Tile mosaic and sculpture designed by Guy Harvey on towers at four corners of the bridge_Port St. Lucie

LAP Forms

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Form NumberForm Name
SampleLocal Agency Program Certification ToolWord Form
SampleLocal Agency Program Certification-Materials Testing and Acceptance Quality Assurance ReviewWord Form
Sample Sub Recipient Compliance Assessment ToolWord Form
Agreements and Exhibits
350-000-15Emergency Local Government Emergency Relief Reimbursement AgreementWord Form
525-010-40Local Agency Program AgreementSearch for Form
525-010-32 Local Agency Program Supplemental Agreement Word Form
 Project Certifications
SampleClear Letter - No Environmental Permit RequiredWord Form
SampleClear Letter - Permits RequiredWord Form
SampleClear Letter - RailroadWord Form
SampleClear Letter - UtilitiesWord Form
575-095-05LAP Right of Way Certification, Certification with Exceptions and LAP Initial Design and BuildConsolidated Forms
Procurement - Professional Services and Construction
Title VI & Non-DiscriminationAppendices A&E, Nondiscrimination Contract Assurances (required in all contracts)Word Form
275-030-11DBE Bid Package InformationPDF Form
Word Form
375-020-27 Contract Bond (in Bid Blank)PDF Form
375-030-32 Certification Regarding Debarment, Suspension...for Federal Aid Contracts Word Form
375-030-33 Lobbying Certification Word Form
375-030-34 Disclosure of Lobbying Word Form
375-030-91Vendor Eligibility Prior to Contract of Award Word Form
375-030-83DBE Bid Opportunity FormWord Form

PSU Procurement
Local Agency Program (LAP) Checklist for Federally Funded Professional Services Contracts Federal and State RequirementsWord Form
375-030-18Consultant AffirmationPDF Form
Word Form
375-020-08Proposal (in Bid Blank) FORM 
375-020-30 Contract Affidavit (in Bid Blank) PDF Form
375-030-30 Truth in Negotiation Word Form
375-030-50 Conflict of Interest Certification Word Form
375-040-84LAP Terms for Federal Aid Professional Services Contracts PDF Form
Word Form
SampleCalculating Fee mock Up                                                                                                                        Calculating Fee Mock Up How to Guide - Developed by District 6                  Excel Form
PDF Form
700-010-04Estimate of Contract Time Excel Form
 Construction Procurement
FHWA 1273 Required Contract Provisions - Federal-Aid Construction ContractsPDF Form 
525-010-44 Local Agency Program (LAP) Checklist for Construction Contracts (Phase 58)-Federal RequirementsWord Form
575-060-13Non-Collusion Declaration of ComplianceWord Form
525-010-46LAP Certification of Current Capacity
PDF Form
Word Form
 Construction Administration
SampleQAR Checklist - Developed by District 4 and District 6Word Form
SampleQAR Checklist - Developed by District 4 and District 6 - GeotechWord Form
700-050-56Daily Log (Sample)Page Link
700-010-38Certification of Payment (Sample)PDF Form 
700-010-42Certification for Stockpiled Materials (Sample)PDF Form 
525-010-54Local Programs Project Monitoring Status ReportWord Form
525-010-53Local Programs Invoicing Template Excel Form
Project Close Out
525-010-42 Local Agency Program Final Inspection and Acceptance of Federal-Aid ProjectPDF Form
Word Form
525-010-47 Local Agency Program Record of Final Plans and Documents Word Form
525-010-50Local Agency Program Performance Evaluation Word Form