R-1850 - 01/14/2020 - AGREEMENTS - Resolutions Supporting Documents (4)IIinOIS Department Local Public Agency Agreement
of Transportation for Federal Participation
LOCAL PUBLIC AGENCY
Local Public Agency Count Section Number
Village of Oak Brook uPage 17-00049-00-PV
Fund Type ITEP SRTS HSIP Numbers MPO Name MPO TIP Number
STU, CMAQ CM:A:P :08-17-00027--
Construction on State Letting Construction Local Letting Day Labor Local Administered Engineering Right-of-Way
Construction Engineering Right of Way
Job Number Pro'ect Number Job Number Pro e Number Job Number Project Number
C-91-007-18 BFN9(911)
This Agreement is made and entered into between the above local public agency, hereinafter referred to as the"LPA"and the State of
Illinois, acting by and through its Department of Transportation, hereinafter referred to as"STATE". The STATE and LPA jointly propose to
improve the designated location as described below. The improvement shall be consulted in accordance with plans prepared by,or onbehalfoftheLPAandapprovedbytheSTATEusingtheSTATE's policies and procedures approved and/or required by the FederalHighwayAdministration, hereinafter referred to as"FHWA".
LOCATION
Stationing
Local Street/Road Name Key Route Length From To
North York Rd 2678 0.16 mi 27+62 36+00
Location Termini
Harger Rd to Roosevelt Rd
Current Jurisdiction Existing Structure Number(s) Add Location
IDOT, Village of Oak Brook, ISTHA
Remove
LOCATION
StationingLocalStreet/Road Name Ke i Route Length From To
Harger Road 1446 0.22 mi 119+50 130+86
Location Termini
Westbound 1-88 Entrance to North York Rd
Current Jurisdiction Existing Structure Number(s) Add Location
Village of Oak Brook
Remove
PROJECT DESCRIPTION
The project involves reconstruction of Harger Road at a new alignment and providing widening at York Road to
improve the existing intersection at York Road and Harger Road. As part of the project the Salt Creek Trail will
be realigned to cross under Harger Road through an underpass. The items of work include pavement
reconstruction, resurfacing, and widening, underpass structure, HMA bike paths, retaining walls, storm sewers,
earth excavation, erosion control, landscaping, tree removal, proposed trees, lighting improvements and signal
improvements.
LOCAL PUBLIC AGENCY APPROPRIATION -REQUIRED FOR STATE LET CONTRACTS
By execution of this Agreement the LPA attests that sufficient moneys have been appropriated or reserved by resolution or ordinance tofundtheLPAshareofprojectcosts.A copy of the authorizing resolution or ordinance is attached as an addendum.
Check One
METHOD OF FINANCING-(State-Let Contract Work Only)
METHOD A-Lump Sum(80%of LPA Obligation
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Lump Sum Payment-Upon award of the contract for this improvement,the LPA will pay the STATE within thirty(30)calendar days of
billing, in lump sum, an amount equal to 80%of the LPA's estimated obligation incurred under this agreement.The LPA will pay to the
STATE the remainder of the LPA's obligation (including any nonparticipating costs)in a lump sum within thirty(30)calendar days of billing
in a lump sum, upon completion of the project based on final costs.
METHOD B- Monthly Payments of due by the of each successive month.
Monthly Payments-Upon award of the contract for this improvement,the LPA will pay to the STATE a specified amount each month for
an estimated period of months,or until 80%of the LPA's estimated obligation under the provisions of the agreement has been paid. The
LPA will pay to the STATE the remainder of the LPA's obligation (including any nonparticipating costs)in a lump sum, upon completion of
the project based upon final costs.
METHOD C - LPA's Share Balance divided by estimated total cost multiplied by actual progress payment.
Progress Payments-Upon receipt of the contractor's first and subsequent progressive bills for this improvement,the LPA will pay to the
STATE within thirty(30)calendar days of receipt, an amount equal to the LPA's share of the construction cost divided by the estimated
total cost multiplied by the actual payment(appropriately adjust for nonparticipating costs)made to the contractor until the entire obligation
incurred under this agreement has been paid.
Failure to remit the payment(s)in a timely manner as required under Methods A, B,or C shall allow the STATE to internally offset, reduce,
or deduct the arrearage from any payment or reimbursement due or about to become due and payable from the STATE to the LPA on this
or any other contract.The STATE at its sole option, upon notice to the LPA, may place the debit into the Illinois Comptroller's Offset
System(15 ILCS 405/10.05)or take such other and further action as may be required to recover the debt.
