Trip/Project Inspection Report

This section not reviewed during this visit EQ)

GENERAL TRIBAL STATUS QUESTIONS

1, Has the Tribe's LRTP been reviewed and/or updated by the Tribe within the last 5 years from its last submission?
Yes—No If No, explain.

2. Has the Tribe’s TTIP been updated within the last 4 years from its last approval? Yes — No If No, explain.

3, Is the Tribe using a method or software that adequately tracks all transportation funds provided and expended?
Yes — No If No, explain.
Does the Tribe have written Financial, Procurement and Property Management Policies? Yes - No If No, explain.

5. Are all Annual Reports completed and on file? Yes — No If No, explain.
6. Does the Tribe have any personal property/equipment that was purchased using TTP funds or was received from
GSA Excess and Surplus? Yes— No Was all property/equipment visually located? Yes — No If No, explain the

reason property/equipment was not visually identified.

Additional Comments:

This section not reviewed during this visit Bk)

GENERAL PROJECT QUESTIONS

1. Are there any Contract Modifications? Yes—No If Yes, explain.
2, Has time been added to the Contract? Yes —No If Yes, explain.
3. Do working conditions on the project appear safe? Yes ~ No If No, explain.

Additional Comments:

This section not reviewed during this visit EX)

PREVAILING WAGES/SUBCONTRACTS

Were all the subcontracts reviewed and approved prior to subcontractor starting work? Yes ~ No
Was the SAM. gov website searched to verify that the contractor nor all subcontractors were on the debarred list?
Yes-—No

3, Have wage rate interviews been performed? Yes - No

4, Are there any discrepancies found from the wage rate interviews? Yes ~ No

5. If there are any Davis-Bacon compliance issues, have they been adequately addressed? Yes ~ No

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Does the contractor submit certified payrolls weekly? Yes - No
Are the certified payrolls reviewed by the project staff? Yes — No

Additional Comments:

This section not reviewed during this visit EQ)
ENVIRONMENTAL

1, Is the Contractor adhering to the environmental commitments in the PS&E? Yes — No
2, Is the NPDES NOI posted and located on the project that allows the public to view and are the permits available at
the project site location? Yes — No
3, Are BMPs installed properly, inspected, and maintained in accordance with the SW3P, with any BMP modifications
updated on the SW3P/erosion control plan? Yes ~ No
Note: The PS&E should be viewed to identify all environmental commitments that are to be provided on the project.

Additional Comments:



Trip/Project Inspection Report

3, Is the surface of the concrete screeded enough times and at appropriate intervals to produce a uniform surface
true to grade and free of voids? Yes — No

4, Does the Contractor perform sufficient checks with a long-handled straightedge on the plastic concrete to ensure
that the final surface will be within tolerance? Yes —No

5, Is the concrete finished to a uniform texture with a carpet drag, burlap drag, or broom finish from a work bridge or
platform immediately after completing the straightedge checks? Yes ~ No

6. Are tines/grooves being provided at the adequate spacing and the adequate depths? Yes — No

7. Is curing compound being applied at a consistent/uniform rate within an adequate timeframe? Yes - No

Additional Comments:

This section not reviewed during this visit
FINAL PROJECT SITE VISIT

1, Has a punch list been generated that provides for any items that need to be corrected? Yes — No

2. Are all items in the PS&E related to environmental commitments compliant, correct and complete? Yes - No

3. Is there a plan of action in place to close out all environmental commitments/permits prior to project closeout?
Yes — No

4, Are there any claims associated with the project? Yes— No. If yes, refer to 10.d. of this section.

5. Was all sampling and testing (frequency/location) conducted in accordance with contract requirements for
Earthwork, Structures, Asphalt, and PCC Yes — No

6. Are all failed tests documented and provide for any pay deductions or remove and replace actions? Yes - No

7. Were all traffic control inspections completed at the appropriate frequency and on file? Yes No

8. Are payroll records Davis-Bacon rate compliant unless Tribe performs work with its own employees? Yes — No

9. Were the as-built plans available for review during the final inspection? Yes ~ No

10. Was the Tribe notified of the necessary information that would need to be provided to FHWA in order to closeout
the project.* Yes —No These would include:

a. Date of final inspection — a date that the final inspection report was generated as a result of a final
inspection conducted between the Tribe and the contractor.

b. Date of final acceptance letter — the date when the owner provided written documentation that they have
accepted the project.

