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BLR FORMS
Last updated:
December 23, 2008
| In order to provide continuity and simplicity in the administration and
expenditure of funds, the Department has provided a number of pre-printed
forms for local agency use. These forms have been reproduced in an
electronic format to be readily accessible and more easily used.
|
| The Files below are MS Word templates. If you do not have MS Word to
read these files, see Tips and Tools for
a free copy of WordViewer.
Notice: The BLR Forms have been renumbered to correspond with chapters in
the new BLR Manual. Please use the Cross Reference Sheet listing
Old to New BLR Forms, or the
Cross Reference Sheet listing
New to Old BLR Forms to
reference the appropriate form. The first two numbers refer to chapter. The
third number refers to section. The last two numbers are sequential. For
example, BLR 05610: Chapter = 05, Section = 6 and Sequence = 10.
Use of the new forms is effective July 1, 2005, but old forms will be
accepted until July 31, 2005. Old forms received after July 31, 2005 will be
returned.
Usage Key: C = County, R = Road District, M = Municipality
|
|
BLR02110 |
07/05 |
Resolution
Certifying Names to Take the Examination for County Engineer |
C |
|
BLR02111 |
7/05 |
Resolution Certifying Names to take the Examination for Co. Eng. & Requesting
the Consent of IDOT to the Reappointment of the incumbent |
C |
|
BLR02120 |
7/05 |
Resolution
Requesting Consent of IDOT to the Reappointment of the Incumbent as County
Engineer |
C |
|
BLR 02121 |
8/19/08 |
Resolution Reappointing County Engineer |
C |
|
BLR02122 |
7/05 |
Resolution
Appointing County Engineer (Fixed Salary) |
C |
|
BLR 02123 |
8/19/08 |
Resolution Appointing County Engineer |
C |
|
BLR02124 |
07/05 |
Resolution
Concurring in the Joint Appointment of a County Engineer
|
C |
|
BLR 02125 |
8/19/08 |
Resolution Appointing a County Engineer Jointly with County
|
C |
|
BLR02130 |
07/05 |
Resolution
Requesting Consent of the IDOT to the Appointment of an Acting County Engineer |
C |
|
BLR 03210
|
01/07 |
Resolution Establishing a Class II or Class III
Designated Truck Route
|
C, M |
|
BLR 04100 |
01/10/08 |
Project Application
for Local Rail-Highway Crossing Safety Program |
|
|
BLR04310
|
01/06 |
Ordinance for
Municipal Census |
M |
|
BLR04311
|
01/06 |
Affidavit
for Municipal Census |
M |
|
BLR04312
|
01/06 |
Affidavit for
Municipal Annexation |
M |
|
BLR 05210
|
04/08/08 |
Local Agency-State
Jurisdictional Transfer |
C,R,M |
|
BLR 05211 |
04/08/08 |
Local Agency-State
Agreement for Jurisdictional Transfer
|
C,R,M |
|
BLR 05212
|
04/08/08 |
Local
Agency Agreement for Jurisdictional Transfer
|
C,R,M |
|
BLR 05310
|
03/26/08 |
Local
Agency Agreement for Federal Participation
| C,M
|
|
BLR 05311 |
11/30/07 |
Local Agency Amendment
for Federal Participation |
C,M |
|
BLR 05320
|
11/30/07 |
Economic Development
Program Agreement |
C,M |
|
BLR 05321
|
11/30/07 |
Truck Access Route Program (TARP) Agreement |
C,M |
|
BLR 05322 |
11/30/07 |
Economic
Development/TARP Agreement |
C,M |
|
BLR 05323 |
11/30/07 |
Local Agency/State Agreement (Non-Federal) |
|
|
BLR 05510
|
11/06 |
Preliminary Engineering Services Agreement for
Motor Fuel Tax Funds
|
C,M |
|
BLR 05511
|
11/06 |
Preliminary Engineering and Construction Guidance
Agreement for MFT Funds
|
C,M |
|
BLR 05512
|
11/06 |
Preliminary Construction Engineering Services
Agreement for MFT Funds
|
C,M |
|
BLR05520
|
07/05 |
Maintenance Engineering to be Performed by a
Consulting Engineer
|
C,M |
|
BLR 05610 |
09/06 |
Preliminary
Engineering Service Agreement for Federal Participation |
C,M |
|
BLR05611
|
09/06 |
Construction Engineering Services Agreement for
Federal Participation
|
C,M |
|
BLR05612
|
07/05 |
Request for Construction Engineering Services
Performed by Local Forces |
C,M |
|
BLR05613 |
12/05 |
Engineering Payment
Record |
C,M |
|
BLR 05620 |
11/06 |
Invoice |
C,R,M |
|
BLR 06310
|
07/05 |
Bridge Record
|
C,M |
|
BLR 06510
|
06/07 |
Local Agency Load Rating Request
|
C,R,M |
|
BLR 09110 |
11/06 |
Resolution for Improvement by County Under the Illinois Highway Code |
C |
|
BLR 09111 |
11/06 |
Resolution for Improvement by Municipality Under the Illinois Highway Code |
M |
|
BLR 09120 |
11/06 |
Statement of
Proposed Road Improvement |
C,R |
|
BLR 09130 |
06/07 |
Co.
