sh|s± ± v± · 2020-04-16 · proposal requirements proposals must be submitted for this project...

3045 05/04/20 noon est

ERIC BURNS Various Various

PROGRAM MANAGER FOR ANCILLARY STRUCTURES

PROPOSAL REQUIREMENTS

Proposals must be submitted for this project electronically. Proposal submittal requirements are listed in PART IV – INSTRUCTION FOR SUBMITTING PROPOSALS at the following link Selection Guidelines for Service Contracts

FINANCIAL REQUIREMENTS FOR NON-PREQUALIFIED Revised 2/2020

Financial Requirements for Non‐Prequalified Consultants/Vendors

E-VERIFY REQUIREMENTS E-Verify is an Internet based system that allows an employer, using information reported on an employee’s Form I-9, Employment Eligibility Verification, to determine the eligibility of that employee to work in the United States. There is no charge to employers to use E-Verify. The E-Verify system is operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration. E-Verify is available in Spanish.

The State of Michigan is requiring, under Public Act 200 of 2012, Section 381, that as a condition of each contract or subcontract for construction, maintenance, or engineering services that the pre-qualified contractor or subcontractor agree to use the E-Verify system to verify that all persons hired during the contract term by the contractor or subcontractor are legally present and authorized to work in the United States.

Information on registration for and use of the E-Verify program can be obtained via the Internet at the DHS Web site: http://www.dhs.gov/E-Verify.

The documentation supporting the usage of the E-Verify system must be maintained by each consultant and be made available to MDOT upon request.

It is the responsibility of the prime consultant to include the E-Verify requirement documented in this NOTIFICATION in all tiers of subcontracts.

DIGITAL SIGNATURE OF CONTRACTS On January 4, 2018, Contract Services Division implemented the use of CoSign as the exclusive software for digitally signing all consultant contracts and consultant contract related documents. All other digital signing methods are no longer accepted. Prior to using CoSign, all external partners must apply for a free digital signature user account by submitting a MDOT Digital Signature Certificate Request Form.

http://www.michigan.gov/documents/MDOT_Consultant-Vendor_Selection_Guidelines-0106_145222_7.pdf?20150707153457

https://www.michigan.gov/documents/mdot/Financial_Requirements_for_Non_Prequalified_Vendors_605817_7.pdf

https://www.michigan.gov/documents/mdot/Financial_Requirements_for_Non_Prequalified_Vendors_605817_7.pdf

http://www.dhs.gov/E-Verify

https://mdotjboss.state.mi.us/webforms/GetDocument.htm?fileName=2122.pdf

https://mdotjboss.state.mi.us/webforms/GetDocument.htm?fileName=2122.pdf

MDOT INSURANCE UPDATED 3.9.17

At a minimum, the insurance types and limits identified below, may be required from the selected

consultant, prior to contract award.

Required Limits Additional Requirements

Commercial General Liability Insurance

Minimal Limits:

$1,000,000 Each Occurrence Limit

$1,000,000 Personal & Advertising Injury Limit

$2,000,000 General Aggregate Limit

$2,000,000 Products/Completed Operations

Consultants must have their policy endorsed

to add “the State of Michigan, its

departments, divisions, agencies, offices,

commissions, officers, employees, and

agents” as additional insureds

Automobile Liability Insurance

Minimal Limits:

$1,000,000 Per Occurrence

Workers' Compensation Insurance

Minimal Limits:

Coverage according to applicable laws

governing work activities.

Waiver of subrogation, except where waiver is

prohibited by law.

Employers Liability Insurance

Minimal Limits:

$500,000 Each Accident

$500,000 Each Employee by Disease

$500,000 Aggregate Disease

Professional Liability (Errors and Omissions) Insurance

Minimal Limits:

$1,000,000 Per Claim

The Insurer shall provide at least thirty (30) days written notice of cancellation. The Prime Consultant

will be responsible to verify subconsultant(s) compliance with MDOT’s insurance requirements.

NOTIFICATION MDOT CONSULTANT MENTOR-PROTÉGÉ PROGRAM

FOR 100% STATE FUNDED PROJECTS

The Michigan Department of Transportation’s (MDOT) Consultant Mentor-Protégé Program is designed to assist in sustaining and enhancing the capacity of small business consultants to successfully compete for new vendor-consultant procurement opportunities. There is also an opportunity to promote improved performance and efficiencies in the overall procurement and delivery of effective and efficient engineering and technical services to the department

The Protégé must have an approved Protégé application submitted to the Mentor-Protégé Committee, per the instructions on the application. Also, in order to become a Protege and be included as a Protege on Mentor-Protege project submittals, the Protege firm must be financially prequalified by MDOT, and must follow all other requirements as identified in the MDOT Consultant Mentor-Protege Program Procedures. The current list of approved Protégé firms is available on the SBP website at www.michigan.gov/mdotsbp .

Proposers teaming with multiple Protégés will not increase or decrease the amount of points available to be awarded in this section.

Scoring The Mentor-Protégé relationship will be described in the ‘Understanding of Service” portion of the proposal and will describe the work to be performed by the Protégé, and how this work fits into the project scope, as well as how the Mentor will guide and oversee that work. The points awarded will not exceed twenty (20) percent of the total number of points available for the Understanding of Service portion of the proposal. The Mentor-Protégé Plan is not to be submitted with the technical proposal, but developed by the Mentor selected for the project, and submitted with the Priced Proposal for evaluation by the Mentor-Protégé Committee. The Plan is not given a numerical score, but will receive a Pass/Fail determination. A contract will not be awarded until the Plan has received a passing determination.

Scoring for the “Qualifications of Team” will only consider those team members who are prequalified in the service categories required for the scope of services contained herein. Protégés must not be considered in the evaluation and scoring of the team’s qualifications.

Work Items If any of the Proposal elements of work are being performed by a Protégé who is not prequalified in that service category, the Mentor is responsible to ensure that the work produced meets the Department’s standards, requirements, and quality expectations. In the event the Protégé is unable to perform the tasks required of the work or produce deliverables acceptable to the Department, the Mentor will be required to complete those tasks and deliverables.

Evaluation of the Mentor-Protégé Plan The Mentor-Protégé Plan will be developed by the Mentor selected for the project and submitted with the Priced Proposal. The Department’s Office of Business Development will periodically evaluate execution of the Mentor-Protégé Plan for the Mentor-Protégé relationships contained in this Proposal. This may include interviews with any of the parties engaged in this contract, observation of interactions between parties to the contract, and review of work products associated with the contract. The Project Manager must incorporate the performance of the Mentor-Protégé Plan in the consultant performance evaluation process.

Compensation The time and effort required to execute the Mentor-Protégé Plan within this proposal are compensable as part of this contract. The Price Proposal should clearly define the hours and

costs associated with this effort, to be negotiated with the MDOT Project Manager based on the specifics of the Mentor-Protégé Plan.

