11-M. Sample Form - Rating Sheet.pdf

SAMPLE FORM – RATING SHEET

PROJECT NAME: EAST DISTRICT - B MEDIAN MAINTENANCE - FY2026

CONTRACTOR NAME:

CONTRACT NUMBER:

INSPECTION DATE: ______________

Rating S = Satisfactory U = Unsatisfactory

ITEM

NO.

Item Description Rating Comments

Albemarle Rd Medians (medians on Albemarle Rd. from E. WT Harris Blvd. to Wilgrove-Mint Hill Rd.; includes 4 grass and concrete medians on Circumferential Rd. at Albemarle Rd.)

Idlewild Rd. North Medians (2 medians on Idlewild Rd. North at WT Harris Blvd.)

Lawyers Rd. Extension Medians (medians on Lawyers Rd. Ext. between E. WT Harris Blvd. and Albemarle Rd.)

Linda Lake Median and Right of Way (1 triangular median on Linda Lake Dr. at Lakeside Dr. N.; also includes Right of Way on Highland Ave. on the SE corner of the intersection with Robinson Church Rd.)

W. T. Harris Blvd. Medians (medians on WT Harris Blvd. from Independence Blvd. to US 29; includes 2 medians on Milton Rd.

at WT Harris Blvd.)

SIGNATURE OF INSPECTOR

DATE

PROJECT NAME: WEST DISTRICT - B MEDIAN MAINTENANCE – FY2026

CONTRACT NUMBER:

INSPECTION DATE: ______________

Rating S = Satisfactory NI = Needs Improvement U = Unsatisfactory

Item Description Rate Comment

1 Ashley Park Medians (includes 1 median at 2400 Columbus Cir. and 1 median on Heywood Ave. at Meredith Ave.)

Beam-Shopton Roundabout (includes Roundabout only at the intersection of Beam Rd. and Shopton Rd.)

Clanton Rd. Medians (Medians on Clanton Rd. from West Blvd. to Sargent Dr.)

Mayfair Connectivity Path (2700 Mayfair Ave - includes both sides of walking path to wood line between Mayfair Ave. and Kenhill Dr.)

Morris Field Dr. Medians (Medians on Morris Field Dr. from Billy Graham Pkwy to Wilkinson Blvd.)

Mulberry Church Rd. Roundabout (Roundabout at Mulberry Church Rd. and Westport Rd.; includes 3 concrete medians around the perimeter of the roundabout.)

Remount Rd. Medians (Medians on Remount Rd. from Youngblood St. to West Blvd.)

Sheets Circle Median (1 median on Sheets Circle at Tuckaseegee Rd.)

Sirus Ln. Median (1 median on Sirus Ln. at Byrum Dr.)

Steelecreek Medians (includes medians on Steelecreek Rd. from Rigsby Rd.

to Shopton Rd. West, medians on Dixie River Rd. from Steele Creek Rd. to Shopton Rd., and 1 median on Shopton Rd. West at Steelcreek Rd.

Tilden Rd. Median (1 Median on Tilden Rd. at Moore’s Chapel Rd.)

Tyvola Rd. West Medians (Medians on Tyvola Rd. West from S. Tryon St. to Sugar Creek bridge)

Item Description Rate Comment

West Blvd. Right-of-Way (Landscaped Corners on West Blvd. at Old Steele Creek Rd., Clanton Rd., and Remount Rd.; includes 3 landscape beds and 3 medians on West Blvd. at the ramps to I-77 and Revolution Park Dr.; also includes 1 landscape bed on Markland Dr. at Old Steele Creek Rd.)

Westinghouse Blvd. Median (1 median on Westinghouse Blvd. at Pioneer Ave)

Wilkinson Blvd. Medians (Medians on Wilkinson Blvd. from Suttle Ave. to Billy Graham Pkwy. overpass; also includes 2 triangular medians at the intersection of Stafford Dr./Harlee Ave. at Wilkinson Blvd.)

PROJECT NAME: SCIP DISTRICT MEDIAN MAINTENANCE - FY2026 ____________________

CONTRACT NUMBER:

INSPECTION DATE: ____________________

Rating S = Satisfactory NI = Needs Improvement U = Unsatisfactory

Item Description Rating Comment

1 Archdale Signature Intersection and medians

(Includes planting strips on all 4 corners at the intersection of Archdale Dr. and South Blvd.;

planting strips on Archdale between South Blvd.

and Ingleside Dr.; all medians on Archdale from Cherry Crest Ln. to Old Reid Rd.; also includes 1 median on Old Reid Rd. at Archdale Dr.)

2 Arrowood Signature Intersection

(Includes planting strips on Arrowood Rd. from England St./Old Pineville Rd. intersection to South Blvd. and one median tip at shopping center entrance; all 4 corners of the intersection of Arrowood Rd .and England St./Old Pineville Rd., and 2 Corners on the Starbrook Dr. side of the intersection with South Blvd.)

Dewitt Road Medians

(Medians on Dewitt Rd. from Clanton Road to Freeland Lane)

4 Old Pineville Road Medians

(Medians on Old Pineville Rd. from Arrowood Rd.

to Tyvola Rd.)

Sharon Road West Intersection

(Includes planting strips on the corners of South Blvd. and Sharon Road West Intersection and right-of -way at the Sharon Rd. West station; also includes 1 median on Sharon Rd. West at South Blvd.)

South Blvd Medians and Right-of-Way

(Medians on South Blvd. from I-485 to Sterling Dr.;

also includes planting strips around property at 3030 South Blvd.)

Starmount Medians

(Includes 3 medians on Starbrook Dr. at South Blvd., 1 median on Woodstream Dr. at Starbrook, 1 median on Thorncliff Dr. at Woodstream; and 1 median on Larkfield Ln. at South Blvd.)

8 Tyvola Signature Intersection and Medians

Item Description Rating Comment

(includes medians, corners, and planting strips on Tyvola Rd. from South Blvd. intersection to Old Pineville Rd., excluding planting strip and corner on northwest part of intersection)

Woodlawn Signature Intersection and Medians

(includes medians, corners, and planting strips on Woodlawn Rd. from South Blvd. Intersection to Old Pineville Rd.)