Colorado Department of Transportation MATERIALS DOCUMENTATION

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					    Colorado Department of Transportation                                                 MATERIALS DOCUMENTATION RECORD                                   Project:           EcoTrail Recreation
    CDOT Form #250, 7/06                                                                                                                                   Location:               Minturn
    Version 9.1 EXC                               Estimated Field Requirements for Minimum Materials                                                       Region:                     3
                                                  Sampling, Testing, and Inspection and Record of Field                                                    Date:
                                                  and Central Laboratory Documentation of Materials.                                                       Page No:
                                                                                                                                                           Contractor:
                                                                                                                                                           Project Code:


                                            PROJECT TO BE TESTED AND DOCUMENTED PER THE 2009 FIELD MATERIALS MANUAL

                                            Forward to the Bridge, Preinspection Unit, the list of materials suppliers and subcontractors
                                            upon receipt of the contractor.


                                            UPON COMPLETION OF WORK

                                            The contractor shall submit a certification verifying that all steel permanently incorporated in the project
                                            was produced or manufactured in the United States, either with no exception or with minor exception
                                            whose project delivered cost did not exceed the allowable amount.

                                            Upon receiving this certification, the Project Engineer will attach original
                                            to the completed CDOT Form 250 and submit to appropriate files.


    ITEM                                            TYPE OF               QUANTITY              TESTS             PROJECT ACCEPTANCE                            FINAL        LABORATORY             # OF CHECK TESTS
    NUMBER     DESCRIPTION                           TESTS                  PLAN               REQUIRED           TEST REPORTED                                QUANTITY      CHECK TESTS            REQUIRED & SUBMITTED


       203     Embankment Material                                                                                                                                                                      Preliminary Report #'s
               (C.I.P.)                                                ______________                                                                       ______________                               Construction Shear
                                                                          cubic yard                                                                           cubic yard                                       Tests
               Note: Project                       TESTABLE                                                         ____________________________                                                      ______________________
               Acceptance Test:                 In-Place Density       ______________ ________________              ____________________________             ____________                             ______________________
               500 cubic yards or less,                                   cubic yard         required               ____________________________               cubic yard                             ______________________
               visually inspect and                                                     ________________            ____________________________                                                      ______________________
               document in Project                                                           reported               ____________________________                                                      ______________________
               Files.                           Moist-Den Curve         1 per soil type                             ____________________________
                                                                                                                    ____________________________
                                                   Soil Survey
                                                 (Classification)      CDOT Form 219 Date Submitted: __________



    ITEM                                            TYPE OF               QUANTITY              TESTS             PROJECT ACCEPTANCE                            FINAL        LABORATORY             # OF CHECK TESTS
    NUMBER     DESCRIPTION                           TESTS                  PLAN               REQUIRED           TEST REPORTED                                QUANTITY      CHECK TESTS            REQUIRED & SUBMITTED

                                                                                                                                                                               1/per source/per          Preliminary Reports
       206     Import Select Wall           Gradation,                                                                                                                              project               No.'s & Laboratory
               Backfill                     Atterberg Limits           ______________        _____________          ____________________________            ______________    ________________           Check Tests Reports
               (Class 1 Structural)                                          ton                required            ____________________________                  ton              required           ______________________
                                                                                                                    ____________________________                                                      ______________________
               (Note: required tests is                                                    ________________         ____________________________                                                      ______________________
               based off of 905 cubic                                                           reported            ____________________________                                                      ______________________
               yards from the given                                                                                 ____________________________                                                      ______________________
               1,649 tons.)                                                                                         ____________________________
                                            In-Place Density                                                        ____________________________
                                            (See Schedule)                                  _______________         ____________________________
                                                                                                required           _____________________________
                                                                                            _______________        _____________________________
                                                                                                reported           _____________________________

                                            Moist-Den Curve, If in roadbed - 1 per source                         Upon project completion, submit completed CDOT
                                                                                                                  Form 194, to Region. Date submitted ________________.

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    Colorado Department of Transportation                                                     MATERIALS DOCUMENTATION RECORD                               Project:            EcoTrail Recreation
    CDOT Form #250, 7/06                                                                                                                                   Location:                Minturn
    Version 9.1 EXC                                   Estimated Field Requirements for Minimum Materials                                                   Region:                      3
                                                      Sampling, Testing, and Inspection and Record of Field                                                Date:
                                                      and Central Laboratory Documentation of Materials.                                                   Page No:
                                                                                                                                                           Contractor:
                                                                                                                                                           Project Code:



                                                          Plan                  Final
       207      Top Soil                                                                                           Certified Test Result (CTR) Required.

