California Department of Transportation

Local Assistance Procedures Manual (LAPM) Forms

All forms below are provided in PDF version, while corresponding word version (or excel) of forms may be available for downloading when available Word Icon (or Excel Icon ) is clicked.

If you need a special form (fillable PDF version or Word version), which is not posted in the following table, or find any error on the form, please contact DLA.Webmaster@dot.ca.gov

Chapter 2   Roles and Responsibilities
Exhibit 2-A: Caltrans Local Assistance Offices Exhibit 2-B: Federal-Aid Project Responsibilities List for Delegated Projects Off SHS
Chapter 3    Project Authorization
Exhibit 3-A: Request for Authorization to Proceed with Preliminary Engineering (fillable)
Exhibit 3-B: Request for Authorization to Proceed with Right of Way (fillable)
Exhibit 3-C: Request for Authorization to Proceed with Utility Relocation (fillable)
Exhibit 3-D: Request for Authorization to Proceed with Construction (fillable)
Exhibit 3-E: Request for Authorization to Proceed Data Sheet(s)(fillable)
Exhibit 3-F: Instructions for Request for Authorization Data Sheet
Exhibit 3-G: Federal Project Log Sheet (Minimum Requirements) (fillable)
Exhibit 3-H: Request for Capital Subvention Reimbursement Allocation (fillable)
Exhibit 3-I: Request for Local Advance Construction Authorization (fillable)
Exhibit 3-J: Request for Transfer of Federal Funds to the Federal Transit Administration
Exhibit 3-K: Administrative Procedures for Transfer of Funds to FTA
Exhibit 3-L: Local Assistance Project Prefixes (fillable)
Exhibit 3-M: Federal Highway Transportation Programs
Exhibit 3-N: Federal Highway Discretionary Programs
Exhibit 3-O: Sample "Local Federal-Aid Finance Letter" (fillable--user has to enter all data)
Exhibit 3-P: Sample "Delegated Project Authorization"
Exhibit 3-Q: Request for Authorization to Proceed with Non-Infrastructure Project (fillable)
Exhibit 3-R: Non-Infrastructure Project Work Plan Sample (fillable)
Chapter 4     Agreements
Exhibit 4-B: Local Agency Agreement Execution Checklist (fillable)
Exhibit 4-C: Master Agreement
Exhibit 4-D: Sample-Program Supplement Agreement (fillable)
Chapter 5    Invoicing
Exhibit 5-A: Sample Federal-Aid Invoice (Except for STIP projects) (fillable)
Exhibit 5-B: Sample Federal-Aid Invoice with Different Rates (Except for STIP projects)(fillable)
Exhibit 5-C: Sample of State Project Invoice (fillable)
Exhibit 5-D: Sample Right of Way Invoice (fillable)
Exhibit 5-E: Sample of "STIP Project" Federal Invoice
Exhibit 5-F: Sample of "STIP Project: State Invoice
Exhibit 5-G: Alternative Payment Procedure Sample
Exhibit 5-I: Sample Indirect Cost Rate Proposal
Exhibit 5-J: Local Agency Invoice Review Checklist (fillable)
Exhibit 5-K: Billing Summary
Exhibit 5-L: Billing Summary Instructions
Exhibit 5-M: Sample Scenarios Pro Rata vs. Lump Sum Agreements
Chapter 6    Environmental Procedures
Exhibit 6-A: Preliminary Environmental Study (PES) Form (fillable)
Exhibit 6-B: Instructions for Completing the Preliminary Environmental Study (PES) Form
Exhibit 6-C: Table 2 - Exempt Projects
Exhibit 6-D: Table 3 - Exempt Projects
Exhibit 6-E: Categorical Exclusion Checklist (fillable)
Exhibit 6-F: Categorical Exemption/Categorical Exemption Determination Form (fillalbe)
Exhibit 6-G: NEPA/CEQA Revalidation Form (fillable)
Exhibit 6-H: External Certifications Environmental Document Quality Control Reviews (fillable)
Exhibit 6-I: Instructions for Completing the External Certifications
Exhibit 6-J: PES (NI) Form (fillable)
Exhibit 6-K: PES (NI) Form Instructions
Chapter 7    Field Review
Exhibit 7-A: Instructions for Field Review Form
Exhibit 7-B: Field Review Form (fillable)
Exhibit 7-C: Roadway Data (Fillable)
Exhibit 7-D: Major Structure Data (fillable)
Exhibit 7-E: Railroad Grade Crossing Data (fillable)
Exhibit 7-F: Airport Data (fillable)