THE LPA AGREES:
1. To acquire in its name,or in the name of the STATE if on the STATE highway system, all right-of-way necessary for this project in
accordance with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies
Act of 1970, and established State policies and procedures. Prior to advertising for bids,the LPA shall certify to the STATE that all
requirements of Titles II and III of said Uniform Act have been satisfied.The disposition of encroachments, if any,will be
cooperatively determined by representatives of the LPA,the STATE, and the FHWA if required.
2.To provide for all utility adjustments and to regulate the use of the right-of-way of this improvement by utilities, public and private,
in accordance with the current Utility Accommodation Policy for Local Public Agency Highway and Street Systems.
3.To provide for surveys and the preparation of plans for the proposed improvement and engineering supervision during construction
of the proposed improvement.
4.To retain jurisdiction of the completed improvement unless specified otherwise by addendum(addendum should be accompanied
by a location map). If the improvement location is currently under road district jurisdiction, a jurisdictional addendum is required.
5.To maintain or cause to be maintained the completed improvement(or that portion within its jurisdiction as established by
addendum referred to in item 4 above)in a manner satisfactory to the STATE and the FHWA.
6. To comply with all applicable Executive Orders and Federal Highway Acts pursuant to the Equal Employment Opportunity and
Nondiscrimination Regulations required by the U.S. Department of Transportation.
7.To maintain for a minimum of 3 years after final project close out by the STATE, adequate books, records and supporting
documents to verify the amounts, recipients and uses of all disbursements of funds passing in conjunction with the contract.The
contract and all books, records, and supporting documents related to the contract shall be available for review and audit by the
Auditor General and the STATE. The LPA agrees to cooperate fully with any audit conducted by the Auditor General,the STATE,
and to provide full access to all relevant materials. Failure to maintain the books, records, and supporting documents required by
this section shall establish presumption in favor of the STATE for recovery of any funds paid by the STATE under the contract for
which adequate books, records and supporting documentation are not available to support their purported disbursement.
8.To provide if required,for the improvement of any railroad-highway grade crossing and rail crossing protection within the limits of
the proposed improvement.
9. To comply with Federal requirements or possibly lose(partial or total)Federal participation as determined by the FHWA.
10. (Local Contracts or Day Labor)To provide or cause to be provided all of the initial funding, equipment, labor, material and
services necessary to complete the project.
11.(Preliminary Engineering) In the event that right-of-way acquisition for,or construction of,the project for which this preliminary
engineering is undertaken with Federal participation is not started by the close of the tenth fiscal year following FHWA
authorization,the LPA will repay the STATE any Federal funds received under the terms of this agreement.
12. (Right-of-Way Acquisition) In the event construction has not commenced by the close of the twentieth fiscal year following FHWA
authorization using right-of-way acquired this agreement,the LPA will repay the STATE any Federal Funds received under the
terms of this agreement.
13.(Railroad Related Work)The LPA is responsible for the payment of the railroad related expenses in accordance with the LPA/
railroad agreement prior to requesting reimbursement from the STATE. Requests for reimbursement should be sent to the
appropriate IDOT District Bureau of Local Roads and Streets Office. Engineer's Payment Estimates shall be in accordance with
the Division of Cost.
14. Certifies to the best of its knowledge and belief that it's officials:
a. are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered
transactions by any Federal department or agency;
b. have not within a three-year period preceding this agreement been convicted of or had a civil judgment rendered against them
for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public(Federal,
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State or local)transaction or contract under a public transaction;violation of Federal or State antirust statutes or commission of
embezzlement,theft,forgery, bribery,falsification or destruction of records, making false statements receiving stolen property;
c.are not presently indicted for or otherwise criminally or civilly charged by a governmental entity(Federal,State, Local)with
commission of any of the offenses enumerated in item(b)of this certification; and
d. have not within a three-year period preceding the agreement had one or more public transactions(Federal, State,Local)
terminated for cause or default.
15.To include the certifications, listed in item 14 above, and all other certifications required by State statutes,in every contract,
including procurement of materials and leases of equipment.
16.(STATE Contracts).That execution of this agreement constitutes the LPA's concurrence in the award of the construction contract
to the responsible low bidder as determined by the STATE.