                                                     ____________          ____________                            CTR and CDOT Form 157 Nos. ______________
                                                       cubic yard            cubic yard


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      ITEM                                               PLAN                 FINAL
     NUMBER DESCRIPTION                                QUANTITY              QUANTITY


       208      Erosion Control                                                                                    Field Inspect.

      Culvert Inlet Protection (Erosion Log):      __________ each       __________ each                            CDOT Form 157 Nos.____________

                                   Siltfence:      __________ lin ft.    __________ lin ft.                         CDOT Form 157 Nos.____________

          Stabilized Construction Entrance:        __________ each       __________ each                            CDOT Form 157 Nos.____________


`

      ITEM
     NUMBER DESCRIPTION


       212      Seeding & Sodding               Seed: COC and CDOT Form 157 Nos. ____________________.

                                                Sod: Contractor shall submit to the Project Engineer a sample of sod 6 1/2 ft x 2 ft for comparison standard.
                                                Document on CDOT Form No. 157: CDOT Form 157 Nos. ____________________.

                                                Fertilizer: Field inspect. Document on project records. COC and CDOT Form 157 Nos._____________.


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      ITEM                                             TYPE OF                 PLAN               TESTS                  PROJECT ACCEPTANCE                      FINAL          LABORATORY             # OF CHECK TESTS
     NUMBER DESCRIPTION                                 TESTS                QUANTITY            REQUIRED                  TEST REPORTED                        QUANTITY        CHECK TESTS               SUBMITTED

                                                                                                                                                                                  1 per source          Preliminary Reports
       304      Aggregate Base                  Gradation and                  617                             ____________________________                                        per project           No.'s & Laboratory
                Course                          Atterberg Limits          _________________________________    ____________________________                     __________   ____________________       Check Tests Reports
                Class 6                                                         ton           required         ____________________________                         ton             required         ______________________
                                                                                        ___________________    ____________________________                                                          ______________________
                                                                                              reported         ____________________________                                                          ______________________
                                                                                                               ____________________________                                                          ______________________
                                                                                                               ____________________________                                                          ______________________
                                                In-Place Density                           ___________________ ____________________________                                                          ______________________
                                                                                                  required     ____________________________                                                          ______________________
                                                                                           ___________________ ____________________________                                                          ______________________
                                                                                                  reported     ____________________________                                                          ______________________
                                                                                                               ____________________________                                                          ______________________
                                                    Moist-Den Curve                             1 per source   ____________________________
    Colorado Department of Transportation                                              MATERIALS DOCUMENTATION RECORD                       Project:             EcoTrail Recreation
    CDOT Form #250, 7/06                                                                                                                    Location:                 Minturn
    Version 9.1 EXC                               Estimated Field Requirements for Minimum Materials                                        Region:                       3
                                                  Sampling, Testing, and Inspection and Record of Field                                     Date:
                                                  and Central Laboratory Documentation of Materials.                                        Page No:
                                                                                                                                            Contractor:
                                                                                                                                            Project Code:

                                            R-Value: Min. _______ Tested _______

                                            Designated Source? (Y/N) _______

`

      ITEM                                         TYPE OF                PLAN              TESTS               PROJECT ACCEPTANCE                 FINAL           LABORATORY             # OF CHECK TESTS
     NUMBER DESCRIPTION                             TESTS               QUANTITY           REQUIRED               TEST REPORTED                   QUANTITY         CHECK TESTS               SUBMITTED

                                                                                                                                                                          *                Preliminary Reports
       403     Hot Mix                                                                                       ____________________________                                                   No.'s & Laboratory
               Asphalt                      Asphalt Content          _________________________________       ____________________________        ___________   ____________________        Check Tests Reports
               Grading                                                     ton           required            ____________________________            ton              required          ______________________
                                                                                   ___________________       ____________________________                                               ______________________
               Note: All tests, 500 tons                                                 reported            ____________________________                                               ______________________
               or less, visually inspect                                                                     ____________________________                                               ______________________
               and document in Project                                                                       ____________________________    Bituminous Tolerance _____                 ______________________
               Files.                       In-Place Density                           ___________________   ____________________________                                               ______________________
                                                                                             required        ____________________________    RAP % ______                               ______________________
                                                                                       ___________________   ____________________________                                               ______________________
                                                                                             reported        ____________________________    T.S.R. = _____                             ______________________
                                                                                                             ____________________________                                               ______________________
                                                                                                             ____________________________                                               ______________________
                                            Gradation                                  ___________________   ____________________________                                               ______________________
                                                                                             required        ____________________________                                               ______________________
                                                                                       ___________________   ____________________________                                               ______________________
                                                                                             reported        ____________________________                                               ______________________
                                                                                                             ____________________________                                               ______________________
                                                                                                             ____________________________                                               ______________________
                                                Fractured Faces                        ___________________   ____________________________                                               ______________________
                                                                                             required        ____________________________                                               ______________________
                                                                                       ___________________   ____________________________                                               ______________________
                                                                                             reported        ____________________________                                               ______________________
                                                                                                             ____________________________                                               ______________________
                                                                                                                                                                                        ______________________
               __1%__                       Hydrated Lime                                                    ____________________________                                               ______________________
                                            Gradation                _________________________________       ____________________________                                               ______________________
                                                                           ton          required **          ____________________________                                               ______________________
                                                                                   ___________________       ____________________________                                               ______________________
                                                                                       Submitted **          ____________________________                       (Add 1 to this number
                                                                                                                                                                    if applicable)
               * Minimum of 1st rep and each 10k or fraction thereof. 1st rep required even if comercial source.
               ** HYDRATED LIME, Acceptance Samples, submitted to Central Laboratory for gradation testing. See Item 307 of Schedule. Chemical: CDOT Form 157 Nos. ___________.
               25 LB Aggregate Belt Cut Sample in accordance with CP30 is Required to be submitted with 1st Rep Sample
`




