CENTRAL FEDERAL LANDS 

HIGHWAY DIVISION 

 A guide for Contractors and FHWA contract administration personnel on CFL Field Projects 

 To be used with CFL Standard Specifications for Construction of Roads and Bridges on Federal 

CONSTRUCTION PAYNOTE AND 

DOCUMENTATION EXAMPLE BOOK

Last Updated: April 2012

 Highway Projects
Construction Paynote Examples 

This book was developed to be used as a guideline for Central Federal Lands Highway Division 

staff, our partnering agencies, and the contractors we work with. The Construction Paynote

Examples book gives examples of how a contractor should submit a request for payment 

(paynote), and examples of documentation that adequately support their request. 

Contractors should refer to Section 109 of the FP03 for details of how particular items of work 

should be measured and paid. Examples in this book were created to demonstrate various 

methods of measurement and support documentation. This book shows examples of support 

documentation (certifications, calculations, tickets, etc.).These are solely examples and do not 

intend to summarize all support documentation needed prior to payment of any given pay item. 

The method or requirements prescribed in the FP03 or Special Contract Requirements 

supersedes any examples given in the Field Note Sample Book. 

General Instructions 

• Paynotes shall be completed in blue pen or typed on a computer

• White‐out is not allowed. 

• To correct an error, strike out the mistake, write the correction above or below, and initial next 

to the correction. 

• Paynotes and any support documentation shall be organized and clearly legible. 

• All sections of the paynote must be filled in. 

• Paynotes shall be signed by an approved contractor representative. Paynotes will not be 

accepted for payment without the contractor’s signature. 

• Paynotes will not be accepted without quality certifications, test results, and/or any other 

required documentation for materials used in the work. 

• Certifications for any given item of work should include a statement from the Contractor that 

certifies that the material meets specifications and will be used on the project. All material 

placed for any given item of work should also be identifiable (i.e. roll numbers for silt fence, 

heat numbers for pipe, etc.). 

• A single submittal of a certification is acceptable for multiple pay requests as long as the 

material for the item of work being performed is include within the certification.

• Paynotes shall be completed in a timely fashion per section 109.01 of the FP-03 or the Special 

Contract Requirements. 

• For items with material incentive, QL-pay factors shall be computed and reported in a timely 

fashion per section 109.01 of the FP-03 or the Special Contract Requirements. Also, see 

section 106.05 of the FP-03 or the Special Contract Requirements. 
EEBACS 

The Engineer Estimating, Bidding, Award and Construction System (EEBACS) is an integrated 

system that provides for estimation, solicitation/award, and contract administration of FLH’s 

construction projects. EEBACS is a Web-based system that is maintainable and scalable. 

Portions of the Construction module will also be offered in an off-line version – Not currently 

available, under development. EEBACS consists of a series of components that tracks costs 

from a project’s inception through final acceptance. 

The Construction module tracks information as the project progresses through construction. It 

provides for the development, approval, and tracking of payments for contract items. The 

Construction module also allow for tracking and management of other contract administration 

information including contract modifications, equipment, personnel, subcontractors, and contract 

status. In the Construction phase EEBACS provides the capability to: 

• Create, track and approve Inspector Daily Reports (IDR); 

• Create, track and approve Contractor Daily Reports (CDR); 

• Create and track the Project Engineer’s Daily Dairy;

• Track onsite personnel and equipment; 

• Track subcontractors and associated information; 

• Create and track Contract Modifications; 

• Document and track contract administration and status; 

• Create, track and approve payments to the contractor; and

• Generate detailed reports of how the project was constructed, including cost, 

equipment, and personnel. 

The format used for the paynotes displayed in this example book mimics the 

general format of the EEBACS paynote page. Central Federal Lands intends to 

implement EEBACS with a select number of projects in 2012. Eventually, EEBACS 

will be used on all projects advertised by CFL. A blank paynote is provided on the 

following page (if an electronic copy is desired, speak to the Project Engineer to 

obtain the file).To date, the FP-03 and our Special Contract requirements do not 

require the Contractor to use any specific form for paynotes. For non-EEBACS 

projects, the Contractor may use this form if desired. However, if the Contractor 

chooses to use another paynote format, the format must comply with section 

109.01 of the FP-03 or the Special Contract Requirements.

NOTE: An EEBACS user manual is available for the Contractor if desired. Please talk to the 

Project Engineer to request access. 
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 
TABLE OF CONTENTS (Arranged by Pay Unit) 

Section 1: LUMP SUM Items 

15101 Mobilization ...............................................................................................Page 1

15201 Construction Survey and Staking ..............................................................Page 9

15401 Contractor Testing ....................................................................................Page 13

Section 2: STATION Items 

15206 Slope, Reference & Clearing Stake ..........................................................Page 20

Section 3: EACH Items 

15204 Drainage Structure Survey and Staking.....................................................Page 22

25125 Boulder ......................................................................................................Page 25

63316 Remove and Reset Signs ..........................................................................Page 27

Section 4: HOUR/WEEK Items 

62201 Motor Grader .............................................................................................Page 29

63510 Temporary Traffic Control, Traffic and Safety Supervisor .........................Page 30

63506 Temporary Traffic Control, Flagger ...........................................................Page 41 

Section 5: ACRE Items 

20101 Clearing and Grubbing ..............................................................................Page 44 

62406 Placing Conserved Topsoil .......................................................................Page 50 

62510 Seeding, Hydraulic Method .......................................................................Page 56 

Section 6: LNFT/METER/MILE Items 

15703 Soil Erosion Control, Silt Fence ................................................................. Page 64

41411 Crack Cleaning and Sealing .....................................................................Page 67

55101 Driven Piles ...............................................................................................Page 71

60201 Culvert .......................................................................................................Page 90

63401 Pavement Markings ..................................................................................Page 93

Section 7: SQUARE FEET/SQUARE YARD Items 

20303 Removal of Pavement, Asphalt ................................................................. Page 96

20701 Earthwork Geotextile, Geogrid ..................................................................Page 99

25801 Reinforced Concrete Retaining Wall .........................................................Page 103

30306 Pulverizing ................................................................................................Page 107

63504 Temporary Traffic Control, Construction Sign ...........................................Page 112

Section 8: CUBIC YARD Items 

20401 Roadway Excavation ................................................................................Page 116

20420 Roadway Embankment .............................................................................Page 120
20441 Waste ........................................................................................................Page 124

25101 Placed Riprap ...........................................................................................Page 129

60101 Concrete ...................................................................................................Page 133

Section 9: TON Items 

40301 Hot Asphalt Concrete Pavement ...............................................................Page 139

41201 Tack Coat ..................................................................................................Page 149

Section 10: GALLON Items 

15801 Watering for Dust Control .........................................................................Page 153

63404 Pavement Marking ....................................................................................Page 155

Appendix

A. Sample Haul Vehicle Volume Calculations .....................................................Page 158

B. Sample Water Truck Volume Calculations ......................................................Page 160

C. Volume Correction Factors for Asphalt ...........................................................Page 161

D. Metric Conversion Factors ...............................................................................Page 162

E. Example of Contractor’s Invoice and Support Data .........................................Page 163

F. QL-Pay Example 30101 ...................................................................................Page 165

G. QC Plan Example.............................................................................................Page 168

 
TABLE OF CONTENTS (Arranged by FP-03 Division) 

Division 150: Project Requirements 

15101 Mobilization ...............................................................................................Page 1

15201 Construction Survey and Staking ..............................................................Page 9 

15204 Drainage Structure Survey and Staking.....................................................Page 22

15206 Slope, Reference & Clearing Stake ..........................................................Page 20

15401 Contractor Testing ....................................................................................Page 13

15703 Soil Erosion Control, Silt Fence ................................................................. Page 64

15801 Watering for Dust Control .........................................................................Page 153

Division 200: Earthwork 

20101 Clearing and Grubbing ..............................................................................Page 44

20303 Removal of Pavement, Asphalt ................................................................. Page 96

20401 Roadway Excavation ................................................................................Page 116

20420 Roadway Embankment .............................................................................Page 120

20441 Waste ........................................................................................................Page 124

20701 Earthwork Geotextile, Geogrid ..................................................................Page 99

Division 250: Slope Reinforcement and Retaining Walls 

25101 Placed Riprap ...........................................................................................Page 129

25125 Boulder ......................................................................................................Page 25

25801 Reinforced Concrete Retaining Wall .........................................................Page 103

Division 300: Aggregate Courses 

30306 Pulverizing ................................................................................................Page 107

30101 Aggregate QL-Pay Example .....................................................................Page 165

Division 400: Asphalt Pavements and Surface Treatments 

40301 Hot Asphalt Concrete Pavement ...............................................................Page 139

41201 Tack Coat ..................................................................................................Page 149

41411 Crack Cleaning and Sealing .....................................................................Page 67

Division 550: Bridge Construction 

55101 Driven Piles ...............................................................................................Page 71

Division 600: Incidental Construction 

60201 Culvert .......................................................................................................Page 90

62201 Motor Grader .............................................................................................Page 29

62406 Placing Conserved Topsoil .......................................................................Page 50

62510 Seeding, Hydraulic Method .......................................................................Page 56
63316 Remove and Reset Signs ..........................................................................Page 27

63401 Pavement Markings ..................................................................................Page 93

63404 Pavement Marking ....................................................................................Page 155

63504 Temporary Traffic Control, Construction Sign ...........................................Page 112

63506 Temporary Traffic Control, Flagger ...........................................................Page 41 

63510 Temporary Traffic Control, Traffic and Safety Supervisor .........................Page 30

Appendix

 A. Sample Haul Vehicle Volume Calculations .....................................................Page 158

 B. Sample Water Truck Volume Calculations ......................................................Page 160

 C. Volume Correction Factors for Asphalt ...........................................................Page 161

 D. Metric Conversion Factors ...............................................................................Page 162

 E. Example of Contractor’s Invoice and Support Data .........................................Page 163

 F. QL-Pay Example 30101 ................................................................................... Page 165

 G. QC Plan Example.............................................................................................Page 168
SECTION 1: LUMP SUM ITEMS 

15101 Mobilization .............................................................................................Page 1

15201 Construction Survey and Staking ............................................................Page 9

15401 Contractor Testing ...................................................................................Page 13

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON LPSM ITEMS: 

Items paid by Lump Sum typically have very specific directions for when and how they will be 

paid. Please refer to the FP, the Special Contract Requirements, and plans for your project for 

detailed instructions prior to submitting any pay notes. In almost all cases, lump sum items 

require specific documentation prior to any payment. Lump sum items are not directly measured 

for payment but general measurements may be made to verify or estimate progress.
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 2 for this item 

 SD PRA BADL 10(5) Badlands Loop Road

 1 1

N/A (for EEBACS only)

15101-0000 Mobilization LPSM

06/30/11

 N/A (for EEBACS only) 

 Schedule A 

06/01/11 06/30/11

$500,000 (LPSM)

Joe the Inspector & Bob the Contractor 

06/30/11

07/10/11

Bob the Contractor

06/30/11 Joe the Inspector

Jane the Project Engineer

Notice to Proceed was issued on May 27, 2011. 

Bond premiums, SF 25 and 25A were submitted to FHWA on May 29, 2011. 

Began mobilizing construction equipment to the project on 06/01/11. 

Began construction activities on 06/05/11.

-Refer to FP-03 151.03(b) 

-Original contract amount ($12,000,000) minus mobilization ($1,000,000) = revised total ($11,000,000) 

-Contract work complete to date (06/30/11) = $750,000 (which is greater than 5% contract amount via other bid items) 

Pay lesser of the following two amounts 

(a) 50% of mobilization = $500,000 

(b) 5% of original contract = $600,000

See attached SF25 (performance bond) and SF25A (payment bond)

Page 1






U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Payment 2 of 2 and final payment for this item 

SD PRA BADL 10(5) Badlands Loop Road 

 32 3

N/A (for EEBACS only)

15101-0000 Mobilization LPSM

08/31/11

N/A (for EEBACS only)

Schedule A 

08/01/11 08/31/11

$500,000 (LPSM)

Joe the Inspector & Bob the Contractor

08/31/11

09/09/11

Bob the Contractor

08/31/11 Joe the Inspector

Jane the Project Engineer

Notice to Proceed was issued on May 27, 2011. 

Bond premiums, SF 25 and 25A were submitted to FHWA on May 29, 2011. 

Began mobilizing construction equipment to the project on 06/01/11. 

Began construction activities on 06/05/11.

-Refer to FP-03 151.03(b) 

-Original contract amount ($12,000,000) minus mobilization ($1,000,000) = revised total ($11,000,000) 

-Contract work complete to date (08/31/11) = $3,000,000 (which is greater than 10% contract amount via other bid items) 

Previous Payment = $500,000 (Pay Period #1) 

Remaining balance for payment: $1,000,000 - $500,000 = $500,000 

Pay $500,000 in Pay Period 3 

Mobilization is now 100% complete

N/A

Page 8
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example #1 of 1 for this item 

WY ERFO 261(1) Cedar Pass Road

 15 2

N/A (for EEBACS only

15201-0000 Construction Survey and Staking LPSM

07/31/11

N/A (for EEBACS only)

Schedule A

07/24/11 07/31/11

$2,971.50 (LPSM)

Joe the Inspector & Bob the Contractor

07/31/11

08/07/11

Bob the Contractor

07/31/11 Joe the Inspector

Jane the Project Engineer

Construction Survey and Staking activities began on 07/01/10. 

Pipe plots (7/24 to 7/30): STA 100+56, 104+78, 106+67, 107+95 

Pipe Staking (7/24, 7/27): STA 100+56, 104+78 

Clearing Stakes RT and LT (7/24 to 7/28): STA 100+00 to 152+80 

Reference Stakes RT and LT (7/26, 7/27): STA 100+00 to 152+80 

Slope Stakes RT and LT (7/30,7/31): STA 100+00 to 152+80

Per agreement with FHWA CO and Contractor Owner, the breakdown of work for all LPSM survey work is as follows: 

15% pipes, 5% curb/drainage, 60% clearing/ref/slope, 5% red tops, 7% blue tops, 3% parking and 5% misc. (signs/striping,etc.) 

