Right of Way Utility Forms Library

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Right of Way

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 Liaison; or, Dale Shafer, Webmaster.

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	03/2009
Conflict Letter, Non-Reimbursable (first notice)	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
Final Plans to Utility	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	12/2012
Special Provision Example		Word

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
One-Call Reminder to Utility	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

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	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
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 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

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	12/2012
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	03/2009
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

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
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

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

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


K-L

Currently there are no forms in this section.

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


P-R

S-Z

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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