                                                                       Plan Quantity      Final Quantity             Field Inspect.
       504     MSE Path Retaining Wall
               w/ Geogrid
                                                                       __________       _______________    CDOT Form 157 Nos.________________.
                                                                         Sq. Ft.             Sq. Ft.


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    Colorado Department of Transportation                                              MATERIALS DOCUMENTATION RECORD                           Project:                EcoTrail Recreation
    CDOT Form #250, 7/06                                                                                                                        Location:                    Minturn
    Version 9.1 EXC                               Estimated Field Requirements for Minimum Materials                                            Region:                          3
                                                  Sampling, Testing, and Inspection and Record of Field                                         Date:
                                                  and Central Laboratory Documentation of Materials.                                            Page No:
                                                                                                                                                Contractor:
                                                                                                                                                Project Code:


                                                                       Plan Quantity       Final Quantity
       514     Pedestrian Path Rail

                                                                        __________       _______________     CDOT Form 157 Nos.________________.                         CTR is required.
                                                                           lin ft.             lin ft.


`


                                                                                                Plan                Approved Quantities As             Final
       603     Culverts                               Type                  Size          (Lin Ft or each)                Reported                    Quantity      CDOT Form 157 Numbers.


                                                 ____________         ____________         ____________                 ____________              ____________       ___________________

                                                 ____________         ____________         ____________                 ____________              ____________       ___________________

                                                 ____________         ____________         ____________                 ____________              ____________       ___________________

                                                 ____________         ____________         ____________                 ____________              ____________       ___________________

                                            See Item 604 in Schedule for Certification procedure for each type.
                                            Document that material is on the Preapproved list and tabulate final quantities on CDOT Form 157.
                                            Total reported quantity must meet or exceed final project quantities.
                                            RUBBER GASKETS AND JOINT FILLERS: See Schedule for requirements.




                                                                                               Plan                          Final                                                                 Materials Represented
       606     Guard Rail                             Type                                   Quantities                    Quantities                                                              & CDOT Form 157 Nos.

                                                                                                                                                                                               _________________________
                                                 ____________                              ____________                 ____________            POSTS, BLOCKS and RAIL:
                                                                                                                                                See Item 606 in Schedule for                   _________________________
                                                 ____________                              ____________                 ____________            Certification procedures.
                                                                                                                                                                                               _________________________
                                                 ____________                              ____________                 ____________
                                                                                                                                                                                               _________________________
                                                 ____________                              ____________                 ____________

                                            See Item 604 in Schedule for Certification procedure.


                                                                                          Plan Quantities               Final Quantities        Materials Represented
       607     Fence                                Pay Item                              (Lin Ft or Each)              (Lin Ft or Each)        CDOT Form 157 Nos.

                                                                                                                                                                                              See Schedule for Certification
                                                 ____________                              ____________                 ____________            _______________                               procedure for each type.
                                                                                                                                                _______________                                 _________________________
                                                 ____________                              ____________                 ____________            _______________
                                                                                                                                                 _______________                               _________________________
                                                 ____________                              ____________                 ____________
                                                                                                                                                Other Form Nos/Dates:                          _________________________
                                                 ____________                              ____________                 ____________             _______________
    Colorado Department of Transportation                                       MATERIALS DOCUMENTATION RECORD                    Project:                EcoTrail Recreation
    CDOT Form #250, 7/06                                                                                                          Location:                    Minturn
    Version 9.1 EXC                         Estimated Field Requirements for Minimum Materials                                    Region:                          3
                                            Sampling, Testing, and Inspection and Record of Field                                 Date:
                                            and Central Laboratory Documentation of Materials.                                    Page No:
                                                                                                                                  Contractor:
                                                                                                                                  Project Code:




                                                                                   Plan Quantities         Final Quantities       Materials Represented
       613     Lighting                       Pay Item                             (Lin Ft or Each)        (Lin Ft or Each)       CDOT Form 157 Nos.

