Materials Source List



Materials Source ListPre-Con Date FORMTEXT ?????Contractor Name and Address:Contract FORMTEXT ????? FORMTEXT ?????County FORMTEXT ????? FORMTEXT ?????Section FORMTEXT ????? FORMTEXT ?????Route FORMTEXT ?????Job No. FORMTEXT ?????District FORMTEXT ?????Listed below are the proposed Producers or Suppliers of materials for the above section. If any of the following items do not apply to this contract, please write NA under the Producer/Supplier. If there is any additional material to be included in this contract, please write in the provided space below.MaterialEvidence of InspectionAs taken from the Project Procedure Guide at website epoxyCert or Mark FORMTEXT ?????Chemical adhesive (Dowel & Tiebar)List FORMTEXT ?????Glass Capsule for Anchor BoltsList FORMTEXT ?????AggregateFor Mixtures & Granular UseList + Tick. FORMTEXT ?????Lightweight, for P. C. ConcreteCert FORMTEXT ?????Riprap, ConcreteList + Tick. FORMTEXT ?????Riprap, StoneList + Tick. FORMTEXT ?????Bridge Bearing PadsElastomeric (Whole Pad)Cert or LA 15 or (*BMPR) FORMTEXT ?????FabricLA 15 or Test FORMTEXT ?????Pot, Floating BearingsBMPR FORMTEXT ?????Bituminous MaterialsPG Asphalt Binder(List or Test) + Bill of Lading FORMTEXT ?????Road Oil & Cutback Asphalt(List or Test) + Bill of Lading FORMTEXT ?????Emulsified Asphalt(List or Test) + Bill of Lading FORMTEXT ?????Hot Mix AsphaltHot Mix Asphalt (QC/QA)Daily Plant Report + Tick. + Test FORMTEXT ?????Block/BrickClay or Shale Building BrickTest FORMTEXT ?????Clay or Shale Paving BrickTest FORMTEXT ?????Concrete Building BrickList FORMTEXT ?????Concrete PaverList FORMTEXT ?????Precast Block Revetment MatList FORMTEXT ?????Precast Articulated Block Revetment MatList FORMTEXT ?????Segmental Concrete Block Walls (Retaining Wall)List FORMTEXT ?????Concrete Masonry Units for Buildings/Catch Basin/Manhole/Inlet/Valve VaultList FORMTEXT ?????Bridge Rail Railing -Structural SteelBMPR or LA 15 or Test FORMTEXT ????? -Aluminum, Steel, Stainless SteelCert or LA 15 FORMTEXT ?????Post, Anchoring DeviceCert or LA 15 FORMTEXT ?????Cementitious MaterialsCementCalcium AluminateTest FORMTEXT ????? Portland or Blended(List or Test) + Bill of Lading FORMTEXT ?????Rapid HardeningList FORMTEXT ?????Finely Divided Minerals - Fly Ash, Ground Granulated Blast Furnace Slag, Microsilica, High-Reactivity MetakaolinList or Test FORMTEXT ?????Chemicals/AdmixturesHMA-Anti-strip Additive for Bituminous MixturesList FORMTEXT ?????HMA- Asphalt Truck Release AgentList FORMTEXT ?????Calcium Chloride (Dry, Liquid) Dust PalliativeTest FORMTEXT ????? PCC – Calcium Chloride AcceleratorCert FORMTEXT ?????CLSM- Air Entraining AdmixtureList FORMTEXT ?????PCC-Corrosion InhibitorList FORMTEXT ?????PCC-Latex EmulsionCert FORMTEXT ?????PCC-Air-Entraining AdmixtureList FORMTEXT ?????PCC-Type A-G AdmixturesList FORMTEXT ?????PCC–Rheology Modifying AdmixtureList FORMTEXT ?????PCC–Viscosity Controlling AdmixtureList FORMTEXT ?????PCC-Membrane Curing CompoundLA 15 or IL OK or Test FORMTEXT ?????PCC-Membrane Curing Compound/Linseed Oil EmulsionLA 15 or IL OK or Test FORMTEXT ?????Concrete Seat SealerList FORMTEXT ?????Protective Coat (Linseed Oil/Petroleum Spirits)LA 15 or IL OK or Test FORMTEXT ?????Rock Salt, Sodium ChlorideTest FORMTEXT ?????Water, for concrete, mortar, or curingPotable Source or Test FORMTEXT ?????Weed KillerMark or Vis FORMTEXT ?????ConcretePolymer ConcreteList FORMTEXT ?????Portland Cement Concrete- other than QC/QADaily Plant