Local Assistance Procedures Manual (LAPM) Forms

All forms below are provided in PDF or fillable PDF (F-PDF) version along with a Word or Excel version if available.
Note: form titles with “LAPM” are hosted on the Caltrans Electronic Forms System (CEFS); form titles with “Exhibit” are hosted by DLA. Refresh your browser or clear the cache to access the latest version of these documents.

This website was updated on 10/01/2024.

Chapter 2 Roles and Responsibilities
Exhibit 2-B: Federal-Aid Project Responsibilities List for Delegated Projects Off SHS (PDF) Financial Plan Checklist (PDF)
Project Management Plan Checklist (PDF)
Chapter 3 Project Authorization
LAPM 3-A: Project Authorization/Adjustment Request (REV 10/2024)

(Please DO NOT open the form in Browser. Right-click above link and choose "save link/target as" to save the form. Then open the form with Adobe Acrobat/Reader)

Exhibit 3-H: Request for Capital Subvention Reimbursement Allocation/De-Allocation (F-PDF), EX3-H (DOCX)
Exhibit 3-I: Request for Local Advance Construction Authorization (F-PDF), EX3-I (DOCX)
Exhibit 3-J: Request for Transfer of Federal Funds to the Federal Transit Administration (PDF), EX3-J (DOCX)
Exhibit 3-K: Administrative Procedures for Transfer of Funds to FTA (PDF)
Exhibit 3-L: Local Assistance Project Prefixes (PDF)
Exhibit 3-P: Sample "Delegated Project Authorization"(PDF)EX3-P(DOCX)EX3-P(Excel)
Exhibit 3-R: Non-Infrastructure Project Work Plan Sample (PDF), EX3-R (DOCX) , EX3-R(Excel)

For ER Projects please visit ER Forms
Chapter 4 Agreements
Exhibit 4-B: Local Agency Agreement Execution Checklist (F-PDF)
Exhibit 4-C: Master Agreement - Administering Agency-State Agreement for Federal-Aid Projects (PDF)
Exhibit 4-D: Sample-Program Supplement Agreement (F-PDF), EX4-D(DOCX)
Exhibit 4-E: Master Agreement - Administering Agency-State Agreement for State-Funded Projects (PDF)
Chapter 5 Invoicing
LAPM 5-A: Local Agency Invoice (REV 09/2023)
(Please DO NOT open the form in Browser. Right-click above link and choose "save link/target as" to save the form. Then open the form with Adobe Acrobat/Reader)
Exhibit 5-G: Alternative Payment Procedure Sample (F-PDF-March 2015), EX5-G(DOCX)
Chapter 6 Environmental Procedures
Exhibit 6-A: Preliminary Environmental Study (PES) Form (F-PDF), EX6-A (DOCX)
Exhibit 6-B: Instructions for Completing the Preliminary Environmental Study (PES) Form (PDF)
Exhibit 6-J: PES (NI) Form (F-PDF), EX6-J (DOCX)
Exhibit 6-K: PES (NI) Form Instructions (PDF)
Chapter 7 Field Review
Exhibit 7-A: Instructions for Field Review Form (PDF)
Exhibit 7-B: Field Review Form (F-PDF)
Exhibit 7-C: Roadway Data (F-PDF)
Exhibit 7-D: Major Structure Data (F-PDF), EX7-D(DOCX)
Exhibit 7-E: Railroad Grade Crossing Data (F-PDF), EX7-E(DOCX)
Exhibit 7-F: Airport Data (F-PDF)
Exhibit 7-G: Field Review Attendance Roster (PDF), EX7-G(DOCX)
Exhibit 7-I: Systems Engineering Review Form (SERF) (F-PDF)
Chapter 8 Public Hearings
Exhibit 8-A: Sample Notice of Public Hearing (PDF), EX8-A(DOCX) Exhibit 8-B: Sample Notice of Opportunity for Public Hearing (PDF), EX8-B (DOCX)
Chapter 9 Civil Rights and Disadvantaged Business enterprises
Exhibit 9-A: DBE Implementation Agreement for Local Agencies (F-PDF), EX9-A(DOCX)
LAPM 9-B: Local Public Agency DBE Annual Submittal Form, EX9-B(DOCX)
Exhibit 9-C: Local Agency ADA Annual Certification Form (F-PDF), EX9-C (DOCX)
Exhibit 9-D: Contract Goal Methodology (Excel)
Exhibit 9-E: Sample Evaluation of Good Faith Effort (F-PDF), EX9-E(DOCX)
Exhibit 9-F: Monthly Disadvantaged Business Enterprise (DBE) Payment (Excel)
Exhibit 9-G: Sample Procedure for Good Faith Efforts (PDF)
Exhibit 9-H: Sample Procedure for Reconsideration Hearing (PDF)
LAPM 9-I: DBE Confirmation
LAPM 9-J: DBE Commercially Useful Function
LAPM 9-K: DBE Joint Check Agreement Request
Exhibit 9-P: Prompt Payment Certification (Excel)
Chapter 10 Consultant Selection
Exhibit 10-B: Suggested Consultant Evaluation Sheet (F-PDF), EX10-B(DOCX)
Exhibit 10-G: Individual A&E Task Order DBE Tracking Sheet (F-PDF)
Exhibit 10-I: Notice to Proposers DBE Information (PDF), EX10-I(DOCX)
Exhibit 10-O1: Consultant Proposal DBE Commitment (F-PDF), EX10-O1 (DOCX)
Exhibit 10-O2: Consultant Contract DBE Commitment (F-PDF), EX10-O2 (DOCX)
Exhibit 10-Q: Disclosure of Lobbying Activities (F-PDF), EX10-Q(DOCX)
Exhibit 10-R: AE Sample Contract Language (PDF)
Exhibit 10-S: Consultant Performance Evaluation (F-PDF), EX10-S(DOCX)
Exhibit 10-T: Panel Member Conflict of Interest Confidentiality Statement (F-PDF), EX10-T(DOCX)
Exhibit 10-U: Consultant in Management Position Conflict of Interest Statement (F-PDF), EX10-U(DOCX)
Chapter 11 Design Standards
Exhibit 11-A: Geometric Design Standards for Local 3R Projects (PDF)
Exhibit 11-B: Bridges and Structures (PDF)
Exhibit 11-F: Sample Design Fact Sheet (PDF)
Chapter 12 Plans, Specifications, Estimate
Exhibit 12-B: Bidder's List of Subcontractors (DBE and NON-DBE) (F-PDF)
Exhibit 12-D: PSE Checklist (F-PDF)
Exhibit 12-E: PSE Checklist Instructions (PDF)