¢. A final accounting of all TTP construction project expenditures — the TTP funds associated with the project
to include the amount paid to the contractor and any construction engineering costs.

d. Providing any unresolved or pending claims in the final project closeout report and any costs associated
with those claims, if known. If there are any unresolved or pending claims related to the project after
submission of the final project closeout report, the Tribe will report those amounts through the annual
(PORT) reporting.

* These documents include the final inspection, final acceptance letter, and final estimate are not necessary to submit
to FHWA to close out the project. Only the dates and amounts related to the information needed to closeout a
project are required for submittal. The Tribe will need to submit a closeout report (within 120 days of receipt of the
final acceptance letter) to the TC with this information provided, at a minimum. It is recommended that the Tribe
use the Closeout Template to provide for this information as the templates requests this information.

Additional Comments:



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Has all testing equipment been calibrated and certified prior to measuring densities and optimum moisture
content for all embanked material? Yes - No

Has all gradations, densities, and plasticity passed within the required limits for the type of soils on the project?
Yes-No

Excavation:
Are all excavations being sloped to ensure adequate and positive drainage to avoid flooding on the project and
damaging adjacent property outside the ROW? Yes — No

Is the contractor clearing and grubbing to a satisfactorily depth? Yes — No

Is excavated topsoil being stockpiled for later use? Yes ~ No
Are all unsuitable materials excavated being disposed of appropriately? Yes - No

Additional Comments:

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This section not reviewed during this visit EQ)

MATERIALS/TESTING, GRADING, HMA/PCC PAVEMENT
Materials/Testing:

Is all rebar properly stored on site and elevated? (check at construction area/Contractor on-site yard) Yes ~ No
Are the materials testing staff certified? Yes - No

Are all material certifications completed and on file? Yes ~ No

Are all materials tested per applicable specification? Yes — No

Has the laboratory conducting acceptance testing been approved by an independent laboratory qualification
program? Yes —No

Are the plant, scale and truck certification on file and current (at least every 6-months)? Yes — No

Is the Guide Schedule (testing frequency) of sampling and testing being followed for all required material
placements? Yes —No

Is sampling and testing data up to date and on file? Yes ~ No

Are the material delivery tickets reviewed and determined to be acceptable by the inspector prior to placement to
ensure the correct material is being delivered for the work to be completed within an adequate time for
placement? Yes—No

Have all iron and steel products been certified for Buy America requirements? Yes — No

Does the Tribe or owner's representative control the location for Tribal acceptance or verification testing and take
immediate possession (and maintain possession) of cores and/or concrete cylinders? Yes — No

. Are there any test results that were out of specification tolerances? Yes — No If yes, are the failed tests
documented in the files with cross-references to retests? Yes — No

Are the Mix Designs on file and approved? Yes—No

. Are the concrete batch tickets or equivalent for each load of concrete on file and properly filled? Yes — No

Subgrade/SubBase/Base:

Is adequate drainage being provided to protect the existing roadbed and reduce flooding impacts to adjacent
properties (i.e. are ditches and slopes being maintained? Yes ~ No

Have the sub-grade, subbase or lower course been properly prepared for each lift placed (i.e. lift thickness
maximums; obtained minimum density and moisture content)? Yes - No

Is surface clipped, skinned, or tight bladed to an acceptable depth? Yes - No

. Is surface sealed immediately after finishing? Yes - No



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Trip/Project Inspection Report

This section not reviewed during this visit BQ)
TRAFFIC CONTROL
Are the project's traffic control layout and detour (if used) adequate? Yes - No
Are all traffic control devices installed according to TCP standard sheets and PS&E? Yes — No
Are channelizing devices clear, clean, straight and provide appropriate guidance to drivers for daytime and provide
reflectivity for nighttime conditions? Yes — No
Are signs visible day and night and have appropriate sight distance? Yes — No
Are pavement markings visible and adequate for providing guidance day and night (if required)? Yes - No
Are temporary shifts, tapers and lane closures laid out with good visibility and are adequately designed? Yes — No
Are flaggers attentive and responsible, with appropriate high visibility gear and equipment? Yes — No
Do concrete barriers or guardrail ends have end treatment or protection? Yes — No
Were any pavement drop-offs observed? Yes ~ No

. If Pedestrian facilities were present before construction, are walkways closures posted as required, are signs out of

the pedestrian path, and are ADA compliant detour routes provided? Yes ~ No
Are there any traffic control plan changes? Yes ~ No If so, who approved the changes?

