Local Assistance Procedures Manual (LAPM) Forms

All forms below are provided in PDF or fillable PDF (F-PDF) version along with a Word or Excel version if available.
Note: form titles with “LAPM” are hosted on the Caltrans Electronic Forms System (CEFS); form titles with “Exhibit” are hosted by DLA. Refresh your browser or clear the cache to access the latest version of these documents.

Chapter 2 Roles and Responsibilities
Exhibit 2-B: Federal-Aid Project Responsibilities List for Delegated Projects Off SHS (PDF) Financial Plan Checklist (PDF)
Project Management Plan Checklist (PDF)
Chapter 3 Project Authorization
LAPM 3-A: Project Authorization/Adjustment Request (REV 01/2022)

(Please DO NOT open the form in Browser. Right-click above link and choose "save link/target as" to save the form. Then open the form with Adobe Acrobat/Reader)

Exhibit 3-G Federal Project Log Sheet (F-PDF)
Exhibit 3-H: Request for Capital Subvention Reimbursement Allocation/De-Allocation (F-PDF), EX03H (DOCX)
Exhibit 3-I: Request for Local Advance Construction Authorization (F-PDF), EX03I (DOCX)
Exhibit 3-J: Request for Transfer of Federal Funds to the Federal Transit Administration (PDF), EX3J (DOCX)
Exhibit 3-K: Administrative Procedures for Transfer of Funds to FTA (PDF)
Exhibit 3-L: Local Assistance Project Prefixes (PDF)
Exhibit 3-P: Sample "Delegated Project Authorization" (PDF), EX03P (DOCX), EX03P(Excel)
Exhibit 3-R: Non-Infrastructure Project Work Plan Sample (PDF), EX03R (DOCX) , EX03R(Excel)


For ER Projects please visit ER Forms
Chapter 4 Agreements
Exhibit 4-B: Local Agency Agreement Execution Checklist (F-PDF)
Exhibit 4-C: Master Agreement - Administering Agency-State Agreement for Federal-Aid Projects (PDF)
Exhibit 4-D: Sample-Program Supplement Agreement (F-PDF), EX04D (DOCX)
Exhibit 4-E: Master Agreement - Administering Agency-State Agreement for State-Funded Projects (PDF)
Chapter 5 Invoicing
LAPM 5-A: Local Agency Invoice (REV 08/2020)
(Please DO NOT open the form in Browser. Right-click above link and choose "save link/target as" to save the form. Then open the form with Adobe Acrobat/Reader)
Exhibit 5-G: Alternative Payment Procedure Sample (F-PDF-March 2015)EX05G (DOCX)
Chapter 6 Environmental Procedures

Exhibit 6-A: Preliminary Environmental Study (PES) Form (F-PDF), EX06A (DOCX)

Exhibit 6-B: Instructions for Completing the Preliminary Environmental Study (PES) Form (PDF)
Exhibit 6-C: Table 2 - Exempt Projects (PDF), EX06C (DOCX)
Exhibit 6-D: Table 3 - Exempt Projects (PDF),
Exhibit 6-E: Categorical Exclusion Checklist(Deleted)
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 (PDF)
Exhibit 6-J: PES (NI) Form (F-PDF), EX06J (DOCX)
Exhibit 6-K: PES (NI) Form Instructions (PDF)
Chapter 7 Field Review
Exhibit 7-A: Instructions for Field Review Form (PDF)
Exhibit 7-B: Field Review Form (F-PDF), EX07B (DOCX)
Exhibit 7-C: Roadway Data (F-PDF)
Exhibit 7-D: Major Structure Data (F-PDF), EX07D (DOCX)
Exhibit 7-E: Railroad Grade Crossing Data (F-PDF), EX07E (DOCX)
Exhibit 7-F: Airport Data (F-PDF)
Exhibit 7-G: Field Review Attendance Roster (PDF), EX07G (DOCX)
Exhibit 7-I: Systems Engineering Review Form (SERF) (F-PDF)
Chapter 8 Public Hearings
Exhibit 8-A: Sample Notice of Public Hearing (PDF), EX08A (DOCX) Exhibit 8-B: Sample Notice of Opportunity for Public Hearing (PDF), EX08B (DOCX)
Chapter 9 Civil Rights and Disadvantaged Business enterprises
Exhibit 9-A: DBE Implementation Agreement for Local Agencies (F-PDF), EX09A (DOCX)
Exhibit 9-B: Local Agency DBE Annual Submittal Form (F-PDF), EX09B (DOCX)
Exhibit 9-C: Local Agency ADA Annual Certification Form (F-PDF), EX09C (DOCX)
Exhibit 9-D: Contract Goal Methodology (Excel)

Exhibit 9-E: Sample Evaluation of Good Faith Effort (F-PDF), EX09E (DOCX)
Exhibit 9-F: Monthly Disadvantaged Business Enterprise (DBE) Payment (Excel)
Exhibit 9-G: Sample Procedure for Good Faith Efforts (PDF)
Exhibit 9-H: Sample Procedure for Reconsideration Hearing (PDF)

