Mndot Utility Certification Form Utility Coordination For Id/iq Projects
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1MnDOT Utility Certification Form
Utility Coordination for ID/IQ Projects
Project Information:
S.P.
________________________________
Task No. _______________________
Other Project No(s). ___________________________________________________________
MnDOT District Project Manager: _________________________________________________
UTILITY COORDINATION CERTIFICATION
This certification is submitted with regard to existing utilities on the above noted project(s).
1) There are no utility relocations to be made on the above referenced project(s).
_________________________________
________________________________
Project Manager
Date
Or
2) There are utility relocations to be made on the above referenced project(s). The following utility
companies have been issued Notice & Orders and must complete the required relocations prior to the
_____ day of _______, 20_____.
Utility Company
Notice & Order Date
The following steps have been completed in accordance with State Statutes.
Date
Checklist Step
Utility Coordination Tasks
Completed
1
Utilities Identified – Gopher State One Call
2 & 3
Information Meeting Conducted (If Applicable)
5
Design Meeting Conducted
9
Gopher State One Call Contacted (90 Day Notice)
Statutes also require holding at least one preconstruction meeting to coordinate utility relocation.
_________________________________
________________________________
Project Manager
Date
Contract Document Information
• Utility information depicted on final plans – must indicate survey quality level.
• Special Provision Information Included in Proposal – utility contact information, relocation
description and schedule, pre-work activities, and restrictions.
NOTE: This form should be completed and saved to with the project files. Submit a copy to the
Utilities Engineer..
ID/IQ Certification Form
8/20/2013
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