See attached spreadsheets: 2.94% of 15% completed of pipe survey, 16.87% of 60% completed of clearing/ref/slope stakes 

Pay 2.94% + 16.87% = 19.81% X ($15,000 LPSM) = $2,971.50 

Pipe Culvert Survey Breakdown Spreadsheet, Clearing/Ref/Slope Staking Breakdown Spreadsheet 

Note: Pipe plots have been submitted and approved prior to payment (see example of acceptable pipe plot)

Page 9
# Date Complete Pipe Plots

(10%)

Pay

Percentage* Date Completed Staking(5%)

Pay

Percentage**

1 7/24/2011 100+56 0.59 7/24/2011 100+56 0.29

2 7/24/2011 104+78 0.59 7/27/2011 104+78 0.29

3 7/30/2011 106+67 0.59 Not yet completed 106+67 0.29

4 7/30/2011 107+95 0.59 Not yet completed 107+95 0.29

5 Not yet completed 108+98 0.59 Not yet completed 108+98 0.29

6 Not yet completed 110+09 0.59 Not yet completed 110+09 0.29

7 Not yet completed 115+78 0.59 Not yet completed 115+78 0.29

8 Not yet completed 118+03 0.59 Not yet completed 118+03 0.29

9 Not yet completed 119+89 0.59 Not yet completed 119+89 0.29

10 Not yet completed 124+45 0.59 Not yet completed 124+45 0.29

11 Not yet completed 137+36 0.59 Not yet completed 137+36 0.29

12 Not yet completed 152+56 0.59 Not yet completed 152+56 0.29

13 Not yet completed 167+66 0.59 Not yet completed 167+66 0.29

14 Not yet completed 231+45 0.59 Not yet completed 231+45 0.29

15 Not yet completed 235+63 0.59 Not yet completed 235+63 0.29

16 Not yet completed 247+11 0.59 Not yet completed 247+11 0.29

17 Not yet completed 260+13 0.59 Not yet completed 260+13 0.29

*Pipe Plot Pay Percentage = ((1/17)*0.1)*100

**Staking Pay Percentage = ((1/17)*0.05)*100

Survey and Staking (LPSM)

WY ERFO 261(1), Cedar Pass Road

Pipe Culverts‐17 total (15% of LPSM)

Page 10
Date Station  ‐ Station Length (feet) Date Station  ‐ Station Length (feet) Date Station  ‐ Station Length (feet)

07/24/11 100+00 ‐ 116+00 1600 7/26/11 100+00 ‐ 123+00 2300 7/30/11 100+00 ‐ 122+50 225007/25/11 116+00 ‐ 128+00 1200 7/27/11 123+00 ‐ 152+80 2980 7/31/11 122+50 ‐ 152+80 303007/27/11 128+00 ‐ 143+00 150007/28/11 143+00 ‐ 152+80 980

5280 5280 5280

WY ERFO 261(1), Cedar Pass Road

Survey and Staking (LPSM)

Clearing, Reference and Slope Staking: 100+00 to 269+00 = 16,900 feet total (60% of Survey and Staking 

Clearing (18%) Reference (18%) Slope (18%)

Total Length in feet = Total Length in feet = Total Length in feet =

Page 11
Page 12
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Payment 1 of 2 for this item 

WY ERFO 261(1) Cedar Pass Road

 5 1

N/A (for EEBACS only)

15401-0000 Contractor Testing LPSM

08/31/10

N/A (for EEBACS only)

Schedule A

08/12/10 8/31/10

$2,500 (LPSM)

Joe the Inspector & Bob the Contractor 

08/31/10

09/05/10

Bob the Contractor

08/31/10 Joe the Inspector

Jane the Engineer

On 8/12/10 testing facilities were established and approved by FHWA, qualified testing personnel were identified and approved 

by FHWA, and SF-1413's for the subcontractor performing this work were submitted and later approved by FHWA. 

On 8/24/11, testing began for site 6 embankment work. 

 

Per 154.07(a), 25% of the item amount, not to exceed 0.5 percent of the original contract amount, will be paid after all the 

testing facilities are in place, qualified sampling and testing personnel are identified, and the work being tested has started. 

-Original Contract Amount = $1,000,000 

-Contractor Testing Amount = $10,000 

Pay lesser of the following two amounts 

a) $1,000,000 x %0.5 = $5,000 

b) $10,000 X %25 = $2,500 

Note:To date, a low % of total testing has been completed...per Contractor and FHWA, prorated payment will be begin on PP 2.

(1) QC Plan (Appendix G) (2) Material Testing Lab Accreditation (3) Site 6 embankment testing reports 8/24/11 - 8/31/11 

(4) Material Tester Certificates (NOT SHOWN) 

Page 13


U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Payment 2 of 2 and final payment for this item 

WY ERFO 261(1) Cedar Pass Road

 36 2

N/A (for EEBACS only)

15401-0000 Contractor Testing LPSM

9/30/10

N/A (for EEBACS only)

Schedule A

9/1/10 9/30/10

$2,272.72 (LPSM)

Joe the Inspector & Bob the Contractor 

9/30/10

10/02/10

Bob the Contractor 

9/30/10 Joe the Inspector

Jane the Project Engineer

From 9/1/10 to 9/30/10 Embankment (for RSS embankment construction) and Aggregate Base Testing (see attached test 

results) 

Per 154.07(b), payment for the remaining portion of the item amount will be prorated based on the total work complete. 

Testing facilities/personnel in place and item begin = 25% (75% remaining) Paid Estimate 1 on 8/31/10 

 

Original contract amount ($1,000,000) minus contractor testing ($10,000) = revised total ($990,000) 

Contract work complete to date (09/30/10) = $300,000 ($300,000/$990,000 X %100 = %30.3) 

%30.3 (contract work complete to date) X 75% (remaining testing work to be paid) = %22.72 

%22.72 X $10,000 = $2,272.72

(1) Site 5 Embankment Testing Summary (2) Site 5 embankment testing reports (3) Site 5 aggregate testing reports 10/30/11

Page 16
Date Station Elev. (ft.) Proctor Density 

(PCF)

Moisture 

(%) % Compaction (+/-) Moisture Pass (Y/N)

9/27/2011 277+55 8938 In-Situ: 121.5 PCF @12.3% 116.6 14 96.0 1.7 Y

9/27/2011 277+58 8939.5 In-Situ: 121.5 PCF @12.3% 115.9 12.7 95.4 0.4 Y

9/29/2011 277+50 8945 In-Situ: 121.5 PCF @12.3% 118.9 14.5 97.9 2.2 Y

9/29/2011 277+15 8945 In-Situ: 121.5 PCF @12.3% 120.6 13 99.3 0.7 Y

9/30/2011 277+25 8945.5 In-Situ: 121.5 PCF @12.3% 118 13.8 97.1 1.5 Y

9/30/2011 277+20 8946 In-Situ: 121.5 PCF @12.3% 117.9 14.2 97.0 1.9 Y

9/30/2011 276+55 8946 In-Situ: 121.5 PCF @12.3% 116.9 14.1 96.2 1.8 Y

9/30/2011 277+45 8947 Rch Pit: 130.4 PCF @6.7% 126.8 7.2 97.2 0.5 Y

10/1/2011 277+40 8948 Rch Pit: 130.4 PCF @6.7% 124.9 8.1 95.8 1.4 Y

10/1/2011 277+30 8948.5 Rch Pit: 130.4 PCF @6.7% 129.2 7.7 99.1 1 Y

10/1/2011 277+15 8949.5 Rch Pit: 130.4 PCF @6.7% 126.1 7.6 96.7 0.9 Y

10/3/2011 277+00 8951.5 Rch Pit: 130.4 PCF @6.7% 125.7 8 96.4 1.3 Y

10/4/2011 277+00 8953 Rch Pit: 130.4 PCF @6.7% 129.7 8.1 99.5 1.4 Y

10/5/2011 277+15 8954 Rch Pit: 130.4 PCF @6.7% 125.7 5.9 96.4 -0.8 Y

10/6/2011 277+25 8956 Rch Pit: 130.4 PCF @6.7% 126 6.4 96.6 -0.3 Y

10/14/2011 277+20 8957.5 Rch Pit: 130.4 PCF @6.7% 128.7 6 98.7 -0.7 Y

10/14/2011 276+55 8959 Rch Pit: 130.4 PCF @6.7% 127.2 6.3 97.5 -0.4 Y

10/14/2011 277+45 8960.5 Rch Pit: 130.4 PCF @6.7% 128 6.1 98.2 -0.6 Y

10/14/2011 277+20 8962 Rch Pit: 130.4 PCF @6.7% 128.9 7.4 98.8 0.7 Y

10/15/2011 277+55 8963.5 Rch Pit: 130.4 PCF @6.7% 130.2 7.2 99.8 0.5 Y

10/15/2011 277+45 8965 Rch Pit: 130.4 PCF @6.7% 129.8 7.1 99.5 0.4 Y

10/16/2011 276+40 8966.5 Rch Pit: 130.4 PCF @6.7% 128.7 8.4 98.7 1.7 Y

10/18/2011 277+30 8968 Rch Pit: 130.4 PCF @6.7% 129.5 8.2 99.3 1.5 Y

10/19/2011 277+15 8969.5 Rch Pit: 130.4 PCF @6.7% 129.5 7.4 99.3 0.7 Y

10/19/2011 276+20 8971 Rch Pit: 130.4 PCF @6.7% 133.2 13.2 102.1 6.5 Y

10/20/2011 277+55 8972.5 Rch Pit: 130.4 PCF @6.7% 137.2 9.8 105.2 3.1 Y

10/21/2011 277+45 8974 Rch Pit: 130.4 PCF @6.7% 127.7 8.1 97.9 1.4 Y

10/21/2011 277+40 8975.5 Rch Pit: 130.4 PCF @6.7% 128.7 7.4 98.7 0.7 Y

10/22/2011 277+30 8977 Rch Pit: 130.4 PCF @6.7% 126.6 7.4 97.1 0.7 Y

10/23/2011 276+15 8978.5 Rch Pit: 130.4 PCF @6.7% 130 6.9 99.7 0.2 Y

10/24/2011 277+10 8980 Rch Pit: 130.4 PCF @6.7% 129.9 6.9 99.6 0.2 Y

10/25/2011 277+00 8981.5 Rch Pit: 130.4 PCF @6.7% 126.4 6.3 96.9 -0.4 Y

10/27/2011 276+50 8983 Ten Pit: 137.2 PCF @ 4.3% 133.9 4.6 97.6 0.3 Y

10/28/2011 277+50 8984.5 Ten Pit: 137.2 PCF @ 4.3% 136.3 5.3 99.3 1 Y

10/29/2011 277+00 8986 Ten Pit: 137.2 PCF @ 4.3% 130.9 4 95.4 -0.3 Y

10/30/2011 276+70 8988 Ten Pit: 137.2 PCF @ 4.3% 137.1 5.1 99.9 0.8 Y

10/30/2011 276+30 8990.5 Ten Pit: 137.2 PCF @ 4.3% 135.1 4.9 98.5 0.6 Y

Site 5 EMBANKMENT TESTING SUMMARY

WY ERFO 261(1), Cedar Pass Road, CONTRACTOR INC.

See example of Contractor Daily Test Report (submitted to FHWA each day) 

Page 17


SECTION 2: STATION ITEMS

15206 Slope, Reference & Clearing Stake ..........................................................Page 20

 

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON STA ITEMS: 

Items paid by the STA are generally items that include many miles of continuous work (i.e. 

Staking, Ditch Reconditioning, Pulverizing, and Rumble Strip). A Station is generally paid once 

every 50’ or 100’ (i.e. for intervals of 50’, work from station 100+00 to 200+00 = 2 stations). 

Please review the plans and specifications for payment intervals on your specific project. 

Payment by station is determined from the approved centerline referencing stakes. Station

quantities shown in the Plans are estimates and are generally very accurate, but only actually 

ordered and performed quantities are paid. Please refer to the FP, the Special Contract 

Requirements, and plans of your project for detailed instructions prior to submitting any pay 

notes. 
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

SD PFH 17-1(8) Hill City to Lead

 22 2

N/A (for EEBACS only)

15206-0000 Slope, Reference, & Clearing Stake STA

10/28/10

 N/A (for EEBACS only)

Schedule B

10/24/10 10/28/10

26.67 (STA)

Joe the Inspector & Bob the Contractor 

10/28/10

11/04/10

Bob the Contractor

10/28/10 Joe the Inspector

Jane the Project Engineer

Clearing and Grubbing Staking: 10/24/10 & 10/28/10, STATION 85+80 to 126+00 (50' intervals)* 

*See Slope, Reference, and Clearing & Grubbing Stake Daily Totals Spreadsheet 

19.00 STA + 7.67 STA = 26.67 STA 

Pay 26.67 STA

(1) Slope, Reference, and Clearing & Grubbing Stake Daily Totals Spreadsheet

Page 20
DATE STA START STA END

INTERVAL

STAKED (FEET)

TOTAL STA

STAKED

1/3 OF TOTAL STA STAKED

(PAY AMOUNT)

10/1/2010 11+00 21+50 50 21 7.00

10/2/2010 22+00 34+00 50 24 8.00

10/3/2010 34+50 52+00 50 35 11.67

10/4/2010 52+50 74+00 50 43 14.33

10/7/2010 74+50 98+00 50 47 15.67

10/8/2010 98+50 114+00 50 31 10.33

10/10/2010 114+50 120+00 50 11 3.67

TOTALS = 212 70.67

DATE STA START STA END

INTERVAL

STAKED (FEET)

TOTAL STA

STAKED

1/3 OF TOTAL STA STAKED

(PAY AMOUNT)

10/11/2010 11+00 33+50 50 45 15.00

10/14/2010 34+00 57+00 50 46 15.33

10/15/2010 57+50 87+00 50 59 19.67

10/16/2010 87+50 100+00 50 25 8.33

10/17/2010 100+50 114+00 50 27 9.00

TOTALS = 202 67.33

DATE STA START STA END

INTERVAL

STAKED (FEET)

TOTAL STA

STAKED

1/3 OF TOTAL STA STAKED

(PAY AMOUNT)

10/20/2010 11+00 55+00 50 88 29.33

10/21/2010 55+50 85+00 50 59 19.67

10/24/2010 85+50 114+00 50 57 19.00

10/28/2010 114+50 126+00 50 23 7.67

TOTALS = 227 75.67

CLEARING AND GRUBBING STAKING (1/3 of total work for this item)

Pay Period 3 (10‐1‐2010 to 10‐31‐2010)

15206‐0000: Slope, Reference, and Clearing & Grubbing Stake Daily Totals

SD PFH 17‐1(6) Hill City to Lead

Pay Unit: STA

SLOPE STAKING (1/3 of total work for this item)

REFERENCE STAKING (1/3 of total work for this item)

Page 21
Section 3: EACH ITEMS

15215 Survey and Staking, Drainage Structure....................................................Page 22

25125 Boulder ......................................................................................................Page 25

63316 Remove and Reset Signs ..........................................................................Page 27

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON EACH ITEMS: 

Items paid by the EACH are generally items that are appropriate to track on an individual basis 

(i.e. placing boulders, placing a gate, culvert end sections, traffic control cones, etc.). Payment

by each is the actual number of units completed and accepted. Quantities shown in the Plans 

are estimates; only actually ordered and performed quantities are paid. Generally, when 

submitting for payment on items paid by the EACH, it is required to show on the paynote when 

the item was completed, where the item was placed (stationing/offset/sketch on the plans) and 

how many items were placed. Please refer to the FP, the Special Contract Requirements, and 

plans of your project for detailed instructions prior to submitting any pay notes. 
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

UT PFH 39-1(2) 7 Mile Gooseberry Road

 34 2

N/A (for EEBACS only)

15215-3000 Survey & Staking, Drainage Structure EACH

9/17/08

 N/A (for EEBACS only)

Option X

09/15/08 9/17/08

5 (EACH)

Joe the Inspector & Bob the Contractor 

9/17/08

10/01/08

Bob the Contractor 

9/17/08 Joe the Inspector

Jane the Project Engineer

Pipe location: 

9/15/08: 18+855 

9/17/08: 17+520, 17+697, 17+832, 18+050 

Each culvert above has been plotted and staked per contract requirements. 