SBP Participation If a Protégé is a certified SBP firm, but not prequalified in the work area they are performing, it makes the work performed by the Protégé ineligible for credit toward the SBP goal on that project only. If a certified SBP is performing other work unrelated to this arrangement, they will be eligible for SBP credit for any work not included in the Mentor-Protégé program.

If a Protégé is terminated for cause or by mutual consent, it must be disclosed to MDOT as soon as determined. The Mentor shall identify the feasibility and practicality of a replacement Protégé. If the Committee and the Project Manager agree that it is in not feasible or practical to replace the Protégé, the Mentor will determine how the work will continue, and obtain approval from the Committee and the Project Manager. The contract may be amended, including a potential decrease in the contract dollar value. MDOT will not increase the contract dollar value due to a replacement Protégé or change in team members responsibilities.

Future participation by the Protégé in the Mentor-Protégé program will be determined by the Committee.

1 Revised Posted Scope: 4/16/2020

Michigan Department of Transportation

SCOPE OF SERVICE FOR

SPECIALTY SERVICES PROGRAM MANAGER

Ancillary Structures Program MENTOR PROTÉGÉ PROGRAM

Revised 4/8/2020 Revised 4/16/2020- Added Appendix A and E

CONTROL SECTION: Various JOB NUMBER: Various PROJECT LOCATION: Various locations throughout the State. PROJECT DESCRIPTION: This scope of services is for the solicitation of expert transportation professionals to work with, represent and act as a Michigan Department of Transportation (MDOT) representative for various program and project services in support of MDOT owned ancillary structures program. Ancillary structures currently within MDOT inventory is as follows:

*Table 1: Ancillary Structures Inventory Structure Asset Quantity Unit

Sign Cantilever 918 Each Communication Tower 23 Each Dynamic Message Sign (DMS) Support Structure 193 Each Environmental Sensor Station (ESS) Lattice Tower 102 Each Lighting Tower 157 Each Noise Barrier Wall 348911 Ft Retaining Wall 279787 Ft Spun Concrete Pole 297 Each Steel Strain Pole 386 Each Sign Truss 832 Each Wood Pole 301 Each Culverts less than 10' 36869 Each Frangible Lights 760 Each Non-Frangible Lights 946 Each Embedded Poles 89 Each Mast Arms 97 Each

* This table represents known asset data, not inclusive of location or condition assessment data. See Appendix A for Ancillary Structures Inventory with MDOT Region breakdown. It is


anticipated that this inventory will change as new projects are completed and older assets are retired through the life of the contract. The goal is to develop and maintain an ancillary structures database framework (inventory and condition ratings), similar to established processes for the National Bridge Inspections Standards (NBIS), and to develop an asset management program for ancillary structures. The database framework must be compatible with existing MDOT user interface systems for asset management activities. Develop standard plans for ancillary structures without existing plans and update existing applicable standard plans. Develop of ancillary structures specifications. Create consistency in ancillary structure types deployed by MDOT. It is anticipated that one consultant will be selected as the Program Manager Consultant (PMC) for services in support of the Ancillary Structures Program. ANTICIPATED SERVICE START DATE: July 1, 2020 ANTICIPATED SERVICE COMPLETION DATE: June 30, 2025 DBE PARTICIPATION REQUIREMENT: N.A PRIMARY PREQUALIFICATION CLASSIFICATION(S): Design – Bridges Design – Bridges: Safety Inspections Design – Project Development Studies SECONDARY PREQUALIFICATION CLASSIFICATION(S): *Design – Geotechnical: Advanced *Design – Roadways Intermediate *Design – Traffic: ITS – Design & System Manager *Design – Traffic: Signing – Freeway *Design – Traffic: Signing – Non-Freeway *Design – Traffic: Signal *Design – Traffic: Work Zone Mobility & Safety *Design – Traffic: Work Zone Maintaining Traffic Plans & Provisions *Design – Hydraulics II *Design - Utilities: Roadway Lighting *Surveying- Right of Way *Surveying- Road Design *Surveying: Structure *Surveying: Hydraulics *Precautionary


PREFERRED QUALIFICATIONS AND CRITERIA: It is preferred that the selected consultant team with qualified firm(s) in the Small Business Program (SBP) to perform work task under this contract. MDOT PROJECT MANAGER: Eric M. Burns, P.E. Structure Preservation Section Engineer MDOT Bureau of Bridges and Structures 6333 Lansing Road Lansing, MI 48917 PH: 517-636-6946 SERVICE PERIOD: The selected PMC will assist and support MDOT in developing and administering portions of the Ancillary Structures Program. The PMC will be assigned a Task Order with a scope of work with distinct work tasks and job number, contingent upon satisfactory performance, assistance needed and available funding. The amount of work assigned to the PMC will be determined by project needs, workload, and the MDOT Project Manager (PM). CONFLICT OF INTEREST: The PMC and its sub-consultants performing will not be allowed to participate or join any design-build team on projects developed under this master contract. This includes but is not limited to: Design-Build-Finance, Design-Build-Finance-Maintain and Design-Build-Finance-Operate-Maintain projects. If projects developed under this master contract follows a design-bid-build process, the construction engineering services may not be completed by those firms working on final design, and preparation for bid letting activities. The PMC must certify that there is no conflict of interest with the subject project. If there is a conflict with the subject project, then the PMC must describe the conflict on Form 5100D. MDOT considers it a conflict of interest for a PMC to represent more than one party in relation to any given project regardless of which phases of the service are involved. Conflict of interest includes a proposal for a PMC to perform services for MDOT and the construction contractor on the same construction project. PMC can find Conflict of Interest Guidance for Project Managers and Consulting Firms on MDOT’s website.


GENERAL PROJECT INFORMATION: This contract is for various planning, inspection, scoping, preliminary engineering and other related services in the overall development of a statewide ancillary structures program to identify, report, and address all ancillary structures on the MDOT’s system. The goal of the project is to inspect the assets, collect and manage inspection data, identify and prioritize work recommendations, and develop design plans when necessary for all MDOT owned ancillary structure assets by Spring of 2023. The PMC’s primary services are for program development and management to assistance the MDOT PM. All work performed by the Program Management PMC will be assigned using task orders based on a multi-phase Master Contract. It is MDOT’s intent to issue task orders for all necessary activities to complete the program management services; however, issuance shall be based on having sufficient funding. SCOPE OF WORK: The selected PMC services could include work at the broad program administration level down to specific project level work tasks. Tasks throughout the life of the contract may include assisting with planning, inspection, scoping, preliminary engineering, and other data analysis in the development of an ancillary structures program, using preliminary criteria as noted in the Program Development Section below. The scope of work is generally comprised of the following elements:

Program development, review of current ancillary structures locations and condition data. Develop ancillary structures inspection / design standards and scoping criteria. Review existing guidance, policies and procedures, and update as needed. Develop a comprehensive inventory with condition data, and input into the appropriate software used for inventory and condition tracking. The collection of data, database building and data analysis structure should closely resemble the already establish procedure as part of MDOT’s NBIS program. Perform data collection.

