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Utility Forms Library

Overview and Contact Information

 
  Welcome to the Oregon Department of Transportation's Utility Relocation Program Forms Library. This page is meant to be a comprehensive list of forms used in the Utility Relocation program.
 
To open the actual form, click on the form name. Some forms are in Microsoft Word or Excel, or in Adobe PDF. You need to have Adobe Acrobat Reader to open the PDF files.
 
If you have questions or comments regarding this page or the forms, please contact Heather Howe, State Utility and Railroad Liaison; or, Dale Shafer, Webmaster.
 
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FORMS, NON-REIMBURSABLE


Form
Name        
Description                       
File Format
Last Update
Certification - Utility  Complete this form at PSE certifying that all utility work has been completed, or that all necessary arrangements have been made for it to be undertaken and completed as required for property coordination with the physical construction schedule. Send the Certification to the State Utility Liaison.  Word 10/2013
  
  
  
  
  
 

Conflict Letter, Non-Reimbursable

(first notice) 

UPDATED! Initial notification to utilities indicating that facilities owned by the company conflict with the construction of a project and should be relocated or adjusted before construction begins. Use this form when the utility is not reimbursable. 

Word 04/2014
  
  
  
 
Letter to use when you send a utility complete final construction plans for a project.  Word 03/2009 
 
 
 
Project Notification Letter Initial notification to the utilities indicating that based on current plan review and utility locates there are no utility conflicts with utility facilities. The utility needs to review the mapping of your facilities on the enclosed plans for completeness and accuracy.​ Word​ 02/2014
Special Provision Example   Word  

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FORMS, PROJECT SCOPING


Form
Name        
Description                       
File Format
Last Update
DAP Utility Report, Complex   Example: List of utilities that have been facilities identified within. Word 1995
 
ODOT Survey Request  Work request form to be submitted to the Region Survey group. Word  
 Letter to send to the Utility reminding them of OAR 952-02-08, Operators to Respond to Notifications Requesting Design Information. Word  
One-Call Request   Form used when calling for utility locates on a project. The form should be completed prior to calling the Oregon Utility Notification Center (OUNC).  Word  
 
 
 
One-Call Response   Form used by caller to record locate information as caller receives call backs from utilities. Word  
Pothole Information Sheet   Pothole field data sheet. Excel  
 
 
Project Contact List  Use this form to place all utilities and their contact information. PDF  
Utility Relocation Information Form  The utility will complete this form and send it to the Region Utility Specialist. A sample form is included. Send this form to the utility with the conflict letter and list.  Word  

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FORMS, REIMBURSABLE


Form
Name        
Description                       
File Format
Last Update
Billing - Actual Cost    Document to be completed by Utility when submitting for a reimbursable utility. Excel  03/2009 
 
 
Certificate of Materials Origin (CMO)  This certification is made for the purpose of establishing materials acceptance under the Contract Special Provisions titled 00160.20(a) Buy America. All iron or steel manufacturing processes, including protective coatings, for the domestic materials described above occured within the United States of America. Excel 
 
02/2013  
 
Certification - Estoppel Completed by the utility stating that they should be reimbursed because the utility facilities were placed on private property with the permission of the fee owner of the property. Word 03/2009 
 
Certification - Prescription  Completed by the Utility stating that they should be reimbursed because they have prior rights by prescription. (These facilities are relocated on private property and a search of the records does not disclose any recorded or unrecorded easement for said facilities). Word 03/2009 
 
 
 
 
 
 
Certification - Reimbursement  Form to be completed by the Utility Specialist when there is reimbursable work. Word 05/2012  
 
Conflict Letter - Reimbursable UPDATED! Initial notification to utilities indicating that facilities owned by the company conflict with the construction of a project and should be relocated or adjusted before construction begins. Use this form when the utility is reimbursable.  Word  04/2014  
  
  
  
  
 
Cost Split Worksheet - Template  Example of when ODOT and a Utility split the cost on a project.  Excel  
 
 
 
Disposition of Utility Property This form can be used as a guide to help understand the different circumstances when a Utility facility currently occupies a portion of the future right of way to be acquired by the State for construction of an Oregon Transportation Commission (OTC) project.  PDF  
 
 
 
 
 
Project Notification Letter Initial notification to the utilities indicating that based on current plan review and utility locates there are not utility conflicts with utility facilities. The utility needs to review the mapping of your facilities on the enclosed plans for completeness an accuracy.​ Word​ ​12/2012
Reimbursement Information Form To be completed by a Utility prior to any PE work being completed by a utility when there is reimbursable work.   PDF, fillable 12/2011
 