17.That for agreements exceeding$100,000 in federal funds,execution of this agreement constitutes the LPA's certification that:
a.No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,to any person for influencing
or attempting to influence an officer or employee of any agency,a member of congress,an officer or employee of congress,or
any employee of a member of congress in connection with the awarding of any federal contract,the making of any cooperative
agreement, and the extension,continuation, renewal,amendment or modification of any Federal contract,grant, loan or
cooperative agreement.
b. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a member of congress,an officer or employee of congress or an employee of a
member of congress in connection with this federal contract,grant, loan,or cooperative agreement,the undersigned shall
complete and submit standard form-LLL, "Disclosure Form to Report Lobbying", in accordance with its instructions.
c.The LPA shall require that the language of this certification be included in the award documents for all subawards(including
subcontracts,subgrants and contracts under grants, loans and cooperative agreements), and that all subrecipients shall certify
and disclose accordingly.
18.To regulate parking and traffic in accordance with the approved project report.
19.To regulate encroachments on public rights-of-way in accordance with current Illinois Compiled Statutes.
20.To regulate the discharge of sanitary sewage into any storm water drainage system constructed with this improvement in
accordance with the current Illinois Compiled Statutes.
21.To comply with the federal Financial Integrity Review and Evaluation(FIRE)program,which requires States and subrecipients to
justify continued federal funding on inactive projects.23 CFR 630.106(a)(5)defines an inactive project as a project in which no
expenditures have been charged against federal funds for the past twelve(12)months.
22.(Reimbursement Requests)For reimbursement requests the LPA will submit supporting documentation with each invoice.
Supporting documentation is defined as verification of payment,certified time sheets or summaries,vendor invoices,vendor
receipts, cost plus fix fee invoice, progress report, personnel and direct cost summaries,and other documentation supporting the
requested reimbursement amount(Form BLR 05621 should be used for consultant invoicing purposes).LPA invoice requests to
the STATE will be submitted with sequential invoice numbers by project.
23.(Final Invoice)The LPA will submit to the STATE a complete and detailed final invoice with applicable supporting
documentation of all incurred costs, less previous payments, no later than twelve(12)months from the date of completion of work
or from the date of the previous invoice,which ever occurs first. If a final invoice is not received within this time frame,the most
recent invoice may be considered the final invoice and the obligation of the funds closed. Form BLR 05613(Engineering Payment
Record)is required to be submitted with the final invoice on the engineering projects.
24.(Project Closeout)The LPA shall provide the final report to the appropriate STATE district office within twelve(12)months of the
physical completion date of the project so that the report my be audited and approved for payment. If the deadline cannot be met,
a written explanation must be provided to the district prior to the end of the twelve(12)months documenting the reason and the
new anticipated date of completion. If the extended deadline is not met,this process must be repeated until the project is closed.
Failure to follow this process may result in the immediate close-out of the project and loss of further funding.
25.(Project End Date)For Preliminary Engineering projects the end date is ten(10)years from the execution date of the agreement.
For Right-of-Way projects the end date is fifteen(15)years from the execution date of the agreement.For Construction projects
the end date is five(5)years for projects under$1,000,000 or seven(7)years for projects over$1,000,000 from the execution
date of the agreement. Requests for time extensions and joint agreement amendments must be received and approved prior to
expiration of the project end date. Failure to extend the end date may result in the immediate close-out of the project and loss of
further funding.
26.(Single Audit Requirements)That if the LPA expends$750,000 or more a year in federal financial assistance they shall have an
audit made in accordance with 2 CFR 200. LPA's expending less than$750,000 a year shall be exempt from compliance.A copy
of the audit report must be submitted to the STATE(Office of Internal Audit, Room 201, 2300 South Dirksen Parkway,Springfield,
Illinois,62764)within 30 days after the completion of the audit,but no later than one year after the end of the LPA's fiscal year.
The CFDA number for all highway planning and construction activities is 20.205.
27. That the LPA is required to register with the System for Award Management or SAM,which is a web-enabled government-wide
application that collects,validates, stores,and disseminates business information about the federal government's trading partners
in support of the contract award and the electronic payment processes.To register or renew, please use the following website:
https://www.sam.ciov/SAM/
28.(Required Uniform Reporting)To comply with the Grant Accountability and Transparency Act(30 ILCS 708)that requires a
uniform reporting of expenditures. Uniform reports of expenditures shall be reported no less than quarterly using (DOT's BoBS
2832 form available on IDOT's web page under the"Resources"tab.Additional reporting frequency may be required based upon
specific conditions,as listed in the accepted Notice of State Award(NOSA). Specific conditions are based upon the award
recipient/grantee's responses to the Fiscal and Administrative Risk Assessment(ICQ)and the Programmatic Risk Assessment
Printed 01/07/20 Page 3 of 6 BLR 05310(Rev. 10/03/19)
PRA).