Program / Asset management, risk management, contract administration, program/project

controls, inspection and testing services for ancillary structures, quality assurance services,

communication services, and administrative support.

Preliminary engineering, scoping and supporting data collection focused on managing

items of greatest risk to achieving MDOT’s ancillary structure goals. This also includes

assisting MDOT with utility coordination, along with coordination with other agencies,

such as MEGLE and MDNR, and working towards programmatic agreements.


PROGRAM DEVELOPMENT: The purpose of this activity is to gather / collect all pertinent data relative to ancillary structures to develop the following for MDOT Approval:

Develop naming convention Develop and maintain inspection standards which includes:

o Develop/review condition ratings data for each ancillary structure type. Rate each ancillary structure type 1-4 (except for retaining and sound wall which will be rated on a National Bridge Inspection Standard (NBIS) scale of 0-9. See Appendix B for Rratings Gguidelines for Retaining Walls and Sound Walls). Inspect and rate culverts (which will be rated 9-1) according the “Culvert Assets Collection Guide”). See Appendix BC – Sample Draft Inspection Procedures and Appendix CD – Sample Draft Inspection Forms.

Design structural inventory/inspection forms to be developed by MDOT in MDOT systems. (AASHTOWare BrM)

Design As built / final inspection forms to be developed by MDOT in MDOT systems (AASHTOWare BrM)

Develop risk-based inspection intervals and criteria Review ancillary locations Develop a plan to collect the following ancillary structure data including but not limited

to: o Inventory data – Review MDOT projects/lettings to identify impacts to ancillary

structure inventory. o Inspection and condition data o Provide required lane closures. The PMC will be responsible for coordinating lane

closures with the TSC and obtaining permits. The PMC will also be responsible for furnishing, operating and removing all traffic control devices.

o Equipment required to collect the data. The PMC will be responsible for furnishing and operating the required equipment to inspect the structure.

Perform inspections, provide ratings, verify locations, and collect inventory data. Develop and utilize a Request for Action process similar to the process used for bridge

assets. See Appendix DF – Sample Request for Action. o Identify work recommendations that should be completed prior to the next

inspection o Using engineering judgement, prioritize actions and provide recommendations. o Track completion of RFA’s and outstanding RFA needs. o Provide reports of RFA status as necessary

Develop updates to existing guidance, standards, policies, procedures, and manuals. Outline of asset management plan which includes but in not limited to:

o Number of structures per rating 1-4 for each ancillary structure type (except for

retaining walls, and sound walls which will be rated on a National Bridge Inspection

Standard (NBIS) scale of 0-9; and culverts less than 10’ that will be rated 9-1

according to the “Asset Collection & Condition Assessment Guide for 1’-10’ Span

Culverts” guide )

o Analyze and develop asset management strategies for each ancillary structure type


o Review condition strategies for possible preservation methods for each ancillary

structure types

o Calculate ancillary structure condition state performance targets.

o Analyze existing template funding and propose funding templates in order to meet

varying targets. Provide potential targets based on proposed funding levels.

o Provide recommendations for asset management for each ancillary structure type.

PROGRAM MANAGEMENT: The purpose of this activity is to provide overall direction, establish cost and schedule-control procedures, and identify the requirements for providing oversight for the ancillary structure program. The tasks within this activity are based on the following general categories:

An ancillary structure program risk registry listing risks, risk allocation, reduction options & strategies, and risk assessment reports updated on a regular basis

Develop and implement an Ancillary Structures Charter Establish specific program/project control procedures Develop and implement ancillary structure quality-control and quality assurance measures Program reporting and documentation Stakeholder outreach Provide recommendations for small business opportunities Participate as appropriate in dispute resolution process between consultants, vendors,

contractors and MDOT. As-needed quality assurance reviews of ancillary structure plans and specifications

prepared by MDOT and/or MDOT’s consultants to ensure program consistency. The PMC will also be responsible for reviewing plans for conformance of MDOT and local agencies master plans.

The PMC will also aid in the development of an overall governance structure for the program, to ensure critical buy-in from each group, decision-making hierarchy, and tactical execution of the program. After data collection and inclusion of data into MDOT systems the PMC shall perform a network level review, and begin to develop projects as directed by MDOT and based on the criteria including, but are not limited to:

Network level review and capital investment strategy for potential ancillary structures based on:

o Scope of work, and preliminary estimate development based on condition: Ancillary Structure replacements for critical structures Ancillary Structure rehabilitation activities for poor structures Maintenance and Preservation strategies for fair to good Ancillary Structure

o Call for Projects/ 5-year plan

Identify ancillary structure to be packaged with road, bridge, and or other

ancillary structure projects

o Overall asset management to achieve and maintain condition goals o Review and verification of existing ratings not performed by PMC

Other items to consider in analysis:

o Ancillary structure needs: Removal


Rehabilitation versus replacement Consideration of overall life cycle asset management plans, in alignment

with Transportation Asset Management Council (TAMC) goals

o Geography: Group to obtain geographic economies of scale

Consider ITS infrastructure and outages, network of signs and signals as it relates to Ancillary Structures

o Proposed schedule

Based on condition of ancillary structures Based on schedule of nearby projects

PROJECT SCOPING/PRELIMINARY ENGINEERING: Develop the ancillary structures project’s preliminary engineering/design for the contractor(s) to have a sufficient level of information to propose on the program contracts with a minimum of risk. To minimize risk on the program all potential risks shall be identified and reviewed at the construction contract packaging level as well as for the overall program. Tasks may include survey, preliminary ancillary structure design, draft transportation management plan (TMP) development, NEPA compliance, geotechnical investigations, environmental/hazardous material testing, utility investigations, railroad coordination, development of standard plans and rehabilitation details, and field reconnaissance. Deliverables and/or sub-tasks: These deliverables include but are not limited to:

o Preparation of preliminary ancillary structure designs o Project estimating o Ancillary structure & retaining wall studies o Identification of risk assessment o Assistance with aesthetic features development o Coordination of utilities o Coordination with other agencies o Support for survey activities o Assistance with right of way activities o Geotechnical services o Documentation and preparation of financial, costs & budgets o Review of other consultants’ work

Data analysis, project scoping, and preliminary engineering sufficient for the development of ancillary structures for various project delivery methods and strategies. To minimize risk on the program all potential risks identified at the preliminary engineering level shall be identified and reviewed for “go” or “no go” types of decision making. Tasks may include various surveys, scoping, preliminary roadway and structure engineering, and draft transportation management plan (TMP) development sufficient to evaluate proposed ancillary structures impacts on regional mobility. Tasks may also include geotechnical investigations, third-party coordination, field reconnaissance, and preliminary NEPA scoping reviews to identify environmental constraints.