 
 
Special Provision Example  Word
Special Provisions  Letter sent to the Specification Writer for Section 150.50 Cooperation with Utilities Word  06/2009
Transmittal - Request Form  Utility Specialist to use this form when requesting work be completed by the State Utility Liaison.  Word  09/2010  
  
 
UTILITY BILLING CHECKLIST.docxUTILITY BILLING CHECKLIST.docx ​Word ​02/2014
Utility Billing Memo  Utility Specialist uses when requesting the State Utility Liaison to make a payment to a utility.  Word  03/2009 
Utility Estimate Form  Example estimate form. A utility to complete and send to the Utility Specialist for reimbursable work.  Word  
 
 
X-Permit Package (Example 1)  An example of what a completed X-permit looks like.  PDF  
 
 
X-Permit Special Provisions - Fee Title Holding  Document to be completed when a X-permit will be issued to a utility with a compensable interest or a prior right fee title holding.  Word  03/2009 
 
 
 
X-Permit Special Provisions - Easement Holding Document to be completed when a X-permit will be issued to utilities with a compensable interest or a prior right easement holding.  Word  03/2009 
 
 
 

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LPA Projects Involving Utilities

ODOT is the designated state agency to implement Oregon’s federal-aid highway program.  Because of this, the Federal Highway Administration also places overall responsibility for county and city federal-aid road projects with ODOT.  The local agency program is administered by ODOT through the Regional offices and their Local Liaison.
 
The LPA Procedures Guide outlines the basic requirements governing the relocation and reimbursement procedures and practices to be used by a Local Public Agency (LPA) on federally funded local projects. The procedures are intended to be used as general guidelines by LPA's in the execution of their projects.
 

Form Name Description  File Format Last Update
Certification - Reimbursement (LPA) Form to be filled out by the Utility Specialist when there is a reimbursable work. Word 3/2009
Certification - Utility Form (LPA) Complete this form at PSE to certify that for a project all utility work has been completed or that all necessary arrangements have been made for it to be undertaken and completed as required for proper coordination with the physical construction schedule. Send the Certification to the State Utility Liaison. Word 02/2014
Conflict Letter, Non-Reimbursable (LPA) Initial notification to utilities indicating that facilities owned by the company conflict with the construction of a project and should be relocated or adjusted before construction begins. Use this form when the utility is not reimbursable.  Word 12/2012
Conflict Letter, Reimbursable (LPA) Initial notification to utilities indicating that facilities owned by the company conflict with the construction of a project and should be relocated or adjusted before construction begins. Use this form when the utility is reimbursable. Word 12/2012
Project Notification Letter Initial notification to  the utilities indicating that based on current plan review and utility locates there are no utility conflicts with utility facilities. The utility needs to review the mapping of your facilities on the enclosed plans for completeness and accuracy.​ Word​ ​12/2012
Utility Billing Memo (LPA) Utility Specialist to use when requesting the State Utility to make a payment to a utility. Word 03/2009
 
 
 
 
 
 
 
 

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A-C

 
Form
Name        
Description                       
File Format
Last Update
Agreement Process for Reimbursable Utilities  Agreement process for a reimbursable Utility. PDF  03/01/2006
 
 
 
BPA Application for Proposed Use of BPA Right of Way ​Use this "No Cost" form when submitting plans to BPA. This streamlines BPA's review time

​PDF

(WORD Version)

Bridge Design Desk Manual 1.4.7  Excerpt form the ODOT Bridge Design Manual discussing roles and responsibilities, general requirements, design and detailing for utility attachments to state highway bridges.  PDF  
 
 
 
 
Carry Through Manhole-Storm (RD354)  Carry through manhole-storm standard drawing. DGN/PDF 06/2009
 
 
 
Certification - Utility  Complete this form at PSE certifying that all utility work has been completed, or that all necessary arrangements have been made for it to be undertaken and completed as required for property coordination with the physical construction schedule. Send the Certification to the State Utility Liaison. ​Word ​10/2013
Checklist - Utility Relocation Process An overview to use throughout an entire project processing of utility relocations.  PDF 03/2011
Checklist - Reimbursable Utility Relocation Process A checklist to use for tracking the submittal, receipt from utility owner, and transmittal to State Utility Liaison for each utility on a project that has reimbursable relocations.  PDF 03/2011
Checklist - Non-Reimbursable Relocation Process A checklist to use for tracking the submittal, receipt from utility owner, and transmittal to State Utility Liaison for each utility on a project that has reimbursable relocations.  PDF 03/2011
Concrete Encasement of Pipes (Detail 545)    PDF  
 