Request for Rd. Dist. Motor Fuel Tax Funds to be Used to Retire Indebtedness |
C |
|
BLR09140 |
07/05 |
Statement of
Financing of Local Improvement Project |
M |
|
BLR 09150 |
11/06 |
Request
for Expenditure/Authorization of Motor Fuel Tax Funds
|
C,R,M |
|
BLR 09210 |
9/28/07 |
Township
Bridge Program |
C |
|
BLR09220
|
07/05 |
Agreement for County Engineer's Salary |
C |
|
BLR 10100 |
10/9/08 |
Motor Fuel Tax Certification/Project Status |
|
|
BLR 10210
|
11/06 |
Preliminary Bridge and Hydraulic Report
|
C,M |
|
BLR10220
|
07/05 |
Asbestos Determination Certification for Local
Highway Bridges
|
C,M |
|
BLR11310
|
07/05 |
Special Provisions
|
C,M |
|
BLR11510 |
07/05 |
Estimate of Cost
|
C,R,M |
|
BLR12110 |
07/06 |
Rental Schedule of
Privately Owned Equipment |
C,R,M |
|
BLR 12210
|
12/08/08 |
Proposal / Contract Cover
|
C,R,M |
|
BLR 12220
|
01/09/08 |
Notice to Bidders
|
C,R,M |
|
BLR12221
|
07/05 |
Proposal
|
C,R,M |
|
BLR12222
|
07/05 |
Schedule of Prices
|
C,R,M |
|
BLR12223 |
07/05 |
Signatures
|
C,R,M |
|
BLR12230 |
07/05 |
Local Agency Proposal Bid Bond
|
C,R,M |
|
BLR 12240
|
12/06 |
Notice of Material Letting
|
C,R,M |
|
BLR12241
|
07/05 |
Material Proposal Schedule of Prices
|
C,R,M |
|
BLR12250 |
07/05 |
Request for Quotations
|
C,R,M |
|
BLR 12310 |
6/3/08 |
Computer Data for Contractors Bulletin
|
C,M |
|
BLR12315 |
08/05 |
Tabulation of Bids |
C,R,M |
|
BLR12320 |
07/05 |
Contract
|
C,R,M |
|
BLR12321
|
07/05 |
Contract Bond
|
C,R,M |
|
BLR 12325 |
04/07 |
Apprenticeship or Training Program Certification
|
|
|
BLR12330
|
07/05 |
Acceptance of Proposal to Furnish Materials and
Approval of Award
|
C,R,M |
|
BLR 13210
|
7/21/08 |
Request for Approval of Change in Plans
|
C,R,M |
|
BLR 13220
|
7/21/08 |
Local Agency/Contractor Trust Agreement
|
C,R,M |
|
BLR13230 |
07/05 |
Engineer's Payment Estimate
|
C,R,M |
|
BLR13231
|
01/06 |
Engineer's Final Payment Estimate
|
C,R,M |
|
BLR13310
|
07/05 |
Certification of Local Agency Material Test
Procedures
|
C,M |
|
BLR 13311
|
07/05 |
Local Agency Report of Certified/Approved Asphalt
|
C,R,M |
|
BLR 13312 |
4/07 |
Contractor's Report of Source of Materials |
|
|
BLR 13510
|
11/07/07 |
Final Report, Notice of Completion and Acceptance
of Improvement Constructed Under the Illinois
|
C,R,M |
|
BLR 14210 |
1/4/06 |
Special
Assessments - Public Benefit Retirement Schedule |
M |
|
BLR 14220 |
11/06 |
County Maintenance
Resolution |
C |
|
BLR14221
|
07/05 |
County or Township Estimate of Maintenance Costs
|
C,R |
|
BLR 14230 |
11/06 |
Resolution for Maintenance of Streets and Highways by Municipality
|
M |
|
BLR14231
|
02/06 |
Municipal Estimate of Maintenance Costs
|
M |
|
BLR14232
|
07/05 |
Municipal Maintenance Operations
|
M |
|
BLR14310
|
12/05 |
Municipal Maintenance Expenditure Statement
|
M |
|
BLR14320
|
08/05 |
MFT Maintenance Expenditure Statement
|
C,R |
|
BLR15110 |
07/05 |
Credit Transaction
for Motor Fuel Tax Account |
C,R,M |
|
BLR15310 |
07/05 |
General Improvement
Bond Issues-Description, Ordinance, Election and Bond Data |
C,M |
|
BLR 15311 |
7/18/08 |
General
Improvement or Refunding Bond Issues - Tax Levy and Bond Retirement Schedule |
C,M |
|
BLR15312 |
07/05 |
Refunding or
Refinancing Bond Issues-Issued to Retire General Improvement Bonds or Public
Benefits
|
C,M |
|
BLR15313 |
07/05 |
Refunding
or Refinancing Bond Issues Schedule |
|
|
BLR15314 |
07/05 |
Certification
Cancellation of Tax Levy |
R,M |
|
BLR15410 |
07/05 |
Special
Assessments-Description Court, Legal, and Financial Data |
M |
|
BLR15411 |
07/05 |
Obligation
Retirement Resolution |
C,M |
|
BLR 22110
|
4/22/08 |
Local Project Development Report for Group II
Categorical Exclusions & Design App.
|
C,M |
|
BLR 22111 |
12/23/08 |
Local Project Development Report for Group I Categorical Exclusions and Design Approval
|
C,M |
|
BLR 22112 |
12/23/08 |
Categorical Exclusion Group I and Design Approval |
C.M |
|
BLR 22120
|
11/06 |
Approval of Design Variance
|
C,M |
|
BLR22410
|
07/05 |
Initial Coordination Meeting Data
|
C,M |
|
BLR24110
|
07/05 |
Certification/Project Status
|
|
|
BLR24310 |
07/05 |
Unit Prices Agreement |
C,R,M |
|
BLR33410
|
07/05 |
Local Agency Pavement Preservation (LAPP) Approval
|
C,M |
|
BLR38410
|
07/05 |
Notice of Violation - Section 9-123 of IL Highway
Code
|
C,R,M |
|
|
|
|
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