BLR 33410
|
11/18/11 |
See Form BLR 46300
|
|
|
BLR 45300 |
11/21/11 |
Pavement Preservation Program Participation |
|
|
BLR 45310 |
11/21/11 |
Estimate of Pavement Preservation Costs Approval |
|
|
BLR 45320 |
11/21/11 |
Estimate of Pavement Preservation Costs |
|
|
BLR 46300 |
11/18/11 |
Local Agency Pavement Preservation or Functional
Overlay Approval |
C,M |
|
BoBS 3952 |
12/15/10 |
Request for Road, Bridge, and Other Related Laws of Illinois
- 2010 Edition |
|
|
|