 
 
Concrete Encasement of Pipes (RD306)  Concrete easements, cradle and cap.  DGN/PDF 2009
 
 
 
Conflict List Use this form to identify all utility conflicts pertaining to the project and send with the utility conflict letter.  Excel 08/2009
​Use this letter to meet the legal requirements for first notice as per OAR 734-055. ​Word ​05/2012
Contractor Utility Meetings  Language to use in the contract when a Contractor Utility Meeting is required.  Word  
 
 
Cooperation with Utilities SP150.50  Section 00150, control of work, 2008 specials.  Word 06/04/2009
 
 

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D-E


Form Name         Description                        File Format Last Update
Designation of Secondary Highways  Resolution. Location and designation of secondary highways. PDF 12/1933
 
 
 
Easement Law  Opinion on Oregon Law on Easements. In Oregon there are four ways an easement may be applied. They are recorded by document, unrecorded document, prescription, and estoppel.  PDF 09/1966
 
 
 
 
Example: Utility Specs 1  Example of what SP150.50 should look like. PDF  
 
 
Example: Utility Specs 2  Example of what SP 150.50f should look like.  PDF  
 
 

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F-J


Form Name         Description                        File Format Last Update
Hand Dug Guardrail Posts  Use this spec located under 00810 when a utility is in conflict. Word 06/04/09
 
 
 
Highway Designation Map  Legal Designation of State Highways map. PDF  
 
 
 
Highway Designation thru Cities  File No. 3a: Resolution of Primary Highway Designation thru Cities. PDF 06/1935
 
 
 
History of State Highways  History of how early roads and State Highway's were established. History of primary and secondary state highways. History of county roads. History of city streets. History of forest highway system. PDF 2009 
 
 
 

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K-L

Currently there are no forms in this section.

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M-O


Form Name         Description                        File Format Last Update
Matrix - Prior Rights Determination   This document helps identify if a utility is reimbursable or non-reimbursable based on the location of the utility.  PDF  
 
 
 
Modified Guardrail - Removed Posts (RD470)   Guardrail over low-fill culverts. DGN/PDF   2009
 
 
 
 
Modified Guardrail - Short Posts (BR266)   Modified type 2A rail. DGN/PDF 2009
 
 
 
 
Notification of Claim Recovery   Letter sent to a utility when they are responsible for delaying the contractor.  Word  
 
 
Oregon Highway Numbers   List of the Oregon State Highway System listed alphabetically and numerically.  PDF 05/2000
 
 
 
Overview of Ownership Rights   General Reference Document: Covered in this report are topics that generate the basic questions of "documented rights" as well as some background information for further clarification and understanding of ODOT rights. Topics include 1) Designation and establishment of state highways; 2) Resoluted right of way; 3) Right of way widths; 4) Historical status of a road; 5) Changes to ODOT highways; 6) Miscellaneous highway legislation; and 7) Where to find information.  PDF 10/1997
 
 
 
 
 
 
 
 
 
 

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P-R


Form
Name        
Description                        File Format Last Update
Siphon Box (RD376)   Miscellaneous drainage structures siphon box.  DGN/PDF 2009
 
 
Street Cut (RD302)   Street cut standard drawings.    DGN/PDF   
 
 
SUE Quality Levels   Lists the SUE quality leaves from Level A to D. PDF  
 
 
Time Requirement Letter (2nd Notice) Relocation time requirement letter that is sent to the utility stating what the utilities have told ODOT their relocation/adjustment work will be. This includes the relocation completion date.  Word 03/2009
Utility Attachments on Structures SP589   Standard specification 00589 utility attachments on structure.  Word 03/31/2008
 
 
 
Utility Funding - Programming Process  Utility Relocation funding and authorization process. PDF 10/25/2005
 
 
 
Utility Attachment on Structure Request Form   Data sheet for the Utility Attachment on Structures process. Word 05/20/2005
 
 
Utility Preconstruction Conference SP180.42  Standard specification 00589 utility attachments on structure.     
 
 
 
 
Work Restriction Zone (Detail)  PDF  
 
 

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S-Z

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