Exhibit 12-F: Cost-Effectiveness / Public Interest Finding / A&E Noncompetitive (F-PDF)
Exhibit 12-G: Required Federal-aid Contract Language (PDF)
Exhibit 12-H: Sample Bid (PDF)EX12-H(DOCX)
Chapter 13 Right of Way
Exhibit 13-A: Short Form - Right of Way Certification for Local Assistance Project (F-PDF)(rev. May 2024)
Exhibit 13-B: Right of Way Certification (Off State Highway System)(DOCX)
Exhibit 13-C: Consultant Selection Criteria and Guide (PDF)
Exhibit 13-D: Uniform Relocation Act Benefits Summary (PDF)
Exhibit 13-E: Preliminary Engineering Right of Way Checklist (F-PDF) (rev. May 2024)
Exhibit 13-F: Local Public Agency Real Property Services Checklist (F-PDF)
Chapter 14 Utility Relocations
Exhibit 14-A: Local Agency Submittal Requirements for Federal Participation in Utility Relocations (F-PDF), EX14-A(DOCX)
Exhibit 14-B: Local Agency Utility Agreement Provisions for Federal Participation (F-PDF), EX14-B(DOCX)
Exhibit 14-C: FHWA Specific Authorization/Approval of Utility Agreement (F-PDF), EX14-C(DOCX)
LAPM 14-D: Notice To Owner-Local Assistance (F-PDF)
LAPM 14-D-REV: Revised Notice To Owner-Local Assistance (F-PDF)
Exhibit 14-E: Report of Investigation (F-PDF), EX14-E(DOCX)
Exhibit 14-F: Utility Agreements (F-PDF), EX14-F(DOCX)
Exhibit 14-G: Utility Agreement Clauses (PDF), EX-14G(DOCX)
Exhibit 14-H: Right of Way Utilities Through Stages of Project Development (PDF)
Exhibit 14-I: Local Agency/Utility Owner Special Agreement (F-PDF), EX14-I (DOCX)
Chapter 15 Advertise and Award Project
Exhibit 15-A: Local Agency Construction Contract Administration Checklist (F-PDF), EX15-A(DOCX)
Exhibit 15-B: Resident Engineer's Construction Contract Administration Checklist (F-PDF)
Exhibit 15-C: Project Advertising Checklist (F-PDF) (rev. July 2024)
Exhibit 15-D: Bid Tabulation Summary Sheet (Sample) (F-PDF), EX15-D (DOCX)
Exhibit 15-G: Construction Contract DBE Commitment (F-PDF)
Exhibit 15-H: Proposer/Contractor Good Faith Effort (F-PDF), EX15-H(DOCX)
Exhibit 15-I: Local Agency Bid Opening Checklist (F-PDF), EX15-I(DOCX)
Exhibit 15-L: Contract Award Checklist (F-PDF) (rev. July 2024)
Exhibit 15-M: Detail Estimate (F-PDF)
Chapter 16 Administer Construction Contracts
LAPM 16-A: Weekly Statement of Workings Days
LAPM 16-B: Subcontracting Request
LAPM 16-C1: Assistant Engineer’s Daily Report
LAPM 16-C2: Resident Engineer’s Daily Report
Exhibit 16-G: Corroboration Report (MR-0104) (PDF), EX16-G(DOCX)
Exhibit 16-I: Notice of Material to be Used (Form CEM-3101) (F-PDF), EX16-I(Excel)
