California Department of Transportation

Local Assistance Procedures Manual (LAPM) Forms

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

If you need a special form (fillable PDF with or without header/footer, Word or Excel), which is not posted in the following table, or find any error on the form, please contact DLA Publication Manager at

Note: LAPM form number prefixes are gradually shifting from “Exhibit” to “LAPM”. As the form number prefixes are updated, a notation will be added to indicate that the Exhibit is superseded until the next annual LAPM update. Active Exhibit links within LAPM Chapters will maintain existing nomenclature until the next annual update, but will redirect to the updated LAPM form where applicable.

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 Rev. 5/30/19

Chapter 3    Project Authorization

LAPM 3-A: Project Authorization /Adjustment Request (fillable)

Exhibit 3-G: Federal Project Log Sheet (fillable)
Exhibit 3-H: Request for Capital Subvention Reimbursement Allocation/De-Allocation (Word, F-PDF)
Exhibit 3-I: Request for Local Advance Construction Authorization (Word, F-PDF)
Exhibit 3-J: Request for Transfer of Federal Funds to the Federal Transit Administration (Word, PDF)
Exhibit 3-K: Administrative Procedures for Transfer of Funds to FTA
Exhibit 3-L: Local Assistance Project Prefixes
Exhibit 3-M: Federal Highway Transportation Programs (Word, PDF)
Exhibit 3-N: Federal Highway Discretionary Programs (Word, PDF)
Exhibit 3-P: Sample "Delegated Project Authorization" (Word, Excel, F-PDF)
Exhibit 3-R: Non-Infrastructure Project Work Plan Sample (Word, Excel, F-PDF)

Superseded by LAPM 3-A as of April 1, 2019

Exhibit 3-A: Request for Authorization to Proceed with Preliminary Engineering (Word, F-PDF)
Exhibit 3-B: Request for Authorization to Proceed with Right of Way (Word, F-PDF)
Exhibit 3-C: Request for Authorization to Proceed with Utility Relocation (Word, F-PDF)
Exhibit 3-D: Request for Authorization to Proceed with Construction (fillable)(Word, F-PDF)
Exhibit 3-E: Request for Authorization to Proceed Data Sheet(s)(fillable)
Exhibit 3-F: Instructions for Request for Authorization Data Sheet
Exhibit 3-O: Sample "Local Federal-Aid Finance Letter" (Excel, F-PDF)
Exhibit 3-Q: Request for Authorization to Proceed with Non-Infrastructure Project (Word, F-PDF)

Chapter 4     Agreements
Exhibit 4-A: Request for Authorization to Proceed with Preliminary Engineering (deleted)
Exhibit 4-B: Local Agency Agreement Execution Checklist (Word, F-PDF)
Exhibit 4-C: Master Agreement - Administering Agency-State Agreement for Federal-Aid Projects
Exhibit 4-D: Sample-Program Supplement Agreement (Word, F-PDF)
Exhibit 4-E: Master Agreement - Administering Agency-State Agreement for State-Funded Projects
Chapter 5    Invoicing
LAPM 5-A: Local Agency Invoice
Exhibit 5-A: Sample Federal-Aid Invoice (Except for STIP projects) (Word, PDF--March 2015 Version-fillable)
Exhibit 5-B: Sample Federal-Aid Invoice with Different Rates (Except for STIP projects) (Word, PDF--March 2015 Version-fillable)
Exhibit 5-C: Sample of State Project Invoice (February 2015 Version-fillable) (Word, PDF--February 2015 Version-fillable)
Exhibit 5-D: Sample Right of Way Invoice February (Word, PDF--March 2015 Version-fillable)
Exhibit 5-E: Sample "STIP or ATP Project" Federal Invoice (fillable) (Word, F-PDF)
Exhibit 5-F: Sample "STIP or ATP Project" State Invoice (Word, PDF--March 2016 Version-fillable)
Exhibit 5-G: Alternative Payment Procedure Sample (Word, PDF--March 2015 Version-fillable)
Exhibit 5-I: Sample Indirect Cost Rate Proposal (February 2015 Version) (Word, PDF--February 2015 Version-fillable)
Exhibit 5-J: Local Agency Invoice Review Checklist (Word, PDF--March 2018 Version-fillable)
Exhibit 5-K: Billing Summary (Word, PDF--October 2015 Version-fillable)
Exhibit 5-L: Billing Summary Instructions (February 2015 Version)
Exhibit 5-M: Sample Scenarios Pro Rata vs. Lump Sum Agreements (Word, PDF--February 2015 Version-fillable)
Chapter 6    Environmental Procedures
Exhibit 6-A: Preliminary Environmental Study (PES) Form (Word, F-PDF)
Exhibit 6-B: Instructions for Completing the Preliminary Environmental Study (PES) Form (Word, PDF)
Exhibit 6-C: Table 2 - Exempt Projects (Word, PDF)
Exhibit 6-D: Table 3 - Exempt Projects (Word, PDF)
Exhibit 6-E: Categorical Exclusion Checklist (SER Forms Website)
Exhibit 6-F: Categorical Exemption/Categorical Exclusion Form (CE/CE) (SER Forms Website)
Exhibit 6-G: NEPA/CEQA Re-validation Form (SER Forms Website)
Exhibit 6-H: External Quality Control Certification Sheet (SER Forms Website)
Exhibit 6-I: Instructions for Completing the External Certifications
Exhibit 6-J: PES (NI) Form (Word, F-PDF)
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)
Exhibit 9-F: Monthly Disadvantaged Business Enterprise (DBE) Payment (Optional Best Practices Tool)
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-C.2a: State-only funded A&E Consultant Contract Reviewers Checklist new form
Exhibit 10-C.2b: Instruction for State-only funded A&E Consultant Contract Reviewers Checklist new form Rev. 3/7/19
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-G: Individual A&E Task Order DBE Tracking Sheet (fillable)
Exhibit 10-H1~H3: Sample Cost Proposal (Example #1 thru #3) (fillable)
Exhibit 10-H4: Cost Proposal for Caltrans with Previaling Wages
Exhibit 10-I: Notice to Proposers DBE Information (fillable)
Exhibit 10-J: Standard Contract Provisions for Subconsultant/DBE Participation (deleted)
Exhibit 10-K: Consultant Annual Certification of Indirect Costs and Financial Management System (fillable)
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 (fillable)
Exhibit 10-O2: Consultant Contract DBE Commitment (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 (fillable)
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-B: Bridges and Other Structures
Exhibit 11-C: Deleted
Exhibit 11-D: Deleted
Exhibit 11-E: Deleted
Exhibit 11-F: Sample Design Fact Sheet
Chapter 12    Plans, Specifications, & Estimate
Exhibit 12-B: Bidder's List of Subcontractors (DBE and NON-DBE) (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 (fillable)
Exhibit 12-H: Sample Bid

