CHAPTER 2 APPENDIX

Appendix 2-1

Definitions

 

 

Appendix 2-2

Reserved for Future Use

 

 

Appendix 2-3

"Registration of Minor, Nonrecurring Use of Water" (DNR Form 20)

 

 

Appendix 2-4

Subcontractor Authorization and EEO Poster Notice

 

 

Appendix 2-5

A – EEO is the Law – English with Supplement

 

B – EEO is the Law – Spanish with Supplement

 

 

Appendix 2-6

Notice Concerning False Statement and Records (Form FHWA 1022)

 

 

Appendix 2-7

A – Employee Rights Under the Davis Bacon Act (WH 1321) – English

 

B – Employee Rights Under the Davis Bacon Act (WH 1321) – Spanish

 

 

Appendix 2-8

A – Job Safety and Health (IOSH 70-8025)

 

B – Family and Medical Leave Act (WHD-1420)

 

C – Employee Polygraph Protection Act (WHD-1462)

 

 

Appendix 2-9

Reserved for Future Use

 

 

Appendix 2-10

Project Engineer’s EEO Project Site Inspection/Wage Rate Report (Form 650170)

 

 

Appendix 2-11

Reserved for Future Use

 

 

Appendix 2-12

Reserved for Future Use

 

 

Appendix 2-13

Reserved for Future Use

 

 

Appendix 2-14

Certified Transcript of Labor Payroll/Statement of Compliance (Form 830176) and Completed Samples

 

 

Appendix 2-15

Traffic Control Non-Compliance Flow Chart

 

 

Appendix 2-16

Subcontract Request (Form 830231)

 

 

Appendix 2-17

Statement of DBE Commitments (Form 102115)

 

 

Appendix 2-18

Reserved for Future Use

 

 

Appendix 2-19

Certification of DBE Accomplishment (Form 102116)

 

 

Appendix 2-20

Request to Lease Excess Land

 

 

Appendix 2-21

Contract Quantity Agreement (Form 830230)

 

 

Appendix 2-22

Request to Release Retained Funds

 

 

Appendix 2-23

Certification of Subcontractor Payments (Form 518002)

 

 

Appendix 2-24

Reserved for Future Use

 

 

Appendix 2-25

Reserved for Future Use

 

 

Appendix 2-26

Reserved for Future Use

 

 

Appendix 2-27

Charging of Contract Time

 

 

Appendix 2-28

Weekly Report of Working Days for Incentive/Disincentive Clause

 

(Form 830241)

 

 

Appendix 2-29

Reserved for Future Use

 

 

Appendix 2-30

Reserved for Future Use

 

 

Appendix 2-31

Change Order Authorization Matrix

 

 

Appendix 2-32

Interest Payment Information – Primary & Interstate Projects

 

(Form 830235)

 

 

Appendix 2-33

Noncomplying Tests or Measurements of Material Incorporated into the Project

 

 

Appendix 2-34

Price Adjustment Schedules

 

A - Aggregate Gradation Test Deviation

 

B - Concrete Slump

 

C - Concrete Air Content, Water Cement Ratio, Vibrator Frequency, Certified Plant Inspection, & Late Curing Application

 

D - Bridge Floor Resurfacing and Overlay Projects

 

E - Out-of-Tolerance Tining

 

F - Liquid Asphalt Noncomplying Viscosity or Penetration

 

G - Asphalt Residue Deficiency

 

H - Asphalt Binder (Noncomplying Dynamic Shear Rheometer)

 

I - Asphalt Binder (Noncomplying Bending Beam Rheometer)

 

J - Deviation in Asphalt Binder Content

 

K - Segregation

 

L - Steel H-Pile Weight Deficiency

 

M - Asphalt Binder (Noncomplying Elastic Recovery)

 

N - PCC Pavement Edge Damage

 

O - Erosion & Sediment Control Non-Compliance Flow Chart

P - Noncomplying Asphalt Binder Replacement (Failure to Bump Grade)

 

 

Appendix 2-35

Sample Fuel Adjustment Worksheet – English

 

 

Appendix 2-36

Reserve for Future Use

 

 

Appendix 2-37

As-Built Adhesive Backed Standard Format Samples:

 

Certification Block (Form 520003)

 

Extra Work Order Log (Form 520004)

 

Estimated Project Quantities (100-0) (Form 520007)

 

Estimated Project Quantities (100-1) (Form 520008)

 

Check List for As-Built Plan Preparation