Exhibit 16-K: Report of Inspection of Material (Form MR-0029) (PDF) EX16-K (DOCX)
LAPM 16-N: Employee Interview: Labor Compliance/EEO
LAPM 16-N ESP: Employee Interview: Labor Compliance/EEO (Spanish Form) 
Exhibit 16-O: Federal-Aid Highway Construction Contractor's Annual EEO Report(Excel)       
Exhibit 16-UF: Full and Final Potential Claim Record (F-PDF), EX16-UF(DOCX)
Exhibit 16-UI: Initial Potential Claim Record (F-PDF), EX16-UI(DOCX)
Exhibit 16-US: Supplemental Potential Claim Record (F-PDF), EX16-US(DOCX)
Exhibit 16-W: Source Inspection Request to TransLab (PDF), EX16-W(DOCX)
Exhibit 16-Y: Monthly Progress Payment Item Quantity Calculation Sheet (F-PDF), EX16-Y(DOCX)
Exhibit 16-Z1: Monthly DBE Trucking Verification (F-PDF), EX16-Z1(DOCX)
Chapter 17 Project Completion
Exhibit 17-A: Cover Letter and Federal Report of Expenditures Checklist (F-PDF), EX17-A(DOCX)
Exhibit 17-B: Final Inspection of Federal-Aid Project (FHWA Form 1446C) (F-PDF), EX17-B(DOCX)
Exhibit 17-C: Final Inspection Form (F-PDF), EX17-C(DOCX)
Exhibit 17-E: Sample Change Order Summary (F-PDF)
Exhibit 17-F: Final Report-Utilization of Disadvantaged Business Enterprises (DBE) and First-Tier Subcontractors (F-PDF), EX17-F(DOCX)
Exhibit 17-F1: Final Report-Utilization of Disadvantaged Business Enterprises (DBE) for A&E On-Call Contracts (Excel)
Exhibit 17-G: Materials Certificate (F-PDF)
Exhibit 17-H: Cover Letter and Final Report of Expenditures Checklist (PE Only) (F-PDF), EX17-H(DOCX)
Exhibit 17-I: Cover Letter for Report of Completion of Structures (F-PDF)
Exhibit 17-J: Report of Completion of Structures on Local Streets and Roads (F-PDF), EX17-J(DOCX)
Exhibit 17-K: Sample Report of Completion of Right of Way (PDF), EX17-K (DOCX)
Exhibit 17-L: Sample Report of Expenditures for Force Account Projects (PDF), EX17-L(DOCX)
Exhibit 17-M: Final Project Expenditure Report - State Only (F-PDF), EX17-M (DOCX)
Exhibit 17-O: Disadvantaged Business Enterprises (DBE) Certification Status Change (F-PDF), EX17-O(DOCX)
Chapter 18 Maintenance
Exhibit 18-A: Maintenance Review Checklist (F-PDF), EX18-A(DOCX)
Exhibit 18-B: Sample Resolution (F-PDF), EX18-B(DOCX)
Exhibit 18-C: City-County Road System EDP Input Form HCC 342 (PDF)
Exhibit 18-D: Mileage of Maintained Roads (F-PDF)

If you have any questions or wish to make comments for ongoing improvements to the manual, please feel free to contact the DLA Publication Manager.

Please feel free to send comments regarding this web site to the DLA Webmaster.