Superseded by LAPM 3-A as of April 1, 2019

Exhibit 12-A: Preliminary Estimate of Cost (fillable)
Exhibit 12-C: PS&E Certification (fillable)
Chapter 13    Right of Way
EXHIBIT 13-A: Short Form - Right of Way Certification for Local Assistance Project (Word, F-PDF)
EXHIBIT 13-B: Right of Way Certification (Off State Highway System) (Word, PDF)
Exhibit 13-C: Consultant Selection Criteria and Guide (Word, PDF)
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(fillable)
Exhibit 14-B: Local Agency Utility Agreement Provisions for Federal Participation(fillable)
Exhibit 14-C: FHWA Specific Authorization/Approval of Utility Agreement(fillable)
LAPM 14-D: Notice to Owner
LAPM 14-D-REV: Revised Notice to Owner
Exhibit 14-E: Report of Investigation (fillable)
Exhibit 14-F: Utility Agreements (fillable)
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: Construction Contract DBE Commitment (fillable)
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 (fillable)
Exhibit 15-N: Finance Letter Use Exhibit 3-O
Chapter 16    Administer Construction Contracts
Exhibit 16-A: Weekly Statement of Working Days (fillable)
Exhibit 16-B: Subcontracting Request (fillable)
Exhibit 16-C: Resident and Assistant Engineers Daily Report (fillable)
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 Log Summary (Form Mr-0110)
Exhibit 16-I: Notice of Material to be Used (Form CEM-3101) (fillable)
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 (deleted)
Exhibit 16-M: Notice of Materials to be Inspected (Form MR-0028)
Exhibit 16-N: Employee Interview: Labor Compliance/EEO (fillable) Rev. 7/11/18
Exhibit 16-O: Federal-Aid Highway Construction Contractor's Annual EEO Report
Exhibit 16-P: Employee 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-UI: Initial Potential Claim Record (fillable)
Exhibit 16-UF: Full and Final Potential Claim Record (fillable)
Exhibit 16-US: Supplemental Potential Claim Record (fillable)
Exhibit 16-V: Source Inspection Request to DLAE
Exhibit 16-W: Source Inspection Request to TransLab
Exhibit 16-Y: Monthly Progress Payment Item Quantity Calculation Sheet (fillable)
Exhibit 16-Z1: Monthly DBE Trucking Verification (fillable)
Exhibit 16-Z2: Acceptance Testing Results Summary Log (fillable)
Chapter 17    Project Completion
Exhibit 17-A: Cover Letter and Federal Report of Expenditures Checklist (fillable)
Exhibit 17-B: Final Inspection of Federal-Aid Project (FHWA Form 1446C)(fillable)
Exhibit 17-C: Final Inspection Form (fillable)
Exhibit 17-D: Federal-Aid Final Invoice
Exhibit 17-E: Sample Change Order Summary (fillable) Revised 3/21/19
Exhibit 17-F: Final Report-Utilization of Disadvantaged Business Enterprises (DBE) and First-Tier Subcontractors (fillable)
Exhibit 17-F1 A&E On-Call: Final Report-Utilization of Disadvantaged Business Enterprises (DBE) for On-call Contracts (fillable) new form
Exhibit 17-G: Materials Certificate (fillable)
Exhibit 17-H: Cover Letter and Final Report of Expenditures Checklist (PE Only)(fillable)
Exhibit 17-I: Cover Letter for Report of Completion of Structures (fillable)
Exhibit 17-J: Report of Completion of Structures on Local Streets and Roads (fillable)
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 (fillable)
Exhibit 17-N: EEM Program Final Report of Right of Way Expenditures (fillable)
Exhibit 17-O: Disadvantaged Business Enterprises (DBE) Certification Status Change(fillable)
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 (fillable)
Chapter 19    Oversight and Process Reviews
Exhibit 19-A: Pre-Construction Review Checklist (fillable)Rev. 5/23/18
Exhibit 19-B: Construction Review Checklist (Mid-Project) (fillable)Rev. 5/10/18
Exhibit 19-C: Post-Construction Review Checklist (fillable) Rev. 8/29/18

If You have any questions about any forms, please contact

Page Last Updated: May 24, 2019

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