Text Size:   A+ A- A   •   Text Only
Find     
Site Image

Utility Forms Library

Overview and Contact Information

ODOT's utility forms library is a comprehensive list of the forms needed during the utility relocation process.
 
Questions should be forwarded to State Utility and Railroad Liaison Heather Howe.
 
Please note: Some form names have revised to align with ProjectWise naming conventions.
Back to Top

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 completion. Send the certification to the state utility liaison. ​Word ​10/2013
​Conflict Letter - Non-reimbursable 1st Notice ​Initial notification to utilities indicating that facilities owned by the company conflict with the construction of a project and should be relocated and/or adjusted before construction begins. ​Word ​04/2014
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 its facilities for completeness and accuracy. ​Word ​02/2014
 
Back to Top

FORMS, PROJECT SCOPING

​Form Name ​Description ​File Format ​Last Update
DAP Utility Report, Complex ​Example: List of utilities that have been identified ​Word ​05/1995
ODOT Survey Request ​Work request form to be submitted to the region survey group. ​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 to the region utility specialist. Send this form to the utility with the conflict letter and list. ​Word

Back to Top

FORMS, REIMBURSABLE

​Form Name ​Description ​File Format ​Last Update
Billing - Actual Cost ​Document to be completed by the utility owner when submitting for a reimbursable utility. ​Excel ​03/2009
Certificate of Materials Origin (CMO) ​This certification establishes material 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 occurred within the United States. ​Excel ​02/2013
Certification - Reimbursement ​Form to be completed by the utility specialist when there is reimbursable work. ​Word ​05/2012
Conflict Letter - Reimbursable ​Initial notification to utility owners that facilities conflict with the construction of a project and should be relocated and/or adjusted before construction begins. Word​ ​04/2014
Cost-split Worksheet template ​Example of when ODOT and a utility owner split the cost of 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 occupies a portion of the future right of way to be acquired by the state for an upcoming project. ​PDF
Project Notification Letter ​Initial notification to the utility owner when facilities are not in conflict with project plan. The utility needs to review the mapping of its facilities on the plans for completeness and accuracy. ​Word ​12/2012
Reimbursement Information form ​To be completed by a utility owner prior to any preliminary engineering work, when reimbursable work exists. ​PDF ​12/2011
Transmittal - Request Form For use by utility specialist when requesting work be completed by state utility liaison. ​Word ​09/2010
Utility Billing Checklist ​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. Utility owner completes and send to the utility specialist for reimbursable work. ​Word
X-Permit Package ​An example of an X-Permit. ​PDF
X-Permit Special Provisions - Fee Title Holding ​Document to be completed when an 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 an X-permit will be issued to utilities with a compensable interest or a prior right easement holding. ​Word ​03/2009
 
Back to Top

Local Public Agency 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 Local Public Agency (LPA) Procedures Guide outlines the basic requirements governing the relocation and reimbursement procedures and practices to be used by a Local Public Agency 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 reimbursable work. ​Word ​03/2009
Certification - Utility Form LPA ​Complete this form at PSE to certify that all utility work has been completed, or that all necessary arrangements have been made for completion. Send the certification to the state utility liaison. ​Word ​02/2014
Conflict Letter - Non-reimbursable LPA Use this form when the utility is not reimbursable. Initial notification to utility owners that facilities conflict with the construction of a project and should be relocated or adjusted before construction begins. ​Word ​12/2012
Conflict Letter - Reimbursable LPA Use this form when the utility is reimbursable. ​Initial notification to utility owners that facilities conflict with the construction of a project and should be relocated or adjusted before construction begins. ​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 For use by utility specialist to use when requesting the state utility to make a payment to a utility. ​Word ​03/2009
​Relocation Time Requirements 2nd Notice ​Relocation time requirement letter that is sent to the utility stating what the utilities have told ODOT their relocation and/or adjustment work will be. This includes the relocation completion date. ​Word ​03/2009
 
Back to Top

A-C

 
​Form Name ​Description ​File Format ​Last Update
Agreement process for reimbursable utilities ​Agreement process for a reimbursable utility. ​PDF ​03/2006
BPA application for proposed use of BPA right of way ​Use this "no cost" form when submitting plans to BPA. This will streamline BPA review time.

​PDF

Bridge Design Desk Manual ​Excerpt from 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 completed form to the state utility liaison. ​PDF ​10/2013
Checklist - Utility Relocation Process ​An overview to use throughout an entire project processing of utility relocations. ​PDF ​03/2001
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
Contractor Utility Meetings Contract language to use when Contractor Utility Meetings are required. ​Word
Cooperation with Utilities SP150.50 ​Section 00150, control of work, 2008 specials. ​Word ​06/2009
 
Back to Top

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 easement law and its application. ​PDF ​09/1966
Example - Utility Specifications 1 ​Example of SP150.50 ​PDF
Example - Utility Specifications 2 ​Example of SP150.50f ​PDF
 
Back to Top

F-J

 
 
 
​Form Name ​Description ​File Format ​Last Update
Hand-dug Guardrail Posts ​Use this specification, under 00810, when a utility is in conflict. ​Word ​06/2009
Highway Designation Map Legal designation of state highway map. ​PDF
Highway Designation through Cities ​File 3a: Resolution of primary highway designation through cities. ​PDF ​06/1935
History of State Highways ​History of how early roads and state highways were established, including this history of: primary and secondary state highways, county roads, city streets, and the forest highway system. ​PDF ​2009
 
Back to Top

K-L

Currently there are no forms in this section.
Back to Top

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 covering: 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) Information sources. ​PDF ​10/1997
 
Back to Top

P-Z

​Form Name ​Description ​File Format ​Last Update
Road Establishment File Index Cross Reference ​PDF
Siphon Box (RD376) ​Miscellaneous drainage structures siphon box. ​DGN/PDF ​2009
Special Provisions 150 ​Provide to the specification writer. ​Word ​01/2015
Street Cut (RD302) ​Street cut standard drawings. ​DGN/PDF
SUE Quality Levels ​Lists the SUE quality levels from 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 structures. ​Word ​03/2008
Utility Attachments on Structures Request Form ​Data sheet for the utility attachment on structures process. ​Word ​05/2005
Utility Funding - Programming Process ​Utility relocation funding and authorization process. ​PDF ​10/2005
Utility Preconstruction Conference SP180.42 ​Standard specification 00589 utility attachments on structure.
Utility Relocation Information Sheet ​Word
Work Restriction Zone (Detail) ​PDF
 
Back to Top