LPM - Field Review by DZb377p

VIEWS: 5 PAGES: 22

									Local Assistance Procedures Manual                                                                       EXHIBIT 7-A
                                                                                   Instructions for Field Review Form



                             INSTRUCTIONS FOR FIELD REVIEW FORM


The Applicant shall complete the Field Review Form in accordance with Chapter 7, “Field Review” of this
manual. The District Local Assistance Engineer (DLAE) should be consulted for clarification. If Caltrans or
other interested parties are to be involved in meetings, to assist in completion, the applicant should fill out the
form as completely as possible prior to any meeting(s). The form must be completely filled out prior to
submission of the PES Form.
Item 1.             PROJECT LIMITS
Briefly describe the physical limits or nature of project. Attach a list, as needed, for multiple or various locations.
Indicate length of project to nearest one-tenth of mile. Use 0.1, if a spot location. Include additional sheets, if
needed, to clearly define the project location or scope of work.
Item 2.             WORK DESCRIPTION

Briefly describe major components of the proposed work, e.g., signals, bridge replacement, ridesharing,
pedestrian features, etc.

Item 3.             PROGRAMMING DATA

All federal-aid funded projects (except Emergency Relief unless additional capacity is being added) are required
to be included in a Regional Transportation Plan and the most current FHWA/FTA approved FSTIP. If project is
within an MPO area, indicate the MPO or RTPA’s FTIP1 that includes the project and the fiscal years of the
FTIP. Also list the page of the FTIP or Amendment Project Planning Number (PPNO), if available and the
FHWA/FTA approval date. For non-MPO areas include the same information from FSTIP.
Indicate the federal funds and phases listed in the FTIP/FSTIP. For CMAQ projects name the Air Basin.

Item 4.             FUNCTIONAL CLASSIFICATION

For a roadway project, check appropriate functional classification category. See the discussions of specific fund
programs in the Local Assistance Program Guidelines (LAPG) for system eligibility. Indicate N/A for projects
not related to a specific road or street system.
Item 5.             STEWARDSHIP CATEGORY
For roadway projects, indicate if project is on the National Highway System (NHS), and whether project is State-
Authorized or a FHWA Full Oversight project on the Interstate per stewardship agreement. With some
exceptions, projects on the State Highway System are subject to Caltrans Oversight, and on the Interstate are
subject to FHWA Full Oversight; otherwise, the project is subject to DLAE oversight. Refer to Figure 2-1,
“Required FHWA Oversight Federal-Funded Projects” in Chapter 2 of this manual.

Item 6.             CALTRANS ENCROACHMENT PERMIT REQUIRED
An encroachment permit is required for projects encroaching within the state highway right of way. The
applicant should contact the District Permit Officer early in the process.




1
    The FTIP must be incorporated into an FHWA approved FSTIP.
                                                                                                           Page 7-11
LPP 08-04                                                                                           December 31, 2008
EXHIBIT 7-A                                                                     Local Assistance Procedures Manual
Instructions for Field Review Form


Item 7.           COST BREAKDOWN ESTIMATE

List estimated breakdown of all project phases and indicate phases for which federal participation will be
requested. Include all known costs, but include each cost in only one group. Check whether “Value Engineering
Analysis” is required for this project. (For structures-related projects financed with Highway Bridge Program
[HBP] funds, the current HBP operating procedures limit preliminary engineering costs including environmental
costs to twenty-five (25%) percent of the total construction cost. Any exceptions must be approved in writing by
the HBP program manager.)


Item 8.           PROPOSED FUNDING

Fill in total cost of federal-funded project, type, and amount of federal-aid funds, i.e. STP, CMAQ, etc., and the
matching-fund breakdown.

If state funds are involved, indicate source such as STIP.

Item 9.           PROJECT ADMINISTRATION

Indicate name of agency that will be responsible for administering each project phase. Also indicate the use of a
consultant for any phase. Indicate if Caltrans’ review of PS&E will be requested. If Yes, begin discussions with
DLAE on availability of staff. All PS&E documents to be reviewed must be in Caltrans format.

Item 10.          SCHEDULES

The local agency should indicate their proposed advertisement date. This will give the involved parties a date for
scheduling. However, the discussion of requirements and time frames may require adjustment of the
advertisement date. Critical dates in the schedule should be noted in the remarks.