NOTE: Under the terms of the Grant Funds Recovery Act(30 ILCS 705/4.1),"Grantor agencies may withhold or suspend the
distribution of grant funds for failure to file requirement reports"if the report is more than 30 calendar days delinquent,without any
approved written explanation by the grantee,the entity will be placed on the Illinois Stop Payment List.(Refer to the Grantee
Compliance Enforcement System for detail about the Illinois Stop Payment List: https://www.iIlinois.gov/sites/GATA/Pages/
ResourceLibrary.aspx)
THE STATE AGREES:
1. To provide such guidance,assistance,and supervision to monitor and perform audits to the extent necessary to assure validity of
the LPA's certification of compliance with Title II and III Requirements.
2. (State Contracts)To receive bids for construction of the proposed improvement when the plans have been approved by the
STATE(and FHWA, if required)and to award a contract for construction of the proposed improvement after receipt of a
satisfactory bid.
3. (Day Labor)To authorize the LPA to proceed with the construction of the improvement when agreed unit prices are approved,
and to reimburse the LPA for that portion of the cost payable from Federal and/or State funds based on the agreed unit prices
and engineer's pay estimates in accordance with the division of cost page.
4. (Local Contracts)For agreements with federal and/or state funds in engineering, right-of-way, utility work and/or construction
work:
a.To reimburse the LPA for federal and/or state share on the basis of periodic billings, provided said billings contain sufficient
cost information and show evidence of payments by the LPA;
b.To provide independent assurance sampling and furnish off-site material inspection and testing at sources normally visited by
STATE inspectors for steel, cement, aggregate, structural steel, and other materials customarily tested by the STATE.
IT IS MUTUALLY AGREED:
1. Construction of the project will utilize domestic steel as required by Section 106.01 of the current edition of the Standard
Specifications for Road and Bridge Construction and federal Buy America provisions.
2. That this Agreement and the covenants contained herein shall become null and void in the event that the FHWA does not approve
the proposed improvement for Federal-aid participation within one(1)year of the date of execution of this agreement.
3. This agreement shall be binding upon the parties,their successors and assigns.
4. For contracts awarded by the LPA,the LPA shall not discriminate on the basis of race, color, national origin or sex in the award
and performance of any USDOT-assisted contract or in the administration of its DBE program or the requirements of 49 CFR
part 26.The LPA shall take all necessary and reasonable steps under 49 CFR part 26 to ensure nondiscrimination in the award
and administration of USDOT-assisted contracts.The LPA's DBE program, as required by 49 CFR part 26 and as approved by
USDOT, is incorporated by reference in this agreement. Upon notification to the recipient of its failure to carry out its approved
program,the STATE may impose sanctions as provided for under part 26 and may, in appropriate cases, refer the matter for
enforcement under 18 U.S. C 1001 and/or the Program Fraud Civil Remedies Act of 1986(31 U.S.0 3801 et seq.). In the
absence of a USDOT-approved LPA DBE Program or on state awarded contracts,this agreement shall be administered under
the provisions of the STATE'S USDOT approved Disadvantaged Business Enterprise Program.
5. In cases where the STATE is reimbursing the LPA, obligation of the STATE shall cease immediately without penalty or further
payment being required if, in any fiscal year,the Illinois General Assembly or applicable federal funding source fails to appropriate
or otherwise make available funds for the work contemplated herein.
6. All projects for the construction of fixed works which are financed in whole or in part with funds provided by this agreement and/or
amendment shall be subject to the Prevailing Wage Act(820 ILCS 130/0.01 et seq.)unless the provisions of the act exempt its
application.
ADDENDA
Additional information and/or stipulations are hereby attached and identified below as being a part of this agreement.
1. Location Map
2. Division of Cost
3. Resolution for Funding Commitment
4. Government Accountability and Transparency Act
Add Row
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The LPA further agrees as a condition of payment,that it accepts and will comply with the applicable provisions set forth in this agreement
and all Addenda indicated above.