Total = 5 EACH 

Approved pipe calculations/plots for each pipe being paid for (only 18+855 shown in this example)

Page 22


U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

NM PRA CAVE 10(1) Carlsbad Caverns

 65 2

N/A (for EEBACS only)

25125-0000 Boulders EACH

06/12/11

 N/A (for EEBACS only)

Schedule B

06/11/11 06/12/11

24 (EACH)

Joe the Inspector & Bob the Contractor 

06/12/11

07/13/11

Bob the Contractor

06/12/11 Joe the Inspector

Jane the Project Engineer

-6/11/11: 10 boulders placed every 15 feet from Station 29+80 to 31+30 (as approved by the CO) 

-6/12/11: 14 boulders placed every 15 feet from Station 31+45 to 33+55 (as approved by the CO)

-(10 boulders placed on 6/11/11) + (14 boulders placed on 6/12/11) = 24 BOULDERS TOTAL 

-Pay 24 boulders EACH 

See attached plan sheet, D14 for placement details

Page 25
Page 26
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

UT PFH 39-1(2) 7 Mile Gooseberry Road

 112 4

N/A (for EEBACS only)

63316-1000 Remove and Reset Sign EACH

05/27/09

 N/A (for EEBACS only)

Schedule C

05/07/09 5/27/09

20 (EACH)

Joe the Inspector & Bob the Contractor 

05/27/09

6/05/09

Bob the Contractor

5/27/09 Joe the Inspector 

Jane the Project Engineer

See attached remove and reset sign support documentation spreadsheet for location and description of work. 

-Pay 20 EACH 

Remove and reset sign support documentation spreadsheet

Page 27
Removed/

Reset

Work 

Completed Station Side Sign

5+75 RT Reverse turn sigh right

11+75 RT Pavement Ends

14+50 LT Reverse turn sigh right

x 5/27/2009 25+68 Rt Lights on for safety

x 5/27/2009 54+95 RT MP 1

x 5/27/2009 107+75 RT MP 2

x 5/24/2009 160+55 RT MP 3

x 5/24/2009 213+35 RT MP 4

x 5/24/2009 266+15 RT MP 5

x 5/24/2009 318+95 RT MP 6

x 5/24/2009 371+75 RT MP 7

x 5/19/2009 424+55 RT MP 8

x 5/19/2009 450+35 LT Rd #7830

x 5/12/2009 450+34 LT 22 National Forest

x 5/12/2009 478+69 RT MP 9

x 5/12/2009 530+15 RT MP 10

x 5/12/2009 563+50 LT Rd #7860

x 5/7/2009 582+95 RT MP 11

x 5/7/2009 605+00 RT Intersection Ahead

x 5/7/2009 607+80 RT Satsop Center 7/Wynoochee Lake 6

x 5/7/2009 610+64 RT 22 National Forest

x 5/7/2009 613+34 LT Montesano 30

x 5/7/2009 614+83 RT Lights on for safety

63316 Remove and Reset Signs

Page 28
Section 4: HOUR/WEEK ITEMS

62201 Motor Grader .............................................................................................Page 29

63510 Temporary Traffic Control, Traffic and Safety Supervisor .........................Page 30

63506 Temporary Traffic Control, Flagger ...........................................................Page 41

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON HOUR ITEMS: 

Items paid by the Hour are only paid when ordered by the CO. Hour quantities shown in the 

Plans are estimates; only actually ordered and performed quantities are paid. Please refer to the 

FP, the Special Contract Requirements, and plans for your project for detailed instructions prior 

to submitting any pay notes. In order to fully provide documentation for measurement and 

payment, advance consideration should be given to tracking the individual persons or 

equipment that are used and the specific start and stop times. For clarity, hourly ordered work 

should be completed separately from other items when possible.
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

ND PRA THRO 10(3) North Unit Scenic Drive 

 123 5

N/A (for EEBACS only)

62201-0900 Wheel Loader,2 Cubic Yard Capacity Hours

10/11/2009

 N/A (for EEBACS only)

Schedule C

10/08/2009 10/11/2009

25.0 (Hours)

Joe the Inspector & Bob the Contractor 

10/11/09

10/11/09

Bob the Contractor

10/11/09 Joe the Inspector

Jane and the Project Engineer

(1) Station 385+00 to 395+00 LT on 10/11/09: Move boulders from 1200 to 1730 = 5.5 hours* 

(2) Station 385+00 to 410+10 RT on 10/10/09: Move NPS stockpile from 0700 to 1530 (1/2 hr lunch) = 8 hours* 

(3) Station 227+00 parking lot entrance on 10/09/09:Move NPS stockpile from 0700 to 1530 (1/2 hr lunch) = 8 hours* 

(4) Station 87+50 cross road pipe RT on 10/08/09 from 0700 to 1030 = 3.5 hours* 

*Extra work directed by CFL project engineer and performed by Tom the Operator on the CAT 950H 

From Location/Description: 

Total quantity (Hours) = 5.5 + 8 + 8 + 3.5 = 25 Hours 

 

N/A

Page 29
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

CA PFH 112-1(1) South Fork Smith River Road

 67 3

N/A (for EEBACS only)

63510-0100 Traffic Control Supervisor WEEK

8/21/10

 N/A (for EEBACS only)

Option X

8/15/10 8/21/10

1 (WEEK)

Joe the Inspector & Bob the Contractor 

8/21/10

9/5/10

Bob the Contractor

8/21/10 Joe the Inspector

Jane the Inspector 

Certified Traffic Control Supervisor, Cassie Fitzhugh worked 7 consecutive days from 08/15/10 to 08/21/10. 

See attached Daily Traffic Control Reports 

Per SCR 635.26, measure Traffic and Safety Supervisor by the week (7 consecutive days, beginning and ending at midnight on 

the same day of the week) for the work described in Subsection 156.08. Payment will be full compensation for the work 

prescribed. 

08/15/10 to 08/21/10 = 1 week 

 

Scanned T.C.S Certifications, Daily Traffic Control Reports

Page 30










U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

ND PRA THRO 10(3) North Unit Scenic Drive

 212 6

Example: NM

63506-0500 Flagger HOUR

10/29/2009

 Example: A1040 

Schedule A

10/29/09 10/29/09

24 (HOURS)

Joe the Inspector & Bob the Contractor 

10/29/09

11/12/09

Bob the Contractor 

10/29/09 Joe the Inspector

Jane the Project Engineer

10/29/2009 = 24.0 hours* 

*See supporting documentation 

Per SCR 635.26, payment will be full compensation for the work prescribed. 

Sum of hours from Location/Description = 24.0 hours 

Pay 24.0 hours 

 

Daily Record of Flagger Hours, Flagger Certification

Page 41


Section 5: ACRE Items

20101 Clearing and Grubbing ..............................................................................Page 44

62406 Placing Conserved Topsoil .......................................................................Page 50

62510 Seeding, Hydraulic Method .......................................................................Page 56

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON ACRE ITEMS: 

Items paid by the ACRE are generally items that include large areas of work (i.e. Seeding, 

Clearing, Topsoil, Rolled Erosion Control Product, etc.). ACRE quantities shown in the Plans 

are estimates; only actually ordered and performed quantities are paid. Please refer to the FP, 

the Special Contract Requirements, and plans of your project for detailed instructions prior to 

submitting any pay notes. Make longitudinal and traverse measurement by the foot or meter and 

then use appropriate conversion factors to convert to an ACRE or HECTARE, respectively. It is 

not okay to determine longitudinal lengths based off of station ranges; the length must be 

physically measured or surveyed. Generally, when submitting for payment on items paid by the 

ACRE, it is required to show on the paynote when the work was performed, where the work was 

performed (station ranges and offsets), measurement sketches, measurement calculations, 

survey reports if performed, and necessary conversion calculations.
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

OR PFH 244-1(1) Sunriver to Mt. Bachelor

 27 2

N/A (for EEBACS only)

20101-0000 Clearing and Grubbing ha

01/03/2006

 N/A (for EEBACS only)

OPTION Y

12/29/2005 01/03/2006

2.863 ha

Joe the Inspector & Bob the Contractor 

01/03/2006

01/07/2006

Bob the Contractor 

01/03/2006 Joe the Inspector

Jane the Project Engineer

From 12/29/2005 to 1/03/2006, workers cleared and grubbed both sides of the roadway from Station 13+320 to Station 14+500. 

Per attached clearing report, Station 13+320 to Station 14+500 = 28,628 square meters = 2.863 ha 

Pay 2.863 ha 

(1) Clearing Report for plan quantities 

Page 44
Page 45
Page 46
Page 47
Page 48
458 +

462 +

461 +

460 +

458 +

454 +

457 +

467 +

474 +

486 +

497 +

507 +

527 +

530 +

526 +

532 +

537 +

527 +

495 +

473 +

468 +

464 +

448 +

469 +

412 +

338 +

385 +

412 +

403 +

400 +

398 +

431 +

459 +

425 +

397 +

390 +

391 +

383 +

387 +

419 +

472 +

525 +

540 +

649 +

643 +

554 +

563 +

531 +

526 +

546 +

577 +

593 +

598 +

594 +

615 +

661 +

563 +

426 +

385 +

TOTAL     = 28628

OR PFH 244‐1(1) Clearing and Grubbing Summary (December 2005 to January 2006)

Page 49
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

SD PFH 17-1(6) Hill City to Lead

 211 6

N/A (for EEBACS only)

62406-0200 Placing Conserved Topsoil, 2" depth ACRE

8/22/2010

 N/A (for EEBACS only)

Schedule A

8/17/2010 8/21/2010

1.134 (ACRE)

Joe the Inspector & Bob the Contractor 

8/22/10

8/25/10

Bob the Contractor 

8/22/10 Joe the Inspector

Jane the Project Engineer 

(a) 8/17/2010: Placed Conserved Topsoil at Deerfield STA 31+00 to 35+15 RT 

(b) 8/18/2010: Placed Conserved Topsoil at Deerfield STA 35+15 to 41+20 RT 

(c) 8/19/2010: Placed Conserved Topsoil at Deerfield and Newton Trail Slope STA 38+50 to 41+50 LT 

(d) 8/20/2010: Placed Conserved Topsoil at the slope of Newton Fork Ranch 

(e) 8/21/2010: Placed Conserved Topsoil at Deerfield STA 49+00 to 41+50 LT 

Note: Topsoil placed by Tim the Operator with a Hitachi EX230 Excavator. 

Per FP-03 624.07, payment will be full compensation for the work prescribed in this section. 

From Location/Description: 

(a) 4,162.5 SF* + (b) 14,970.0 SF* + (c) 4,861 SF* + (d) 3,317 SF* + (e) 22,086 SF* = 49,396.5 SF 

 

(49,396.5 SF) / (43,560 SF/ACRE) = 1.134 ACRE 

*See attached Placing Conserved Topsoil Sketches and Calculations

(1) Placing Conserved Topsoil Sketches and Calculations 

Page 50





U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

SD PFH 17-1(6) Hill City to Lead

 137 6

N/A (for EEBACS only)

62510-2000 Seeding, Hydraulic Method ACRE

8/4/10

 N/A (for EEBACS only)

Option W

8/1/10 8/3/10

0.652 (ACRE)

Joe the Inspector & Bob the Contractor 

8/4/10

8/7/10

Bob the Contractor

8/5/10 Joe the Inspector

Jane the Project Engineer

(A) 8/1/2010: Hydraulic Seeding at Burnt Fork, top of bench* 

(B) 8/2/2010: Hydraulic Seeding at Burnt Fork, slope* 

(C) 8/3/2010: Hydraulic Seeding at Burnt Fork, ditch* 

*See attached sketch 

From Location/Description: 

(A) 7,626 SF* + (B) 12,780.5 SF* + (C) 8,000 SF* = 28,406.5 SF 

 

(28,406.5 SF) / (43,560 SF/ACRE) = 0.652 ACRE 

*See attached Hydraulic Seeding Sketches and Calculations

(1) Hydraulic Seeding Sketches and Calculations (2) Hydraulic Seeding Certification

Page 56







Section 6: LNFT/METER/MILE ITEMS

15705 Soil Erosion Control, Silt Fence ................................................................. Page 64

41411 Crack Cleaning and Sealing .....................................................................Page 67

55101 Driven Piles ...............................................................................................Page 71

60201 Culvert .......................................................................................................Page 90

63401 Pavement Markings ..................................................................................Page 93

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON LNFT/METER/MILE ITEMS: 

Items paid by length are generally items that are appropriate to measure from end-to-end. 

Length quantities shown in the Plans are estimates; only actually ordered and performed 

quantities are paid. Please refer to the FP, the Special Contract Requirements, and plans of 

your project for detailed instructions prior to submitting any pay notes. Generally, items paid by 

length are measured with approved devices along the length of the item from end-to-end; 

parallel to the base or foundation; along the top; along the front face; or along the invert. Do not 

measure overlaps. It is necessary to measure lengths as specified within the contract for that 

specific item. Items measured by length often have differing measurement methods based on 

the item. When submitting for payment on items paid by length, it is required to show on the 

paynote when the work was performed, where the work was performed (station ranges, offsets, 

depths, sketches), measurement calculations, who measured the work, survey reports if 

performed, and necessary conversion calculations (i.e. feet to mile). 
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

AZ PFH 43-1(4) Sunrise Park- Big Lake Road

 71 3

N/A (for EEBACS only)

15705-0100 Soil Erosion Control, Silt Fence LNFT

07/31/11

 N/A (for EEBACS only)

Option X

7/2/2011 7/2/2011

408 (LNFT)

Joe the Inspector & Bob the Contractor 

08/31/11

09/05/11

Bob the Contractor

08/31/11 Joe the Inspector

Jane the Project Engineer 

1) 7/02/11: 123+46 to 124+60 RT, 116' measured 

2) 7/02/11: 124+77 to 125+75 RT, 100' measured 

3) 7/02/11: 127+00 to 128+97 RT, 195' measured 

Sum of silt fence from Location/Description = 116' + 100' + 195' = 408' 

Pay 408 LNFT of Silt Fence 

 

Per FP-03, section 157.16 (a), 50% of the unit bid price will be paid upon installation. See attached Silt Fence Payment 

Summary Sheet for retention information. 

NOTE: Do not show retention information on any paynotes.

Silt Fence Certification, Silt Fence Payment Summary Sheet 

Page 64
Quantity Date PP Quantity Date PP Quantity Date PP

64 6/29/11 233 116.5 29-Jun 2 58.25 31-Aug 4 TBD 0.75

66 6/30/11 124 62 29-Jun 2 31 31-Aug 4 TBD 0.75

69 7/1/11 156 78 1-Jul 3 39 31-Aug 4 TBD 0.75

71 7/2/11 408 204 2-Jul 3 102 31-Aug 4 TBD 0.75

76 7/3/11 321 160.5 29-Jun 3 80.25 31-Aug 4 TBD 0.75

80 7/6/11 231 115.5 29-Jun 3 57.75 31-Aug 4 TBD 0.75

82 7/7/11 345 172.5 29-Jun 3 86.25 31-Aug 4 TBD 0.75

Totals 1818 909 454.5 0.75

AZ PFH 43-1(4), Sunrise Park- Big Lake Road

Silt Fence Payment Summary Sheet 

Per section 157.16 of the FP-03

Paynote # Paynote 

Date 

Total 

Quantity 

(feet)

Perecentage 

of total qnty 

paid to date 

50 % paid upon 

installation 

25% paid upon 50% 

completion of project 

25% paid upon 

removal 

Option X 

Page 65
Page 66
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

PRA DINO PRES 1(11) Pavement Preservation 

 121 4

N/A (for EEBACS only)

41410-1000 Crack, Cleaning and Sealing MILE

08/30/11

 N/A (for EEBACS only)

Option X

08/31/11 08/31/11

6.68 (MILE)

Joe the Inspector & Bob the Contractor 

08/31/11

09/05/11

Bob the Contractor

08/31/11 Joe the Inspector

Jane the Inspector

Deerlodge Entrance Road, Deerlodge pullouts/aprons/ditches, and Deerlodge Information Kiosk Parking Area have all been 

cracked sealed per contract specification on 08/31/11. 

