5921-099_LAPM_Field_Review_Package_1.30.26.pdf

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Local Assistance Procedures Manual Exhibit 7-B Field Review Form

Exhibit 7-B: Field Review Form

Local Agency Field Review Date Project Number Locator (Dist/Co/Rte/PM)

Project Name Bridge No.(s)

1. PROJECT LIMITS (see attached list for various locations)

Net Length (miles) On NHS? Yes No

2. WORK DESCRIPTION

ITS project or ITS element (Signal, electronics, communication and information processing projects will be ITS projects)

Yes No

If yes, choose: High-Risk (formerly “Major”) ITS Low-Risk (formerly “Minor”) ITS Exempt ITS

3. FUNCTIONAL CLASSIFICATION

On the Federal-aid System Off the Federal-aid System

Principal Arterial – Freeway or Expressway Rural Minor Collector

Other Principal Arterial Local

Minor Arterial Bike/ Ped paths not on existing road

Major Collector

Urban Minor Collector

4. CALTRANS ENCROACHMENT PERMIT Is it required? Yes No

5. STATE ONLY FUNDS Is State-Only Funded? Yes No

January 2023

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Local Assistance Procedures Manual Exhibit 7-B Field Review Form

6. COST ESTIMATE BREAKDOWN

(Including Structures) ($1,000’s) Federal Participation

PE Environmental Process Yes No Design Yes No ITS System Manager or Integrator Yes No

CONST Const. Contract Yes No Const. Engineering Yes No

R/W Preliminary R/W Work Yes No Acquisition Yes No

No. of Parcels Yes No Easements Yes No Right of Entry Yes No RAP (No. Families) Yes No RAP (No. Bus) Yes No

Utilities (Exclude if included in contract items) Yes No

TOTAL COST

6a. Value Engineering Analysis Required? Yes No (Yes, if total project costs are $50M or more on the NHS, or $40M or more for bridges on and off the NHS)

7. PROJECT ADMINISTRATION

Agency Consultant State

PE Environmental Process Design System Manager/Integrator

R/W All Work CONST ENGR Contract CONSTRUCTION Contract

MAINTENANCE

8. SCHEDULES Proposed Advertisement Date

Other Critical Dates

9. PROJECT MANAGER’S CONCURRENCE

Local Entity Representative Date

Signature Phone

Title

Date of Field Review If not performed please attach justification to this form

Local Assistance Procedures Manual Exhibit 7-B Field Review Form

Caltrans (District) Representative (Attendance required if project is on NHS) Date

Signature Phone

Title

FHWA Representative Date

Signature Phone

Title

10. LIST OF ATTACHMENTS

(Including all appropriate attachments if field review is required. See the “[ ]” Notation for minimum required attachments for non-NHS projects.)

Field Review Attendance Roster or Caltrans Roster Vicinity Map (Required for Construction Type Projects)

IF APPLICABLE (Complete as required depending on type of work involved)

Roadway Data Sheets [Req’d for Roadway projects] Typical Roadway Geometric Section(s) [Req’d for Roadway projects] Major Structure Data Sheet [Req’d for HBP] Signal Diagram Railroad Grade Crossing Data Sheet Collision Diagram Sketch of Each Proposed Alternate Improvement CMAQ/RSTP State STIP Match Existing Federal, State and Local ADA deficiencies not included on other Attachments System Engineering Review Form (SERF) Req’d for High-Risk (formerly “Major”) and Low-Risk (formerly “Minor”) ITS projects

11. PROJECT REVIEW NOTES

A. MINUTES OF FIELD REVIEWS (See Attachment) B. ISSUES OR UNUSUAL ASPECTS OF PROJECT (See Attachment)

Distribution: Original with attachments – Local Agency Copy with attachments (2 copies if HBP) – DLAE

Local Assistance Procedures Manual Exhibit 7-C Roadway Data

Exhibit 7-C: Roadway Data

Federal Project Number: __________________ Street Name: ___________________________

1. Traffic Data

Current ADT ______ Year ______ Future ADT____ __ Year ______ DHV _____ Trucks ____ (%)

Terrain (check one): Flat Rolling Mountainous

Design Speed ________________

Yes mph _______ No Proposed Speed Zone:

2. Geometric Informtion

ROADWAY SECTION

Min. Stds. selected: AASHTO 3R Local

Facility Year Min. Thru Traffic Lanes Shoulders Median Width Constr.