APPROVED APPROVED
State of Illinois
Local Public Agency Department of Transportation
N OfOfflclal Print or Type Name Omer Osman P.E.,Acting Secretary Date
O
a5=L 71 By:
Signature Date Director of Planning & Programming Date
Director of Planning &Programming Date
The above signature certifies the agency's Tin number is
366009534 conducting business as a Governmental Entity.
Duns Number 038513818 Philip C. Kaufmann, Chief Counsel Date
Chief Fiscal Officer CFO Date
NOTE: if the LPA signature is by an APPOINTED official, a resolution authorizing said appointed official to execute this
agreement is required.
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ADDENDA NUMBER 2
Local Public Agency County Section Number
Village of Oak Brook DuPage 17-00049-00-PV
Construction Engineering Right of Way
Job Number Project Number Job Number Project Number Job Number Pro ect Number
C-91-007-18 N9(91 1)
DIVISION OF COST
Federal Funds State Funds Local Public Agency
Type of Work Fund Type Amount Fund Type Amount Fund Type Amount Totals
Participating Construction STU 1,843,600.00 55% 1,508,400.00 45%3,352,000.00
Construction Engineering STU 184,360.00 55% 150,840.00 45% 335,200.00
Participating Construction CMAQ 2,119,910.00 1,331,190.00 3,451,100.00
Construction Engineering CMAQ 211,990.00 133,910.00 345,900.00
Non-Participating Construction 8,100.00 8,100.00
Total $4,359,860.001 Total ITotall $3,132,440.00 7,492,300.00
Add
If funding is nota percentage of the total place an asterisk in the space provided for the percentage and explain below:
The CMAQ funding was originally intended to be 80%/20%, but due to anticipated increase in unit prices, Local Match amount was increased.
NOTE:The costs shown in the Division of Cost table are approximate and subject to change.The final LPA share is dependent on the final Federal and State participation.The actual
costs will be used in the final division of cost for billing and reimbursement.
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Instructions for BLR 05310 -Page 1 of 3
NOTE: Form instructions should not be included when the form is submitted.
This form shall be used when a local public agency(LPA)project involves Federal-Aid,with or without state funds and this standard form is
sufficient to describe all details of the agreement. For more information refer to the Bureau of Local Roads and Streets Manual(BLRS)
Chapter 5. For signature requirements refer to Chapter 2,Section 3.05(b)of the BLRS manual. When filling out this form electronically,
once a field is initially completed,fields requiring the same information will be auto-populated.
Local Public Agency
Name of LPA Insert the name of the LPA
County Insert the name of the county in which the LPA is located.
Section Number Insert the section number applied to this project.
Fund Type Insert the funding type(s)being used for this project(e.g.STU,STIR, ITEP, etc.)
ITEP,SRTS, HSIP Number Insert the ITEP,SRTS, HSIP number assigned to this project.
MPO Name Insert the name of the Metropolitan Planning Organization(MPO)in which the LPA is located
if applicable. If not applicable, select"N/A".
MPO Tip Number Insert the MPO Tip Number assigned to this project,this is required for all projects located
within the MPO planning boundaries if applicable. If not,insert"N/A".
Construction on State Letting Check this box if the construction portion of this project will be on a state held letting.
Day Labor Check this box if the project will be constructed using day labor.
Local Administered Engineering Check this box if the LPA is administering the engineering locally.
Right-of-Way Check this box if Right-Of-Way is part of the project.
Construction
Job Number Insert the job number assigned for the construction portion,the number will begin with a"C
Project Number Insert the project number assigned to the construction portion of this project.
Engineering
Job Number Insert the job number assigned for the engineering portion of this project.
Project Number Insert the project number assigned to the engineering portion of this project.
Right-of-Way
Job Number Insert the job number assigned for Right-of-Way for the project, if applicable.The number will
begin with a"R".
Project Number Insert the project number assigned to the Right-of-Way for the project, if applicable.
Location Use the add location button to add additional locations if needed for up to a total of five
location. If there are more than five locations, use various.
Local Street/Road Name Insert the local street/road name.
Key Route Insert the key route of the street/road listed above.
Length Insert the length in miles as it pertains to the location listed above. For a structure insert 0.01.
Station
From Insert the beginning station of the project as it pertains to the key route for this location for this
project.
To Insert the ending station of the project as it pertains to the key route for this location for this
project.