Are the Traffic Control Inspections conducted with detail findings for both day and night? Yes— No
Is the Contractor addressing the Traffic Control deficiencies in a timely manner? Yes — No

Additional Comments:

This section not reviewed during this visit
MATERIAL DOCUMENTATION/PROJECT RECORDS

Are the material delivery tickets accurate and complete, and available in the project files? Yes — No
Have all mix designs been approved by an authorized Tribal representative prior to work progressing with that
item of work? Yes ~ No

Are pay folders adequately documented and do project records provide adequate assurance that quantities are
accurate and uniform? (includes field measurements, calculations, invoices, or daily work report as required) Yes
-No

Is all unnegotiated added work justified and necessary and does the project records provide for adequate
assurance that the material quantities, labor hours, and equipment usage are accurate and uniform? Yes — No
Are inspector daily reports and/or project diaries current, properly filed and adequately support work progress?
Yes—No

Additional Comments:

This section not reviewed during this visit Ba)

EMBANKMENT/EXCAVATION

Embankment
Are all embankments being sloped to ensure adequate and positive drainage to avoid flooding on the project and
damaging adjacent property outside the ROW? Yes— No

Has all material being embanked on the project met the minimum specifications? Yes - No

Is all compaction equipment being used appropriately and per specifications necessary to achieve optimum
compaction? Yes — No

Is all embankment compacted at adequate depths and layered to get to finish grade? Yes ~ No



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Trip/Project Inspection Report

Were beams profiled to determine actual camber or sag of beams prior to placing the panels, pan forms, steel,
etc.? Yes—No The profile grade line, panel elevation, and bearing seat elevations may need to be adjusted to
obtain the required clear cover over the slab reinforcement and the required slab thickness.
Have voids beneath the deck panels or pan forms been sealed to prevent excessive grout leakage? Yes — No
Reinforcing Steel
Is reinforcement accurately located in the forms and firmly held in place, before and during concrete placement,
by means of bar supports, adequate in strength and number to prevent displacement and to keep the steel at the
proper distance from the forms? Yes ~ No
‘Are manual placements of steel securely wired together at all intersections? Yes - No
Are tie wires, bar chairs, supports or clips used with epoxy coated reinforcement fully coated with epoxy? Yes —
No
Has all visible damage to epoxy coating been repaired? Yes - No
Dry Run:
Is the clear cover for the top mat of reinforcement within minimum tolerances? Yes ~ No
Before pour, is all placing, finishing, and curing equipment adjusted properly readily available? Yes ~ No
Are there sufficient work bridges available for finishing operations? Yes ~ No
Are there backup vibrators available? Yes — No Special rubber-tipped vibrators are required for epoxy coated
steel.
Is there enough evaporation retardant and curing compound available? Yes - No
Can fogging equipment apply water in a fine mist not a spray? Yes — No
Concrete Placement:
‘Are manual placements of steel secured together with wire ties or locking support chairs at each intersection and
is the steel mat clean and clear of dirt and debris? Yes —No
Are the longitudinal reinforcement splices staggered to avoid having more than 1/3 of the splices within a 2-ft.
longitudinal length of each lane of pavement? Yes — No
Are steel lap length minimums provided? Yes ~ No
Is the ambient temperature in the shade 35°F and rising or above 40°F? Yes —No Concrete should not be placed
when ambient temperature in the shade is 40°F and falling. Do not place concrete on frost covered steel.
Is the temperature of the concrete between 50°F and 80°F? Yes -No
Is concrete placed within the approved time limit after batching? For non-agitating equipment, concrete has a
shorter time limit after batching to be placed? Yes — No
Are all forms, deck panels, beams, etc. thoroughly wetted prior to concrete placement? Yes - No
Are immersion vibrators spaced at adequate intervals to allow for sufficient consolidation of the concrete? Yes —
No
Has the bridge slab been protected and maintained at the appropriate temperature ranges for the required
timeframes? Yes —No

