| |
Missouri Department of Transportation

Social Media Facebook Twitter Flickr Blog YouTube RSS

Forms for Contractor Use 

Construction and Contractor Related

Affidavit for Compliance with Prevailing Wage Law (117 kb, 1 page)
ADA Checklist (10.3 mb,19 pages)
Contractor Affidavit Regarding Settlement of Claims  (C-242) (50 kb, 1 page)
Contractor Nuclear Density Form (68 kb, 2 pages)
Contractor Performance Questionnaire - 2014 (94 kb, 13 pages)
Lead Abatement MODOT Contractor Informational Packet (50 kb, 1 page)
Lead Abatement MODOT FA Project Notification (69 kb, 1 page)
Lead Abatement MODOT Project Notification (78 kb, 1 page)
Lead Abatement MODOT Project Re-Notification (73 kb, 1 page)
Lead Abatement Program Contact Info (25 kb, 1 page)
Request to Subcontract Work (C-220) (127 kb, 3 pages)
Subcontractor Certification Regarding Affirmative Action (100 kb, 1 page)
Value Engineering Proposal  (C-104) (139 kb, 2 pages)
Contractor Questionnaire (24 kb, 2 pages)
DBE Program Submittal (5.8 mb, 144 pages)
Prequalification Questionnaire (115 kb, 5 pages)
Contractor's Monthly Trainee Report (52 kb, 1 page)
Trainee Notification (42 kb, 1 page)
Trainee Example Letter (9 kb, 1 page)
Project Conflict Resolution Flowchart (14 kb, 1 page)
Wage Flowchart for Federal Jobs - Precon (9 kb, 1 page)
Wage Flowchart for State Jobs - Precon (8 kb, 1 page)
2AA Sheet - Blank (47kb, 1 page)
2AA Sheet - Example (114kb, 1page)
Welder Qualification Form 530kb, 1 page  Electronically fillable
Waste Disposal Agreement 264kb, 1 page  Electronically fillable
ARRA Coding Instructions (12.6kb,  2 pages)
FHWA Form 1589 Contractor Employment Report Link to FHWA website
Electronic Documentation Choice Request Form (25kb 1page)
SiteManager Contractor Payment Schedule Form - 2014 (8kb, 1page)

Federal Aid Posters

Equal Employment Opportunity (EEO) Policy - Example (8 kb, 1 page)
Equal Employment Opportunity is the Law   (also available in Spanish) (24 kb, 1 page)  ( Spanish 15 kb, 1 page)
Notice FHWA 1022 (138 kb, 1 page)
Wage Rate Info FHWA-1495    (also available in Spanish) (72 kb, 1page)
Discrimination in Employment is Prohibited by Law MCHR-09 (also in available in Spanish) (42 kb, 2 pages)
Job Safety & Health Protection (OSHA)   (also available in Spanish) (41 kb, 1 page)  ( Spanish 99 kb, 1 page)
Your Rights Federal Minimum Wage 1088     (also available in Spanish) (25 kb, 1 page)  ( Spanish 46 kb, 1 page)
Notice to Employees Polygraph Protection Act WH 1462    (also available in Spanish) (34 kb, 2 pages) ( Spanish 158 kb, 2 pages)
Notice to Employees Davis Bacon 1321   (also available in Spanish) (67 kb, 2 pages)
Notice to Workers Disability Paid at Special Minimum Wage WH 1284 (100 kb, 2 pages)
Your Rights Family Medical Leave Act (FMLA) WH 1420   (also available in Spanish) (62 kb, 1 page)
ARRA-Know your Rights Under the Recovery Act!  Revised 10-29-09 (34 kb, 1 page)
Employee Rights Under the National Labor Relations Act   (also available in Spanish) (42 kb, 2 pages)
Storm Water Permit "Sign" (50 kb 1 pages)
Job Site Bulletin Board Checklist (72 kb, 1 page)
Letter Appointing EEO Officer  

State Aid Posters

Workers Compensation Law WC 106 (also in available in Spanish) (207 kb, 2 pages) ( Spanish 75 kb, 2 pages)
Unemployment Benefits Laws (also in available in Spanish) (75 kb, 1 pages) (Spanish 35 kb, 1 page)
Discrimination in Public Accommodations MCHR-07 (also in available in Spanish) (132 kb, 1 pages)
Discrimination in Employment is Prohibited by Law MCHR-09 (also in available in Spanish) (132 kb, 1 pages)

Materials  Related

Transfer Request of Inspected Material (25 kb, 1 page)
New Product Evaluation Form                                 (112 kb, 4 pages)  
PAL Shippers Transmittal Form (37 kb, 1 page)
PAL Fabricators Receival Form (42 kb, 1 page)
PAL Program Inclusion Certifications and Guarantee Statement (122 kb, 1 page)
Concrete Mix Design Submittal Form (76 kb, 1 page)
Pipe Shipping Submittal Form:  CMP, RCP, Precast Drainage Unit & Precast Box Culvert 52 kb, 1 page)

Pipe Shipping Submittal Form:  Thermoplastic

(64 kb, 1 page)

Producer Supplier Listing Form

(148 kb, 4 page)

Asphalt Pay Factor Worksheet:     Payfactor v6.24

(357 kb, multiple page)

Asphalt Inspectors Worksheets:     Plant Inspection v5.02         Cumulative Gradation  

(916 kb, multiple page)
Asphalt Inspectors Worksheets:     Plant Inspection v4.62         Non-Cumulative Gradation (916 kb, multiple page)
Corelok Aggregate Workbook (56 kb, 1 page)
Durable Aggregate Calculation (25 kb, 1 page Excel)
Aggregate Quality Control Plan (20 kb, 1 page)
Recycle Binder Contribution 2.11 (116 kb, 1 page)

 

Utility / Right of Way  Related

Permit to Work on Right of Way  
MoDOT Notice of Intent to Perform Work
 

The documents are provided in Acrobat Reader format. Free Acrobat Reader download PDF Icon
About Us
How Do I...
Contact Us
Missouri Department of Transportation
Central Office
105 W. Capitol Avenue
Jefferson City, MO 65102
1-888-ASK-MODOT (275-6636)
1-866-831-6277 (Motor Carrier Services)
Drivers License Offices
horz_bar
| | |
Missouri State Government
© 2013 Missouri Department of Transportation. All Rights Reserved.   Privacy Policy.
 
 
 
 
RSS FeedYoutubeBlogFlickrTwitter Facebook