Location Termini Insert the beginning and ending termini as it pertains to this location for this project.
Existing Structure Number(s) Insert the existing structure number(s)for this project.
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BLR 05310(Rev.10/03/19)
instructions for BLR 05310 -Page 2 of 3
Add Location Use this button to add additional locations.A total of four additional locations can be added. If
there are more than 5 locations,do not add each location. Instead,insert"Various"in the first
location field.
Project Description Insert a description of the work to be accomplished by this project.
Method of Financing This area is for state-let-contracts only.Check one.
Method A If this box is checked insert the dollar amount equal to 80%of the LPA's total obligation.
Method B If this box is checked insert the number of monthly payments needed to repay 80%of the
LPA's estimated obligation.
Method C If this box is checked insert the dollar amount of the LPA's share of the construction costs for
this project.
For State Let Construction Projects:
Addenda
Within the Addenda table, check the box as applicable. Insert the item number of the addenda and a description of the item.
1. Location Map Attach a location map to this agreement showing all locations being improved by this project.
2. Division of Cost Insert the division of cost page(see separate instructions for completing this document).
3. LPA Appropriation Resolution For State-Let construction projects,the LPA must pass an appropriation resolution covering
the local share of the project.Attach the resolution for this appropriation.
4. IDOT Fiscal Approval Signature Page
Approved
Local Public Agency The appropriate LPA official shall insert their name,sign and date. Insert the LPA's TIN
number and DUNS Number.
Illinois Dept of Transportation The appropriate IDOT official shall sign and date here.
For Local Let Projects:
1. Location Map Attach a location map to this agreement showing all locations being improved by this project.
2. Division of Cost Insert the division of cost page(see separate instructions for completing this document)
For additional addenda,check this box and insert a description of the item and attach it to the agreement.
Approved
Local Public Agency The appropriate LPA official shall insert their name,sign, and date. Insert the LPA's TIN
number and DUNS Number.
Illinois Dept of Transportation The appropriate IDOT officials shall sign and date here.
Division of Cost Table:
When the LPA desires to use one or more lump-sum amounts before the federal percentage is calculated, specify the order in which it
should be used and the"not to exceed"amount.The following provides an example of the wording that may be used:
Lump-sum$60,000 TARP funds not to exceed 50%of final cost of project credited to the project to be utilized first.
Lump-sum to be utilized second not to exceed$20,000 EDP funds.
Lump-sum to be utilized third not to exceed$40,000 SMA funds.
These specified amounts will be used in sequence,with the federal and local percentages calculated after they are deducted.
When the LPA desires to use a percent"not to exceed"commitment,the federal and state funds will be used concurrently at the specified
percentages up to the"not to exceed"amount
Example:
Maximum STIR participation 80%not to exceed$100,000
Lump-sum SMA not to exceed$20,000 to be used as a match to the federal funds
Be advised that the"not to exceed"amount specified under a percentage commitment will be tied up and unavailable for programming until
the project is closed out and a documentation review has been completed by IDOT or FHWA, if required.
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BLR 05310(Rev.10/03/19)
Instructions for BLR 05310-Page 3 of 3
Division of Cost Table:
Use a separate line for each type of work as it relates to the fund type for federal, state and/or LPA funds.
Type of Work Choose the type of work from the drop down list.Types to choose from are: Participating
Construction, Non-Participating Construction, Preliminary Engineering, Construction
Engineering, Right-of-Way, Railroads, Utilities,and Materials.
Federal Funds If federal funds are being used on this project complete the following for federal funds.Fund Type Choose the type of federal fund type form the drop down.
Amount Insert the amount of federal funds for the type listed under fund type.
Insert the percentage of federal funds for this type.
State Funds If state funds are being used on this project complete the following for state funds.
Fund Type Choose the type of State Funds from the drop down.
Amount Insert the amount of state funds for the type listed under fund type.
Insert the percentage of state funds for this type.
Local Public Agency Funds
Fund Type Insert the type of LPA funds being used on this project.
Amount Insert the amount of LPA funds for the type listed under fund type.
Insert the percentage of local funds for this type.
Explanation Insert any necessary additional information as to how the funding is being applied for this
project.
A minimum of three(3)originals executed by the LPA must be submitted to the District through its Regional Engineer's Office.Distribution will be as follows:
District file
Bureau of Local Roads Central Office(2)
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BLR 05310(Rev.10/03/19)