PROCUREMENT: Recommend traditional or innovative contracting delivery options such as design-build, CMGC and/or other delivery options necessary to assist MDOT with selection and award of contracts to construct and/or rehabilitate Ancillary Structures. WORK TASKS: The MDOT PM will contact the PMC through a letter and scope of work detailed with specific tasks and timeframes required. Work tasks will be issued throughout the length of the contract including any extensions to the master contract that may be executed. The letter will state the specific needs, the MDOT job number and control section, task descriptions, services required, required deliverables and the timeframe in which the work shall be required for submission and completion. It is possible that some of the tasks will be conducted on an expedited schedule and the PMC is required to provide adequate expert staff to meet or exceed the schedule. The PMC may work on a Work Task basis provided the PMC has performed adequately on previous project(s) and Work Tasks. Performance will consider work on this contract as well as performance on other contracts with MDOT. The PMC will submit a plan of work, as defined in the letter request. The plan will consist of the PMC’s proposed work tasks and staffing plan to successfully accomplish the tasks. MDOT approvals and actions will also be listed in the plan within the stated timeframe. MDOT will review the work plan and collaborate with the PMC to modify if needed. MDOT or the PMC may request a meeting prior to acceptance of the final plan of work. The plan should include:

1. The names of all personnel, including key staff chosen and available to provide the specified tasks.

2. The names of the sub-consultants, their personnel and role in task completion. 3. The names of which firms are performing which prequalification classifications. 4. A method detailing how the tasks will be completed, delivered & maintained within the

schedule, including MDOT involvement and the estimated dates for milestone events. 5. A conflict of interest statement covering the PMC and sub-consultant(s). 6. A list of what is needed from MDOT and when it is needed to meet the specific tasks and

schedule. 7. A priced proposal in accordance with current requirements.

MDOT reserves the right to approve the final plan of work based on the PMC’s understanding of the specific project tasks and proposed personnel. GENERAL STAFFING REQUIREMENTS: The PMC is expected to provide a satisfactory number of qualified personnel to effectively execute the contracted responsibilities. Depending on the task and schedule, there may be work during nighttime hours, on weekends, and/or under expedited time constraints. The number of personnel needed during any task may change as the project progresses.


The PMC will adequately staff each task in advance of the start of work, in order to be properly prepared to satisfy the responsibilities. However, the PMC must not assign any personnel until submitting in writing first for MDOT’s review and approval, the qualifications of each person proposed to be assigned to the task. The PMC must submit this request for approval to the MDOT PM at least two weeks before the date an individual is expected to start work. The PMC will need approval for any changes to key personnel as provided in the contract. An amended Form 5100G will need to be submitted along with a resume and a reason for the switch to assure MDOT, a comparable substitute is being utilized. If the PMC does not get approval for this substitution, MDOT will not accept the hours worked as billable and the PMC will be working at their risk. An individual who is previously approved by the MDOT PM, but whose performance is later determined to be unsatisfactory, will not be allowed to continue the task and project, and may be replaced by the PMC if an alternate is acceptable to the MDOT PM.

When the personnel need of a task are reduced, the PMC will reduce the number of its staff. Any adjustment of work forces as recommended by the MDOT PM will be accomplished within one week after notification. MDOT reserves the right to add or reduce staff on tasks as it so desires during the contract. REQUIRED MDOT GUIDELINES AND STANDARDS: Work shall conform to current MDOT, FHWA, and AASHTO practices, guidelines, policies, and standards (i.e., Road Design Manual, Bridge Design Manual, Special Details, Standard Plans, Published MDOT Design Advisories, Drainage Manual, Roadside Design Guide, A Policy on Geometric Design of Highways and Streets, Michigan Manual of Uniform Traffic Control Devices; FHWA Guidelines for the Installation, Inspection, Maintenance and Repair of Structural Supports for Highway Signs, Luminaires and Traffic Signals, etc.). The PMC is required to use the MDOT Current Version of Bentley CAD Software (published at Section 2.2.2 of the Design Submittal Requirements) with the current MDOT workspace (published at Section 2.2.1 of the Design Submittal Requirements). 3D Models are required for all applicable projects. See Chapter 2 of the Design Submittal Requirements for a complete listing of applicable projects. The PMC shall comply with all MDOT CADD standards and file naming conventions. The PMC also shall comply with the most current version of AASHTOWare Bridge Management (BrM) data requirements for inspection data and inspection reports.


MDOT RESPONSIBILITIES: MDOT will provide written notice providing clear direction for the process to be adhered to and the final deliverables. Work is to be performed consistent with 23 CFR Part 450, 23 CFR Part 650, and 49 CFR Part 613 (Statewide and Metropolitan Planning Rule), and other applicable state and Federal regulations. MDOT will also provide direction for the development of the specific work tasks.

Schedule and conduct meetings. Provide pertinent reference materials and share previous and current data, studies,

plans, reports, analyses, etc. Coordinate and facilitate internal reviews, resolve issues and provide decisions at

critical points through the schedule. Modify/Develop MDOT systems to incorporate ancillary structure inspection

processes PMC RESPONSIBILITIES: The responsibilities will be to complete the scope and specified work tasks, per federal and state requirements, ensuring NEPA compliance.

The PMC must adhere to all applicable OSHA and MIOSHA safety standards, including the appropriate traffic signs for the activities and conditions for this job and perform field operations in accordance with the Department’s Personal Protective Equipment (PPE) policy as stated in the MDOT Guidance Document #10118.

Meet with the MDOT PM to review project, location of data sources and contact persons, and review relevant MDOT operations. The PMC shall review and clarify project issues, data needs and availability, and the sequence of events and team meetings that are essential to complete the task by the completion date.

A. Complete work tasks as assigned by MDOT PM.

B. Prepare required plans, illustrations, evaluations, details, graphics,

presentation materials, and others as needed.

C. Provide solutions to any unique problems that may arise.

D. Maintain a Project Record which includes a history of significant

events (changes, comments, etc.).

E. Record and submit type-written minutes for all project related meetings to the MDOT PM within two weeks of the meeting. MDOT will provide and distribute official meeting minutes, as needed.

F. Provide to MDOT, by entering MDOT ProjectWise at scheduled

milestone dates, copies of ancillary structure inspections, draft and final plans, information, data, etc. needed. Electronic copies in Word format will also be required.


G. Prepare and submit electronically (native format or PDF) into MDOT ProjectWise, any information, reports, illustrations, associated analysis or drawings.

H. Attend any project-related meetings as directed by the MDOT PM.

I. Attend any other meetings, as directed to assist in responding to concerns and/or questions, if needed. This may require assistance with preparation of graphics, maps, etc.

J. Incorporate pertinent information as required in the specific deliverable.

K. The MDOT PM shall be the official MDOT contact person for the PMC and shall be made aware of all communications. The PMC must either address or send a copy of all correspondence to the MDOT PM. This includes all sub correspondence and verbal contact records.

L. Contact the MDOT PM whenever discoveries have the potential to require changes in the scope of work.

M. Develop a decision process tracking plan to document decisions made and information considered so this can be used for education and knowledge transfer as the program develops.