ITEM 11.          PROJECT MANAGER’S CONCURRENCE

The local agency project manager shall sign and date the field review form to signify agreement on the
parameters proposed for development of the project. The DLAE and FHWA representative shall sign the
document when attending field reviews. This document is then a guidance reference for further development of
the project to assure that it adheres to the programmed concept, or that any changes is approved by the manager
(and/or DLAE and FHWA, if appropriate).

Item 12.          LIST OF ATTACHMENTS

The first two items are appropriate for all reviews. Others to be added depend on the type of project. For required
field reviews, all applicable attachments must be submitted. For optional field reviews, see the “[ ]” notations for
attachments required for specific types of projects. All existing federal, state, or local Americans with
Disabilities Act (ADA) deficiencies, if not identified on other Attachments, should be listed here


Note: The Federal Damage Assessment Form (DAF) shall be used as the field review document for Emergency
Relief projects.




12 Page 7-12
September 29, 2008                                                                                        LPP 08-03
Local Assistance Procedures Manual                                                                EXHIBIT 7-B
                                                                                             Field Review Form



                            EXHIBIT 7-B FIELD REVIEW FORM

 Local Agency      _______________________________              Field Review Date     __________________
 Project Number    _______________________________                        Locator     __________________
                                                           (Dst/Co/Rte/PM/Agncy)
 Project Name      _______________________________                   Bridge No.(s)    __________________

 1. PROJECT LIMITS (see attached list for various locations) _____________________________________
     _______________________________________________________________________________________
     _________________________________________ Net Length                ______________ (mile)
 2. WORK DESCRIPTION _________________________________________________________________
     _
     _______________________________________________________________________________________
   ITS project or ITS element: Yes ____          No ____
    If yes, choose: High-Risk (formerly “Major”) ITS  , Low-Risk (formerly “Minor”) ITS   , Exempt ITS
 3. PROGRAMMING DATA                FTIP (MPO/RTPA) ______________ FY              ________ Page       ____
     Amendment No. __________ FTIP PPNO _______ FHWA/FTA Approval Date                         ___________
     Federal Funds        $________________ Phases       PE    ______       R/W _______        Const ____
     Air Basin: ________________________ (CMAQ only)
 4. FUNCTIONAL CLASSIFICATION:
      URBAN _________                                      RURAL ______
         Principal Arterial: ______                         Principal Arterial: ______
            Minor Arterial: ______                             Minor Arterial: ______
                 Collector: ______                            Major Collector: ______
                    Local: ______                             Minor Collector: ______
                                                                   Rural Local: ______
 5. STEWARDSHIP CATEGORY
    FHWA Full Oversight (Stewardship): Yes       No

     State-Authorized         (Stewardship):     No      (a) DLAE oversight:           Yes      __   No    __
     Yes
                                                   (b) District Construction       Yes __            No    __
                                             oversight:
        ITS High-Risk project or element requiring FHWA oversight per stewardship: Yes __            No    __
 6. CALTRANS ENCROACHMENT PERMIT (b) DistrictConstruction: _____ No _____
                                                Is it required?    Yes
 7. COST ESTIMATE BREAKDOWN                                 $1,000’s                 Fed. Participation
     (Including Structures)
            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        ____


                                                                                                     Page 7-13
LPP 10-01                                                                                        April 30, 2010
EXHIBIT 7-B                                                                      Local Assistance Procedures Manual
Field Review Form

                                                               _________________
                               TOTAL COST              $       _________________



 7a. Value Engineering Analysis Required?             Yes      _____        No    _____
     (Yes, if total project costs are
       $25M or more on the
      Federal-aid System, or
      $20M or more for bridges)