See attached support documentation for exact locations of work

Per SCR 414.06, measure crack cleaning and sealing by the mile of one lane of roadway measured along the centerline 

denoting total length in miles. For parking areas or other locations quantified by areas in square feet, measure miles based on

an 11 foot lane width. 

Pay 6.68 miles (see attached support documentation for calculations) 

Support Calculations and Certifications 

Page 67



U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

 PFF OR 127-1(1) Boulder Creek Bridge 

 214 5

N/A (for EEBACS only)

55101-1300 Steel H-piles 250 x 85, in place METER

01/10/08

 N/A (for EEBACS only)

Schedule B

01/01/08 01/10/08

152.4 (meters)

Joe the Inspector & Bob the Contractor

01/10/08

01/17/08

Bob the Contractor

01/10/08 Joe the Inspector

Jane the Project Engineer

Centerline Abutment STA 8+143.037*: 

PIle 1: Driven 01/01/08 and 01/02/08 Pile 6: Driven 01/05/08 

PIle 2: Driven 01/02/08 Pile 7: Driven 01/05/08 and 01/08/08 

PIle 3: Driven 01/03/08 Pile 8: Driven 01/08/08 

Pile 4: Driven 01/04/08 Pile 9: Driven 01/09/08 

Pile 5: Driven 01/04/08 Pile 10: Driven 01/10/08 *See attached Pile Layout 

Piles 1 through10 were each driven 15.24 meters 

(15.24 meters/pile) X (10 piles) = 152.4 meters 

Pile Layout. Example for an acceptable Micro-pile submittal, capacity computation, and certification. 

Page 71
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Page 73
Page 74
Page 75
Page 76
Page 77
Page 78
Page 79
Page 80
Page 81
Page 82
Page 83
Page 84
Page 85
Page 86
Page 87
Page 88
Page 89
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

UT PFH 39-1(2) Sevenmile Gooseberry

 132 3

N/A (for EEBACS only)

60201-0800 600mm pipe culvert METER

08/15/09

 N/A (for EEBACS only)

Schedule A

08/12/09 08/13/09

26.50 (meters)

Joe the Inspector & Bob the Contractor 

08/13/09

08/31/09

Bob the Contractor 

08/13/09 Joe the Inspector

Jane the Contractor

Culvert Crossing at Station 19+930 

(1) Culvert pipe plot submitted on 7/31/09 

(2) Culvert pipe plot approved by FHWA on 8/04/09 (see attached) 

(3) Culvert pipe staked and excavated on 08/12/09 

(4) Culvert pipe installed (Heat # 052637) and backfilled on 08/13/09 

Per approved pipe plot and from field measurement verification, the length of the culvert installed at STA 19+930 = 26.50 

meters 

Pay 26.50 meters 

Pipe Plot STA 19+930, Pipe Certifications

Page 90
Page 91

U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

CA PFH 112- 1(1) South Fork Smith River Road

 345 7

N/A (for EEBACS only)

63404-0400 Pavement markings, type A, Solid LNFT

3/30/11

 N/A (for EEBACS only)

Schedule A

3/30/11 3/30/11

25,432.20 (LNFT)

Joe the Inspector & Bob the Contractor

3/30/11

4/2/11

Bob the Contractor

3/30/11 Joe the Inspector

Jane the Project Engineer

On 08/30/10: A continuous, Type-A, double-yellow, 4-inch permanent pavement marking line was painted per contract 

requirements from STATION 21+00 to 148+00 

Per FP-03 634.13, measure solid pavement lines from end to end of each continuous line. 

STATION 21+00 to 148+00 = 12,700 LNFT (STA to STA). Measurement by walking the line from end to end with a 

measurement wheel = 12,716.10 LNFT. 

(12,716.10 LNFT per line) X (2 lines) = 25,432.20 LNFT

Paint Certification (not shown in this book) 

Page 93


Section 7: SQUARE FEET/SQUARE YARD Items 

20303 Removal of Pavement, Asphalt ................................................................. Page 96

20703 Earthwork Geotextile, Geogrid ..................................................................Page 99

25801 Reinforced Concrete Retaining Wall .........................................................Page 103

30306 Pulverizing ................................................................................................Page 107

63504 Temporary Traffic Control, Construction Sign ...........................................Page 112

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON SQUARE FEET/ SQUARE YARD ITEMS: 

Area quantities shown in the Plans are estimates; only actually ordered and performed 

quantities are paid. Please refer to the FP, the Special Contract Requirements, and plans of 

your project for detailed instructions prior to submitting any pay notes. Typically, area items are 

measured on a plane parallel to the surface being measured. Items paid by area are sometimes 

irregularly shaped items. It is generally acceptable to simplify irregularly shaped items by 

breaking down areas into shapes with easily calculated areas such as squares, rectangles, 

circles, semi circles, trapezoids, triangles, etc. When breaking down areas into simpler shapes, 

the process should be mutually agreed upon by the Contractor and a FHWA representative. It is 

also acceptable to measure the area of items from an approved survey method. When 

submitting for payment on items paid by area, it is required to show on the paynote when the 

work was performed, where the work was performed (station ranges, offsets, sketches), 

measurement and calculations with area formulas clearly noted, who measured the work, 

survey reports if performed, and necessary conversion calculations (i.e. square yard to square 

feet). 
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

CA PRA SEKI 10(8) Generals Highway

 52 2

N/A (for EEBACS only)

20303-1600 Removal of Pavement SQYD

10/29/10

 N/A (for EEBACS only)

OPTION X 

10/22/10 10/29/10

5322 (SQYD)

Joe the Inspector & Bob the Contractor 

10/29/10

11/5/10

Bob the Contractor 

10/29/10 Joe the Inspector

Jane the Project Engineer

(1) Station 663+00 to 660+75 on 10/22/10 = 688.89 SQYD* (7) Station 647+25 to 645+66 on 10/28/10 = 427.28 SQYD* 

(2) Station 660+75 to 657+75 on 10/23/10 = 897.06 SQYD* (8) Station 645+66 to 644+00 on 10/29/10 = 481.94 SQYD* 

(3) Station 657+75 to 655+50 on 10/24/10 = 625.00 SQYD* 

(4) Station 655+50 to 653+00 on 10/25/10 = 643.33 SQYD* 

(5) Station 653+00 to 650+75 on 10/26/10 = 562.22 SQYD* 

(6) Station 650+75 to 647+25 on 10/27/10 = 995.83 SQYD* *See removal of pavement quantity spreadsheet. 

Per FP-03 203.08, payment will be full compensation for the work prescribed. 

From Location/Description: 

Total quantity (SQYD) = 688.89 + 897.06 + 625.00 + 643.33 + 562.22 + 995.83 + 427.28 + 481.94 = 5321.56 SQYD 

Round the total to the zero decimal place... Pay 5322 SQYD 

Removal of pavement quantity spreadsheet

Page 96
STA

Measured

Roadway

Width (feet)

STA 1 STA 2 Length

(feet)

Average

Roadway Width

(feet)

Area

(SQFT)

AREA

(SQYD)

Date

Completed

634+00 26.10 634+00 635+00 100.00 25.05 2505.00 278.33

635+00 24.00 635+00 635+75 75.00 22.50 1687.50 187.50

635+75 21.00 635+75 636+75 100.00 21.00 2100.00 233.33

636+75 21.00 636+75 637+25 50.00 22.00 1100.00 122.22

637+25 23.00 637+25 637+75 50.00 23.50 1175.00 130.56

637+75 24.00 637+75 638+25 50.00 25.00 1250.00 138.89

638+25 26.00 638+25 638+81 56.00 29.00 1624.00 180.44

638+81 32.00 638+81 639+00 19.00 32.50 617.50 68.61

639+00 33.00 639+00 639+17 17.00 34.00 578.00 64.22

639+17 35.00 639+17 639+50 33.00 35.50 1171.50 130.17

639+50 36.00 639+50 639+91 41.00 31.00 1271.00 141.22

639+91 26.00 639+91 640+25 34.00 24.50 833.00 92.56

640+25 23.00 640+25 640+50 25.00 23.00 575.00 63.89

640+50 23.00 640+50 641+50 100.00 23.00 2300.00 255.56

641+50 23.00 641+50 642+00 50.00 22.50 1125.00 125.00

642+00 22.00 642+00 642+75 75.00 22.00 1650.00 183.33

642+75 22.00 642+75 643+25 50.00 23.00 1150.00 127.78

643+25 24.00 643+25 643+69 44.00 24.00 1056.00 117.33

643+69 24.00 643+69 644+00 31.00 24.50 759.50 84.39

644+00 25.00 644+00 644+50 50.00 26.50 1325.00 147.22 10/29/2010

644+50 28.00 644+50 645+25 75.00 26.50 1987.50 220.83

645+25 25.00 645+25 645+66 41.00 25.00 1025.00 113.89

645+66 25.00 645+66 646+00 34.00 24.50 833.00 92.56 10/28/2010

646+00 24.00 646+00 646+50 50.00 24.00 1200.00 133.33

646+50 24.00 646+50 647+00 50.00 24.00 1200.00 133.33

647+00 24.00 647+00 647+25 25.00 24.50 612.50 68.06

647+25 25.00 647+25 647+75 50.00 26.00 1300.00 144.44 10/27/2010

647+75 27.00 647+75 648+00 25.00 28.00 700.00 77.78

648+00 29.00 648+00 648+25 25.00 28.50 712.50 79.17

648+25 28.00 648+25 648+75 50.00 28.00 1400.00 155.56

648+75 28.00 648+75 649+25 50.00 28.00 1400.00 155.56

649+25 28.00 649+25 649+75 50.00 25.00 1250.00 138.89

649+75 22.00 649+75 650+75 100.00 22.00 2200.00 244.44

650+75 22.00 650+75 651+18 43.00 22.00 946.00 105.11 10/26/2010

651+18 22.00 651+18 651+50 32.00 27.00 864.00 96.00

651+50 32.00 651+50 651+75 25.00 31.50 787.50 87.50

651+75 31.00 651+75 652+25 50.00 29.00 1450.00 161.11

652+25 27.00 652+25 653+00 75.00 13.50 1012.50 112.50

MEASUREMENTS CALCULATIONS

CA PRA SEKI 10 (8) GENERALS HIGHWAY

Option X Item 20303‐1600 Removal of Pavement (SQYD)  

PAGE 1

NOT YET

COMPLETED

562.22

427.28

481.94

995.83

Page 97
STA

Measured

Roadway

Width (feet)

STA 1 STA 2 Length

(feet)

Average

Roadway Width

(feet)

Area

(SQFT)

AREA

(SQYD)

Date

Completed

653+00 22.00 653+00 653+50 50.00 22.00 1100.00 122.22 10/25/2010

653+50 22.00 653+50 654+25 75.00 22.00 1650.00 183.33

654+25 22.00 654+25 654+80 55.00 23.00 1265.00 140.56

654+80 24.00 654+80 655+25 45.00 25.00 1125.00 125.00

655+25 26.00 655+25 655+50 25.00 26.00 650.00 72.22

655+50 26.00 655+50 656+00 50.00 26.00 1300.00 144.44 10/24/2010

656+00 26.00 656+00 656+50 50.00 26.50 1325.00 147.22

656+50 27.00 656+50 657+00 50.00 25.50 1275.00 141.67

657+00 24.00 657+00 657+25 25.00 23.00 575.00 63.89

657+25 22.00 657+25 657+75 50.00 23.00 1150.00 127.78

657+75 24.00 657+75 658+75 100.00 25.50 2550.00 283.33 10/23/2010

658+75 27.00 658+75 659+25 50.00 27.00 1350.00 150.00

659+25 27.00 659+25 660+03 78.00 27.50 2145.00 238.33

660+03 28.00 660+03 660+50 47.00 28.00 1316.00 146.22

660+50 28.00 660+50 660+75 25.00 28.50 712.50 79.17

660+75 29.00 660+75 661+25 50.00 28.00 1400.00 155.56 10/22/2010

661+25 27.00 661+25 661+96 71.00 27.00 1917.00 213.00

661+96 27.00 661+96 662+25 29.00 27.00 783.00 87.00

662+25 27.00 662+25 662+50 25.00 27.00 675.00 75.00

662+50 27.00 662+50 663+00 50.00 28.50 1425.00 158.33

663+00 30.00

TOTAL (this estimate) = 5321.56

MEASUREMENTS

688.89

897.06

625.00

643.33

CALCULATIONS

CA PRA SEKI 10 (8) GENERALS HIGHWAY

Option X Item 20303‐1600 Removal of Pavement (SQYD)  

PAGE 2

Page 98
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

Example: ND PRA THRO 10(3) Example: North Unit Scenic Drive

 213 6

N/A (for EEBACS only)

20703-0000 Geogrid SQYD

10/27/09

 N/A (for EEBACS only)

Schedule A

10/26/09 10/26/09

48.77 (SQYD)

Joe the Inspector & Bob the Contractor 

10/27/09

11/5/09

Bob the Contractor 

10/27/09 Joe the Inspector

Jane the Project Engineer

On 10/26/2009: Approved biaxial geogrid was placed at the following locations: 

Hole 1: 33+00 to 33+14 = 16.33 SQYD* 

Hole 2: 33+60 to 33+75 = 9.17 SQYD* 

Hole 3: 34+20 to 34+36 = 23.27 SQYD* 

*See attached Geogrid sketch/calculation sheet 

16.33 SQYD + 9.17 SQYD + 23.27 SQYD = 48.77 SQYD 

 

PAY 48.77 SQYD TOTAL 

Geogrid sketch/calculation sheet and biaxial geogrid certification.

Page 99



U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

NOTE 2: Prior to payment being made. certifications for reinforcing steel, cement and concrete test results need to be submitted by the Contractor. 

CA PRA SEKI 10(8) General's Highway

 341 6

N/A (for EEBACS only)

25801-0300 RC Retaining Wall, 8' Type-1 Granite SQFT

10/28/09

 N/A (for EEBACS only)

Schedule A

10/10/10 10/28/10

142.81 (SQFT)

Joe the Inspector & Bob the Contractor 

10/30/10

11/5/10

Bob the Contractor

10/30/10 Joe the Inspector

Jane the Project Engineer

10/10/2010: Excavation for Footing (F-3), Excavation for Footing (F-7) 

10/11/2010: Excavation for Footing (F-12) 

10/20/2010,10/21/2010: Footing Concrete Pour, 55201-L02-0007, 55201-L02-0008 (F-12) 

10/26/2010: Footing Concrete Pour, 55201-L02-0010 (F-7) 

10/28/2010: Footing Concrete Pour, 55201-L02-0012 (F-3)

Per agreement with FHWA CO and Contractor Owner, the following breakdown of work for all retaining wall work is as follows: 

28% excavation, 30% footing (concrete), 30% stem (concrete) and 12% backfill. 

