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.

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 05/2021)

(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(Word)
Exhibit 3-I: Request for Local Advance Construction Authorization (F-PDF), EX03I(Word)
Exhibit 3-J: Request for Transfer of Federal Funds to the Federal Transit Administration(PDF)EX3J(Word)
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(Word), EX03P(Excel) 
Exhibit 3-R: Non-Infrastructure Project Work Plan Sample (PDF)EX03R(Word) , EX03R(Excel)
Superseded by LAPM 3-A as of April 1, 2019
Exhibit 3-A: Request for Authorization to Proceed with Preliminary Engineering
Exhibit 3-B: Request for Authorization to Proceed with Right of Way
Exhibit 3-C: Request for Authorization to Proceed with Utility Relocation
Exhibit 3-D: Request for Authorization to Proceed with Construction
Exhibit 3-E: Request for Authorization to Proceed Data Sheet(s)
Exhibit 3-F: Instructions for Request for Authorization Data Sheet
Exhibit 3-O: Sample "Local Federal-Aid Finance Letter"(F-PDF), EX03O(Excel)
Exhibit 3-Q: Request for Authorization to Proceed with Non-Infrastructure Project

For ER Projects please visit the LAPG Forms website under Chapter 11
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(Word)
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(Word)
Exhibit 5-I: Sample Indirect Cost Rate Proposal (F-PDF-February 2015)EX05I(Word)
Exhibit 5-M: Sample Scenarios Pro Rata vs. Lump Sum Agreements (reference Tables 5.1 and 5.2 in LAPM Chapter 5)

Superseded by LAPM 5-A as of October 15, 2019

Exhibit 5-A: Sample Federal-Aid Invoice (Except for STIP projects)
Exhibit 5-B: Sample Federal-Aid Invoice with Different Rates (Except for STIP projects)
Exhibit 5-C: Sample of State Project Invoice
Exhibit 5-D: Sample Right of Way Invoice February
Exhibit 5-E: Sample "STIP or ATP Project" Federal Invoice
Exhibit 5-F: Sample "STIP or ATP Project" State Invoice
Exhibit 5-J: Local Agency Invoice Review Checklist
Exhibit 5-K: Billing Summary (F-PDF--October 2015), EX05K(Word)
Exhibit 5-L: Billing Summary Instructions
Chapter 6 Environmental Procedures

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

Exhibit 6-B: Instructions for Completing the Preliminary Environmental Study (PES) Form (PDF)
Exhibit 6-C: Table 2 - Exempt Projects (PDF)EX06C(Word)
Exhibit 6-D: Table 3 - Exempt Projects (PDF)EX06D(Word)
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(PDF)
Exhibit 6-J: PES (NI) Form (F-PDF)EX06J(Word)
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(Word)
Exhibit 7-C: Roadway Data (F-PDF)EX07C(Word)
Exhibit 7-D: Major Structure Data (F-PDF)EX07D(Word)
Exhibit 7-E: Railroad Grade Crossing Data (F-PDF)EX07E(Word)
Exhibit 7-F: Airport Data (F-PDF)EX07F(Word)
Exhibit 7-G: Field Review Attendance Roster (PDF)EX07G(Word)
Exhibit 7-I: Systems Engineering Review Form (SERF) (F-PDF)EX07I(Word)
Chapter 8 Public Hearings
Exhibit 8-A: Sample Notice of Public Hearing (PDF)EX08A(Word) Exhibit 8-B: Sample Notice of Opportunity for Public Hearing (PDF)EX08B(Word)
Chapter 9 Civil Rights and Disadvantaged  Business enterprises
Exhibit 9-A: DBE Implementation Agreement for Local Agencies (F-PDF)EX09A(Word)
Exhibit 9-B: Local Agency DBE Annual Submittal Form (F-PDF)EX09B(Word)
Exhibit 9-C: Local Agency ADA Annual Certification Form (F-PDF)EX09C(Word)
Exhibit 9-D: Contract Goal Methodology (Excel)