 8. PROPOSED FUNDING                         Total Cost                 Cost Share
    Grand Total                              $ ____________
    Federal Program         #1_________      $ ____________ Fed.     $ _________ Reimb. Ratio _________
    (Name/App. Code)        #2_________      $ ____________ Fed.     $ _________ Reimb. Ratio _________
    Matching Funds Breakdown         Local:                   .      $ _________ _____%
                                                                   $ _________
                                     State:                          $ _________ _____%
                                     Other:                          $ _________ _____%
    State Highway Funds?        Yes      _____       Source __________________________       No _____
    State CMAQ/RSTP Match Eligible                    Yes   _______        No ______     Partial _____
    Is the Project Underfunded? (Fed $ < Allowed Reimb.)                   Yes ______        No _____
 9. PROJECT ADMINISTRATION
                                                            Agency            Consultant         State
    PE                      Environ Process            _______________ ______________        ___________
                            Design                     _______________ ______________        ___________
                            System Man./Integ. _______________
                                                       _______________ ______________        ___________
     R/W                      All Work                 _______________       ______________         ___________
     CONST ENGR               Contract                 _______________       ______________         ___________
     CONSTRUCTION             Contract                 _______________       ______________         ___________
     MAINTENANCE                                       _______________       ______________         ___________
                                                       _______________                              ___________

     Will Caltrans be requested to review PS&E?                                  Yes ______        No _____
 10. SCHEDULES:         PROPOSED ADVERTISEMENT DATE                _________________________________________
    Other critical dates: __________________________________________________________________
    ______________________________________________________________________________________
 11. PROJECT MANAGER’S CONCURRENCE

    Local Entity               _________________________________________                   Date:       ___________

     Signature & Title         _________________________________________                   Phone No.   ___________

     Is field review required?      Yes   ______          No   ______

    Caltrans (District):           _______________________________________                 Date:       ___________

     Signature & Title:            _______________________________________

 12. LIST OF ATTACHMENTS (Include all appropriate attachments if field review is required. See the “[ ]” notation for
     minimum required attachments for non-NHS projects)
     ______    Field Review Attendance Roster or Contacts Roster
     ______    Vicinity Map (Required for Construction Type Projects)

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

Page 7-14
October 11, 2007                                                                                          LPP 07-05
Local Assistance Procedures Manual                                                                    EXHIBIT 7-B
                                                                                                 Field Review Form

     ______    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 HBRR]            _____ Signal Warrants
     ______    Railroad Grade Crossing Data Sheet                     _____ Collision Diagram

    _____     Airport Data Sheet (if within 10,000 feet)
    _____     Sketch of Each Proposed Alternate Improvement         _____ CMAQ/RSTP State STIP Match
    _____     TE Application Document                               _____ Systems Engineering Review Form (SERF)
    _____     Existing federal, state, and local ADA deficiencies         Req’d for High-Risk (formerly “Major”) and
              not included on other Attachments                           Low-Risk (formerly “Minor”) ITS projects


 13. DLAE FIELD REVIEW NOTES:

      A. MINUTES OF FIELD REVIEWS




      B. ISSUES OR UNUSUAL ASPECTS OF PROJECT




                                                                                                        Page 7-14a
LPP 10-01                                                                                             April 30, 2010
EXHIBIT 7-B                                                       Local Assistance Procedures Manual
Field Review Form

 (Attachment to Field Review Form)


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




Page 7-16
October 11, 2007                                                                          LPP 07-05
EXHIBIT 7-C    Local Assistance Procedures Manual
Roadway Data




                                     Page 7-14a
LPP 10-01                          April 30, 2010
Local Assistance Procedures Manual                                                                              EXHIBIT 7-C
                                                                                                                Roadway Data

                                                 ROADWAY DATA
1. TRAFFIC DATA

    Current ADT ____       Year 200 __ Future ADT ______      Year 200___ DHV ____ Trucks __%
    Terrain (Check One)            ____ Flat    _____ Rolling        ____ Mountainous
    Design Speed        ____________
    Proposed Speed Zone           ____ Yes          mph _______                  ____ No

2. GEOMETRIC INFORMATION
                                                  ROADWAY SECTION

                                                  Thru Traffic Lanes                        Shoulders
                           Min.
               Year       Curve         No. of         Total                       Each Width                          Median
 Facility     Constr.     Radius        Lanes          Width           Type           Lt/Rt             Type           Width
Exist.
Prop.
Min. Stds. selected:
  AASHTO____
          3R ____
      Local ____
             N/E Contig. Sect.
             S/W Contig Sect.