Per approved wall profile: (F-3) 77.29 SQFT + (F-7) 82.88 SQFT + (F-12) 86.05 SQFT = 246.22 SQFT 

28% excavation + 30% footing (concrete) = 58% 

246.22 SQFT X 58% = 142.81 SQFT

(1) Approved Wall 3B Profile (2) 25801-0300 Work Breakdown Spreadsheet (3) Wall 3B Quantity Spreadsheet 

NOTE: This item has a seperate pay factor adjustment for 552 concrete (see appendix for an example)

Page 103

CA PRA SEKI 10(8)

Generals Highway

Sequoia/ King’s Canyon National Park

Allen Engineering Contractor, Inc.

Wall Footing Excavation (28) Footing (30) Stem (30) Backfill (12)

F‐##

F‐##

F‐##

F‐##

F‐##

F‐##

F‐##

F‐##

F‐##

F‐3 10/10/2010 10/28/2010 11/29/2010 12/30/2010

F‐7 10/10/2010 10/26/2010 11/27/2010 12/28/2010

F‐12 10/11/2010 10/21/2010 11/22/2010 12/23/2010

25801‐0300B Reinforced Concrete Retaining Wall 8' Type 1 Granite

##

##

3B

Page 105
Wall 

Section

MainlineStation to

MainlineStation to

BaselineSta. to

BaselineSta

GraniteGuardwall

GraniteGuardwall, 

Type 1

(o.f. 

formlined)

Granite -

Parapet, 

Type 1 

(o.f 

formlined)

GraniteParapet, 

Type 2

(all faces 

formlined)

Granite -Wall Height(Type 1)

Granite -Wall Height(Type 1)

Granite -Wall Height(Type 1)

Granite -Wall Height(Type 1)

Granite -Wall Heigh(Type 1)

4 ft 6 ft 8 ft 10 ft 12 ft 

Pay per ft Pay per ft Pay per ft Pay per ft

GW3 629+75.00 629+98.45 00+00.00 00+06.00 6GW3 00+06.00 00+30.00 24

Wall 3 629+98.45 630+16.19 00+30.00 00+36.00 6.00 22.800Wall 3 00+36.00 00+42.00 6.00 34.577Wall 3 00+42.00 00+48.00 6.00 37.284Wall 3 630+16.19 630+34.19 00+48.00 00+54.00 6.00 40.007Wall 3 00+54.00 00+66.00 12.00 112.971Wall 3 630+34.19 630+65.47 00+66.00 00+72.00 6.00 59.57

Wall 3 00+72.00 00+78.00 6.00 51.258

Wall 3 00+78.00 00+90.00 12.00 82.877

Wall 3 00+90.00 00+96.00 6.00 58.001

Wall 3 630+65.47 630+96.01 00+96.00 01+02.00 6.00 59.83

Wall 3 01+02.00 01+08.00 6.00 53.214

Wall 3 01+08.00 01+20.00 12.00 100.052

Wall 3 01+20.00 01+26.00 6.00 41.670

Wall 3 630+96.01 631+26.01 01+26.00 01+32.00 6.00 44.384

Wall 3 01+32.00 01+38.00 6.00 33.646

Wall 3 01+38.00 01+50.00 12.00 63.343

Wall 3 01+50.00 01+56.00 6.00 19.167

Total Area for Retaining Wall 41.967 131.566 246.222 375.496 119.40Total Length for Guardwall 6.000 24.000Total Length for Parapet 36.000 90.000Total Length of Site 3 = 42

Wall Unit Price $1,800 $1,400 $1,100 $500 $250 $260 $270 $280 $29Wall Costs $10,800 $33,600 $39,600 $45,000 $10,492 $34,207 $66,480 $105,139 $34,62

6.00 24.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0

Guardwall 0.00 0.00 36.00 90.00 41.97 131.57 246.22 375.50 119.4Wall 3 Total Cost

Wall 3B -Sta. 629+75 to Sta. 631+26.01

Pay per SQFT

SEKI10_8 walls for wall 3B.xls 1 of 1 

Page 106
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

ND PRA THRO 10(3) North Unit Scenic Drive

 312 5

N/A (for EEBACS only)

30306-3500 Pulverizing, 7-inch depth SQYD

9/28/09

 N/A (for EEBACS only)

Schedule A

9/28/09 9/29/09

26,897 (SQYD)

Joe the Inspector & Bob the Contractor 

9/29/09

10/5/09

Bob the Contractor

9/29/09 Joe the Inspector

Jane the Engineer

(1) Pulverize station 232+00 to 249+00 = 6,284 SQYD* 9/28/09 

(2) Pulverize station 43+00 to 81+36 = 13,069 SQYD* 9/28/09 

(3) Pulverize station 10+00 to 43+00 = 6,039 SQYD* 9/29/09 

(4) Pulverize Cannon Ball Parking Area = 1,505 SQYD* 9/29/09 

* See attached pulverization sketches and calculations 

Per FP-03 303.11, payment will be full compensation for the work prescribed. 

From Location/Description: 

Total quantity (SQYD) = 6,284 + 13,069 + 6,039 + 1,505 = 26,897 SQYD 

PAY 26,897 SQYD 

(1) Pulverization sketches and calculations. 

Note: Pulverization grading analysis and Compaction results examples are not shown, but are required prior to payment

Page 107




U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

CA PFH 112-1(1) South Fork Smith River Road

 12 1

N/A (for EEBACS only)

63504-1000 TTC, construction sign SQFT

06/09/09

 N/A (for EEBACS only)

Schedule A

06/09/09 06/09/09

115.5 (SQFT)

Joe the Inspector & Bob the Contractor 

06/09/09

07/01/09

Bob the Contractor 

06/09/09 Joe the Inspector

Jane the Project Engineer

Site D / Option X for Clark Road intersection on 6/09/09 = 68.5 SQFT* 

Site D / Option X for Bishop Visitor Center Parking on 6/09/09 = 33.5 SQFT* 

Site C for Boulder Creek Bridge on 06/09/09 = 13.5 SQFT* 

*See attached TTC Construction Sign Support Calculations

Per FP-03 635.27, 50% of the unit bid price will be paid upon installation. See attached TTC Construction Sign Payment 

Summary Sheet for retention information. 

NOTE: Do not show retention information on any paynotes. 

From TTC Construction Sign Support Calculations, total area of signs installed = 115.5 SQFT 

TTC Construction Sign Certification, TTC Construction Sign Support Calculation, TTC Construction Sign Payment Summary 

Sheet 

Page 112


Quantity Date PP Quantity Date PP Quantity Date PP

3 6/5/09 25 12.5 5-Jun 1 6.25 31-Oct 5 TBD 0.75

6 6/6/09 112 56 6-Jun 1 28 31-Oct 5 TBD 0.75

12 6/9/09 115.5 57.75 9-Jun 1 28.875 31-Oct 5 TBD 0.75

15 6/13/09 29 14.5 13-Jun 1 7.25 31-Oct 5 TBD 0.75

16 6/20/09 15 7.5 20-Jun 1 3.75 31-Oct 5 TBD 0.75

19 6/26/09 62 31 26-Jun 1 15.5 31-Oct 5 TBD 0.75

24 7/2/09 14 7 2-Jul 2 3.5 31-Oct 5 TBD 0.75

27 7/3/09 32 16 3-Jul 2 8 31-Oct 5 TBD 0.75

Totals 404.5 202.25 101.125 0.75

CA PFH 112-1(1), South Fork Smith River Road

TTC Construction Sign Payment Summary Sheet 63504-1000 

Per section 635.27 of the FP-03

Paynote # Paynote 

Date 

Total 

Quantity 

(SQFT)

Perecentage 

of total qnty 

paid to date 

50 % paid upon 

installation 

25% paid upon 50% 

completion of project 

25% paid upon 

removal 

Schedule A

Page 115
Section 8: CUBIC YARD ITEMS

20401 Roadway Excavation ................................................................................Page 116

20420 Roadway Embankment .............................................................................Page 120

20441 Waste ........................................................................................................Page 124

25101 Placed Riprap ...........................................................................................Page 129

60101 Concrete ...................................................................................................Page 133

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON VOLUME ITEMS: 

Volume quantities shown in the Plans are estimates; only actually ordered and performed 

quantities are paid. Please refer to the FP, the Special Contract Requirements, and plans of 

your project for detailed instructions prior to submitting any pay notes. Depending on the 

specific item, volume items are measured by the following methods;

(1) Cubic yard in place

(2) Cubic yard in the hauling vehicle

(3) Cubic yard in the structure. 

(4) Cubic yard by metering

Please see section 109.02 (b) and the section of the specific pay item within the contract for 

detailed measurement requirements. When submitting for payment on items paid by volume, it 

is required to show on the paynote when the work was performed, where the work was 

performed (station ranges, offsets, sketches), measurement and calculations with volume

formulas clearly noted, who measured the work, survey reports if performed, and necessary 

conversion calculations (i.e. cubic foot to cubic yard). 
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

CA PFH 112-1(1) South Fork Smith River Road

 126 3

N/A (for EEBACS only)

20401-0000 Roadway excavation CUYD

07/08/09

 N/A (for EEBACS only)

Schedule A

07/03/09 07/04/09

2714.59 (CUYD)

Joe the Inspector & Bob the Contractor 

07/08/09

07/31/09

Bob the Contractor

07/08/09 Joe the Inspector

Jane the Project Engineer

Rock Creek Site Roadway Excavation from Station 206+00 to 207+60 RT (inboard) side rock slope cuts (~1.5H:1.0V)

Per end area calculations from before & after surveyed cross sections, the total excavated area at Rock Creek = 2714.59 CUYD 

Pay 2714.59 CUYD 

Rock Creek As-Built Volumes, Rock Creek As-Built Cross Sections, Rock Creek Survey Data 

Page 116



U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

WY ERFO 261(1) Cedar Pass Road

 125 3

N/A (for EEBACS only)

20420-0000 Embankment construction, reinforced CUYD

10/22/2011

 N/A (for EEBACS only)

Schedule A

10/22/11 10/22/11

453.33 (CUYD)

Joe the Inspector & Bob the Contractor 

10/22/11

11/01/11

Bob the Contractor

10/22/11 Joe the Inspector

Jane the Project Engineer

Reinforced Embankment Construction on 1.5H:1V Reinforced Soil Slope: 1.5 ' lift (el. 8975.5 - el. 8977), STATION 276+25 to 

277+85. 

Per Embankment Calculation (el. 8975.5 -8977), the volume on this lift = 453.33 CUYD 

Pay 453.33 CUYD 

Embankment Calculation (el. 8975.5 -8977), Site 5 Embankment Tracking by Lift, Site 5 Testing Summary

Page 120

Date Station To Staion El. (ft) To El. (ft) Width (ft) (CUYD) Notes

9/27/2011 277+50 - 277+62 8936.5 - 8939.5 35 46.67 Permeable

9/28/2011 277+30 - 277+50 8934.0 - 8938.0 35 103.70 Permeable

9/28/2011 277+30 - 277+50 8938.0 - 8939.5 35 38.89 Permeable

9/28/2011 277+30 - 277+62 8939.5 - 8941.0 32.75 58.22 Permeable

9/29/2011 277+12 - 277+62 8941.0 - 8944.0 30 166.67 Permeable

9/29/2011 277+12 - 277+62 8944.0 - 8945.5 30 83.33 Borrow 

9/30/2011 277+00 - 277+62 8945.5 - 8947.0 30 103.33 Borrow 

10/1/2011 277+00 - 277+62 8947.0 - 8949.5 30 172.22 Borrow 

10/3/2011 276+87 - 277+00 8948.0 - 8949.5 30 21.67 Borrow 

10/3/2011 276+87 - 277+62 8949.5 - 8951.5 30 166.67 Borrow 

10/4/2011 277+15 - 277+45 8948.5 - 8951.5 5 16.67 Borrow 

10/4/2011 276+75 - 277+62 8951.5 - 8953.0 35 169.17 Borrow 

10/4/2011 276+53 - 276+75 8951.5 - 8953.0 25 30.56 Borrow 

10/5/2011 276+53 - 277+62 8953.0 - 8956.0 35 423.89 Borrow 

10/6/2011 276+90 - 277+20 8952.0 - 8957.5 10 61.11 Borrow 

10/6/2011 276+90 - 277+20 8954.0 - 8957.5 10 38.89 Borrow 

10/6/2011 276+90 - 277+20 8956.0 - 8957.5 10 16.67 Borrow 

10/6/2011 276+75 - 277+62 8956.0 - 8957.5 35 169.17 Borrow 

10/6/2011 276+53 - 276+75 8956.0 - 8957.5 25 30.56 Borrow 

10/14/2011 276+53 - 276+75 8957.5 - 8959.0 25 30.56 Borrow 

10/14/2011 276+75 - 277+62 8957.5 - 8959.0 35 169.17 Borrow 

10/14/2011 277+00 - 277+20 8957.5 - 8960.5 20 44.44 Borrow 

10/14/2011 276+53 - 277+62 8959.0 - 8960.5 35 211.94 Borrow 

10/14/2011 276+44 - 277+62 8960.5 - 8962.0 35 229.44 Borrow 

10/15/2011 276+44 - 277+62 8962.0 - 8963.5 35 229.44 Borrow 

10/15/2011 276+44 - 277+66 8963.5 - 8965.0 35 237.22 Borrow 

10/16/2011 276+44 - 277+66 8965.0 - 8966.5 35 237.22 Borrow 

10/18/2011 276+41 - 277+66 8966.5 - 8968.0 60 416.67 Borrow 

10/19/2011 276+41 - 277+66 8968.0 - 8969.5 58 402.78 Borrow 

10/19/2011 276+41 - 277+66 8969.5 - 8971.0 55 381.94 Borrow 

10/20/2011 276+29 - 277+66 8971.0 - 8972.5 53 403.39 Borrow 

10/21/2011 276+25 - 277+80 8972.5 - 8974.0 55 473.61 Borrow 

10/21/2011 276+25 - 277+85 8974.0 - 8975.5 59 524.44 Borrow 

10/22/2011 276+25 - 277+85 8975.5 - 8977.0 51 453.33 Borrow 

10/23/2011 276+25 - 277+85 8977.0 - 8978.5 47 417.78 Borrow 

10/24/2011 276+25 - 277+85 8978.5 - 8980.0 40 355.56 Borrow 

10/25/2011 276+25 - 277+85 8980.0 - 8981.5 40 355.56 Borrow 

10/27/2011 276+15 - 277+95 8981.5 - 8983.0 38 380.00 Borrow 

10/28/2011 276+15 - 277+95 8983.0 - 8984.5 36 360.00 Borrow 

8232.54 CUYD

Site 5 EMBANKMENT TRACKING BY LIFT

WY ERFO 261(1), Cedar Pass Road CONTRACTOR: Rocky Mountain Excavating

RUNNING TOTAL=

Page 122
Date Station Elev. (ft.) Proctor Density 

(PCF)