Exhibit 9-E: Sample Evaluation of Good Faith Effort (F-PDF)EX09E(Word)
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-A: A&E Consultant Audit Request Letter and Checklist(F-PDF)EX10A(Word)
Exhibit 10-B: Suggested Consultant Evaluation Sheet (F-PDF), EX10B(Word)
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-H1~H3: Sample Cost Proposal (Example #1 thru #3) (F-PDF),  EX10H1-H3(Word) 
Exhibit 10-H4: Cost Proposal for Caltrans with Prevailing Wages(Excel)
Exhibit 10-I: Notice to Proposers DBE Information(PDF)EX10I(Word)
Exhibit 10-K: Consultant Annual Certification of Indirect Costs and Financial Management System(F-PDF)EX10K(Word)
Exhibit 10-O1: Consultant Proposal DBE Commitment (F-PDF)EX10O1(Word)
Exhibit 10-O2: Consultant Contract DBE Commitment (F-PDF)EX10O2(Word)
Exhibit 10-Q: Disclosure of Lobbying Activities (F-PDF)EX10Q(Word)
Exhibit 10-R: AE Sample Contract Language (PDF)EX10R(Word)
Exhibit 10-S: Consultant Performance Evaluation (F-PDF)EX10S(Word)
Exhibit 10-T: Panel Member Conflict of Interest Confidentiality Statement (F-PDF)EX10T(Word)
Exhibit 10-U: Consultant in Management Position Conflict of Interest Statement (F-PDF)EX10U(Word)
Chapter 11 Design Standards
Exhibit 11-A: Geometric Design Standards for Local 3R Projects(PDF), EX11A(Word)
Exhibit 11-B: Bridges and Other Structures (PDF)EX11B(Word)
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), EX12B(Word)
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(Word)
Exhibit 12-G: Required Federal-aid Contract Language (PDF)
Exhibit 12-H: Sample Bid (PDF)EX12H(Word)
Superseded by LAPM 3-A as of April 1, 2019
Exhibit 12-A: Preliminary Estimate of Cost (F-PDF), EX12A(Word)
Exhibit 12-C: PSE Certification (F-PDF), EX12C(Word)
Chapter 13 Right of Way
Exhibit 13-A: Short Form - Right of Way Certification for Local Assistance Project(F-PDF)EX13A(Word)
EXHIBIT 13-B: Right of Way Certification (Off State Highway System) (F-PDF)EX13B(Word)
Exhibit 13-C: Consultant Selection Criteria and Guide  (PDF)EX13C(Word)
Exhibit 13-D: Uniform Relocation Act Benefits Summary(PDF)EX13D(Word)
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(Word)
Exhibit 14-B: Local Agency Utility Agreement Provisions for Federal Participation  (F-PDF)EX14B(Word)
Exhibit 14-C: FHWA Specific Authorization/Approval of Utility Agreement  (F-PDF), EX14C(Word)
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(Word)
Exhibit 14-F: Utility Agreements  (F-PDF), EX14F(Word)
Exhibit 14-G: Utility Agreement Clauses(PDF)EX14G(Word)
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(Word)
Chapter 15 Advertise and Award Project
Exhibit 15-A: Local Agency Construction Contract Administration Checklist (F-PDF)EX15A(Word)
Exhibit 15-B: Resident Engineer's Construction Contract Administration Checklist (F-PDF)EX15B(Word)
Exhibit 15-C: Local Agency Project Advertising Checklist (F-PDF)EX15C(Word)
Exhibit 15-D: Bid Tabulation Summary Sheet (Sample) (F-PDF)EX15D(Word)
Exhibit 15-G: Construction Contract DBE Commitment (F-PDF)EX15G(Word)
Exhibit 15-H: Proposer/Contractor Good Faith Effort (F-PDF), EX15H(Word)
Exhibit 15-I: Local Agency Bid Opening Checklist (F-PDF)EX15I(Word)