    Remarks (If design standard exception is being sought, cite standard and explain fully how it varies):
    _________________________________________________________________________________
    _________________________________________________________________________________

3. DEFICIENCIES OF EXISTING FACILITY (Mark appropriate one(s))

    _____      Pavement Surface            Drainage
                                                 ______
    _____      Alignment                   Bridge______
    _____      Crossfall                   Safety (Attach collision diagram or other documentation)
                                                 ______
    _____      Pavement Structure          Federal Americans w/ Disabilities Act (ADA), State or
                                                 ______
                                           Local accessibility requirements
                                    _____ Other (describe below)
    Remarks _________________________________________________________________________
    _________________________________________________________________________________

4. TRAFFIC SIGNALS               ____Yes         ___New (attach warrants)        ___Modified                 _____No

5. MAJOR STRUCTURES                     Structure No.(s) _____________________ (attach structure data sheet)
                                                         _____________________

6. OTHER TRANSPORTATION FACILITIES (Name)
   ________ None
   ________ Railroad _______________________________________                                  (attach railroad data sheet)
   ________ Airports _______________________________________                                  (attach airport data sheet)
   ________ Transit  _______________________________________
   ________ Bicycle _______________________________________




                                                                                                                    Page 7-15
LPP 06-03                                                                                                        July 21, 2006
EXHIBIT 7-C                                                             Local Assistance Procedures Manual
Roadway Data


7. AGENCIES AFFECTED

    Utilities [mark appropriate one(s)]   _______ Telephone   ________ Electrical     ________ Gas
                                          _______ Water       ________ Irrigation
                                          _______ Other       ________ Sanitary

    Major Utility           _____________________________________________________________________
    Adjustment:             _____________________________________________________________________

    High Risk Facilities:   _____________________________________________________________________
                            _____________________________________________________________________

    Other:                  _____________________________________________________________________
                            _____________________________________________________________________

    Remarks:                _____________________________________________________________________
                            _____________________________________________________________________




(Attachment to Field Review Form)

Page 7-16
July 21, 2006                                                                                  `LPP 06-03
Local Assistance Procedures Manual                                                                 EXHIBIT 7-D
                                                                                            Major Structure Data

                                     MAJOR STRUCTURE DATA
                                   (Attach a separate sheet for each structure)

Project Number ____________________
Bridge Name (facility crossed) ____________________________________________________________
State Br. No. ___________       Date Constructed ____________           Historical Bridge Inv. Category _____
Road Name _______________________________                 Location _________________________________
STRUCTURE DATA
                                                                                         Minimum AASHTO
                                         Existing                 Proposed                   Standards
Structure Type                     __________________       ___________________        ___________________
Structure Length                   __________________       ___________________        ___________________
Spans (No. & Length)               __________________       ___________________        ___________________
Clear Width (curb to curb)         __________________       ___________________        ___________________
Shoulder Width                     ______Lt    ______Rt     _______Lt      _____Rt     _______Lt      _______Rt
Sidewalks or bikeway width         ______Lt    ______Rt     _______Lt      _____Rt     _______Lt      _______Rt
Total Br. Width                    __________________       ___________________        ___________________
Total Appr. Rdwy. Width            __________________       ___________________        _________________
1. Preliminary Engineering by                 _________________________________________________
2. Design by                                  _________________________________________________
3. Foundation Investigation by                _________________________________________________
4. Hydrology Study by                         _________________________________________________
Detour, Stage construction, or Close Road     _________________________________________________
                           Length of Detour   ________________

Resident Engineer for Bridge Work: ____ Agency ____ Consultant (On Retainer as City/County Engineer)
Responsible Local Official __________________________________________
Discuss any special conditions; for example, federal ADA, state or local accessibility requirements, or proposed
design exceptions.
        _____________________________________________________________________________
        _____________________________________________________________________________
        _____________________________________________________________________________

ESTIMATED STRUCTURE AND RELATED COSTS:
                                                                                        Federally Participating
            Bridge Cost                                                                    Yes              No
                Construct Bridge              ___________________________            _______             ______
                Bridge Removal                ___________________________            _______             ______
                Slope Protection              ___________________________            _______             ______
                Channel Work                  ___________________________            _______             ______
                Detour - Stage Construction   ___________________________            _______             ______

                                                                                                       Page 7-17
LPP 07-05                                                                                        October 11, 2007
EXHIBIT 7-D                                                                   Local Assistance Procedures Manual
Major Structure Data