N. Coordinate ancillary structures inspections with Transportation Service Centers (TSC’s) and Regions for compliance with maintaining traffic restrictions and for coordinating with active construction projects.

O. The PMC shall be responsible for all traffic control required to perform the tasks as outlined in this Scope of Design Services.

P. The PMC shall be responsible for obtaining up to date access permits and pertinent information for tasks in MDOT Right of Way (ROW). This information can be obtained through Utilities/Permits in the Development Services Division.

Q. Develop chapters for ancillary structures to be incorporated in the Michigan Structures Inspection Manual (MiSIM). See Appendix E – MiSIM Chapters

R. Provide necessary equipment to inspect ancillary structures such as aerial lifts, bucket trucks, etc.

S. Report culverts assets according to the “Culvert Assets Collection Guide”


MONTHLY PROGRESS REPORT: On the first of each month, the PMC shall submit a monthly progress report detailing the work accomplished to date, planned for the next month and any needs.

DELIVERABLES: The PMC shall deliver all computer files associated with the project in their native format (spreadsheets, CADD files, Open Roads Designer (ORD) files, etc.) to be uploaded into ProjectWise, as directed by the MDOT PM. All CAD/ORD files shall be created and identified with standard MDOT file names as shown in the MDOT Standard File Naming Convention that is attached to this document. The electronic files will be published to contractors at the time of letting as Reference Information Documents (RID). The PMC may be asked to upload plans to MDOT’s ProjectWise system

It is the PMC’s responsibility to obtain the current Bentley CAD Workspace as published monthly to comply with MDOT’s standards. Any Bentley CAD/ORD files that do not conform to MDOT standards will be returned for correction at the PMC’s expense.

Proposal documents shall be submitted in their native format with standard naming conventions as well as combined into one pdf file in the sequence specified by MDOT. To provide text search capabilities, the combined proposal shall be created by converting native electronic files to pdf. Scanning to pdf is discouraged except in instances where it is necessary in capturing a legally signed document or when a hard copy version of a document is all that exists.

The PMC will implement digital signature protocols for all applicable documents as determined by MDOT and the MDOT Project Manager. Plan files shall be submitted in their native dgn format with standard naming conventions and compiled into a pdf plan set. Plan sheets shall be plotted to Pdf with full text search and level on/off capabilities in 11” x 17” format. A title sheet shall be printed stamped and signed then scanned for inclusion with the Pdf set. The original title sheet shall be filed by the PMC and stored for a minimum of seven years.

Reference Information Documents (RID) shall be entered into MDOT ProjectWise in the appropriate folder with standard naming conventions and content at milestone submittals as defined by the MDOTwiki website - Chapter 4 and Chapter 5 of the Design Submittal Requirements. The RID files included will depend on the design survey deliverables and project template (See MDOT wiki - Chapter 2 of the Design Submittal Requirements). These files could include but are not limited to: CADD, existing terrain, proposed cross sections, 3D models and files generated for Automated Machine Guidance (AMG) and automated inspection/stakeout activities. It is recommended that the Project Quantity Spreadsheet (PQS) be used to generate the xml files necessary for import into the AASHTOWare Project Preconstruction bid letting software. The .xml files shall be entered MDOT ProjectWise in the appropriate folder. Corresponding PDF files for required reports will be generated as directed by the MDOT Project Manager.

http://mdotwiki.state.mi.us/design/index.php/Chapter_4_-_Developing_3D_Models

http://mdotwiki.state.mi.us/design/index.php/Chapter_1_-_Introduction


http://mdotwiki.state.mi.us/design/index.php/Chapter_2_-_Data_Requirements



The project removal, construction, and profile sheets will require a scale of 1” = 80’ or as approved by the Project Manager. See Section 1.02.12 of the Road Design Manual for further direction. All plans, special provisions, estimates, and other project related items shall meet all MDOT requirements and detailing practices (i.e., format, materials, symbols, patterns, and layout) or as otherwise directed by the MDOT Project Manager. All plans, specifications, and other project related items are subject to review and approval by MDOT. Upon completion of the plan set, the PMC will issue the native final format of all files to the MDOT Project Manager in MDOT ProjectWise. This will include, but not limited to, all corresponding reference files, calculations, meeting notes, CADD files, survey files, spreadsheets, and document files. These will become property of the Department.

CONSULTANT PAYMENT – Actual Cost-Plus Fixed Fee:

Compensation for this project shall be on an actual cost-plus fixed fee basis. This basis of payment typically includes an estimate of labor hours by classification or employee, hourly labor rates, applied overhead, other direct costs, subconsultant costs, and applied fixed fee. The fixed fee for profit allowed for this project is 11.0% of the cost of direct labor and overhead.

All billings for services must be directed to the Department and follow the current guidelines. The latest copy of the "Professional Engineering Service Reimbursement Guidelines for Bureau of Highways" is available on MDOT's website. This document contains instructions and forms that must be followed and used for billing. Payment may be delayed or decreased if the instructions are not followed. Payment to the Consultant for services rendered shall not exceed the maximum amount unless an increase is approved in accordance with the contract with the Consultant. Typically, billings must be submitted within 60 days after the completion of services for the current billing. The final billing must be received within 60 days of the completion of services. Refer to your contract for your specific contract terms. Direct expenses, if applicable, will not be paid in excess of that allowed by the Department for its own employees in accordance with the State of Michigan’s Standardized Travel Regulations. Supporting documentation must be submitted with the billing for all eligible expenses on the project in accordance with the Reimbursement Guidelines. The only hours that will be considered allowable charges for this contract are those that are directly attributable to the activities of this project. MDOT will reimburse the consultant for vehicle expenses and the costs of travel to and from project sites in accordance with MDOT’s Travel and Vehicle Expense Reimbursement Guidelines, dated May 1, 2013. The guidelines can be found at http://www.michigan.gov/documents/mdot/Final_Travel_Guidelines_05-01-13_420289_7.pdf?20130509082418. MDOT’s travel and vehicle expense reimbursement policies are intended primarily for construction engineering work. Reimbursement for travel to

http://www.michigan.gov/documents/mdot/Final_Travel_Guidelines_05-01-13_420289_7.pdf?20130509082418




and from project sites and for vehicle expenses for all other types of work will be approved on a case by case basis. MDOT will pay overtime in accordance with MDOT’s Overtime Reimbursement Guidelines, dated May 1, 2013. The guidelines can be found at http://www.michigan.gov/documents/mdot/Final_Overtime_Guidelines_05-01-13_420286_7.pdf?20130509081848. MDOT’s overtime reimbursement policies are intended primarily for construction engineering work. Overtime reimbursement for all other types of work will be approved on a case by case basis.

http://www.michigan.gov/documents/mdot/Final_Overtime_Guidelines_05-01-13_420286_7.pdf?20130509081848



