2006 Construction Manual

Forms and Reports

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The following forms are intended for use by personnel working on Illinois Department of Transportation contracts. It is important that the instructions for completing these forms are read and understood.

It is your responsibility to obtain and use the most current version of each form.

*Asterisks next to the links indicate that the file has been updated and is posted on the Addendum page.

Introduction

Bureau of Bridges and Structures Forms

Form Number	Form Name
BBS 59	Structural Steel Fabrication
BBS 2557	Pre Project Environmental Submittal Review Checklist
BBS 2558	Pre Project Painting Submittal Review Checklist
BBS 2559	Contractor Environmental Daily Report
BBS 2560A	Non-Conformance Report
BBS 2560B	Non-Conformance Log
BBS 2561	Construction Inspector Project Start Up Checklist
BBS 2562	Construction Inspector Daily (QA) Report
BBS 2563	Contractor Daily (QC) Report

Bureau of Construction Forms

Form Number	Form Name
BC 20*	Affidavit
BC 22*	Authorization of Contract Changes
BC 22 (Excel)	Authorization of Contract Changes
BC 24*	Request for Procurement Policy Board Waiver
BC 49	Material Allowance Affidavit
BC 71*	Final Inspection Report of State Road Work
BC 107	Final Acceptance of Improvement
BC 111*	Checklist for Engineer's Final Payment Estimate
BC 131*	Statement of Material Allowances
BC 163	Report of Employee Interviews
BC 239*	Weekly Report of Resident
BC 255	Progress Schedule
BC 260A*	Request for Approval of Subcontractor
BC 261*	Substance Abuse Prevention Program Certification
BC 334	Core Drill Report - Final Samples
BC 503*	Assignment of Contract/Consent to Assignment of Contract
BC 608	Local Agency Certification to Accompany Engineer's Final Payment Estimates
BC 623	Quantity Book Cover Sheet
BC 625	Quantity Sheet
BC 628	Inspector's Daily Report
BC 635*	Extra Work Daily Report
BC 726	Traffic Control Inspection Report
BC 775	Resident Construction Supervision
BC 776	Resident Inspection - Local Project
BC 777	Notice of Nondiscrimination Clause
BC 930	Consultant Engineer's Daily Personnel and Vehicle Time Distribution Record
BC 931	Consultant Engineer's Private Vehicle Daily Mileage Record
BC 932	Consultant Engineer's Monthly Vehicle Cost Distribution Record
BC 955	Notice of EEO Policy and EEO Officer
BC 981*	Agreement on Accuracy of Plan Quantities (English)
BC 981M*	Agreement on Accuracy of Plan Quantities (Metric)
BC 1012	Certification of Nonsegregated Facilities
BC 1013	Progress Documentation Review
BC 1131	Report of Telephone Calls
BC 1215	Resident Engineer's Request for Authorization for Change Orders
BC 1241	Performance Bond
BC 1256*	Bidder's Employee Utilization Form Construction
BC 1465	Truck Tare Weights
BC 1777*	Contractor's Performance Evaluation
BC 1778	Numerical Guidelines for Use With Contractor's Performance Evaluation
BC 2015	Qualification for Welding Steel Bearing Splices Only
BC 2019	Request for Extension of Time
BC 2115	Subcontractor Payment Agreement (Non-DBE)
BC 2240	Traffic Control Surveillance Report
BC 2256*	Prior Approval Authorization of Contract Change
BC 2259*	NPDES/Erosion Control Inspection Report
BC 2320	Rotational Capacity Test Worksheet
BC 2331*	ICORS PC Backup Schedule
BC 2370*	Equipment Expense Rate Data
BC 2448A	Profile Report for Pavement Smoothness
BC 2448B	Smoothness Assessment Worksheet
BC 2529	Bituminous Paving Daily Record
BC 2531	PCC Paving Daily Record
BC 2544	Report of Bridge Deck Patching Quantities

Bureau of Design and Environment Forms

Form Number	Form Name
BDE 430	Invoice
BDE 804	Request for Authorization for Costs Involving Utility, Railroad or Local Agency Agreement
BDE 2289	Environmental Survey Request, Borrow/Waste/Use Areas
BDE 2342 & 2342A	Contractor Certification Statement

Bureau of Operations Forms

Form Number	Form Name
OPER 725 (formerly BT 725)	Traffic Control Authorization Request
OPER 726	Traffic Control Inspection Report

Federal Highways Administration Forms

Form Number	Form Name
FHWA 47*	Statement of Materials and Labor Used by Contractors on Highway Construction Involving Federal Funds (English)
FHWA 47M*	Statement of Materials and Labor Used by Contractors on Highway Construction Involving Federal Funds (Metric)
FHWA 1495	Wage Rate Information

Illinois Department of Public Health Forms

Form Number	Form Name
IL 482-0631	Water Well Sealing Form

Bureau of Materials and Physical Research Forms

Form Number	Form Name
LM 6	Sample Identification
LW 3	Record of Modulus of Rupture Tests
M 411	Report of Net Cost of Section
MI 303N	QC/QA Quality Assurance Nuclear Density Report QC/QA
MI 305	QC/QA-B Bituminous Mixture Daily Plant Output Hot Bin/Cold Feed QC/QA
MI 308	QC/QA-B Nuclear Asphalt Content and Marshall
MI 504	Field/Lab Gradations
MI 504M	QC/QA Field Lab Gradations
MI 654	Concrete, Air, Slump and Quantity
MI 655	Portland Cement Concrete Strengths
MI 701N	Field Soil Compaction (Nuclear)
MIRC 08	Approved Material Inspection Report

Illinois Environmental Protection Agency Forms

Form Number	Form Name
	Notice of Open Burn *
WPC 621 *	IEPA Notice of Termination (NOT) of Coverage Under the General Permit for Storm Water Discharges Associated with Construction Site Activity
WPC 623 *	IEPA Notice of Intent (NOI) General Permit to Discharge Storm Water Construction Site Activities
WPC 624	IEPA Construction Site Storm Water Discharge Incidence of Non-Compliance (ION)

Bureau of Small Business Enterprises Forms

Form Number	Form Name
SBE 348	Statement of Compliance
SBE 746	Contractor's Weekly Payroll Certificate
SBE 750	Workforce Contact Inspection Report
SBE 956	Equal Employment Opportunity Workforce Analysis
SBE 956c	Consultant's Employee Utilization
SBE 1008	Equal Employment Opportunity Checklist
SBE 1014	Weekly Trainee Report
SBE 1146	Request for Approval of Contractor's Proposed Training Program
SBE 2025	DBE Participation Statement
SBE 2026	DBE Utilization Plan
SBE 2028	DBE/WBE Final Documentation
SBE 2115	DBE Payment Agreement
SBE 2263	Notice Pertaining to False Statements