          Approach Roadway                    ___________________________           _______             ______
          Preliminary Engineering             ___________________________           _______             ______
          Construction Engineering            ___________________________           _______             ______
          Right of Way Costs                  ___________________________           _______             ______
          Utility Relocation                  ___________________________           _______             ______
          Mobilization                        ___________________________           _______             ______
                               Total          ___________________________


          Type of HBRR funds: Check one          Seismic/Voluntary                    Painting (88.53%)
          (Major type if more than one)          (88.53% Fed. Share)                  Painting (80%)
                                                 Rehabilitation (80%)                 Special (80%)
                                                 Replacement (80%)                    Low Water Xing (80%)
                                                 Railing (88.53%)

Summarize HBRR funded costs of above estimate:            Indicate the estimated date for Federal-aid
(HBRR Federal-aid + local match for HBRR only)            Authorization & Obligation or Check the box:
                                                          Date:
       Prelim. Eng.    $_____________                     __________          Not needed for this project

       Right of Way $_____________                        __________         Not needed for this project

       Construction. $_____________                       __________         Not needed for this project

       Total           $_____________

VALUE ENGINEERING ANALYSIS
       Required (Yes, if total project costs for bridge
       are $20M or more)                                     Yes              No

Remarks    __________________________________________________________________________
           _________________________________________________________________________________
           ___________________________________________________________________

***** The following must be attached if the project is funded by the HBRR Program:

               1. Plan view of proposed improvements.

               2. Typical Section.

***** The following is recommended:

               1. Right of way map to determine whether right of way acquisition or construction easements are
                  necessary.




(Attachment to Field Review Form)



Page 7-18
October 11, 2007                                                                                       LPP 07-05
Local Assistance Procedures Manual                                                                       EXHIBIT 7-E
                                                                                          Railroad Grade Crossing Data



                                RAILROAD GRADE CROSSING DATA
                                             (Separate Sheet for each crossing)

Project Number /Name:         ________________________

Name of Railroad:               ________________________________________________________________

Location (Road, City, or County, and Xing No.):            ______________________________________________

Vehicular Traffic:           Daily Traffic using crossing ____       No. of Lanes _____       Speeds (mph) _____

No. of Exist. Tracks:        Main Line _____         Branch Line ______           Passing _____       Other _____

No. of Future Tracks:        ______       No. of Daily Trains; Passenger ____         Freight ____     Total _____

Maximum Speeds:           Passenger _________           Freight ____________

Protection in Place:         __________________________________________________________________

Protection Proposed:         __________________________________________________________________

Skew of Xing ______             Min. Sight Dist. (along track when driver is 100 feet from Xing) ___________

Trains at Night? (Y/N)         ____________           Seasonal Train Traffic? (Y/N)     _________

Ten-Year Accident Record                            Accidents _________        Killed _________      Injured _____


Has local agency requested or received PUC decision concerning:

    Crossing Protection required: __________________________________________________________
    ___________________________________________________________________________________

    Protective devices proposed by local agency: _____________________________________________
    ___________________________________________________________________________________

    Proposed financing of crossing protection: _______________________________________________
    ___________________________________________________________________________________

    Does local agency propose to finance automatic crossing protection as a “G” (safety) project using 100%
    Federal funds? _____________________________________________________________________
    ___________________________________________________________________________________

NOTE: Attach sketch showing relationship of old and new crossing.

Remarks: ______________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

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


                                                                                                              Page 7-19
LPP 09-01                                                                                                 April 30, 2009
EXHIBIT 7-E                    Local Assistance Procedures Manual
Railroad Grade Crossing Data




Page 7-20
February 1, 1998
Local Assistance Procedures Manual                                                              EXHIBIT 7-F
                                                                                                 Airport Data




                                          AIRPORT DATA
                                      (Separate Sheet for each airport)

                                                                          Agency : ____________________
                                      Locator (Dist.-Co.-Route-Agcy. Abbreviation): ____________________
                                                            Project Number /Name: ____________________

NAME                        ______________________________________________________________

LOCATION                    ______________________________________________________________

RUNWAY
  Direction                 ______________________________________________________________

  Distance from Project     _____________________________________________________________