No. of Lanes

Total Width Type Each Width Lt./Rt.

Type

Existing

Proposed

N/E Contig. Sect.

S/W Contig. Sect.

Remarks (if design standard exception is sought, cite standard and explain how it varies):

3. Deficiencies of Existing Facility (mark all that apply)

Pavement Surface Alignment Crossfall Pavement Structure

Drainage Bridge

Safety (attach collision diagram or other documentation) Federal Americans w/Disabilities Act (ADA), State or Local accessibility requirements

Other (describe in remarks below)

Remarks:

January 2022

Local Assistance Procedures Manual Exhibit 7-C Roadway Data

4. Traffic Signals

Yes New (attach warrants) Modified No

5. Major Structures Structure No.(s) (attach structure data sheet)

6. Other Transportation Facilities (name below)

None

Railroad

Airports

(attach railroad data sheet)

(attach airport data sheet)

Transit

Bicycle

7. Agencies Affected Utilities (mark all that apply): Telephone Electrical Gas

Water Irrigation Sanitary

Other

Major Utility Adjustment:

High Risk Facilities:

Other:

Remarks:

January 2022

Local Assistance Procedures Manual Exhibit 13-E Preliminary Engineering Right of Way Checklist

May 2024

Exhibit 13-E: Preliminary Engineering Right of Way Checklist

Federal Project No.: ___________________________________________ Final Design ___________________________ (Expected Start Date)

Anticipated date for Right of Way Certification? ____________________

To: From:

District Local Assistance Engineer: _______________________ Local Public Agency (LPA): _________________________________

Caltrans District: ______________________________________ Contact & Phone No.: _____________________________________

Address: ____________________________________________ Address: _______________________________________________

Email: ____________________________________________ Email: ________________________________________________

1. Is the LPA qualified by Caltrans Division of Right of Way (R/W) – Local Programs? ☐ YES ☐ NO

a. If yes, what is the LPA’s qualification level? (1, 2, or 3): ______ When does qualification approval expire? _______________

Information on qualification levels can be found in Local Assistance Procedures Manual (LAPM) Chapter 13, Section 13.2: Qualification Levels

List the name(s), email(s), and phone number(s) for the LPA’s R/W staff:

Name Email Phone Number

b. If no, does the LPA have a contract with a qualified R/W consultant? ☐ YES ☐ NO ☐ N/A

If yes, list the name(s) and contact information for the R/W consultant(s):

Name Email Phone Number

If no, you will need to follow procedures for procuring a qualified R/W consultant(s) and provide the name(s) and contact information to the Caltrans R/W Local Programs Coordinator as soon as hiring is completed.

2. Does the proposed project require work including surveying, staging, testing, and maintenance on land that the project sponsor does not own or have a permanent easement on? ☐ YES ☐ NO ☐ TBD

a. If the project sponsor has an existing easement, does the easement allow the agency to construct the project in the manner proposed? ☐ YES ☐ NO ☐ TBD

i. Is there an adequate construction duration? ☐ YES ☐ NO ☐ TBD

ii. Is there an expiration date? ☐ YES ☐ NO ☐ TBD

May 2024

b. Does the project require work on other publicly owned or controlled property? ☐ YES ☐ NO ☐ TBD

c. Does the project require Rights of Entry (ROE)? ☐ YES ☐ NO ☐ TBD

3. Does the project scope include work that is outside of the project sponsor’s right of way and is on private property, but not required to successfully complete the project? ☐ YES ☐ NO ☐ TBD

a. If yes, will the work solely benefit the private property owner? ☐ YES ☐ NO ☐ TBD

4. Does the project include work that is on the project sponsor’s property that is being leased to another party? ☐ YES ☐ NO ☐ TBD