. In hot weather, were methods used to maintain adequate concrete temperatures and evaporation rates? Yes —

No
If span is on a profile grade of 1.5% or more, is concrete placement started at the low end? Yes— No
Concrete Finishing:
After the concrete is placed and vibrated in a section wide enough to work, is it leveled struck off, and screeded as
soon as possible? Yes -No
Is there a slight excess of concrete ahead of the screed to fill all low spots? Yes - No



Trip/Project Inspection Report

oe wei, Trip/Project Inspection Report
FJ , U.S. Department of Transportation
. i Federal Highway Administration
"meee we Tribal Transportation Program (TTP)

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EXECUTIVE SUMMARY

Scope of Meeting/Inspection/Review/Other (Note to reviewer: May use the example
language below for construction)

If Construction, then:

Construction activities reviewed included: quality of inspection oversight and contractor workmanship. Construction
inspection staff was interviewed in relation to contract plans and specification requirements for project elements
currently under construction along with observing the contractor's work.

If Meeting, then:

Give a brief description of the discussion that occurred during the meeting.

If Review, then:
Give a brief description for the purpose of the review and a summary of what was reviewed and document any findings.



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$ Trip/Project Inspection Report

Hotmix Asphalt (HMA) Pavement:
19. Is the Tribe ensuring the temperature of the HMAC coming out of the haul truck and the temperature of the
asphalt mix after laydown within the allowed range? Yes — No
20. Is. a bond breaker applied (prime coat, tack coat, etc.) and is clear of debris prior to asphalt placement? Yes - No
21. Are depth checks provided after hotmix is placed prior to rolling? Yes - No
22, Is the rolling pattern approved and followed to allow for optimum compaction before break-over point? Yes — No

Portland Cement Concrete (PCC) Pavement:

23. Are manual placements of steel secured together with wire ties or locking support chairs at alternate intersections

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and is the steel mat clean and clear of dirt and debris? Yes — No
24, Are the longitudinal reinforcement splices staggered to avoid having more than 1/3 of the splices within a 2-ft.
longitudinal length of each lane of pavement? Yes —No
25. Are steel lap length minimums provided? Yes — No

26. Are all forms and sub-pavement thoroughly wetted prior to concrete placement? Yes — No
27. Are immersion vibrators spaced adequately allowing for sufficient consolidation of the concrete? Yes — No
28. Are depth checks of the pavement thickness being conducted at the required frequency? Yes — No

29, Are tines/grooves being provided at the adequate spacing and the adequate depths? Yes — No

30. Is curing compound being applied uniformly and consistently within an adequate timeframe? Yes — No

Additional Comments:

This section not reviewed during this visit EX]
BRIDGES AND STRUCTURES

Drill Shafts:

1, Is the embankment at bridge ends completed before installing drilled shafts that pass through the fill? Yes — No

2. If drilled shafts are located within a Mechanically Stabilized Earth Wall (MSE) volume, are they constructed prior to
construction of the wall? Yes — No

3. If concrete placement is not started within 4 hours of the completion of the shaft excavation, is the hole
reprocessed with the auger as directed, the hole bottom cleaned with an air lift or cleanout bucket, and the slurry
at the bottom of the hole checked for compliance with the slurry requirements? Yes — No

4, Isthe reinforcing steel cage clean of any foreign material prior to placement in the excavated shaft? Yes — No
If the reinforcing steel cage does not reach the bottom of the shaft, is it suspended, or a portion of the longitudinal

steel extended to support the cage on the bottom of the shaft? Yes — No

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6. Is the steel reinforcing cage centered in the excavation using approved centering devices, using enough devices to
hold the cage in position along its entire length? Yes - No
Sub-Structure:

1, Has the alignment, elevation and layout of bents, columns, abutments, headwalls, wingwalls, and caps been
checked? Yes ~ No

2. Was compressive strength 80% of the required 28-day compressive strength prior to the loading of caps or setting

of beams? Yes—No
Super-Structure
Falsework and Forms:
1, Are beams braced in accordance with minimum erection bracing standards? Yes - No



Trip/Project Inspection Report

PHOTOGRAPHS
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Trip/Project Inspection Report

PHOTOGRAPHS
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Trip/Project Inspection Report

PHOTOGRAPHS
Check box if photographs were not taken during this visit Px)