SLOPE RATIO                 ______________________________________________________________

FAA FORM 7460-1*            ______________________________________________________________
                            (Indicate status, attach if available)

REMARKS                     ______________________________________________________________

                            ______________________________________________________________

                            ______________________________________________________________

* Notice of Proposed Construction or Alteration: Required per FAA Regulations 14 CFR, Part 77




                                                                                                  Page 7-21
                                                                                            February 1, 1998
EXHIBIT 7-F        Local Assistance Procedures Manual
Airport Data




Page 7-22
February 1, 1998
Local Assistance Procedures Manual                                                  EXHIBIT 7-G
                                                                   Field Review Attendance Roster




                         FIELD REVIEW ATTENDANCE ROSTER

   Date _________________________________      Project No./Name _________________________

   Project Location __________________________________________________________________


   Name _________________________________       ________________________________________
                   (Please Print)               (Organization)              (Phone Number)

1. _____________________________________       _________________________________________

2. _____________________________________       _________________________________________

3. _____________________________________       _________________________________________

4. _____________________________________       _________________________________________

5. _____________________________________       _________________________________________

6. _____________________________________       _________________________________________

7. _____________________________________       _________________________________________

8. _____________________________________       _________________________________________

9. _____________________________________       _________________________________________

10. _____________________________________      _________________________________________

11. _____________________________________      _________________________________________

12. _____________________________________      _________________________________________

13. _____________________________________      _________________________________________

14. _____________________________________      _________________________________________

15. _____________________________________      _________________________________________

16. _____________________________________      _________________________________________

17. _____________________________________      _________________________________________

18. _____________________________________      _________________________________________

19. _____________________________________      _________________________________________

20. _____________________________________      _________________________________________


                                                                                       Page 7-23
                                                                                 February 1, 1998
EXHIBIT 7-G                      Local Assistance Procedures Manual
Field Review Attendance Roster




Page 7-24
February 1, 1998
Local Assistance Procedures Manual                          EXHIBIT 7-H
                                     State TSM Match (EXHIBIT DELETED)




                                                               Page 7-25
LPP 05-01                                                 October 7, 2005
EXHIBIT 7-H                         Local Assistance Procedures Manual
State TSM Match (EXHIBIT DELETED)




Page 7-26
October 7, 2005                                             LPP 05-01
Local Assistance Procedures Manual                                                                          EXHIBIT 7-I
                                                                                        Systems Engineering Review Form


                      SYSTEMS ENGINEERING REVIEW FORM (SERF)
                                        Part 1. General Project Information

 The SERF is normally submitted as part of the
 E-76 package when initial funding is requested.
 A full description of funding steps for ITS
 projects appears in Section 13.1 of the LAPG.
 The SERF must be filled out for all ITS
 projects unless they are “Exempt.” For
 definitions of an Exempt ITS project, see
 LAPG Section 13.2. A full discussion of how a
 local agency uses the SERF during the
 programming and funding steps is in LAPG
 Section 13.4, in the section titled “Local agency
 (include consultants in project management
 role)”. That process is summarized in the figure
 at the right.
 Please provide the following background information. In most cases, 1-3 sentences will be sufficient for each item, but you
 may include as much as you feel needed. If you need more space, the field will expand automatically.
 A. Project Contact – Name, position, phone, email.




 B. Project Objectives – What is the purpose of the project? What needs (deficiencies) are being addressed?




 C. Project Summary – What solutions will address the needs? What major elements will be installed? What major
 function(s) will be performed?




 D. Work to Date – Any preliminary planning, investigation of options, associated internal or external systems examined,
 etc.?




 E. Risk Assessment Guidance – Although this assessment is not a regulatory requirement, the answers to these questions
 will help you understand the extent of risk involved in this project. A full discussion of risk factors is available in LAPG
 Section 13.2, with a summary in Table 13-1.
 For each question, check Yes or No or Not Sure.
   Question:                                                                                          Yes No Not Sure
   1. Will the project depend on only your agency to implement and operate?
   2. Will the project use only software proven elsewhere, with no new software writing?
   3. Will the project use only hardware and communications proven elsewhere?
   4. Will the project use only existing interfaces (no new interfaces to other systems)?
   5. Will the project use only existing system requirements that are defined in writing?
   6. Will the project use only existing operating procedures that are defined in writing?
   7. Will the project use only technologies with service life longer than 2-4 years?
 If all of the above are Yes, that is a preliminary indication that your project is Low-Risk.