APPENDIX A

Ancillary Structure Region Inventory (2/25/20)Region

Structure Qty Sup North Grand Bay Swest Univ Metro Total

Cantilevers Each 9 3 111 89 117 163 426 918Sign Trusses Each 11 1 130 100 60 161 369 832Light Towers Each 13 0 75 20 4 45 * 157

Frangible Lights Each 0 0 99 438 0 223 * 760Non - Frangible Lights Each 13 0 330 487 0 116 * 946

Mast Arms Each 0 10 6 4 10 13 54 97Dynamic Message Signs (DMS) Each 2 4 31 18 20 24 94 193

Spun Concrete Poles Each 0 4 17 50 35 58 133 297Communication Towers Each 0 0 0 8 0 1 14 23

Enviromental Sensor Station (ESS) Each 39 20 3 30 9 0 1 102Retaining Walls Lft 1200 901 24286 8359 3561 5411 236069 279787

Sound Walls Lft 0 0 24802 23190 36900 41804 222215 348911Culverts under 10' Each 5297 5988 5683 5870 7741 4597 1693 36869Embedded Poles Each 18 6 14 7 20 19 5 89

Steel Strain Poles (ITS) Each 1 10 39 12 6 6 312 386Wood Poles (ITS) Each 9 5 100 45 39 33 70 301

APPENDIX B

RATING GUIDELINES FOR RETAINING WALLS AND SOUND WALLS

NHI Code

Condition Material Description

9 NEW All No deficiencies in any of the structural components that will affect long term performance.

8 GOOD All All structural components are sound and functioning as designed. There may be superficial cracking or weathering of protective components and/or dirt contamination of structural components.

7 GOOD Concrete Insignificant cracks or moderate cracks that are sealed.

MSE Structural cracking or staining of panels is minor and limited to a few locations.

Timber Checks or shakes penetrate less than 5% of the member thickness.

Steel Protective coating failure in very small and scattered locations.

All All components retain full section properties and function as designed.

6 SATISFACTORY Concrete Unsealed moderate-width or map cracks. Minor delamination, spalling, or efflorescence without build-up or rust staining.

MSE Minor uniform tilting of walls that does not require structural review. Structural cracking limited to 5% or less of the area.

Timber Decay or section loss affecting less than 5% of the member section. Splits arrested and concerns mitigated.

Steel Protective coating failures is limited to less than 2% of the surface area with no loss of section.

All Minor deterioration affecting structural components. Scour effects have been arrested with countermeasures.

5 FAIR Concrete Moderate delamination, spalling, or efflorescence. Reinforcement exposure without section loss.

MSE Connections visible at isolated locations where panels are bowing. Joint width between panels is substantially uniform.

Timber Decay or section loss affecting 5% to 10% of the member section. Checks, shakes, and splits have no effect on capacity.

Steel Protective coating failure is limited to less than 5% of the surface area with minor loss of section. Loose fasteners or broken welds present but the connection is in place and functioning as intended.

All Moderate deterioration affecting structural components including minor settlement, shallow scour, or impact damage. All members continue to function as designed.

4 POOR Concrete Considerable cracking, spalling, and efflorescence with heavy build-up or rust staining.

MSE Moderate uniform tilting of walls that does not require structural review. Structural cracking limited to between 10% and 25% of the area. Erosion has exposed the wall base without undermining.

Timber Extensive decay, section loss, checks, shakes, or splits that do not warrant structural review.

Steel Protective coating failure affecting between 5% and 10% of the surface area with some loss of section. Cracks that have not been arrested but do not require structural review.

All Considerable deterioration affecting structural members including partial settlement or scour. All members continue to function as designed.

3 SERIOUS Concrete Considerable areas of spalling, exposed reinforcement with section loss, or heavy rust staining.

MSE Structural cracking occurring on greater than 25% of area. Exposed geotextile fabric or loss of backfill.

Timber Decay or section loss that affects more than 10% of the member section. Checks, shakes, splits may warrant action.

Steel Protective coating failure affecting more than 10% of the surface area with measurable loss of section. Missing fasteners or adjacent broken welds present that do not warrant a structural review.

All Considerable deterioration or damage affecting structural members. Structural evaluation, hydraulic, and/or load analysis may be necessary to determine if the structure can continue to function without restricted loading or immediate repairs.

2 CRITICAL All Deterioration has progressed to the point where the structure will not support design loads and posting, emergency repairs, or shoring with structurally engineered temporary supports is required.

1 IMMINENT All Road is closed to traffic due to wall failure, but corrective action may put it back in service.

0 FAILED All Road is closed due to wall condition. Notify Region and the Bureau of Bridges and Structures

APPENDIX C – SAMPLE INSPECTION PROCEDURE

Truss, Type E, Inspection Procedure

Description

This procedure describes the requirements for the inspection of Type E truss sign support structures.

General Structure Inspection

1) Obtain assignment and coordinate inspection schedule with TSC.

Upon receiving a work assignment from MDOT, the inspector must contact the Project Manager and TSC to coordinate an inspection schedule and obtain the structure location information. Inspector must review the project location to verify which version of the standard plans are included and to ensure all structures requiring inspection are completed. Record all observations on MDOT Truss, Type E, Inspection Report.

2) Establish and record structure location.

Record MDOT Region, County, Route, GPS coordinates (minimum 10 decimal places) and brief location description.

3) Inspect and record sign information.

Stenciling

o Verify the structure number has been stenciled on the structure in accordance with MDOT specifications and note on the inspection report if the structure has not been stenciled.

Sign Legend

o Record information that is provided on the sign.

Sign Connections

o Visually inspect the condition of the sign panel and the sign panel connections to the truss chords. Ensure all U-bolts have been fully tightened and there are no gaps between the vertical I-beam mounting supports, the truss chords, and the U-bolts. Verify that rubber pads separating dissimilar metals have been placed between the steel truss chords and the aluminum mounting supports and that the U-bolts project through the holes in the pads. For trusses with electronic sign panels, the mounting supports are steel, and the rubber pads must be placed between

the steel mounting supports and the aluminum sign cabinet. Record any deficiencies in the remarks section of the inspection report.

4) Inspect and record structure information.