Exhibit 7-G: Field Review Attendance Roster (fillable)
Exhibit 7-H: Deleted
Exhibit 7-I: Systems Engineering Review Form (SERF) (fillable)
Chapter  8    Public Hearings
Exhibit 8-A: Sample Notice of Public Hearing Exhibit 8-B: Sample Notice of Opportunity for Public Hearing
Chapter  9    Civil Rights and Disadvantaged Business Enterprises
Exhibit 9-A: DBE Implementation Agreement for Local Agencies (fillable)
Exhibit 9-B: Local Agency DBE Annual Submittal Form (fillable)
Exhibit 9-C: Local Agency ADA Annual Certification Form (fillable)
Exhibit 9-D: DBE Contract Goal Methodology
Exhibit 9-E: Sample Evaluation of Good Faith Effort (fillable)
Chapter 10    Consultant Selection
Exhibit 10-A: A&E Consultant Audit Request Letter and Checklist (fillable)
Exhibit 10-B: Suggested Consultant Evaluation Sheet (fillable)
Exhibit 10-C: Consultant Contract Reviewers Checklist (fillable)
Exhibit 10-D: Consultant Contract Outline (deleted)
Exhibit 10-E: Sample Payment Clauses (deleted)
Exhibit 10-F: Certification of Consultant, Commissions & Fees (deleted)
Exhibit 10-H: Sample Cost Proposal (Example #1 thru #3)
Exhibit 10-I: Notice to Proposers DBE Information
Exhibit 10-J: Standard Contract Provisions for Subconsultant/DBE Participation (deleted)
Exhibit 10-K: Consultant Certification of Contract Costs and Financial Management System Exhibit 10-L: Local Agency Certification of Cost Analysis (deleted)
Exhibit 10-M: Standard Audit Program Procedures (deleted)
Exhibit 10-N: Accounting & Auditing Guidelines for Contracts with Caltrans (deleted)
Exhibit 10-O1: Consultant Proposal DBE Commitment
Exhibit 10-O2: Consultant Contract DBE Information (fillable)
Exhibit 10-P: Nonlobbying Certification for Federal-Aid Contracts (deleted)
Exhibit 10-Q: Disclosure of Lobbying Activities (fillable)
Exhibit 10-R: A&E Sample Contract Language
Exhibit 10-S: Consultant Performance Evaluation
Exhibit 10-T: Panel Member Conflict of Interest & Confidentiality Statement (fillable)
Exhibit 10-U: Consultant in Management Position Conflict of Interest Statement (fillable)
Exhibit 10-V: Non-Discrimination Clause (deleted)
Chapter 11    Design Standards
Exhibit 11-A: Geometric Design Standards for Local 3R Projects
Exhibit 11-C: Foundation Investigations for Design
Exhibit 11-D: Preliminary Hydrologic/Hydraulic Review Summary (fillable)
Exhibit 11-E: Checklist for Drainage Studies and Reports
Exhibit 11-F: Design Exception Fact Sheet (fillable)
Chapter 12    Plans, Specifications, & Estimate
Exhibit 12-A: Preliminary Estimate of Cost (fillable)
Exhibit 12-B: Bidder's List of Subcontractors (DBE and NON-DBE) (fillable)
Exhibit 12-C: PS&E Certification (fillable)
Exhibit 12-D: PS&E Checklist (fillable)
Exhibit 12-E: PS&E Checklist Instructions
Exhibit 12-F: Request for Approval of Cost-Effectiveness/Public Interest Finding (fillable)
Exhibit 12-G: Required Federal-aid Contract Language
Exhibit 12-H: Sample Bid
Chapter 13    Right of Way
EXHIBIT 13-A: Short Form - Right of Way Certification for Local Assistance Project
EXHIBIT 13-B: Right of Way Certification (Off State Highway System)
Exhibit 13-C: Consultant Selection Criteria and Guide
Exhibit 13-D: Uniform Relocation Act Benefits Summary
Chapter 14    Utility Relocations
Exhibit 14-A: Local Agency Submittal Requirements for Federal Participation in Utility Relocations
Exhibit 14-B: Local Agency Utility Agreement Provisions for Federal Participation
Exhibit 14-C: FHWA Specific Authorization/Approval of Utility Agreement
Exhibit 14-D: Notice to Owner (fillable)
Exhibit 14-E: Report of Investigation (fillable)
Exhibit 14-F: Utility Agreements
Exhibit 14-G: Utility Agreement Clauses
Exhibit 14-H: Right of Way Utilities Through Stages of Project Development
Exhibit 14-I: Local Agency/Utility Owner Special Agreement (fillable)
Chapter 15    Advertise and Award Project