                                                                                                                                                                                See Schedule for Certification
                                                                                    ____________           ____________           _______________                               procedure for each type.
                                            ____________                                                                          _______________                                 _________________________
                                            ____________                            ____________           ____________           _______________
                                                                                                                                   _______________                               _________________________
                                            ____________                            ____________           ____________




                                                                                   Plan Quantities         Final Quantities       Materials Represented
       614     Traffic Control Devices        Pay Item                             (Lin Ft or Each)        (Lin Ft or Each)       CDOT Form 157 Nos.

                                                                                                                                                                                See Schedule for Certification
                                            ____________                            ____________           ____________           _______________                               procedure for each type.
                                                                                                                                  _______________                                 _________________________
                                            ____________                            ____________           ____________           _______________
                                                                                                                                   _______________                               _________________________
                                            ____________                            ____________           ____________            _______________




      ITEM                                    TYPE OF               PLAN              TESTS            PROJECT ACCEPTANCE              FINAL                                         # OF CHECK TESTS
     NUMBER DESCRIPTION                        TESTS              QUANTITY           REQUIRED            TEST REPORTED                QUANTITY                                    REQUIRED AND SUBMITTED
            Various Items

                                                                                                      Submit C.O.C.'s and 157's

                                            ____________        ____________        ____________      _______________________       ____________                                     __________________

                                            ____________        ____________        ____________      _______________________       ____________                                     __________________

                                            ____________        ____________        ____________      _______________________       ____________                                     __________________

                                            ____________        ____________        ____________      _______________________       ____________                                     __________________

                                            ____________        ____________        ____________      _______________________       ____________                                     __________________

                                            ____________        ____________        ____________      _______________________       ____________                                     __________________
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                                            ____________        ____________        ____________      _______________________       ____________                                     __________________
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    Colorado Department of Transportation                                                 MATERIALS DOCUMENTATION RECORD                                  Project:                 EcoTrail Recreation
    CDOT Form #250, 7/06                                                                                                                                  Location:                     Minturn
    Version 9.1 EXC                                Estimated Field Requirements for Minimum Materials                                                     Region:                           3
                                                   Sampling, Testing, and Inspection and Record of Field                                                  Date:
                                                   and Central Laboratory Documentation of Materials.                                                     Page No:
                                                                                                                                                          Contractor:
                                                                                                                                                          Project Code:

                                                 ____________           ____________         ____________             _______________________                ____________                                        __________________




                                                     PROJECT PRICE REDUCTION DOCUMENTATION

      ITEM                                                                                 PRICE REDUCTION                  CALCULATIONS                       CMO/MCR              LINE ITEM NO.
     NUMBER                       DESCRIPTION                                                   AMOUNT                      266/105 DATES                      NUMBERS            ON FINAL ESTIMATE

    ________ ________________________________________________                               ______________                  ______________                  ______________          _______________

    ________ ________________________________________________                               ______________                  ______________                  ______________          _______________

    ________ ________________________________________________                               ______________                  ______________                  ______________          _______________

    ________ ________________________________________________                               ______________                  ______________                  ______________          _______________

    ________ ________________________________________________                               ______________                  ______________                  ______________          _______________


                                                         LABORATORY CHECK TEST DEVIATIONS
      ITEM
     NUMBER          DESCRIPTION                                                              MEMO DATE                         157 NOS.

    ________ ________________________________________________                               ______________                __________________
                                                                                                                                                          Document Major and Significant Independent Assurance deviations
    ________ ________________________________________________                               ______________                __________________              as per 10.4 of the Program in the Field Materials Manual.

    ________ ________________________________________________                               ______________                __________________
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               Attach additional sheets to this form if more space is needed for documentation.
               Isolated relatively small quantities of concrete,reinforcing steel,wire mesh, bolts etc. which are paid for incidentally shall be field inspected to determine conformance with specifications.
               Document in Project Records. If any questions arise concerning the proper documentation of materials during construction, contact the Documentation Unit of the Central Laboratory
               In Denver @ 303-398-6563.

               FIELD DOCUMENTATION ENTERED BY:                               DATE:                                  ENGINEER:
                                                                                                                 PROJECT ENGINEER:                           DATE: DATE:

               ________________________________                      ______________                   __________________________                   _______________

               The entire / Completed Form #250
               Distribution: Resident Engineer                          Documentation Unit (Materials and Geotechnical Branch)
                             Region Materials Engineer                  Central Files
                             FHWA (Oversight Projects only)