form fhwa 17-348 (12/2007) date stamp u.s. … · form fhwa 17-348 (12/2007) u.s. department of...
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
Be sure to adjust designed clearing distances and areas to reflect actual areas of work performed
20101Clearing and grubbing
13+320 to 14+500: 28,628 m2 per FHWA clearing report = 2.863 ha
see attached documentation:(a) Contractor clearing report(b) FHWA clearing report
see stations above 2.863 ha
2.863
ha
Page 13 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20101Clearing and grubbing
375+00 to 400+00: 3.107 acres @ 75% complete = 2.330 acres
**Area grubbed, per Appendix A, 75 % partial payment
see attached documenation:(a) MS Excel spreadsheet(b) FHWA clearing report
see stations above 2.330 acre
2.330
acre
Page 19 of 134
Sta Sta SF375+00.00 376+50.00 7,876.00 1 acre = 43560 square feet376+50.00 383+61.10 33,298.00383+61.10 389+00.00 25,048.00389+00.00 394+50.00 34,852.00394+50.00 398+00.00 19,164.00398+00.00 400+00.00 15,103.00
135,341.00 Total 3.107 acre
Page 20 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
Be sure to confirm that tree isoutside of original clearing limits
20204Additional clearing and grubbing, removal of tree
10+04 LT81' from center line: 1 @ 20" dia: A = (pi/4)(20in)^2 = 314.159 sq.in78' from center line: 1 @ 26" dia: A = (pi/4)(26in)^2 = 530.929 sq.in
11+94 RT79' from center line: 2 @30" dia: A = (2)(pi/4)(30in)^2 = 1413.717 sq.in
2258.805 sq.in = 15.686 sq.ft
Total for payment = 15.686 sq.ft
see stations above 15.686 sq.ft
15.686
sq.ft
Page 27 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20303Removal of Pavement, Asphalt
Area G = (119.88 x 1) = 119.88 m2
see attached plan sheets
0+280 to 0+360 119.88 m2
120
m2
Page 28 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
Example 1
20401Excavation and embankment, roadway exc
105+366 LT to 105+381.5 LT: 33.03m3
see attached documentation for sliver excavation:(a) differential leveling survey notes(b) scaled cross section notes(c) average end area calculations(d) irregular polygon area calculations
see stations above 33.03m3
33
m3
Page 30 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20401Roadway excavation
Performed 85% of the roadway exc from station 27+857 to 33+500.
Total excavation from 27+857 to 33+500 = 24,205 m3
24,205 x 0.85 = 20,574.3 m3
see attached documentation:(a) total mass spreadsheet(b) guidelines for percentage of payments for partially complete work
see stations above 20,574.3 m3
20,574
m3
Page 37 of 134
Contractor Generated Notes
FHWA project staff should provide a note toreflect that calculations are accurate and reflectthe original design or adjusted quantities
Page 38 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20402Excavation and embankment, subexcavation
487+82 to 488+38: (56' long)(8' wide)(1' deep) = 448 ft3
489+07 to 489+28: (21' long)(24' wide)(1.75' deep) = 882 ft3
491+58 to 492+06: (48' long)(10' wide)(1.5' deep) = 720 ft3
490+72 to 493+80: (308' long)(14' wide)(0.8' deep) = 3449.6 ft3
Total = 5499.6 ft3 = 203.7CY
see stations above 203.7 CY
204
CY
Page 40 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20402Excavation and embankment, subexcavation
101+440 to 101+680 = 2639.4m3
see attached documents:(a) average end area calculations(b) cross-section end area reports(c) irregular polygon area calculations
see stations above 2639.4m3
2639
m3
Page 41 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20406Select Borrow
Subexcavation backfill from station104+200 to station 104+220
see attached documentation:(a) daily mass record(b) street delivery report - spread report
see stations above 115.7 t
115.7
t
Page 47 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement:
(h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Manager
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
Field Sample Notebook April 2011
Page 59 of 171
20701Eathwork Geotextile, Type VIII-B
Crew Installed Fabric From 11+696 to 11+765
Total Length=69m
Width of Fabric=16.3m
Depth of Trench= 1m x 2 for both sides = 2m
Total Installed: (69m x 16.3m)+(69m x 2m)= 1262.7 m2
*See attached sheets
11+696 to 11+765 1262.7 m2
1262.7
m2
Page 50 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
21101Roadway Obliteration, method 1
Obliteration Area Calculations:30+00 27' LT, 36' RT = 63'
avg. width = 64.5' area = (64.5')(50') = 3225 sq.ft29+50 30' LT, 36' RT = 66'
avg. width = 64.5' area = (64.5')(50') = 3225 sq.ft29+00 24' LT, 39' RT = 63'
avg. width = 66' area = (66')(50') = 3300 sq.ft28+50 27' LT, 42' RT = 69'
avg. width = 66' area = (66')(50') = 3300 sq.ft28+00 27' LT, 36' RT = 63'
avg. width = 63' area = (63')(50') = 3150 sq.ft27+50 27' LT, 36' RT = 63'
avg. width = 64.5' area = (64.5')(20') = 1290 sq.ft27+30 27' LT, 39' RT = 66'
Total = 17490 sq.ft = 1943.3 sq.yd
see stations above 1943.3 sq.yd
1943
sq.yd
Page 53 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
25101Placed riprap, class 3
19+320: 10m long x 2.5m wide x 0.5m thick = 12.5m320+140: 7m long x 2m wide x 0.3m thick = 4.2m3
Total = 16.7m3
see attached placed riprap detail
see stations above 16.7 m3
17
m3
Page 54 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
25101Placed riprap, class 2
Class 2 riprap placement at 104+300 LT to 104+447 LT: 2503.2 m3
see attached documentation:(a) average end area hand calculation sheet
see stations above 2503.2 m3
2503
m3
Page 57 of 134
In order to check the As-Builts when the project iscomplete, these quantities should also have areference to center line. Page 58 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
25103Keyed riprap
Station 1+005 – End SectionArea Volume = 215.0 m3
Station 1+015Area Volume = 729.3 m3
Station 1+030Area Volume = 789.3 m3
Station 1+045Area Volume = 695.3 m3
Station 1+060Area Volume = 208.5 m3
Station 1+070 – End SectionTotal = 2637.4 m3
see attached criss-cross + average end area calculation spreadsheet
see stations above 2637.4 m3
2637
m3
Page 59 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
25125Boulder
Crew placed 4 boulders as directed by FHWA in Rockefeller Turnout.
see attached plan sheet
see stations above 4 EA
4
EA
Page 61 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
26201Rockery Wall
Rockery wall station 104+31 to station 104+61.1 (12' left offset from center line)= 134.27 m2
see attached documentation:(a) field cross section(b) irregular polygon area calculator sheets
see stations above 134.27 m2
134.3
m2
Page 63 of 134