Utility Coordination Standard Documents

The following standard documents are related to utility coordination for highway improvement projects. These documents are designed to support the coordination process required to follow the rules established under Utility Facility Relocations on Construction Contracts(105 IAC 13). These documents may be most useful to employees of utilities, consultants, contractors and INDOT.

Standard Documents:

Utility Certification

Utility Coordination Certificate
Revision 06/01/2016
(Template/Example)

Certification of Utility Coordination Instruction 3/3/17
(Instructions

Special Provisions 107-R-169 - Example 08/10/2015
(Template/Example)

Letters

Initial Notice of Proposed Project - revised 08/08/2017
(Template/Example)

Request Verification of Existing Facilities - revised 04/18/2013
(Template/Example)

Request Conflict Analysis - revised 04/18/2013
(Template/Example)

Request Work Plan - revised 05/04/2017
(Template/Example)

Work Plan Approved - revised 04/04/2014
(Template/Example)

Send Agreement - revised 08/30/2013
(Template/Example)

Return Agreement - revised 08/30/2013
(Template/Example)

Notice to Proceed - revised 04/26/2013
(Template/Example)

Contractor/Consultant Approval - revised 05/31/2013
(Template/Example)

Contractor Work Complete (5 or 15 day) - revised 04/26/2013
(Template/Example)

Work Plan Complete - revised 03/20/2014
(Template/Example)

Request Final Bill and Itemized Summary - revised 11/01/2014
(Template/Example)

Memo Routing for Agreements - revised 07/17/2015
(Template/Example)

Work Plan & Risk Report

Utility Relocation Work Plan - revised 3/1/2017
(Template/Example)

Utility Risk Report - revised 12/09/2013
(Template/Example)

General

Project Design and Utility Summary Table

Buy America Form INDOT - Revised 3/20/2017

Related Links

Utility Coordination

Utility Coordination Certification

Contact Information

Michael B. Jett
Utilities and Railroad Director
Indiana Department of Transportation
100 N. Senate Ave. IGCN 642
Indianapolis, IN 46204
Office: (317)-232-5081
Email: mjett@indot.in.gov