Moisture 

(%) % Compaction (+/-) Moisture Pass (Y/N)

9/27/2011 277+55 8938 In-Situ: 121.5 PCF @12.3% 116.6 14 96.0 1.7 Y

9/27/2011 277+58 8939.5 In-Situ: 121.5 PCF @12.3% 115.9 12.7 95.4 0.4 Y

9/29/2011 277+50 8945 In-Situ: 121.5 PCF @12.3% 118.9 14.5 97.9 2.2 Y

9/29/2011 277+15 8945 In-Situ: 121.5 PCF @12.3% 120.6 13 99.3 0.7 Y

9/30/2011 277+25 8945.5 In-Situ: 121.5 PCF @12.3% 118 13.8 97.1 1.5 Y

9/30/2011 277+20 8946 In-Situ: 121.5 PCF @12.3% 117.9 14.2 97.0 1.9 Y

9/30/2011 276+55 8946 In-Situ: 121.5 PCF @12.3% 116.9 14.1 96.2 1.8 Y

9/30/2011 277+45 8947 Rch Pit: 130.4 PCF @6.7% 126.8 7.2 97.2 0.5 Y

10/1/2011 277+40 8948 Rch Pit: 130.4 PCF @6.7% 124.9 8.1 95.8 1.4 Y

10/1/2011 277+30 8948.5 Rch Pit: 130.4 PCF @6.7% 129.2 7.7 99.1 1 Y

10/1/2011 277+15 8949.5 Rch Pit: 130.4 PCF @6.7% 126.1 7.6 96.7 0.9 Y

10/3/2011 277+00 8951.5 Rch Pit: 130.4 PCF @6.7% 125.7 8 96.4 1.3 Y

10/4/2011 277+00 8953 Rch Pit: 130.4 PCF @6.7% 129.7 8.1 99.5 1.4 Y

10/5/2011 277+15 8954 Rch Pit: 130.4 PCF @6.7% 125.7 5.9 96.4 -0.8 Y

10/6/2011 277+25 8956 Rch Pit: 130.4 PCF @6.7% 126 6.4 96.6 -0.3 Y

10/14/2011 277+20 8957.5 Rch Pit: 130.4 PCF @6.7% 128.7 6 98.7 -0.7 Y

10/14/2011 276+55 8959 Rch Pit: 130.4 PCF @6.7% 127.2 6.3 97.5 -0.4 Y

10/14/2011 277+45 8960.5 Rch Pit: 130.4 PCF @6.7% 128 6.1 98.2 -0.6 Y

10/14/2011 277+20 8962 Rch Pit: 130.4 PCF @6.7% 128.9 7.4 98.8 0.7 Y

10/15/2011 277+55 8963.5 Rch Pit: 130.4 PCF @6.7% 130.2 7.2 99.8 0.5 Y

10/15/2011 277+45 8965 Rch Pit: 130.4 PCF @6.7% 129.8 7.1 99.5 0.4 Y

10/16/2011 276+40 8966.5 Rch Pit: 130.4 PCF @6.7% 128.7 8.4 98.7 1.7 Y

10/18/2011 277+30 8968 Rch Pit: 130.4 PCF @6.7% 129.5 8.2 99.3 1.5 Y

10/19/2011 277+15 8969.5 Rch Pit: 130.4 PCF @6.7% 129.5 7.4 99.3 0.7 Y

10/19/2011 276+20 8971 Rch Pit: 130.4 PCF @6.7% 133.2 13.2 102.1 6.5 Y

10/20/2011 277+55 8972.5 Rch Pit: 130.4 PCF @6.7% 137.2 9.8 105.2 3.1 Y

10/21/2011 277+45 8974 Rch Pit: 130.4 PCF @6.7% 127.7 8.1 97.9 1.4 Y

10/21/2011 277+40 8975.5 Rch Pit: 130.4 PCF @6.7% 128.7 7.4 98.7 0.7 Y

10/22/2011 277+30 8977 Rch Pit: 130.4 PCF @6.7% 125.7 5.2 96.4 -1.5 Y

10/23/2011 276+15 8978.5 Rch Pit: 130.4 PCF @6.7% 130 6.9 99.7 0.2 Y

10/24/2011 277+10 8980 Rch Pit: 130.4 PCF @6.7% 129.9 6.9 99.6 0.2 Y

10/25/2011 277+00 8981.5 Rch Pit: 130.4 PCF @6.7% 126.4 6.3 96.9 -0.4 Y

10/27/2011 276+50 8983 Ten Pit: 137.2 PCF @ 4.3% 133.9 4.6 97.6 0.3 Y

10/28/2011 277+50 8984.5 Ten Pit: 137.2 PCF @ 4.3% 136.3 5.3 99.3 1 Y

10/29/2011 277+00 8986 Ten Pit: 137.2 PCF @ 4.3% 130.9 4 95.4 -0.3 Y

10/30/2011 276+70 8988 Ten Pit: 137.2 PCF @ 4.3% 137.1 5.1 99.9 0.8 Y

10/30/2011 276+30 8990.5 Ten Pit: 137.2 PCF @ 4.3% 135.1 4.9 98.5 0.6 Y

Site 5 EMBANKMENT TESTING SUMMARY

WY ERFO 261(1), Cedar Pass Road, CONTRACTOR INC.

Page 123
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Payment 1 of 2 for this item 

SD PFH 17-1(6) Hill City to Lead 

 176 4

N/A (for EEBACS only)

20441-0000 Waste CUYD

01/19/2012

 N/A (for EEBACS only)

Schedule A

01/10/2012 01/19/2012

1026 (CUYD)

Joe the Inspector & Bob the Contractor 

01/19/2012

01/20/2012 

Bob the Contractor 

01/20/2012 Joe the Inspector

Jane the Project Engineer

Waste Pile #1 Total 531 CUYD Waste Pile #2 Total 495 CUYD 

(1) Station 23+60 to 24+25 = 117 CUYD* (6) Station 41+68 to 45+42 = 198 CUYD* 

 

(2) Station 24+25 to 26+14 = 99 CUYD* (7) Station 51+98 to 52+74 = 108 CUYD* 

(3) Station 31+17 to 32+09 = 135 CUYD* (8) Station 55+67 to 56+12 = 63 CUYD* 

(4) Station 34+68 to 35+12 = 72 CUYD* (9) Station 56+12 to 57+64 = 90 CUYD* *See spreadsheet for estimate 

(5) Station 40+97 to 41+68 = 108 CUYD* (10) Station 57+64 to 58+02 = 36 CUYD* calculations (based on load counts) 

Per FP-03 204.16.e, measure waste by the cubic yard in its final position. Take cross sections before and after to determine 

final quantity. Payment will be full compensation for the work prescribed in this section. 

From Location/Description: ***This quantity is an interim estimated quantity based on load counts prior to final survey*** 

 

Total estimated quantity Waste pile #1 (CUYD) = 117 + 99 + 135 + 72 + 108 = 531 CUYD 

Total estimated quantity Waste pile #2 (CUYD) = 198 + 108 + 63 + 90 + 36 = 495 CUYD 

Total paid = 531 + 495 = 1026 (CUYD)

Spreadsheet computations based on load counts

Page 124
Date Station to Station Truck Loads

Approximate Volume 

(CUYD) from Truck 

Loads*

Description of Work

1/10/2012 23+60 - 24+25 13 117 Slope Cuts on inboard side. Laid back 

to 1V:1.5H. Waste Pile 1.

1/12/2012 24+25 - 26+14 11 99 Slope Cuts on inboard side. Laid back 

to 1V:1.5H. Waste Pile 1.

1/12/2012 31+17 - 32+09 15 135 Slope Cuts on outboard side. Laid 

back to 1V:2.0H Waste Pile 1.

1/12/2012 34+68 - 35+12 8 72 Slope Cuts on outboard side. Laid 

back to 1V:2.0H Waste Pile 1.

1/13/2012 40+97 - 41+68 12 108 Slope Cuts on inboard side. Laid back 

to 1V:1.5H. Waste Pile 1.

531

1/16/2012 41+68 - 45+42 22 198 Slope Cuts on inboard side. Laid back 

to 1V:1.5H. Waste Pile 2.

1/17/2012 51+98 - 52+74 12 108 Slope Cuts on inboard side. Laid back 

to 1V:1.5H. Waste Pile 2.

1/18/2012 55+67 - 56+12 7 63 Slope Cuts on inboard side. Laid back 

to 1V:1.5H. Waste Pile 2.

1/19/2012 56+12 - 57+64 10 90 Slope Cuts on inboard side. Laid back 

to 1V:1.5H. Waste Pile 2.

1/19/2012 57+64 - 58+02 4 36 Slope Cuts on inboard side. Laid back 

to 1V:1.5H. Waste Pile 2.

495

*

SD PFH 17-1(6) Hill City to Lead 

20441-0000 WASTE (CUYD) TRACKING

Final volume of waste for pay is determined by survey data. Volume of waste from this column is 

soley for tracking. Each truck caries approximately 9 CUYD per load. 

Page 125
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Payment 2 of 2 for this item 

SD PFH 17-1(6) Hill City to Lead 

 180 5

N/A (for EEBACS only)

20441-0000 Waste CUYD

01/26/2012

 N/A (for EEBACS only)

Schedule A

01/10/2012 01/19/2012

5.96 (CUYD)

Joe the Inspector & Bob the Contractor 

01/26/2012

01/27/2012 

Bob the Contractor 

01/27/2012 Joe the Inspector

Jane the Project Engineer

 Quantity based on cross section survey data 

Waste Pile #1 Total 517.86 CUYD *See TIN to TIN volume report 

Waste Pile #2 Total 514.10 CUYD 

NOTE: This item was previously paid on paynote #176 based on estimated interim values. This measurement indicates the final 

measurement per FP-03. 

Per FP-03 204.16.e, measure waste by the cubic yard in its final position. Take cross sections before and after to determine 

final quantity. ***This quantity is the final quantity based on final survey*** 

 

Total quantity Waste pile #1 (CUYD) = 517.86(actual) - 531(interim paid paynote #176) = -13.14 CUYD 

Total quantity Waste pile #2 (CUYD) = 514.10(actual) - 495 (interim paid paynote #176) = 19.10 CUYD 

Net pay for estimate = -13.14 + 19.10 = 5.96 CUYD

Computation checks and TIN to TIN reports 

Page 126


U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

ND PRA THRO 10(3) North Unit Scenic Drive 

 125 3

N/A (for EEBACS only)

25101-2000 RIPRAP, CLASS 2 CUYD

11/08/2009

 N/A (for EEBACS only)

Option Y

10/08/2009 11/08/2009

28.22 (CUYD)

Joe the Inspector & Bob the Contractor

11/08/09

11/09/09

Bob the Contractor

11/09/09 Joe the Inspector

Jane the Project Engineer

(1) Station 385+00 on 11/08/09 = 6.85 CUYD* 

(2) Station 105+50 on 10/21/09 = 8.15 CUYD* 

(3) Station 227+00 on 10/08/09 = 8.94 CUYD* 

(4) Station 87+50 on 10/08/09 = 4.28 CUYD* 

 

*See computations. 

Total quantity (CUYD) = 6.85 + 8.15 + 8.94 + 4.28 = 28.22 CUYD 

 

riprap sketches and computations 

Page 129



U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

ND PRA THRO 10(3) North Unit Scenic Drive

 132 4

N/A (for EEBACS only)

60101-0000 Concrete CUYD

8/10/11

 N/A (for EEBACS only)

Option X

8/08/11 8/10/11

30.39 (CUYD)

Joe the Inspector & Bob the Contractor

8/10/11

9/01/11

Bob the Contractor

8/10/11 Joe the Inspector

Jane the Project Engineer

8/08/11: 1210+76 Footings = 14.75 CUYD* 

8/10/11: 1210+76 Wingwalls and Headwalls = 15.64 CUYD* 

*See Concrete Pour Sketches and Calculations 

Total quantity (CUYD) = 14.75 + 15.64 = 30.39 CUYD 

 

Concrete Pour Sketches and Calculations, 601minor concrete certification example

Page 133





Section 9: TON ITEMS

40301 Hot Asphalt Concrete Pavement ...............................................................Page 139

41201 Tack Coat ..................................................................................................Page 149

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON TON ITEMS: 

Items paid by the Ton are typically required to conform to both specific weighing and receiving 

procedures so that they can be measured, documented, accepted, and paid. Please refer to the 

FP, the Special Contract Requirements, and plans for your project for detailed instructions prior 

to submitting any pay notes. In almost all cases, items by the ton require scale certification 

along with specific weight and receiving documentation. It is best to discuss and review sample 

documentation and procedures for acceptance prior to any production or delivery of material. 

Special care should also be taken to verify and calculate material documentation using the 

correct units and conversions for either Metric tons (ton, “t”) and English tons (Ton, “T”) as the 

case may require.
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

CA PFH 112-1(1) South Fork Smith River Road

 210 6

N/A (for EEBACS only)

40301-0000 Hot asphalt concrete pavement TON

11/11/10

 N/A (for EEBACS only)

Schedule A

11/11/10 11/11/10

223.73 (TONS)

Joe the Inspector & Bob the Contractor 

11/11/10

11/13/10

Bob the Contractor 

11/11/10 Joe the Inspector

Jane the Project 

Mainline paving from Station 101+60 to 113+00: RT(11.5') and LT(10.5' wide), 1.5" lift height per side. 

Weigh Tickets* 198399, 198401, 198402, 198404, 198405, 198406, 198407, 198408, 198409, 198410 

*11/11/10 Weigh Tickets attached 

Per attached 11/11/10 paving weigh tickets, pay 223.73 TONS 

11/11/10 Weigh Tickets, Spread Report, Daily Record of Platform Scale Weights, Daily Yield Calculation 

Note: All required asphalt test results per the contract are also needed prior to payment.

Page 139








CA PFH 112-1(1) South Fork Smith River Road

MARSHALL DAILY YIELD (11/11/10)

Avg Max Avg

LT RT Rice Density

Begin Sta 101+60 101+60

158.8 92.1

End Sta 113+00 113+00

Legnth paved (ft) 1,140 1,140

Avg Width (ft) 10.50 11.50

Depth (ft) 0.125 0.125

CuFt 1,496.3 1,638.8

Total 

CuFt 3,135.0

Compacted

wt, Tons 229.25

Ticket tons 223.72

Yield 0.98

CUMULATIVE TO DATE 2,624.95 TONS

Plan Qty 10,890.0 TONS

% Complete 24.10

Page 148
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

SD PFH 17-1(6) Hill City to Lead

 134 3

N/A (for EEBACS only)

41201-0000 Tack Coat TON

10-25-10

 N/A (for EEBACS only)

Schedule A 

10/25/2010 10/25/2010

0.25 (TONS)

Joe the Inspector & Bob the Contractor 

10/25/10

10/30/10

Bob the Contractor

10/26/10 Joe the Inspector 

Jane the Project Engineer

On 10/25/10 Tack Coat was applied from Station 10+00 to Station 12+50 RT (11' wide). 

Per FP-03 412.08, measure tack coat including water added for dilution. 