Exhibit 15-A: Local Agency Construction Contract Administration Checklist (fillable)
Exhibit 15-B: Resident Engineer's Construction Contract Administration Checklist (fillable)
Exhibit 15-C: Local Agency Project Advertising Checklist (fillable)
Exhibit 15-D: Bid Tabulation Summary Sheet (Sample) (fillable)
Exhibit 15-E: Deleted
Exhibit 15-F: Deleted
Exhibit 15-G: Local Agency Bidder DBE Commitment(Construction Contracts)
Exhibit 15-H: DBE Information - Good Faith Efforts (fillable)
Exhibit 15-I: Local Agency Bid Opening Checklist (fillable)
Exhibit 15-J: Deleted
Exhibit 15-K: Deleted
Exhibit 15-L: Local Agency Contract Award Checklist (fillable)
Exhibit 15-M: Detail Estimate
Exhibit 15-N: Finance Letter Use Exhibit 3-O
Chapter 16    Administer Construction Contracts
Exhibit 16-A: Weekly Statement of Working Days
Exhibit 16-B: Subcontracting Request
Exhibit 16-C: Resident and Assistant Engineers Daily Report
Exhibit 16-D: Certificate of Proficiency
Exhibit 16-E: Independent Assurance Sampling and Testing (Form MR-0102)
Exhibit 16-F: Report of Witness Tests (Form MR-0103)
Exhibit 16-G: Corroboration Report (MR-0104)
Exhibit 16-H: Independent Assurance Sampling and Testing (Form Mr-0110)
Exhibit 16-I: Notice of Material to be Used (Form CEM-3101)
Exhibit 16-J: Notice of Materials to be Furnished (Form MR-0608)
Exhibit 16-K: Report of Inspection of Material (Form MR-0029)
Exhibit 16-L: Sample Federal-Aid Advice Invoice
Exhibit 16-M: Notice of Materials to be Inspected (Form MR-0028)
Exhibit 16-N: Employer Interview: Labor Compliance/EEO
Exhibit 16-O: Federal-Aid Highway Construction Contractor's Annual EEO Report
Links directly to current Form FHWA-1391 (Rev. 09-13)
Exhibit 16-P: Employer Interview: Labor Compliance/EEO (Spanish Form)
Exhibit 16-Q: U.S. Department of Labor, Office of Federal Contract Compliance Programs
Exhibit 16-R: Size, Frequency and Location of Sampling and Testing Tables
Exhibit 16-S: Caltrans Test Method - ASTM Test Method Conversion Chart
Exhibit 16-T: Material Typically Accepted by a Certificate of Compliance
Exhibit 16-U: Notice of Potential Claim
Exhibit 16-V: Source Inspection Request to DLAE
Exhibit 16-W: Source Inspection Request to TransLab
Exhibit 16-Z: Monthly DBE Trucking Verification
Chapter 17    Project Completion
Exhibit 17-A: Sample Cover Letter and Federal Report of Expenditures Checklist (fillable)
Exhibit 17-B: Final Inspection of Federal-Aid Project (FHWA Form 1446C)
Exhibit 17-C: Final Inspection Form (fillable)
Exhibit 17-D: Sample Federal-Aid Final Invoice
Exhibit 17-E: Sample Change Order Summary
Exhibit 17-F: Final Report-Utilization of Disadvantaged Business Enterprises (DBE) First Tier Subcontractors (fillable)
Exhibit 17-G: Materials Certificate
Exhibit 17-H: Deleted
Exhibit 17-I: Sample Cover Letter for Report of Completion of Structures
Exhibit 17-J: Report of Completion of Structures on Local Streets and Roads
Exhibit 17-K: Sample Report of Completion of Right of Way
Exhibit 17-L: Sample Report of Expenditures for Force Account Projects
Exhibit 17-M: Final Project Expenditure Report
Exhibit 17-N: EEM Program Final Report of Right of Way Expenditures
Exhibit 17-O: Disadvantaged Business Enterprises (DBE) Certification Status Change
Chapter 18    Maintenance
Exhibit 18-A: Maintenance Review Checklist (fillable)
Exhibit 18-B: Sample Resolution (fillable)
Exhibit 18-C: City-County Road System EDP Input Form HCC 342
Exhibit 18-D: Mileage of Maintained Roads

If You have any questions about any forms, please contact DLA.webmaster@dot.ca.gov



Accessibility
To report any difficulty experienced in accessing Caltrans programs, services or activities or any discriminations covered under the Americans with Disabilities Act, Section 504 of Rehabilitation Act or the Fair Employment and Housing Act, please contact us at (866)810-6346 Voice; 711 TTY; (916)653-3055 Fax.