Checklist For Engineer's Final Payment Estimate: Please Answer All Questions YES N.A

Checklist for Engineer's
Final Payment Estimate
Prior to submitting the final payment to the Bureau of Construction, the District should review the following checklist questions and,
as appropriate, process the required report, form or documentation. Include a copy of this form with the final papers.
County
Section
Route
District
Contract No.
Job No.
Project
YES
Please Answer All Questions

1.
N.A.
If this contract includes any CRC Pavement, PCC Pavement, PCC Base Course, PCC Base Course Widening, PCC Shoulders, Full-Depth HMA
Pavement, HMA Base Course, HMA Base Course Widening or HMA Shoulders, have they been cored for thickness determination or was a determination
made to not require coring?
Has proper action been taken for any deficient cores?
2.
If this contract includes CRC Pavement, PCC Pavement, PCC Base Course, Full-Depth HMA Pavement or HMA Base Course, have all necessary
surface variation tests been made and all variations corrected?
3.
If this contract includes HMA Concrete Surfacing, have all necessary surface variation tests been made and all variations been deducted or corrected?
4.
If this contract includes the Surface Testing of Pavements (BDE) special provision, has a copy of Form BC 2448b (Smoothness Assessment Worksheet)
been submitted to the Pavement Technology Engineer in the Central Bureau of Materials and Physical Research?
5.
If this contract includes Special Waste Plans and Reports, have 3 copies of the final reports been distributed to the Engineer, one additional copy to the
District Environmental Studies Unit and another additional copy to the Bureau of Design and Environment?
6.
Have Form BBS 2184, Production Pile Driving Data and Form BBS 757, Test Pile Driving Record, been prepared and cross-checked to the field
measurements and sent to the Bureau of Bridges and Structures?
7.
Have photographs been supplied to the District for Borrow, Use and Waste areas and areas stabilized as required by their approval letter and applicable
permits?
8.
If the correspondence of this contract makes any reference to inferior materials or substandard construction which was to be corrected, replaced, or for
which a credit was offered, has the matter been resolved?
9.
Has a Material Certification memorandum been received from the District Project Implementation Contract Support Section?
10. If the contract involves a structure to which the facilities of a utility company have been attached, have you notified the district utility coordinator?
11. If the time limit was exceeded, is the overrun covered by an extension of time or by liquidated damages?
12. Has Form BC-71, Final Inspection Report of State Road Work, been prepared? *
13. Has final inspection of the project been made and the Office of Finance and Administration and the Central Bureau of Construction been notified?
On full oversight projects only, has the Federal Highway Administration also been notified?
*Submit to the Bureau of Construction before or with the final pay estimate.
Printed 6/9/2015
Page 1 of 3
BC 111 (Rev. 01/17/12)
Please Answer All Questions
YES
N.A.
14. If the contract was supervised by Local Agency forces, has the Form BC 608, Local Agency Certification to Accompany Engineer's Final
Payment Estimate, been received?
15. Has the Contractor, and all subcontractors, submitted all the required reports on Form SBE 956, Equal Employment Opportunity Workforce
Analysis?
16. Has the Contractor submitted a Form SBE 2115, Final Payment Agreement, from each DBE/WBE firm utilized on this project which verifies the
amount paid to each?
17. Has the Contractor submitted a Form BC 2115, Subcontractor Payment Agreement (Non-DBE) on this project which verifies the actual amount
paid to each?*
18. Has Form SBE 2028, DBE/WBE Final Documentation, been prepared?
19. If the contract includes pay items for Raised Pavement Markers, Plant Materials or Pavement Markings subject to a final inspection following a
performance period, and the Contractor chooses to take advantage of the provision which allows contract final payment to be made prior to final
inspection of these items when the Contractor provides a surety bond in the full amount of the items listed in the contract, have you received the
separate bond?
20. If the contract includes any pay items which are subject to bid price adjustment, have the applicable pay items been analyzed and appropriate
bid price adjustments been processed?
21. Has Form BC 2544, Report of Bridge Deck Patching Quantities, been prepared and sent to the Bureau of Bridges and Structures and the
District Bridge Maintenance Engineer?
22. Has a Net Cost of Section Report been prepared? *
DBE Compliance
23. I hereby certify that I have reviewed all contracting records and monitored worksites for all Disadvantaged Business
Enterprise (DBE) work to ensure that work committed to DBEs was actually performed by said DBEs, to the best of
my knowledge and belief.
Remarks:_________________________________________________________________________________________
___________________________
Signature of Resident
Article 109.09 Claims Resolution

24. Has the contractor submitted a notice to file a claim and/or are there any unsettled claims on the Contract?
DO NOT submit the contract for final payment until all Art. 109.09 claims have been reviewed through Level 3 or resolved at a lower level.
Documentation Review (As per Construction Memorandum No. 33)

25. Have the project records been examined to determine that all previous documentation citations have been resolved?
26. Has a review been made of randomly selected source documentation? If so, list pay item code number or items examined. (Retain work
sheets.)
Items 25 and 26 reviewed by
Date
(Type this name and date at bottom of the Final Payment Estimate)
Printed 6/9/2015
Page 2 of 3
BC 111 (Rev. 01/17/12)
* Submit to the Bureau of Construction before or with the final payment estimate.
Printed 6/9/2015
Page 3 of 3
BC 111 (Rev. 01/17/12)

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Checklist for Engineer's

Final Payment Estimate

Please Answer All Questions

BC 111 (Rev. 01/17/12)

Please Answer All Questions

Article 109.09 Claims Resolution

Documentation Review (As per Construction Memorandum No. 33)

Items 25 and 26 reviewed by

BC 111 (Rev. 01/17/12)

BC 111 (Rev. 01/17/12)

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