|
LPA Manual - Mail-in Comment/Suggestion Form (PDF)
LPA Appeals Form
PDF or
Word |
Use these Forms to apply
for Transportation Program Funds
for eligible Local Projects
In some cases the link is to the form, and in others,
the link is to the area on the NDOR site where the form may be easily found |
|
Chapter 2 Appendix - Programming the Project |
| |
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- DR 530 Project Programming Request
|
PDF |
Word |
|
PDF |
----- |
| Project Program Agreement Signing Resolution Template |
PDF |
Word |
| Supplemental Project Program Agreement Signing Resolution Template |
PDF |
Word |
| Engineering Services Agreement Signing Resolution Template |
PDF |
Word |
| FCB Inspection Agreement Signing Resolution Template |
PDF |
Word |
| Transportation Enhancement (TE) Intent to Apply Form |
Link to TE Site |
| Transportation Enhancement (TE) Draft Application Form |
Link to TE Site |
| Transportation Enhancement (TE) Final Application Form |
Link to TE Site |
| Safe Routes to School (SRTS) Intent to Apply Form |
Link to SRTS Site |
| Safe Routes to School (SRTS) Draft Non-Infrastructure Application |
Link to SRTS Site |
|
Safe Routes to School (SRTS) Non-Infrastructure Application |
Link to SRTS Site |
| Safe Routes to School (SRTS) Draft Infrastructure Application |
Link to SRTS Site |
| Safe Routes to School (SRTS) Infrastructure Application |
Link to SRTS Site |
| Nebraska Byways Application Form (Interactive fillable PDF) |
PDF |
---- |
| Chapter 4 Appendix - Consultant Selection |
|
|
DR39a - Notification of
Completion - Pre-Letting Consultant Professional Services -
includes instructions |
---- |
Word |
| DR 54 Consultant Evaluation Form |
PDF |
Word |
| DR 162 Cost Breakdown Form |
PDF |
Word |
| DR 250 Consultant Work Order for Local Projects |
PDF |
Word |
| DR 497 Annual Certification for Architect, Engineer & Related Services |
PDF |
Word |
| DR 498 Supplement to Statement of Qualifications for Architect, Engineer & Related Services |
PDF |
Word |
| Template RFP for Engineering Services |
PDF |
Word |
| Conflict of Interest Guidance Document for Local Public Officials, Employees, & Agents |
PDF |
----- |
| Conflict of Interest Disclosure Form for Local Public Officials, Employees, & Agents |
PDF |
Word |
| Conflict of Interest Guidance Document for Consultants |
PDF |
----- |
| Conflict of Interest Disclosure Form for Consultants |
PDF |
Word |
|
PDF |
Word |
- Short-List Ranking Summary Form
|
PDF |
Word |
- Final Selection Ranking Form
|
PDF |
Word |
- Final Selection Ranking Summary Form
|
PDF |
Word |
| Final Selection Memo |
PDF |
Word |
| |
- Template Scope of Services
|
|
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- Template Work Plan for LPA
|
|
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- Template Work Plan for Consultants
|
|
|
| |
- Template Scope of Services
|
|
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- Template Work Plan for LPA
|
|
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- Template Work Plan for Consultants
|
|
|
| Fixed Fee Worksheet |
Excel |
PDF |
| Pre-Negotiation Memo Template |
----- |
Word |
| Post-Negotiation Memo Template |
----- |
Word |
| Locally Funded Procurement Certification Statement |
PDF |
Word |
| LPA/Consultant Locally Funded Professional Services Agreement -
(Sample Agreement, Stop Codes, and Instructions) |
PDF |
----- |
- RC Pre-Construction Expenses
|
|
Word |
- Consultant Preliminary Engineering Invoice
|
|
Word |
- Consultant Construction Engineering Invoice
|
|
Word |
|
|
Word |
| |
|
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| Sample RFP Advertisement |
PDF |
Word |
| Sample Ranking Forms & Final Selection Memo |
PDF |
----- |
Sample Consultant Selection Criteria
|
PDF |
----- |
| Sample Detailed Scope of Services |
PDF |
Word |
| Sample Staffing Plan |
PDF |
----- |
| Sample Detailed Work Plan Matrix
|
PDF |
----- |
| Sample Pre-Negotiation Memo |
PDF |
----- |
| Sample Post-Negotiation Memo |
PDF |
----- |
| Sample DR 250 Consultant Work Order |
PDF |
----- |
| Instructions for DR 250 Consultant Work Order for Local Projects |
PDF |
----- |
Consultant Procurement & Agreement Procedure Flowchart
|
PDF |
----- |
| Consultant Work Order (CWO) Procedure Flowchart |
PDF |
----- |
Locally Funded Procurement Procedure Flowchart
|
PDF |
----- |
| LPA Reimbursement Procedures |
PDF |
----- |
| RC Cost Policy |
Link |
----- |
| Conflict of Interest Guidance
Document for Local Public Officials, Employees & Agents |
Link |
----- |
| Conflict of Interest Guidance Document for Consultants
|
Link |
----- |
|
| 04 10 Review of the Draft Request for Proposal (RFP) |
Link |
----- |
| 04 20 Review of the Final Consultant Ranking Concurrence |
Link |
----- |
| 04 30 Review of the Detailed Work Plan & Independent Cost Estimate |
Link |
----- |
| 04 40 Review of the LPA's Pre-Negotiation Memo & Consultant Fee Proposal |
Link |
----- |
| 04 50 Review of the Post-Negotiation Documentation |
Link |
----- |
| 04 60 Professional Services Agreement Closeout |
Link |
----- |
| 04 70 Locally Funded Consultant Procurement |
Link |
----- |
|
Chapter 5 Appendix - Environmental |
|
Programmatic Categorical Exclusion PCE Form Instructions |
Link to
LP Environmental
Page |
| CE Documentation Form for Federal-Aid
Projects |
Link to
LP Environmental Page |
|
Biological
Evaluation Form for LPAs Instructions |
Link to
LP Environmental Page |
|
CE Documentation Form |
Link to
LP Environmental Page |
| Guidelines for Completing Green Sheets |
PDF |
---- |
| Overview of Green Sheet Procedure |
PDF |
---- |
Green Sheet Form
|
PDF |
Word |
| Environmental & Planning Reference Materials |
PDF |
---- |
| Chapter 6 Appendix - Design |
| LPS Plan Review Checklist |
PDF |
---- |
| PIH Report Outline |
PDF |
---- |
| Chapter 10 Appendix - Civil Rights |
Local Program Projects Financial Management
Systems Expectations |
PDF |
---- |
| DR 441 DBE Goal Achievement |
PDF |
Word |
| DR 442 DBE Identification of Work Performed |
PDF |
Word |
| DR 98 Labor Compliance Interview Form |
PDF |
Word |
| Chapter 11 Appendix - PS & E |
| LPS PS & E Checklist |
PDF |
---- |
| Chapter 12 Appendix - Construction |
| NDOR Standard Change Order Form |
PDF |
Excel |
| Chapter 14 Appendix - Project Close Out |
| Transportation Enhancement (TE) Notice of Project Completion & Materials Certification -
to be furnished to the Project Coordinator before the project can be closed out. |
Link to TE Site |
| DR 441 DBE Goal Achievement |
PDF |
Word |
| DR 442 DBE Identification of Work Performed |
PDF |
Word |
| DR 299 Notification of Project Completion |
PDF |
Word |