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Engineering

Forms

 
Civil Rights/Affirmative Action
 
Construction
DC13 Regional Construction Stormwater Report (xls 27k)
DC16 Disclosure of Investment Activities in Iran (pdf 496k)
DC17 Contractor's Certificate Of Compliance Items Containing Steel & Iron (pdf 927k)
DC17U Utility Certificate of Compliance Items Containing Steel & Iron (pdf 1.9m)
DC18 Request for Approval to Sublet (rtf 293k) - Checklist (rtf 45k)
DC18A Request for Approval to Sublet on Projects Utilizing the 2007 Specifications (pdf 58k)
DC20 Certificate of Completion (pdf 1.1m)
DC21 FHWA Closeout Checklist (pdf 1.6m)
DC30A AsBuilt Summary (rtf 135k)
DC30B AsBuilt Worksheet (rtf 186k)
DC30C AsBuilt Calculation Sheet (rtf 521k)
DC31 Vertical Underclearence Asbuilt Report (xls 34k) - Sample (pdf 77k)
DC32 Structure Construction Completion Notification (pdf 90k)
DC34 Key Contract Personnel (rtf 171k)
DC48 Structural Steel Paint Information Form (xls 32k)
Instructions (doc 24k)
DC55 Force Account Summary (xls 117k)
DC55A Force Account Summary for use with Contracts utilizing BDC12S-07 in the Special Provisions only (xls 161k)
DC74A Contractor's Financial and Equipment Statement Experience Questionnaire and Past Performance Record (rtf 2m)
DC74B Contractor's Updated Financial Statement (rtf 394k)
DC83 Contractor's Performance Evaluation (xls 67k)
Note: For Contracts Bid AFTER June 30, 2011
DC83 Contractor's Performance Evaluation (rtf 317k)
Note: For Contracts Bid BEFORE June 30, 2011
DC100 Permit-By-Rule Notification (pdf 131k)
DC101 FHA Construction Notice (pdf 55k)
DC102c Notification/Certification of Work Completion/Compliance (pdf 27k)
DC102s Notification/Certification of Work Commencement (pdf 34k)
DC103c Dam Safety and Flood Control Completion Report (pdf 110k)
DC103s Dam Safety and Flood Control Completion Notice (pdf 110k)
DC105U Authorization for Utility Field Changes (rtf 115k)
DC115 Pile and Equipment Data (pdf 1.1m)
DC118 Ethics Certification (rtf 37k)
DC123 Contractor's Final Certificate of Compliance (rtf 68k)
DC127 Monthly Summary of Contractor's Payrolls (pdf 1.5m)
DC128 Quarterly Summary of Contractor's Payrolls (pdf 137k)
DC129 Late Payroll Log (rtf 181k)
DC130 RE Checklist (pdf 201k) - Instructions (pdf 42k)
DC144 (a)-(d) Daily Work Report with HMA, Bituminous Materials and Pile Driving Supplements (xls 90k)
DC149 Release of Liens for Materials Stored for Incorporation in Department of Transportation Projects (rtf 43k)
DC150 Design Change During Construction Phase (pdf 1.1m)
DC150U Authorization for Utility Field Changes (rtf 115k)
DC152 Project Supervisor Field Inspection Report (doc 39k)
DC155 Project Closeout Workbook (zip 2.1m)
DC161
2001
Contractual Notice (rtf 217k)
DC161
2007
Contractual Notice (rtf 200k)
1.) NJDOT Step IV Non-Binding Mediation Agreement (rtf 66k)
2.) NJDOT Step IV Non-Binding Mediation Agreement with Consultant Participation (rtf 65k)
DC161R Contractual Notice Release Form (rtf 68k)
DC175 NJDOT Insurance Certificate (rtf 85k)
DC175 '07 NJDOT Insurance Certificate for 2007 (rtf 296k)
DC178 Contractor Supplied Equipment Tranfser (rtf 52k)
DC2891 Material Questionnaire (xls 85k) - Instructions (pdf 60k)
EDU-1 Working Drawing Input Data (rtf 152k) - Instructions (pdf 239k)
EDU-2 Plan Request Form (pdf 1.5m) - Instructions
 