Weigh Out = 6.28 TONS on 10/22/10, Weigh Back = 6.03 TONS on 10/25/10* 

6.28 TONS - 6.03 TONS = 0.25 TONS 

 

*See supporting weigh tickets 

Weigh Tickets with SS-1H certification, Tack Coat Application Calculation, 

Page 149



Section 10: GALLON ITEMS

15801 Watering for Dust Control .........................................................................Page 153

63404 Pavement Marking ....................................................................................Page 155

GENERAL NOTE:

The items shown here are examples only - all measurement, documentation, and payment will 

conform to the project contract requirements regardless of what is shown here. Included here 

are examples of some of the many documentation types that may be required. Often 

documentation such as certifications and qualifications may be submitted and accepted once 

and then referenced accordingly instead of attaching additional copies for each pay note or 

payment period. Many documentation items are required prior to production, delivery, or 

placement; required documentation should be provided at the appropriate time and not 

necessarily at time of payment.

NOTE ON TON ITEMS: 

Items paid by the gallon are either measured, metered, or commercial volumes. Please refer to 

the FP, the Special Contract Requirements, and plans for your project for detailed instructions 

prior to submitting any pay notes. If gallons will be measured or metered onsite, advance 

consideration and discussion should occur to ensure that the methods, equipment, and 

documentation will be acceptable. 
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

HI SR 200(2) Saddle Road

 202 7

N/A (for EEBACS only)

15801-0000 Watering for dust control Mgal

09/24/11

 N/A (for EEBACS only)

Schedule A

09/01/10 09/23/11

25.04 (Mgal)

Joe the Inspector & Bob the Contractor

09/24/11

10/07/11

Bob the Contractor

09/25/11 Joe the Inspector

Jane the Inspector 

9/1/2011 to 9/23/2011: Watering Saddle Road during aggregate placement work performed between Station 125+00 to 165+00

Pay 25.04 Mgal (see attached water log) 

 

Water log 

Note: Volume Certification was provided to the CO on 8/01/11

Page 153
200(2) WATER LOG JULY 2011

Date Ticket # Begin Meter End Meter Quantity (Mgal) Tank Size Pay Quantity ck Location/Use

9/1/2011 388 21.900 25.300 3.400 4.000 0.000 √ Quarry

25.300 28.800 3.500 4.000 0.000 √ Quarry

09/12/11 385 74.400 77.700 3.300 4.000 3.300 √ Base/Rollers

" " 77.700 80.800 3.100 4.000 3.100 √ Rollers

09/13/11 384 80.800 84.200 3.400 4.000 3.400 √ Rollers

09/14/11 383 84.200 87.200 3.000 4.000 0.000 √ Quarry

" " 87.200 90.200 3.000 4.000 0.000 √ Quarry

09/15/11 382 90.700 93.400 2.700 4.000 0.000 √ Quarry

" " 799.000 802.000 3.000 4.000 0.000 √ Quarry

09/19/11 381 15.300 18.500 3.200 4.000 3.200 √ Road

09/21/11 380 18.490 23.000 4.510 4.000 3.700 √ Clean road

" " 23.000 26.060 3.060 4.000 3.060 √ Clean road

" " 26.060 30.000 3.940 4.000 3.940 √ Clean road

09/23/11 379 30.000 33.600 3.600 4.000 3.600 √ Clean riprap

" " 33.600 37.450 3.850 4.000 3.850 √ Clean riprap

07/31/11 6645.900 -0.920 -6.114 Deduct 0.92 gal/ton paving

25.04

Tons paving in August

Page 154
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

Example 1 of 1 for this item 

SD PRA BADL 10(5) Badlands Loop Road 

 174 3

N/A (for EEBACS only)

63404-0200 Pavement markings, Type B (white) GAL

08/06/10

 N/A (for EEBACS only)

Schedule B

08/02/10 08/06/10

15.5 (GAL)

Joe the Inspector & Bob the Contractor 

08/06/10

08/07/10

Bob the Contractor 

08/07/10 Joe the Inspector 

Jane the Project Engineer

(1) Prairie Winds on 08-02-2010 - 3.0 GAL* 

(2) Burns Basin on 08-02-2010 - 3.5 GAL* 

(3) Doors and Windows on 08-03-2010 - 1.0 GAL * 

(4) Homestead on 08-04-2010 - 3.0 GAL* 

(5) Conata on 08-04-2010 - 2.5 GAL* 

(6) Pinnacles on 08-04-2010 - 2.5 GAL* *See pavement marking computations 

Total quantity (GAL) = 3.0 + 3.5 + 1.0 + 3.0 + 2.5 + 2.5 = 15.5GAL 

 

 Pavement marking computations, Paint certification (see page 94)

Page 155


Appendix

A. Sample Haul Vehicle Volume Calculations ....................................................Page 158

B. Sample Water Truck Volume Calculations .....................................................Page 160

C. Volume Correction Factors for Asphalt ..........................................................Page 161

D. Metric Conversion Factors..............................................................................Page 162

E. Example of Contractor’s Invoice and Support Data ........................................Page 163

F. QL-Pay Example 30101 .................................................................................Page 165

G. QC Plan Example...........................................................................................Page 168
Page 158
Page 159
Water Truck Dimensions 

#_142__ Date______ 

a2=2.08’a1=1.46’ 

5’ 

b1=7.83’

A1 = π·a1·b1  = π·(1.46)·(7.83/2)  = 17.98 SF A2 = a2·b1 = (2.08)·(7.83)  = 16.29 SF A1+A2 = 34.27 SF 

Volume = Area x Length 

 = (34.27) (17.25) 

 = 591.16 FT3

1 ft3 = 7.48 Gallons 

Total Volume = 4421.9 gal Total Volume = 4.4 MGAL Truck Measure Agreement Dated________ 

FHWA Representative Contractor Representative 

Length = 17.25’ 

Page 160
Reissued October 18, 2005 Matls. IM T103C 

Supersedes October 3, 2000 Customary Units 

1 

Office of Materials

TEMPERATURE-VOLUME CORRECTIONS FOR ASPHALTIC MATERIALS (CUSTOMARY UNITS) 

GROUP 0 – SPECIFIC GRAVITY AT 60°F OF 0.850 TO 0.966 

LEGEND: t = Observed Temperature in Degrees Fahrenheit 

 M = Multiplier for Correcting Oil Volumes to the Basis of 60°F 

 t M t M t M t M t M 

 0 1.0241 50 1.0040 100 0.9842 150 0.9647 200 0.9456

 1 1.0237 51 1.0036 101 0.9838 151 0.9643 201 0.9452

 2 1.0233 52 1.0032 102 0.9834 152 0.9639 202 0.9448

 3 1.0229 53 1.0028 103 0.9830 153 0.9635 203 0.9444

 4 1.0225 54 1.0024 104 0.9826 154 0.9632 204 0.9441

 5 1.0221 55 1.0020 105 0.9822 155 0.9628 205 0.9437

 6 1.0217 56 1.0016 106 0.9818 156 0.9624 206 0.9433

 7 1.0213 57 1.0012 107 0.9814 157 0.9620 207 0.9429

 8 1.0209 58 1.0008 108 0.9810 158 0.9616 208 0.9425

 9 1.0205 59 1.0004 109 0.9806 159 0.9612 209 0.9422

10 1.0201 60 1.0000 110 0.9803 160 0.9609 210 0.9418

11 1.0197 61 0.9996 111 0.9799 161 0.9605 211 0.9414

12 1.0193 62 0.9992 112 0.9795 162 0.9601 212 0.9410

13 1.0189 63 0.9988 113 0.9791 163 0.9597 213 0.9407

14 1.0185 64 0.9984 114 0.9787 164 0.9593 214 0.9403

15 1.0181 65 0.9980 115 0.9783 165 0.9589 215 0.9399

16 1.0177 66 0.9976 116 0.9779 166 0.9585 216 0.9395

17 1.0173 67 0.9972 117 0.9775 167 0.9582 217 0.9391

18 1.0168 68 0.9968 118 0.9771 168 0.9578 218 0.9388

19 1.0164 69 0.9964 119 0.9767 169 0.9574 219 0.9384

20 1.0160 70 0.9960 120 0.9763 170 0.9570 220 0.9380

21 1.0156 71 0.9956 121 0.9760 171 0.9566 221 0.9376

22 1.0152 72 0.9952 122 0.9756 172 0.9562 222 0.9373

23 1.0148 73 0.9948 123 0.9752 173 0.9559 223 0.9369

24 1.0144 74 0.9944 124 0.9748 174 0.9555 224 0.9365

25 1.0140 75 0.9940 125 0.9744 175 0.9551 225 0.9361

26 1.0136 76 0.9936 126 0.9740 176 0.9547 226 0.9358

27 1.0132 77 0.9932 127 0.9736 177 0.9543 227 0.9354

28 1.0128 78 0.9929 128 0.9732 178 0.9539 228 0.9350

29 1.0124 79 0.9925 129 0.9728 179 0.9536 229 0.9346

30 1.0120 80 0.9921 130 0.9725 180 0.9532 230 0.9343

31 1.0116 81 0.9917 131 0.9721 181 0.9528 231 0.9339

32 1.0112 82 0.9913 132 0.9717 182 0.9524 232 0.9335

33 1.0108 83 0.9909 133 0.9713 183 0.9520 233 0.9331

34 1.0104 84 0.9905 134 0.9709 184 0.9517 234 0.9328

35 1.0100 85 0.9901 135 0.9705 185 0.9513 235 0.9324

36 1.0096 86 0.9897 136 0.9701 186 0.9509 236 0.9320

37 1.0092 87 0.9893 137 0.9697 187 0.9505 237 0.9316

38 1.0088 88 0.9889 138 0.9693 188 0.9501 238 0.9313

39 1.0084 89 0.9885 139 0.9690 189 0.9498 239 0.9309

40 1.0080 90 0.9881 140 0.9686 190 0.9494 240 0.9305

41 1.0076 91 0.9877 141 0.9682 191 0.9490 241 0.9301

42 1.0072 92 0.9873 142 0.9678 192 0.9486 242 0.9298

43 1.0068 93 0.9869 143 0.9674 193 0.9482 243 0.9294

44 1.0064 94 0.9865 144 0.9670 194 0.9478 244 0.9290

45 1.0060 95 0.9861 145 0.9666 195 0.9475 245 0.9286

46 1.0056 96 0.9857 146 0.9662 196 0.9471 246 0.9283

47 1.0052 97 0.9854 147 0.9659 197 0.9467 247 0.9279

48 1.0048 98 0.9850 148 0.9655 198 0.9463 248 0.9275

49 1.0044 99 0.9846 149 0.9651 199 0.9460 249 0.9272

Page 161
 iv

SI(1) (METRIC) TO U .S. CUSTOMARY CONVERSION FACTORS (approximate) 

Symbol When You Know Multiply By To Find Symbol 

LENGTH 

μm micrometers 3.9 x 10-5 inches in

mm millimeters 0.039 inches in

m meters 3.28 feet ft

m meters 1.09 yards yd

km kilometers 0.621 miles mi

AREA 

mm2 square millimeters 0.0016 square inches in2

m2 square meters 10.764 square feet ft2

m2 square meters 1.195 square yards yd2

ha hectares 2.47 acres ac 

km2 square kilometers 0.386 square miles mi2

VOLUME 

mL milliliters 0.034 fluid ounces fl oz 

L liters 0.264 gallons gal 

m3 cubic meters 35.31 cubic feet ft3

m3 cubic meters 1.308 cubic yards yd3

MASS 

g grams 0.035 ounces oz 

kg kilograms 2.202 pounds lb 

Mg megagrams 1.1023 short tons T 

(or "t") (or "metric ton") (2000 lb) 

TEMPERATURE (exact) 

oC Celsius 1.8C +32 Fahrenheit oF 

 temperature temperature 

ILLUMINATION 

lx lux 0.0929 foot-candles fc 

cd/m2 candela/m2 0.2919 foot-Lamberts fl 

MISCELLANEOUS 

J joule 0.7376 foot·poundforce ft·lbf 

N newtons 0.225 poundforce lbf 

kPa kilopascals 0.145 poundforce lbf/in2

 per square inch 

(1) SI is the symbol for the International System of Units. 

Appropriate rounding should be made to comply with Section 4 of ASTM E 380.

Page 162
2

Pave Earth First, Inc.

A. Lincoln

S by SW Survey

We Flag, Inc.

Erosion Control, Inc.

Testers-R-Us, LLC.

Page 163
P.O. Box 5

Somewhere, ID 53852Office: (208) 555-5552

Grangemont Road, ID PFH 67(2)DTFH70-10-C-00009Estimate Number 2

Pave Earth First

Page 164
U.S DEPARTMENT OF TRANSPORTATION 

FEDERAL HIGHWAY ADMINISTRATION 

Central Federal Lands Highway Division 

12300 W. Dakota Ave. Lakewood, Colorado 80228

 Project Number: Project Name: 

Item Quantity Pay Note Sheet

Pay Note Information:

Pay Note #: Pay Period:

 Item Type: 

Pay Item #: Item Description: Pay Unit: 

Date:

Item Line #: 

 Account: 

Pay Note Entry: 

 Work Start Date: Work End Date: 

Location/Description:

Remarks/Calculations:

Support Documentation/References:

TOTAL QUANTITY: 

Interim Measurement

 Measured By: 

Final Measurement

By signature below, I hereby certify that the measurements and calculations shown above are correct to the best of my 

knowledge and that the quantity being measured is subject to direct payment for the identified item under contract. 

Date:

Date:

 Contractor Representative (Print): 

 Contractor Representative (Signature): 

Date: Approved by FHWA Representative (Print): 

Approved by FHWA Representative (Signature): 

 Checked by FHWA Representative (Signature): 

QL PAY EXAMPLE

SD PFH 17-1(6) Hill City to Lead

 142 5

QM

 30101-0000 Agg. Base Lot 1 Material Incentive TON

10-10-10

 N/A (for EEBACS only)

Schedule A

9/02/10 10/02/10

1720.18 ton@$0.67

Joe the Inspector & Bob the Contractor

10/10/10

10/13/10

Bob the Contractor

10/11/10 Joe the Inspector

Jane the Project Engineer 

Material placed under 30101-0000 from 9/2/10 to 10/2/10. See Item for locations 

 

From Location/Description: 

Total quantity (TONS) = 250.84 + 240.03 + 230.64 + 250.68 + 250.92 + 210.99 + 250.08 = 1,720.18 TONS = Lot 1 

1,720.18 TONS WERE PAID ON ESTIMATE 4, 10/02/10. PER ATTACHED QL-PAY REPORT DATED 10/10/10, THE 

CONTRACTOR IS SUBMITTING FOR ADDITIONAL COMPENSATION FOR THIS LOT DUE TO A CALCULATED 1.03 PAY 

FACTOR. 

(1.03 X $22.45) = $23.12 (new unit bid price for Lot 1) 

1720.18 TONS x ($23.12 new unit bid price - $22.45 previously paid) = 1720.18 TONS x ($0.67) = $1,152.52 

 QL-PAY calculation sheet for Lot 1, 30101-0000 unit price

Page 165

Pay

Item No.