                                                                                                                  Page 7-27
LPP 10-01                                                                                                     April 30, 2010
EXHIBIT 7-I                                                                               Local Assistance Procedures Manual
Systems Engineering Review Form

                                    Part 2. Regulatory Compliance Information
 Please answer each question briefly (often one paragraph is enough). If the question cannot be fully answered now, but will
 be answered during the project implementation, please indicate the step at which it will be answered. As you respond to
 each question on this form, the field will expand as you type. Examples of SERF’s can be found at:
 http://www.fhwa.dot.gov/cadiv/segb/examples/del.htm (then click on “FHWA Rule/FTA Policy Compliance Documents”).
 1. Identification of portions of the Regional ITS Architecture (RA) being implemented:
 Instructions: Contact your MPO to get this information from your Regional ITS Architecture (“RA”). In the RA, the
 project might be identified specifically by name and agency, or by a more generic description (e.g. “Arterial Traffic
 Management”). If listed in the RA, document which inventory elements, market packages, subsystems, and//or information
 flows are being completed in this project. If there is no information in your RA, arrange with your MPO to provide them
 this information when your project is designed; they will use it in the next update of the RA.
  Please enter your response here (the field will expand as you type):
 2. Identification of participating agencies roles and responsibilities:
 Instructions: Can you identify all stakeholders that must participate in the implementation phase of this project? What
 are their roles/responsibilities? Have they committed to the responsibilities? Some of this information might appear in
 your RA (e.g., “Operational Concepts” or other sections). If this will be defined in later phase of the project (e.g., Concept
 of Operations), the RA may be a good source to start definition.
 Please enter your response here (the field will expand as you type):
 3. Procedures and resources necessary for operations and management of the system:
 Instructions: Can you identify all stakeholders that must participate in operations, management and maintenance of the
 system throughout its life cycle? What are the roles, responsibilities, and resources required from each stakeholder?
 Examples include: money, special equipment, staff time, special expertise, provision of data, and many more. You should
 consider hardware, software, and communications issues.
 Please enter your response here (the field will expand as you type):
 4. Requirements definitions:
 Instructions: Are the system requirements (functional and performance) already well-defined in writing?
 If yes, indicate where they can be found (e.g., Std. Specs). If they will be defined in later phase of the project, the applicable
 high-level functional requirements in the RA may be a good starting point for writing them. The focus is on “what”
 functions must be performed – not on “how” the technology will be used to perform them.
 Please enter your response here (the field will expand as you type):
 5. Identification of applicable ITS standards and testing procedures:
 Instructions: Do you know yet if any ITS Communications Standards are applicable to this project? If they are applicable,
 will you use them? If your RA identifies specific Architecture Flows, you can ask your MPO to produce a “Standards
 Report” for those Flows; it will identify ITS Standards to consider.
 Please enter your response here (the field will expand as you type):
 6. Analysis of alternative system configurations and technology options to meet requirements:
 Instructions: Have you considered alternative designs yet? This could include system configurations, different
 organizational roles; alternative hardware, software, or communications technology; If you can not yet make a choice of
 available alternatives, this analysis will occur in later phase of the project (High-Level Design).
 Please enter your response here (the field will expand as you type):

 7. Procurement options:
 Instructions: Have you considered different procurement options for each of the project phases (design, implementation,
 operation, and management)? These options could include: off-the-shelf vs. custom, lease vs. buy, fixed-price vs. cost-
 reimbursable, etc. Procurement options must consider the level of staff technical expertise, existing agency procurement
 practices, who will be the project manager, and whether you need a systems engineer and/or system integrator.
 Please enter your response here (the field will expand as you type):

 Comments or Additional Information (if needed):

 Note: If you were able to answer all seven questions above completely and with certainty, then please
 self-certify this project as “Low-Risk” in the E-76. Otherwise, it should be classified as “High-Risk.”
 However, if you feel this is not justified, you may request a review of this SERF by Caltrans and FHWA.

Page 7-28
April 30, 2010                                                                                                         LPP 10-01

								
To top