Truss Chord Connection

o Truss chord connection bolts require a plate washer on the nut end. Visually inspect the truss chord connection to the upright. Verify that all visible nuts are coated with a lubricant dye and that all visible plate washers cover the entire slotted hole. Note any gaps between the bolted connections, loose or missing hardware, missing caps, cracked welds and cracks at the ends of gusset plates. MDOT specifications require the truss chord connection bolts to be tightened to a snug tight condition and then turned an additional 1/3 turn beyond snug tight. Verify that the turn-of-nut markings on all visible nuts show an additional 1/3 turn beyond snug tight. As a minimum, each bolt end should be at least flush with the nut. If there is not at least a flush condition between the bolt end and the nut, record this in the inspection report. Record any hardware that are missing, damaged, or not in their proper location. All bolts, nuts and plate washers must be galvanized. Record any signs of rust.

o Sounding Connection Nuts. Hit the side of the nuts and hit the bolts using a 24 oz. hammer. This is done to check for loose nuts and/or cracked or broken bolts. If the nuts are tight, there is a sharp ringing sound; if the nuts are loose, there is a dull sound. Visually check for any gaps between the nuts, washers and the base plate. Tap one side of each washer placing one hand on the washer opposite the side being tapped. If the washer moves, the nut is not properly tightened.

o Placing a 14 to 19 inch long wrench on each nut, try to move each nut by using one hand on the wrench and pulling firmly using your body weight as leverage. With the wrench on the nut and pulling firmly, check for loose nuts or nuts you can turn either by loosening or tightening. If a nut can be removed, remove it and lubricate the bolt threads and nut bearing face with beeswax or equivalent (not oil or grease). Make sure the flat washer and lock washer are present. If not, place one of each on the bolt before installing the nut (the flat washer should be installed before the lock washer). Reinstall the nut and tighten it with both hands on the end of the wrench turning the nut with full effort until the nut stops turning (you may need more than one wrench to prevent the bolt from turning during initial tightening). Remove only one nut a one time. Repeat this operation, as necessary, until all the nuts have been tightened for a given flange connection. Taking the nut off is only necessary when it can be removed as described above. For documentation purposes, describe each bolt as

located in the top or bottom arm and numbered clockwise on each flange connection while standing looking at the cantilever upright from the roadway with the number one bolt being on top just right of vertical. Note which nuts were removed and reinstalled and any other non-compliant items within the connection.

Truss Chord Splice

o Truss chord splice connection bolts require a flat washer and lock washer on the nut end. Visually inspect the splice connection. Check the bolt head to confirm that the bolt is ASTM A325 and verify that the nuts are coated with a lubricant dye. MDOT specifications require truss chord splice bolts to be tightened to a snug tight condition, fully compressing the lock washer. Note any lock washers which are not fully compressed. Record any hardware that are missing, damaged, or not in their proper location. All bolts, nuts and washers must be galvanized. Record any signs of rust.

Internal Truss Connections

o Internal truss chord connection bolts require a flat washer on the nut end. Visually inspect the internal truss connections. Check the bolt head to confirm that the bolt is ASTM A325 and verify that the nuts are coated with a lubricant dye. MDOT specifications require the internal truss connection bolts to be tightened to a snug tight condition and then turned an additional 1/3 turn beyond snug tight. Verify that the turn-of-nut markings show an additional 1/3 turn beyond snug tight. As a minimum, each bolt end should be at least flush with the nut. If there is not at least a flush condition between the bolt end and the nut, record this in the inspection report. Record any hardware that are missing, damaged, or not in their proper location. All bolts, nuts and washers must be galvanized. Record any signs of rust.

5) Inspect and record anchor bolt information.

Visually inspect the structure base looking for missing or damaged anchor bolts or nuts. Note any damage or corrosion and any bolts that have been bent to align with holes in the base plate. Inspect welds in the base looking for cracks or unusual welds. Inspect the base, gussets, and vertical support for corrosion, cracks, gouges, dents, etc. Inspect the condition of the concrete foundation, noting any spalling, cracks, voids, and general deterioration.

Anchor Bolt Plan

o Mark the bolt numbers on the vertical support with a yellow permanent paint marker corresponding to the example on the inspection reference detail sheet at the end of this procedure for future reference. Attach a plastic tag to the number one anchor bolt between the base plate and the concrete foundation including the date of inspection, structure number, and inspector’s name and organization.

Anchor Bolt ID#

o Record the anchor bolt ID# which is stamped into the exposed end of the anchor bolt.

Turn-of-Nut Verification

o Verify anchor bolts reflect the proper 1/6 and 1/3 turn-of-nut markings. Record any incorrect markings in the remarks section of the inspection report.

Sounding Anchor Nuts

o Hit the side of the top nuts and hit the top of the bolts using a 24 oz. hammer. This is done to check for loose nuts (leveling and top) and/or cracked or broken bolts. If the nuts are tight, there is a sharp ringing sound; if the nuts are loose, there is a dull sound. Visually check for any gaps between the nuts, washers and the base plate. Tap one side of each washer placing one hand on the washer opposite the side being tapped. If the washer moves, the nut is not properly tightened.

Anchor Bolt Projection (P)

o Measure and record the distance between the top of the top nut and the top of the anchor bolt. Note any bolts that are lower than the top of the nut and measure the depth. Record the measurement as a negative projection.

Anchor Bolt Stand-Off Distance (S)

o Measure and record the distance between the top of the concrete foundation and the bottom of the levelling nut. Note any stand-off distances greater than 1 inch in the remarks section of the inspection report.

Anchor Bolt Ultrasonic Results

o Ultrasonic Testing must be performed on all anchor bolts which are tightened using the turn-of-nut method. The individual doing the ultrasonic testing (UT) must be qualified as ASNT Level II, on recommended practice SNT-TC-1A.

Calibrate the ultrasonic unit for straight beam probe method using a 10-inch screen. The probe is placed on a 1-inch calibration block (DSC block or section of anchor bolt) and the indications on the screen are adjusted so that a reflection is positioned at each inch mark. Next, place the probe on a 9-inch-long test bar that has a 1/8-inch-deep saw cut at a set distance (3 inches from the end) in the threaded portion of the rod. Peak the back reflection from the 1/8-inch-deep saw cut until the indication is at 60 or 80 percent of screen height. The dB reading is recorded to establish the “REFERENCE LEVEL.” The “SCANNING LEVEL” is set by adding 14 to 30 dB over the reference level. Calibration should be checked at each location before inspecting any bolts.

Grind all anchor bolt ends flat being sure to remove all galvanizing, paint, dirt, and debris. Ensure the surface is as smooth and flat as possible since surface imperfections 1/16 inch or greater can affect the UT results. Only grind the bolt a sufficient amount to remove any paint and smooth the surface.

Apply couplant (glycerin) to the ends of the bolts. Ultrasonically test the anchor bolts using a circular motion inspection pattern and record the results. When scanning the anchor bolts, there should be no indications on the CRT screen between the initial pulse and the end of the screen (10-inch depth). Any indication that is displayed after the initial pulse is a possible flaw. Record the depth of the discontinuity observed and the amount of dB required to bring the indication to the “REFERENCE LEVEL” on the screen. This is recorded as the “INDICATION LEVEL.”

After the ultrasonic testing is complete, wipe off all the couplant with a wet rag, allow surface to dry completely, and spray the bolt ends with cold galvanizing or zinc-rich paint.