Estimated

Quantity

Unit Bid Price Amount Bid

A- 7

30101-0000 AGGREGATE BASE

5,810

TON 22.45 130,434.50

40301-0000 HOT ASPHALT CONCRETE PAVEMENT

2,445

TON 88.78 217,067.10

40920-1000 FOG SEAL, EMULSIFIED ASPHALT GRADE CSS-1 OR CSS-1H, SS-1 OR SS-1H

3

TON 969.40 2,908.20

41101-0000 PRIME COAT

10

TON 918.38 9,183.80

41105-0000 BLOTTER

50

TON 102.04 5,102.00

41201-1000 TACK COAT GRADE CSS-1, CSS-1H, SS-1, OR SS-1H

3

TON 1,122.46 3,367.38

60103-0000 CONCRETE, HEADWALL AND WINGWALLS

2

EACH 24,490.08 48,980.16

60103-0000 CONCRETE, HEADWALL (PRECAST)

2

EACH 1,020.42 2,040.84

60201-0600 18-INCH PIPE CULVERT

165

LNFT 27.04 4,461.60

60201-0800 24-INCH PIPE CULVERT (CONCRETE)

90

LNFT 45.92 4,132.80

60201-0900 30-INCH PIPE CULVERT

65

LNFT 45.92 2,984.80

60210-0600 END SECTION FOR 18-INCH PIPE CULVERT

4

EACH 255.11 1,020.44

60210-0800 END SECTION FOR 24-INCH PIPE CULVERT (CONCRETE)

2

EACH 1,045.93 2,091.86

Project: PFH 17-1(6)

HILL CITY TO LEAD

Bid Schedule A

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9

Appendix A

Example Quality Control Plan

(Modified by Central Federal Lands

Highway Division on 1/4/99)

ABC Construction Company

P. O. Box 357

Red River, CA 94781

August 18, 1997

Federal Highway Administration 

P. O. Box 78

Sutterville, CA 94832

Gentlemen:

Re: CA FH 93-1(3), Gold Rush Highway

Quality Control Plan

The following items comprise our Quality Control Plan (QCP) required by Subsection 153.02 of the Contract. 

1. All work will be performed in accordance with the contract requirements. ABC will maintain an inspection system

which assures compliance with the contract requirements. Any indication of system deficiencies whether discovered

as a result of the Government's or ABC's checks and tests, will result in modifications to the system to correct these

deficiencies. 

2. This QCP does not endeavor to repeat or summarize contract requirements. It describes the process which ABC

will use to assure compliance with those requirements. The QCP documents broad categories of contract work in

accordance with Subsection 153.02. Necessary details dealing with minor items that may be overlooked in this plan

will be addressed informally between the Quality Control Technician (QCT) and the Project Engineer (PE), as the work

progresses; and will be documented in writing if so requested by the PE. It is understood that the level of QC

accountability and control exercised by ABC on these items will be consistent with the details of this plan.

3. The Project Superintendent, Mr. Ralph Altway has overall responsibility for the successful completion of the project

work. Mr. Altway has had similar responsibilities on other Federal (Corps of Engineers) and State (CALTRANS)

projects.

4. Mr. Leon Williams will be the QCT for the project. He will report directly to Mr. Altway. Mr. Williams is also a

NICET Level IV Technician and Certified by CALTRANS and Nevada DOT as a QC Technician. He has been employed

in this role by ABC for nearly three years. He will be responsible for overseeing day-to-day construction operations

from a QC standpoint. He will assure that all required tests and documentation are completed, and that the results

are furnished to the Government in the time frame required. Mr. Williams is empowered to suspend any operations

which he deems to be in noncompliance with the contract, and/or order corrective measures to assure compliance.

Mr. Williams will complete the Inspector's Daily Record required by Subsection 153.04.

5. As the number of operations or their dispersion on the project starts to overextend Mr. Williams, QC responsibilities

will specifically be assigned to ABC’s supervisory personnel specifically responsible for given operations; or an

assistant to him will be provided. In either case, standards of application of the QCP will be the same. The names,

experience and qualifications of any personnel assuming QCP responsibilities will be provided to the Government in

advance.

6. ABC has an experienced and highly professional staff that is used to the responsibility entailed by the QC

requirements. We therefore do not anticipate any personnel or training problems in complying with them. If any such

problems occur, ABC will take whatever actions are necessary to correct them including retraining, providing more

supervision or removal of poorly functioning personnel.

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10

7. Grading

Preparatory Phase -

QCT will go over erosion control requirements with Project Engineer and order silt fence and other

authorized materials at least two weeks before work starts.

QCT will go over clearing limits and slope limits with PE and Grading Foreman.

Startup Phase -

ABC will Install silt fences and temporary culverts as necessary along pioneer road.

QCT will obtain materials samples for T-99 or T 180 proctor tests as soon as cuts are started. Provide

PE with splits of samples. Provide completed proctor worksheets within 48 hours.

Grading Foreman's name will be provided to Government as soon as known.

QCT will go over lift thickness and other contract requirements with Grading Foreman.

Production Phase -

After startup, Grading Foreman will be responsible for continuous monitoring of QC.

QCT will monitor the work and density with a nuclear gauge. These tests will be at the minimum

levels as required by the contract for non-rock material. The QCT will require additional proctors to

be performed when test results indicate the proctor being used may not be correct, or when the

material changes. One-point proctors will be performed as needed to verify the use of the proper

proctor. If appropriate to the material being tested, the proctor will contain a rock correction and/or

a moisture correction. Only moisture corrections supported by laboratory testing will be used when

testing the compacted material with a density gauge. QCT will advise the Grading Foreman of test

results.

Failing tests will be followed by appropriate corrective [reworking/recompaction] efforts, and retesting.

If the rate of initial failing tests exceeds one out of five, the QCT and Grading Foreman will meet and

formally document the corrective actions to the embankment construction process which will be taken

to resolve the problem.

Grading Foreman will order drying operations or more water when compaction tests or appearance

of fills material indicate that moisture is a problem.

Density tests will be documented in tabular form showing date, time, location, offset, depth below

grade and test result. Results will be provided to PE by the next working day.

Each day QCT will plot test results on control charts in the ABC project lab.

8. Drainage

Preparatory Phase -

QCT will obtain survey crews' stakeout notes and review culvert design prior to submittal to PE for

approval. QCT will obtain approved designs and order culvert and end section materials.

Precast inlets and similar items will be obtained from Williams Precast Co. of Susanville. Copies of

their materials data, mix designs and QC plan will be obtained and furnished to PE 30 days prior to

start of work.

Cast-in-place concrete will be furnished under Section 601 and obtained from Sutterville Quality

Concrete (SQC). QCT will obtain documentation from SQC. QCT will go over their procedures with

them before production. 

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11

QCT will identify a source of backfill material to be used if natural material is too rocky or otherwise

unsuitable. QCT will test the material (proctor) and provide results to PE.

QCT will inspect culvert materials upon arrival and obtain valid materials certifications and submit to

PE.

QCT will go over stakeout notes and contract requirements with pipe crew foreman prior to start of

work. Pipe foreman will be identified to PE prior to start of work.

Startup Phase -

QCT will work nearly continuously with the pipe crew on the first day to verify layout procedures,

bedding preparation and assembly.

QCT will go over proctor data and operation of nuclear gauge with pipe foreman. They will agree on

what passing density readings are for the borrow backfill and other possible backfill materials.

QCT will go over backfill, lift thickness and density monitoring procedures.

For cast-in-place concrete, QCT will be at plant to verify QC procedures at the start of production.

QCT will perform required QC at the site.

Production Phase -

Pipe foreman will be responsible for QC during construction.

The pipe foreman is trained and certified to operate a nuclear density gauge. The pipe foreman will

monitor work and density with a nuclear gauge during backfill operations, and will perform density

testing at the minimum rate required by the contract. QCT will visit each installation on a random

basis to take density tests to verify the pipe foreman’s results. A new proctor will be performed when

test results indicate the proctor being used may not be correct, or when the material changes. Onepoint proctors will be performed as needed to verify the use of the proper proctor. Moisture corrections

will not be used unless supported by laboratory data. Record of density tests will be furnished to the

PE by the following working day.

Failing tests will be followed by appropriate corrective efforts and retesting. If the rate of initial failing

tests exceeds one out of five, the QCT and pipe foreman will meet and formally document the

corrective actions to the embankment construction process which will be taken to resolve the

problem.

For cast-in-place concrete QCT will obtain all required documentation and furnish to PE. QCT will be

at placement site enough to perform required QC tests. QCT will go over QC procedures with

foreman, who will be responsible for QC when the QCT is absent.

9. Subgrade

Preparatory Phase - 

QCT will coordinate with grading foreman and survey crew as to how subgrade will be staked,

controlled and finished.

QCT will go over with grading foreman, any problems with subgrade materials quality - rocky material,

clay or other unsuitable. Such materials will be used in other than subgrade locations.

Startup Phase - 

QCT will coordinate with grading foreman and PE, the acceptable standards and tolerances for

subgrade finishing.

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12

Production Phase - 

Grading foreman will be responsible for day to day QC.

Grading foreman will advise PE when each segment of subgrade is ready for acceptance.

QCT will take subgrade density tests at required frequency using nuclear gauge. One point proctors

will be run whenever materials change or when there are questions as to the suitability of the proctor

being used.

Test results will be plotted on control charts by QCT and also furnished to the PE by the next working

day.

10. Base Course

Preparatory Phase -

Base course will be obtained from Whippel Mountain Aggregates, Inc. (WMA) 

QCT will obtain suppliers quality tests and samples of material for the PE at least 30 days prior to

base work beginning.

QCT will perform proctor tests on base course. QCT will also perform initial gradation tests on

stockpile just prior to startup.

QCT will review supplier's QC procedures including stockpiling, moisture control, process control

testing, and weighing.

QCT will develop dumping spread sheets for base course foreman.

Startup Phase -

QCT will go over delivery and dumping procedures with base course foreman.

QCT will go over spreading and compaction procedures with base course foreman.

Base course will be pugmill mixed and delivered at optimum moisture and in nonsegregated condition

so that processing on the grade will be minimal.

Production Phase -

WMA will be responsible for plant QC. WMA will perform at least one gradation test per day as long

as at least 80% of tests pass. Frequency will be increased if there are more failing tests. 

Grading foreman will be responsible for receiving, dumping, tabulating tonnages and delivering

receiving reports to PE at the end of each day.

Grading foreman will perform occasional (at least one per day) depth checks to verify spread rates.

QCT will obtain gradation samples at the required frequency. Samples will be split, with the splits

delivered to the PE.

11. Asphalt Items

Preparatory Phase -

All asphalt items will be furnished by Allied Paving (AP) of Sutterville. Materials will be hauled to the

site by ABC's hauling sub, and paving or installation of materials will be by ABC.

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13

AP has a lab certified by Caltrans at the plant. Lab supervisor is William Brown, Certified Asphalt

Technician in California.

QCT will obtain required mix design submittals and samples from AP and deliver to PE at least 30

days before work is scheduled to start. AP's QC/Mix Design technician is Allen Rockford who has

15 years in this position and is a certified asphalt technician in California and Nevada. Mr. Rockford

will be the contact for any technical discussions during the mix approval process.

With the mix designs, AP will furnish a separate QC plan dealing with their plant operations,

personnel, etc.

Startup Phase -

QCT will review all specification requirements with paving foreman prior to start of work.

QCT will be in charge of production start up procedures. Documentation and tests will be at his

directions and submitted to the PE. Full production will start when approved by PE.

Production Phase -

Paving foreman will be responsible for QC on a daily basis. QCT will conduct periodic inspections.

QCT or designee will obtain mix sample and cores. Splits will be provided to PE for acceptance.

Contractor samples will be delivered to AP's plant lab for testing. Results will be provided through the

QCT by the following day. We will attempt to set up a system to provide results by FAX.

AP will obtain AC samples at the plant and deliver (through QCT) to PE for testing.

Test results will be plotted on control charts in ABC's onsite lab. QCT will run QL Pay at the end of

each day, or the beginning of the next. Quality problems evident either from inspections or test

results will be dealt with under the direction of the QCT. Work will be suspended if problems cannot

be resolved expeditiously.

12. Structural Concrete

Preparatory Phase -

Wahoo Readymix in Martin, CA will provide PC concrete under Section 552 for the box culverts.

Wahoo’s plant is certified by CalTrans as is their Quality Supervisor, Mr. Larry Ryland. Mr. Ryland

will provide documentation [through ABC’s QCT]of proposed mix design (previously approved by

CalTrans) and all materials 30 days or more prior to first delivery. Wahoo will also be responsible for

all plant QC and inspection of trucks.

QCT will be responsible for onsite QC operations other than the concrete mix itself, e.g. resteel,

forming, concrete placement, finishing, etc. Resteel will be inspected upon delivery for proper

certification, dimensions, storage, etc. QCT will be responsible for stakeout and foundation

preparation prior to forming.

Startup Phase -

QCT will coordinate with Wahoo to schedule delivery operations. Wahoo will send one or more

certified concrete technicians to each concreting operations. Technicians will be responsible for any

final mix adjustments, delivery ticket validation, screening (air, slump, temperature) and acceptance

testing as required by FHWA inspector. Cylinders will be cured onsite at ABC’s lab, and taken to

Wahoo’s lab for breaking. QCT will advise FHWA of scheduled breaks and provide opportunity for

witnessing.

QCT will inspect forming and resteel operations from their inception and work with crews to assure

acceptable tolerances and other compliance. QCT will inspect placement operations including

vibrating and finishing. QCT will inspect curing operations and work with ABC crews to resolve any

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14

problems. All required documentation will be completed by QCT and delivered to FHWA by the day

following each placement operation.

Production Phase - 

Wahoo will continue to provide onsite QC for each concrete delivery.

Once resteel and forming crews are lined out, QCT will make spot checks of their operations, plus

a final inspections two hours or so prior to each placement. QCT will inspect curing QCT will inspect

all surfaces upon stripping and go over any necessary repairs and finishing operations.

13. Miscellaneous Items

This covers items, mostly involving installation of manufactured items such as guardrail, delineators, fencing, etc.

Preparatory Phase - 

QCT will verify all certification requirements, inspect material upon delivery and submit certifications

and other documentation to PE.

QCT will work with survey crew and PE to verify exact stakeout requirements and resolve any potential

stakeout problems.

Startup Phase -

QCT will go over the specification requirement and stakeout data with the foreman in charge of

installation.

QCT will normally be present when any operation begins to resolve problems and verify specification

compliance.

Production Phase -

Foreman will normally be responsible for QC during production. QCT will make spot checks

approximately once a day or more frequently if there are problems.

QCT will perform tests required by the contract and furnish results to PE. QCT will advise PE when

segments of the work are ready for acceptance.

The overall goal of ABC Construction Company’s quality control program is to conduct consistent and effective

processes such that work performed naturally conforms to the contract requirements. Testing and inspection will be

performed and documented for the purpose of evaluating the effectiveness of our work processes, identifying and

correcting non-conforming work, and ensuring the quality of the work is not compromised.

Please advise me if there are any additions or supplements you would like us to make to this QCP. If there are

changes to any items (personnel, suppliers, etc.) we will attempt to provide the PE notice in advance of their impact

on the work.

We need concurrence to proceed with at least the clearing and grading portion of the work by June 1 in order to stay

on our schedule.

Sincerely yours,

Ralph Altway

Ralph Altway

Superintendent

Page 173