Chapter 10 Consultant Selection
Exhibit 10-B: Suggested Consultant Evaluation Sheet (F-PDF), EX10B (DOCX)
Exhibit 10-C: Consultant Contract Reviewers Checklist (database)
Exhibit 10-G: Individual A&E Task Order DBE Tracking Sheet (F-PDF), EX10G(Word)
Exhibit 10-I: Notice to Proposers DBE Information (PDF), EX10I (DOCX)
Exhibit 10-O1: Consultant Proposal DBE Commitment (F-PDF), EX10O1 (DOCX)
Exhibit 10-O2: Consultant Contract DBE Commitment (F-PDF), EX10O2 (DOCX)
Exhibit 10-Q: Disclosure of Lobbying Activities (F-PDF), EX10Q (DOCX)
Exhibit 10-R: AE Sample Contract Language (PDF)
Exhibit 10-S: Consultant Performance Evaluation (F-PDF), EX10S (DOCX)
Exhibit 10-T: Panel Member Conflict of Interest Confidentiality Statement (F-PDF), EX10T (DOCX)
Exhibit 10-U: Consultant in Management Position Conflict of Interest Statement (F-PDF), EX10U (DOCX)
Chapter 11 Design Standards
Exhibit 11-A: Geometric Design Standards for Local 3R Projects (PDF)
Exhibit 11-B: Bridges and Structures (PDF)
Exhibit 11-F: Sample Design Fact Sheet (PDF)
Chapter 12 Plans, Specifications, Estimate
Exhibit 12-B: Bidder's List of Subcontractors (DBE and NON-DBE) (F-PDF)
Exhibit 12-D: PSE Checklist (F-PDF)
Exhibit 12-E: PSE Checklist Instructions (PDF)

Exhibit 12-F: Cost-Effectiveness / Public Interest Finding / A&E Noncompetitive (F-PDF)EX12F (DOCX)
Exhibit 12-G: Required Federal-aid Contract Language (PDF)
Exhibit 12-H: Sample Bid (PDF)EX12H (DOCX)
Chapter 13 Right of Way
Exhibit 13-A: Short Form - Right of Way Certification for Local Assistance Project (F-PDF)
EXHIBIT 13-B: Right of Way Certification (Off State Highway System) (F-PDF), EX13B(DOCX)
Exhibit 13-C: Consultant Selection Criteria and Guide (PDF)
Exhibit 13-D: Uniform Relocation Act Benefits Summary (PDF)
Exhibit 13-E: Reserved
Exhibit 13-F: Local Public Agency Real Property Services Checklist (F-PDF)
Chapter 14 Utility Relocations
Exhibit 14-A: Local Agency Submittal Requirements for Federal Participation in Utility Relocations (F-PDF), EX14A (DOCX)
Exhibit 14-B: Local Agency Utility Agreement Provisions for Federal Participation (F-PDF), EX14B (DOCX)
Exhibit 14-C: FHWA Specific Authorization/Approval of Utility Agreement (F-PDF), EX14C (DOCX)
LAPM 14-D: Notice To Owner-Local Assistance (F-PDF) (REV 08/2020)
LAPM 14-D-REV: Revised Notice To Owner-Local Assistance (F-PDF) (REV 08/2020)
Exhibit 14E: Report of Investigation (F-PDF), EX14E (DOCX)
Exhibit 14-F: Utility Agreements (F-PDF), EX14F (DOCX)
Exhibit 14-G: Utility Agreement Clauses (PDF), EX14G (DOCX)
Exhibit 14-H: Right of Way Utilities Through Stages of Project Development (PDF)
Exhibit 14-I: Local Agency/Utility Owner Special Agreement (F-PDF), EX14I (DOCX)
Chapter 15 Advertise and Award Project
Exhibit 15-A: Local Agency Construction Contract Administration Checklist (F-PDF), EX15A (DOCX)
Exhibit 15-B: Resident Engineer's Construction Contract Administration Checklist (F-PDF), EX15B (DOCX)
Exhibit 15-C: Local Agency Project Advertising Checklist (F-PDF), EX15C (DOCX)
Exhibit 15-D: Bid Tabulation Summary Sheet (Sample) (F-PDF), EX15D (DOCX)
Exhibit 15-G: Construction Contract DBE Commitment (F-PDF), EX15G (DOCX)
Exhibit 15-H: Proposer/Contractor Good Faith Effort (F-PDF), EX15H (DOCX)
Exhibit 15-I: Local Agency Bid Opening Checklist (F-PDF), EX15I (DOCX)
Exhibit 15-L: Local Agency Contract Award Checklist (F-PDF)
Exhibit 15-M: Detail Estimate (F-PDF)
 
