| Utility Forms Library |
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| Overview and Contact Information |
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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. |
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| FORMS, NON-REIMBURSABLE |
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Form
Name
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Description
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File Format
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Last Update
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| 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
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| 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 |
03/2009
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Letter to use when you send a utility complete final construction plans for a project. |
Word |
03/2009
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| Special Provision Example |
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Word |
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| FORMS, PROJECT SCOPING |
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Form
Name
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Description
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File Format
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Last Update
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| DAP Utility Report, Complex |
Example: List of utilities that have been facilities identified within. |
Word |
1995
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| ODOT Survey Request |
Work request form to be submitted to the Region Survey group. |
Word |
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Letter to send to the Utility reminding them of OAR 952-02-08, Operators to Respond to Notifications Requesting Design Information. |
Word |
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| 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 |
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| One-Call Response |
Form used by caller to record locate information as caller receives call backs from utilities. |
Word |
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| Pothole Information Sheet |
Pothole field data sheet. |
Excel |
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| Project Contact List |
Use this form to place all utilities and their contact information. |
PDF |
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| 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 |
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Form
Name
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Description
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File Format
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Last Update
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| Billing - Actual Cost |
Document to be completed by Utility when submitting for a reimbursable utility. |
Excel |
03/2009
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| Certificate of Materials Origin (CMO) |
This certification is amde 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
(Click here to go to the spreadsheet.) |
12/2011
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| 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
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| 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
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| Certification - Reimbursement |
Form to be completed by the Utility Specialist when there is reimbursable work. |
Word |
03/2009
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| 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 |
12/2011
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| Cost Split Worksheet - Template |
Example of when ODOT and a Utility split the cost on a project. |
Excel |
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| 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 |
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| 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
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| Special Provision Example |
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Word |
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| 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
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| 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 |
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| X-Permit Package (Example 1) |
An example of what a completed X-permit looks like. |
PDF |
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| 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
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| 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 |
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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 |
03/2009 |
| 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 |
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 |
03/2009 |
| 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 |
03/2009 |
| 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 |
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| D-E |
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| Form Name |
Description |
File Format |
Last Update |
| Designation of Secondary Highways |
Resolution. Location and designation of secondary highways. |
PDF |
12/1933
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| 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
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| Example: Utility Specs 1 |
Example of what SP150.50 should look like. |
PDF |
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| Example: Utility Specs 2 |
Example of what SP 150.50f should look like. |
PDF |
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| F-J |
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| 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
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| Highway Designation Map |
Legal Designation of State Highways map. |
PDF |
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| Highway Designation thru Cities |
File No. 3a: Resolution of Primary Highway Designation thru Cities. |
PDF |
06/1935
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| 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 |
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Currently there are no forms in this section.
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| M-O |
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| 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 |
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| Modified Guardrail - Removed Posts (RD470) |
Guardrail over low-fill culverts. |
DGN/PDF |
2009
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| Modified Guardrail - Short Posts (BR266) |
Modified type 2A rail. |
DGN/PDF |
2009
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| Notification of Claim Recovery |
Letter sent to a utility when they are responsible for delaying the contractor. |
Word |
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| Oregon Highway Numbers |
List of the Oregon State Highway System listed alphabetically and numerically. |
PDF |
05/2000
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| 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 |
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Form
Name |
Description |
File Format |
Last Update |
| Pavement Cut Moratorium |
This letter serves notice to all involved utilities that a 5-year pavement cut moratorium shall be in place after final paving on any portion of a project has occurred. |
Word |
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| Road Establishment File Index |
County number, county name and the R/W file number. |
PDF |
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| S-Z |
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