6) Inspect and Record Element Ratings (1-4 Scale)

Visually inspect and record element ratings using a 1-4 scale for the following elements and the overall rating for the truss:

Foundation, Base, Column, Chord, Chord Connections, Sign and Sign Supports

Report Writing, Safety and Equipment

Reporting Procedure

All reports must be detailed and accurate and will be used as evidence of work performed. All reports must have a minimum of 12 photos of the overall structure attached. Provide photo of each foundation, leveling nuts, anchor bolts and base, truss to column connection, column and sign(s). Provide any additional photos of deficiencies prior to submitting the report to MDOT. All reports must be submitted to Project Manager and files must be named as detailed below:

???? SN Date (Month, Date, Year)

Example: ???? B332-T- 101220

Safety

All inspections and related work must be in accordance with the Department’s Personal Protective Equipment (PPE) Policy as stated in the MDOT Guidance Document 10118 and

MIOSHA safety standards (use of safety apparel and equipment safety guards). Safety apparel and equipment (hard hats, leather gloves, harnesses, lanyards, safety glasses, safety shoes, and safety vests) must be worn by all workers.

Any unusual or potentially dangerous conditions must be reported immediately to the Project Manager using “Ancillary Structure, Truss, Request for Action Form.”

Equipment/Tool List

Complete Ultrasonic Unit with Straight Beam Probe

Distance and Sensitivity Calibration Block

8-10” calibration anchor bolt with a 1/8” cut 2-4” up from the bottom

Bucket Truck

GPS Unit

Beeswax

Two 14 inch (min) Long Wrenches

Couplant

Rags

Cold Galvanizing Spray or Zinc-Rich Paint

Grinder

4 Foot Level

24 oz. Hammer

Identification Tags

Yellow Paint Markers

Tape Measure

MDOT Standard Plans, SIGN-340-B, SIGN-360-B, and SIGN-700-D

MDOT Truss, Type E, Inspection Report

Inspection Reference Detail

APPENDIX D -SAMPLE INSPECTION REPORT

ichigan Department of Transportation

???? TRUSS, TYPE E INSPECTION REPORT

To be completed in conjunction with Truss, Type E Inspection Procedure File Naming Convention: ???? SN Date.pdf

PAGE 1 OF 2

GENERAL INFORMATION

STRUCTURE # CONTROL SECTION JOB NUMBER DATE

REGION COUNTY ROUTE

LOCATION DESCRIPTION

GPS LAT

_________________________________________ ○GPS LONG

________________________________________ ○

STRUCTURE INFORMATION

TRUSS STANDARD PLAN #

SIGN CONNECTION STANDARD PLAN #

FOUNDATION STANDARD PLAN #

ANCHOR BOLT ID # LH

RH

SIGN LEGEND

VISUAL INSPECTION

CHORD TO UPRIGHT CONNECTION WELDS

BOLTS STRUCTURE BASE & FOUNDATION

WELDS

FOUNDATION

ANCHOR BOLT INSPECTION (LH)

SOUNDING ANCHOR NUTS

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16

ANCHOR BOLT PROJECTION (P)

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16

STAND-OFF DISTANCE (S)

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16

ULTRASONIC TESTING

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16

ANCHOR BOLT INSPECTION (RH)

SOUNDING ANCHOR NUTS

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16

ANCHOR BOLT PROJECTION (P)

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16

STAND-OFF DISTANCE (S)

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16

ULTRASONIC TESTING

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16

ELEMENT RATING ITEM RATING COMMENTS

Foundations 1 2 3 4

Anchor Bolts & Leveling Nuts 1 2 3 4

Base Plates 1 2 3 4

Columns 1 2 3 4

Chord 1 2 3 4

Chord Connections 1 2 3 4

Sign and Supports 1 2 3 4

OVERALLSIGN RATING 1 2 3 4

REMARKS

INSPECTOR COMPANY

APPENDIX E

Michigan Structures Inspection Manual (MiSIM)

Chapter 14 – Ancillary Structures – Retaining Walls

14.01 Purpose

14.02 Responsibilities

14.03 Inspector Qualifications

14.04 Inspection Procedures

14.05 Inspection Reports

14.06 Inspection Frequency

14.07 Entering the Inspection Report

Chapter 15 – Ancillary Structures – Cantilever Sign Supports

15.01 Purpose







Chapter 16 – Ancillary Structures – Truss Sign Supports

16.01 Purpose








Chapter 17 – Ancillary Structures – Mast Arm Poles

17.01 Purpose







Chapter 18 – Ancillary Structures – Dynamic Message Sign Supports

18.01 Purpose







Chapter 19 – Ancillary Structures – Tower Lighting Units

19.01 Purpose








Chapter 20 – Ancillary Structures – Frangible and Non-Frangible Light Standards

20.01 Purpose







Chapter 21 – Ancillary Structures – Culverts under 10 feet

21.01 Purpose







Chapter 22 – Ancillary Structures – Noise Walls

22.01 Purpose








Chapter 23 – Ancillary Structures – Embedded Poles

23.01 Purpose







Chapter 24 – Ancillary Structures – Wood Poles

24.01 Purpose







Chapter 25 – Ancillary Structures – Steel Strain Poles

25.01 Purpose








Chapter 26 – Ancillary Structures – Communication Towers

26.01 Purpose







Chapter 27 – Ancillary Structures – Environmental Sensing Stations (ESS)

27.01 Purpose







Chapter 28 – Ancillary Structures – Spun Concrete Poles

28.01 Purpose







Appendix F - Sample Request for Action Form

ANCILLARY INSPECTION (TRUSS) – REQUEST FOR ACTION

Original: BOBS - Project Manager Copies: Region, TSC, TSMO – Signs. TSMO- ITS BOBS – Statewide Signs

STRUCTURE ID # LAT LONG INSPECTOR DATE

CONTROL SECTION

REGION COUNTY TSC

ROUTE LOCATION DESCRIPTION

PROBLEMS/COMMENTS/EXPLANATION

IMMEDIATE ACTION REQUESTED: □ CLOSE LANE(S) □ CLOSE SHOULDER □ REMOVE SIGN

□ REPAIR SIGN OTHER_________________________

COMMENTS:______________________________________________________________________________________

_________________________________________________________________________________________________

IMMEDIATE ACTION REQUESTED BY: ____________________________________ DATE: __________

IMMEDIATE ACTION COMPLETED DATE: ___________________

COMMENTS:______________________________________________________________________________________

_________________________________________________________________________________________________

CLOSURE OPEN DATE: __________________

INTERMEDIATE ACTION REQUESTED: □ DAMAGE INSPECTION □ DETAILED INSPECTION

□ INSTALL TEMP SIGN □ OTHER ________________________________________________________

CONTACT

□ BOBS -STATEWIDE SIGN SHOP □ TSMO - SIGNS □ BOBS – STRUCTURAL FABRICATION

□ _____________________ TSC -OPERATIONS □ _________________ REGION – OPERATIONS

COMMENTS:

FINAL ACTION REQUESTED: _______________________________________ DATE: __________

REQUESTED BY :___________________________

COMMENTS:______________________________________________________________________________________

_________________________________________________________________________________________________

INCLUDE PHOTOS WITH REQUEST FOR ACTION