Chapter 16 Administer Construction Contracts
Exhibit 16-A: Weekly Statement of Working Days (F-PDF)
LAPM 16-B: Subcontracting Request (NEW 01/2022)
Exhibit 16-C: Resident and Assistant Engineers Daily Report (F-PDF), EX16C (DOCX)
Exhibit 16-D: Certificate of Proficiency (PDF), EX16D (DOCX)
Exhibit 16-G: Corroboration Report (MR-0104) (PDF), EX16G (DOCX)
Exhibit 16-H: Independent Assurance Sampling and Testing Log Summary (Form Mr-0110) (PDF), EX16H(Excel)
Exhibit 16-I: Notice of Material to be Used (Form CEM-3101) (F-PDF), EX16I(Excel)
Exhibit 16-K: Report of Inspection of Material (Form MR-0029) (PDF) EX16K (DOCX)
LAPM 16-N: Employee Interview: Labor Compliance/EEO (NEW 01/2022)
LAPM 16-N ESP: Employee Interview: Labor Compliance/EEO (Spanish Form) (NEW 01/2022)
Exhibit 16-O: Federal-Aid Highway Construction Contractor's Annual EEO Report(Excel)
Exhibit 16-Q: U.S. Department of Labor Office of Federal Contract Compliance Programs (PDF), EX16Q (DOCX)
Exhibit 16-R: Size, Frequency and Location of Sampling and Testing Tables (PDF), EX16R (DOCX)
Exhibit 16-S: Caltrans Test Method - ASTM Test Method Conversion Chart (PDF), EX16S (DOCX)
Exhibit 16-T1: Materials Requiring a Certificate of Compliance per Caltrans Standard Specifications (PDF)
Exhibit 16-T2: Materials Requiring a Certificate of Compliance per the Greenbook (PDF)
Exhibit 16-UF: Full and Final Potential Claim Record (F-PDF), EX16UF (DOCX)
Exhibit 16-UI: Initial Potential Claim Record (F-PDF), EX16UI (DOCX)
Exhibit 16-US: Supplemental Potential Claim Record (F-PDF), EX16US (DOCX)
Exhibit 16-W: Source Inspection Request to TransLab (PDF), EX16W (DOCX)
Exhibit 16-Y: Monthly Progress Payment Item Quantity Calculation Sheet (F-PDF), EX16Y (DOCX)
Exhibit 16-Z1: Monthly DBE Trucking Verification (F-PDF), EX16Z1 (DOCX)
Exhibit 16-Z2: Acceptance Testing Results Summary Log (F-PDF), EX16Z2(Excel)

Pre-Construction Review Checklist (F-PDF)
Mid-Construction Review Checklist (F-PDF)
Post-Construction Review Checklist (F-PDF) 
Chapter 17 Project Completion
Exhibit 17-A: Cover Letter and Federal Report of Expenditures Checklist (F-PDF), EX17A (DOCX)
Exhibit 17-B: Final Inspection of Federal-Aid Project (FHWA Form 1446C) (F-PDF), EX17B (DOCX)
Exhibit 17-C: Final Inspection Form (F-PDF), EX17C (DOCX)
Exhibit 17-E: Sample Change Order Summary (F-PDF)
Exhibit 17-F: Final Report-Utilization of Disadvantaged Business Enterprises (DBE) and First-Tier Subcontractors (F-PDF), EX17F (DOCX)
Exhibit 17-F1 AE On-Call: Final Report-Utilization of Disadvantaged Business Enterprises (DBE) for On-call Contracts (F-PDF)
Exhibit 17-G: Materials Certificate (F-PDF)
Exhibit 17-H: Cover Letter and Final Report of Expenditures Checklist (PE Only) (F-PDF), EX17H (DOCX)
Exhibit 17-I: Cover Letter for Report of Completion of Structures (F-PDF)
Exhibit 17-J: Report of Completion of Structures on Local Streets and Roads (F-PDF), EX17J (DOCX)
Exhibit 17-K: Sample Report of Completion of Right of Way (PDF), EX17K (DOCX)
Exhibit 17-L: Sample Report of Expenditures for Force Account Projects (PDF), EX17L (DOCX)
Exhibit 17-M: Final Project Expenditure Report - State Only (F-PDF), EX17M (DOCX)
Exhibit 17-N: EEM Program Final Report of Right of Way Expenditures (F-PDF), EX17N (DOCX)
Exhibit 17-O: Disadvantaged Business Enterprises (DBE) Certification Status Change (F-PDF), EX17O (DOCX)
Chapter 18 Maintenance
Exhibit 18-A: Maintenance Review Checklist (F-PDF), EX18A (DOCX)
Exhibit 18-B: Sample Resolution (F-PDF), EX18B (DOCX)
Exhibit 18-C: City-County Road System EDP Input Form HCC 342 (PDF)
Exhibit 18-D: Mileage of Maintained Roads (F-PDF)

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