Exhibit 15-L: Local Agency Contract Award Checklist(F-PDF)
Exhibit 15-M: Detail Estimate (F-PDF)EX15M(Word)
Exhibit 15-N: Finance Letter Use Exhibit 3-O 
Chapter 16 Administer Construction Contracts
Exhibit 16-A: Weekly Statement of Working Days(F-PDF)
Exhibit 16-B: Subcontracting Request(F-PDF)EX16B(Word)
Exhibit 16-C: Resident and Assistant Engineers Daily Report (F-PDF)EX16C(Word)
Exhibit 16-D: Certificate of Proficiency (PDF)EX16D(Word)
Exhibit 16-G: Corroboration Report (MR-0104) (PDF)EX16G(Word)
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(Word)
Exhibit 16-N: Employee Interview: Labor Compliance/EEO (F-PDF) Rev. 7/11/18 
Exhibit 16-O: Federal-Aid Highway Construction Contractor's Annual EEO Report(Excel)
Exhibit 16-P: Employee Interview: Labor Compliance/EEO (Spanish Form)(PDF)EX16P(Word)
Exhibit 16-Q: U.S. Department of Labor Office of Federal Contract Compliance Programs(PDF)EX16Q(Word)
Exhibit 16-R: Size, Frequency and Location of Sampling and Testing Tables(PDF)EX16R(Word)
Exhibit 16-S: Caltrans Test Method - ASTM Test Method Conversion Chart (PDF)EX16S(Word)
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(Word)
Exhibit 16-UI: Initial Potential Claim Record (F-PDF)EX16UI(Word)
Exhibit 16-US: Supplemental Potential Claim Record(F-PDF),  EX16US(Word)
Exhibit 16-W: Source Inspection Request to TransLab(PDF)EX16W(Word)
Exhibit 16-Y: Monthly Progress Payment Item Quantity Calculation Sheet (F-PDF)EX16Y(Word)
Exhibit 16-Z1: Monthly DBE Trucking Verification (F-PDF)EX16Z1(Word)
Exhibit 16-Z2: Acceptance Testing Results Summary Log(F-PDF)EX16Z2(Excel) 
Chapter 17 Project Completion
Exhibit 17-A: Cover Letter and Federal Report of Expenditures Checklist (F-PDF)EX17A(Word)
Exhibit 17-B: Final Inspection of Federal-Aid Project (FHWA Form 1446C) (F-PDF)EX17B(Word)
Exhibit 17-C: Final Inspection Form(F-PDF)EX17C(Word)
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(Word)
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)EX17G(Word)
Exhibit 17-H: Cover Letter and Final Report of Expenditures Checklist (PE Only) (F-PDF)EX17H(Word)
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(Word)
Exhibit 17-K: Sample Report of Completion of Right of Way(PDF)EX17K(Word)
Exhibit 17-L: Sample Report of Expenditures for Force Account Projects(PDF)EX17L(Word)
Exhibit 17-M: Final Project Expenditure Report - State Only (F-PDF)EX17M(Word)
Exhibit 17-N: EEM Program Final Report of Right of Way Expenditures (F-PDF)EX17N(Word)
Exhibit 17-O: Disadvantaged Business Enterprises (DBE) Certification Status Change (F-PDF)EX17O(Word)

Superseded by LAPM 5-A as of October 15, 2019
Exhibit 17-D: Federal-Aid Final Invoice
Chapter 18 Maintenance
Exhibit 18-A: Maintenance Review Checklist (F-PDF)EX18A(Word)
Exhibit 18-B: Sample Resolution (F-PDF)EX18B(Word)
Exhibit 18-C: City-County Road System EDP Input Form HCC 342 (PDF)
Exhibit 18-D: Mileage of Maintained Roads (F-PDF) 
Chapter 19 Oversight and Process Reviews
Exhibit 19-A: Pre-Construction Review Checklist (F-PDF)
Exhibit 19-B: Mid-Construction Review Checklist (F-PDF)  
Exhibit 19-C: Post-Construction Review Checklist (F-PDF)             

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