Design
CCEG-1 Contingencies and Escalation (dot 170k) - Information
CCEG-2 Utility Owner Conflict Identification Worksheet (dot 134k) - Information
CON-RQST-2 CCB Construction Change Request (doc 110k) - Information
DDC-RQST Design Document Change Request (pdf 1.8m)
DES-RQST-2 CCB Design Change Request (rtf 179k) - Information
DF15 Request for Approval of Patented/Proprietary Items on FHWA Funded Contract (pdf 954k)
DF16 Request for Approval of Patented/Proprietary Items on Non-FHWA Funded Contract (pdf 92k)
DF17 Field Work Security Letter (pdf 1.4m)
DF18 Work Authorization Letter (pdf 2.3m)
LF-1 Evaluation Form for Controlled Access Facility (Continuous Freeway Lighting) (pdf 1.4m)
LF-2 Evaluation Form for Interchange Lighting (pdf 979k)
LF-3 Evaluation Form for Controlled Access Facility
(New Roadway/Alignment) (pdf 975k)
LF-4 Evaluation Form for Interchange Lighting
(New Alignment) (pdf 979k)
LF-5 Evaluation Form for Non-Controlled Access Facility Lighting (pdf 985k)
LF-6 Evaluation Form for Non-Controlled Access Facility Lighting (New Alignment) (pdf 983k)
LF-7 Evaluation Form for Intersection Lighting (pdf 982k)
LF-8 Evaluation Form for Intersection Lighting
(New Roadway/Alignment) (pdf 981k)
LF-9 Voltage Drop Calculation Form (pdf 1.8m)
QMSESTNS Non-standard Item Number Request - Information
SI01 ESBE/DBE Goals Request (doc 45k)
SI02 SBE Goals Request (doc 43k)
SI03 Classification Codes Worksheet (xls 49k)
SI04 Trainee Request (doc 186k)
TIF-1 ADA Technically Infeasible Form (zip 53k)
 
Electrical
EL11C Regional Electrical Operations Emergency Call Record
(rtf 214k)
EL16C Traffic Signal Inpection Report (rtf 165k)
 
Maintenance
MT17A Application for Utility Opening (pdf 2.3m)
MT23 Cost Estimate of Repair for Guiderail & Appurtenances by Contractor (rtf 117k)
MT32 Driveway Access Permit Application (pdf 2.59m)
MT33A Application for Erection of Pole (rtf 156k)
MT39A Application for Drainage (rtf 153k)
MT80 Highway Sign Request (pdf 1.2m)
MT81 Response to Sign Damage Report (pdf 546k)
MT105A Application for Bridge Attachment (rtf 134k)
MT120A Application for Highway Occupancy (rtf 217k)
MT155 Lot Consolidation or Subdivision Application (pdf 2.35)
MT156 Power of Attorney (pdf 43k)
MT158 Street Improvements Application (pdf 78k)
MT159 Request for Waiver (pdf 69k)
MT160 Street Intersection Application (pdf 2.5m)
 
Operations
AD99 Loss, Theft and Vandalism Report (rtf 65k)
 
Right of Way
RE10 Parcel Information Form for ROW Engineering Manual
(xls 60k)
 
Statewide Traffic Operations
TO100 Weekly Closure Request (pdf 136k)
TO101 Daily Lane and Shoulder Closure Request - Construction
(rtf 118k)
TO102 Daily Lane and Shoulder Closure Request (pdf 1m)
TO103 Advanced Traffic Impact Notice (pdf 1.5m)

 
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  Department of Transportation
  P.O. Box 600
  Trenton, NJ 08625-0600
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  Last Updated:  September 22, 2016