5. Does the scope of the project include work on or within 2.5 miles of the railroad (RR), or light rail, operating or non-operating right of way including overcrossings and/or under crossings? ☐ YES ☐ NO ☐ TBD

a. If yes, answer the following:

i. Will RR involvement require an agreement with the RR to complete? ☐ YES ☐ NO ☐ TBD

ii. Will work near the RR require a ROE? ☐ YES ☐ NO ☐ TBD

iii. Will the project impact the electrical system of the RR? ☐ YES ☐ NO ☐ TBD

6. Are there borrow sites or staging areas for this project? ☐ YES ☐ NO ☐ TBD

a. If yes, have these areas been included in the utility verification maps? ☐ YES ☐ NO ☐ TBD

7. Does the project require relocation either temporary or permanent of public utility facilities and appurtenances (e.g., guy wires, vents, etc.) outside of the project sponsor’s right of way on to private property?

☐ YES ☐ NO ☐ TBD

a. If yes, does the utility owner have an easement on the private property that allows the utility owner’s use of the easement in the manner proposed? ☐ YES ☐ NO ☐ TBD

8. Are there utility cover adjustments to grade or utilities that conflict with the proposed work? ☐ YES ☐ NO ☐ TBD

Note: Utility cover adjustments and conflicts with utility facilities owned by the project sponsor must be addressed on the R/W Certification.

a. Are there utility covers that need adjustment for facilities that are owned by the project sponsor?

☐ YES ☐ NO ☐ TBD

b. Can all existing iron or steel covers be re-used for cover adjustment with no new iron or steel required?

☐ YES ☐ NO ☐ TBD

c. Do anticipated utility relocations include betterments? ☐ YES ☐ NO ☐ TBD

9. Will utility impacts potentially force utilities outside the existing environmental study limits (ESL)? ☐ YES ☐ NO ☐ TBD

10. Are there any Environmentally Sensitive Areas (ESAs) identified where utilities are not able to relocate? ☐ YES ☐ NO ☐ TBD

If yes, ensure that the ESAs are indicated on the conflict maps.

11. Has electrical engineering been consulted for any planned work? ☐ YES ☐ NO ☐ TBD

a. If there is planned work, does it require additional potholing or could it potentially cause utility conflicts? ☐ YES ☐ NO ☐ TBD

12. Are there known high priority utilities within the project that require positive locating (potholing)? ☐ YES ☐ NO ☐ TBD

13. Are there trees that may need to be removed for the utility relocation? ☐ YES ☐ NO ☐ TBD

a. Is there adequate time to accommodate the bird window and have the utilities relocated prior to construction? ☐ YES ☐ NO ☐ TBD

14. Will the elevation of the roadway be increasing which could potentially affect minimum clearances for overhead utilities? ☐ YES ☐ NO ☐ TBD

May 2024

15. Is there any demolition or clearance anticipated prior to construction? ☐ YES ☐ NO ☐ TBD

a. By separate contract? ☐ YES ☐ NO ☐ TBD

16. Does the project require acquisition of airspace rights? ☐ YES ☐ NO ☐ TBD

17. Does the project require personal property, residential, or business occupant(s) relocation? ☐ YES ☐ NO ☐ TBD

18. Does the project adversely impact existing businesses? ☐ YES ☐ NO ☐ TBD

19. Is there adequate access for residents and businesses in areas under construction? ☐ YES ☐ NO ☐ TBD

20. Does the local agency require access to any public or private property for environmental observation or investigation, or hazardous waste or hazardous material testing? ☐ YES ☐ NO ☐ TBD

21. Is there a possibility that the project may require right of way for environmental mitigation? ☐ YES ☐ NO ☐ TBD

22. Does the LPA project impact other local agencies, federal lands, state lands, or Indian lands? ☐ YES ☐ NO ☐ TBD

23. Does the project require easement vacation? ☐ YES ☐ NO ☐ TBD

24. Does the LPA currently have a Resolution granting authority for a signatory for the Right of Way Certification? ☐ YES ☐ NO

Certify by Local Agency Staff and/or Consultant Signature

If scope changes, this checklist will need to be revisited.

Preparer (print)

Preparer (signature) Date

Submit completed PERW Checklist to the DLAE during preliminary environmental studies.

(The PERW Checklist and PES Form may be submitted concurrently, or separately, as each is completed).