Report + Tick. (Tick. not req’d for volumetric mixer) + Test FORMTEXT ?????Portland Cement Concrete Daily Plant Report + Tick. (Tick. not req’d for volumetric mixer) + Test FORMTEXT ?????CAM II- Cement Aggregate MixtureDaily Plant Report + Tick. (Tick. not req’d for volumetric mixer) FORMTEXT ?????CLSM-Controlled Low –Strength Material Daily Plant Report + Tick. (Tick. not req’d for volumetric mixer) + Test FORMTEXT ?????Non-Shrink GroutList FORMTEXT ?????Shotcrete, High PerformanceList + Test FORMTEXT ?????Thin Polymer Overlay System for Bridge DecksList FORMTEXT ?????PCC – Curing Blanket – Burlap, Burlap/Poly, Waterproof Paper, White Poly, Cotton MatVis. Exam FORMTEXT ?????Concrete, PrecastArchitectural ProductsList FORMTEXT ?????Bridge BeamsList + Mark FORMTEXT ?????Bridge SlabsList + Mark FORMTEXT ?????Bridge – Three Sided StructureList + Mark FORMTEXT ?????Drainage ProductsList + Mark FORMTEXT ?????Noise Abatement Wall List FORMTEXT ?????MSE Retaining Wall List FORMTEXT ?????Modular Retaining WallListTraffic BarrierList + Mark FORMTEXT ?????R.O.W., Drainage, Section, and Permanent Survey MarkersList FORMTEXT ?????HeadwallList FORMTEXT ?????Bumper Blocks (Wheel Stops for Cars)List FORMTEXT ?????Picnic Table, Trash Receptacle, PlanterList FORMTEXT ?????Splash BlocksList FORMTEXT ?????Concrete, Precast & Prestressed (Except Piling)Prestressed ProductsIL OK FORMTEXT ?????Concrete RepairMortar, Polymer Modified Portland CementList FORMTEXT ?????Rapid Hardening Cementitious MaterialList FORMTEXT ?????ElectricalCable, unit ductMark or LA15 FORMTEXT ?????Conduit Aluminum, plasticMark or Cert or LA 15 FORMTEXT ????? SteelLA 15 or (Cert + Mark) FORMTEXT ?????Detector LoopLA 15 or Mark FORMTEXT ?????Fiber Optic CableMark or Cert or LA 15 FORMTEXT ?????Ground RodLA 15 or Cert. FORMTEXT ?????Wire, Span or TetherLA 15 or Test FORMTEXT ?????FencingFabric, Post, WireCert or LA 15 FORMTEXT ?????Glare Guard, SlatsVis FORMTEXT ?????Guard RailCable for Road GuardLA 15 or IL OK or Test FORMTEXT ?????Fasteners(Mark + Cert.) or Test FORMTEXT ?????Steel Plate & AccessoriesList + Cert FORMTEXT ?????Steel PostCert. or LA 15 FORMTEXT ?????Traffic Barrier Terminal End SectionNCHRP 350 Pdts.= (List + Cert)or LA 15; Pdts. Not covered by NCHRP 350 = Cert or LA 15 FORMTEXT ?????Wood Posts, PlankMark or Cert. or LA 15 FORMTEXT ?????High Tension Cable Median Barrier(List + Cert) or LA 15 FORMTEXT ?????Joint Fillers & SealersMastic for Precast Concrete PipeCert or LA 15 FORMTEXT ?????Cold- Poured SealerLA 15 or IL OK FORMTEXT ?????Hot- Poured SealerLA 15 or IL OK FORMTEXT ?????Polysulfide SealerMark (if it contains spec. info) or Cert. or LA 15 FORMTEXT ?????Asphalt Fillers PAFLA 15 or IL OK or Test FORMTEXT ?????Fiber – Modified (Pavement Preserv.)Cert FORMTEXT ?????Preformed- Bituminous, cork, foam, fiber, plasticLA 15 or IL Ok or Test FORMTEXT ?????Preformed Elastomeric CompressionLA 15 or IL Ok or Test FORMTEXT ?????Preformed Neoprene, EPDMLA 15 or IL OK or Test FORMTEXT ?????PCC- SiliconeCert or Mark (if it contains spec. info.) or LA 15 FORMTEXT ?????Water Seal, PVCLA 15 or Test FORMTEXT ?????LandscapingAgricultural Lime (Dept of Ag. Prog.)List + Tick. FORMTEXT ?????Excelsior BlanketCert or LA15 FORMTEXT ?????Fiber MatMark or Cert FORMTEXT ?????FertilizerCert (bulk) or Mark (bags) FORMTEXT ?????Mulch StrawVis FORMTEXT ????? Paper, Wood celluloseMark or Cert FORMTEXT ?????Asphalt coated straw Emulsified Asphalt(List or Test) + Bill of Lading FORMTEXT ????? StrawVis FORMTEXT ?????CompostCert FORMTEXT ?????Peat MossCert. or IL OK or LA15 FORMTEXT ?????Seed, SodCert. or IL OK or LA15 FORMTEXT ?????Trees, Shrubs, PlantsVis FORMTEXT ?????Lighting & SignalsControllers & CabinetsVis. Compared to Approved Submittals + Cert FORMTEXT ?????Lamps, Luminaries & BallastVis. Compared to Approved Submittals + Cert FORMTEXT ?????Traffic Signal ComponentsVis. Compared to Approved Submittals + Cert FORMTEXT ?????Break-Away SupportVis. Compared to Approved Submittals + Cert FORMTEXT ?????Poles Steel, AluminumCert or IL OK FORMTEXT ????? WoodMark FORMTEXT ?????Mast Arm AssembliesCert. FORMTEXT ?????Composite Handholes and GulfboxCert FORMTEXT ?????Lumber/TimberTreated or Untreated LumberCert. or Mark FORMTEXT ?????Metal Products, Misc.Aluminum DrainsCert. or Mark or LA 15 FORMTEXT ?????Copper Water PipeMark FORMTEXT ?????Name PlateLA 15 or Vis. FORMTEXT ?????Rodent ShieldVis. FORMTEXT ?????Survey Markers LA 15 or Vis. FORMTEXT ?????MiscellaneousManhole Step, PlasticCert or LA 15 FORMTEXT ?????Geotextile Fabric – French Drain, Ground Stabilization, Pipe Underdrain, Rip Rap, Silt Filter Fence & Weed BarrierMark or Cert or LA15 FORMTEXT ?????Concrete Revetment Mat FabricList FORMTEXT ?????PaintBridge Paint & PrimerTest (Approved Lot) FORMTEXT ?????Pavement Marking PaintLA 15 FORMTEXT ?????Epoxy Pavement Marking Ln.LA 15 or Test FORMTEXT ?????Preform Plastic Pav. Marking Ln.LA 15 or Test FORMTEXT ?????Pavement MarkingGlass BeadsLA 15 or IL OK FORMTEXT ?????Raised Pavement Marker List FORMTEXT ?????Temporary Pavement TapeLA 15 or (IL OK + Batch/Lot Number) FORMTEXT ?????Thermo Letters & SymbolsCert. or LA 15 FORMTEXT ?????Thermoplastic-Granular BlockLA 15 or IL OK FORMTEXT ?????Thermoplastic TapeLA 15 or IL OK FORMTEXT ?????PilingMetal Shell, Steel H, or Steel Sheet or Steel SoldierCert. or LA 15 or IL OK FORMTEXT ?????Precast ConcreteList FORMTEXT ?????Precast, Prestressed ConcreteIL OK FORMTEXT ?????TimberCert. or Mark or LA 15 FORMTEXT ?????Pipe, Culvert & DrainCast or Ductile Iron PipeCert. or LA 15 FORMTEXT ?????Clay Pipe & Drain TileLA 15 or IL OK or Test FORMTEXT ?????Metal Corrugated & ComponentsCert. or IL OK or LA 15 FORMTEXT ?????Pipe-Plastic, PVC, HDPE-water/sewerIL OK or LA 15 or Test FORMTEXT ?????Pipe Fittings – PE, PVCVis FORMTEXT ?????Pipe Liner, PE, PVCIL OK or LA 15 or Test FORMTEXT ?????Pipe UnderdrainIL OK or LA 15 or Test FORMTEXT ?????Plastic Deck DrainCert FORMTEXT ?????Precast Concrete Pipe or Box CulvertList + Mark FORMTEXT ?????Underdrain Mat, Wall DrainLA 15 or Test FORMTEXT ?????SigningCompleted Sign Panels & Standard Reflective SheetingLA 15 or Test FORMTEXT ????? - Aluminum SheetingLA 15 or Test FORMTEXT ?????Post, Break-AwayCert. or IL OK or LA 15 FORMTEXT ?????Posts, Metal & HardwareCert or LA 15. FORMTEXT ?????Post, Tubular (round, rectangle)LA 15 or IL OK or Test FORMTEXT ?????Posts, Steel DelineatorCert or LA 15 FORMTEXT ?????Post, WoodMark or Cert or LA 15 FORMTEXT ?????Reflector, Delineator, TerminalCert or LA 15 FORMTEXT ?????Reflector, PrismCert or LA 15 FORMTEXT ?????Sign Structure, OverheadBBS 59 + Cert. FORMTEXT ?????Structural FastenersBMPR or LA 15 or IL OK FORMTEXT ?????Soil/Modification/StabilizationCAM – Cement Aggregate MixtureTest FORMTEXT ?????TopsoilTest FORMTEXT ?????For IBR Fine- Grained SoilTest FORMTEXT ????? Coarse- Grained SoilTest FORMTEXT ?????For Moisture DensityFine- Grained SoilTest FORMTEXT ?????Coarse- Grained SoilTest FORMTEXT ?????Pozzolanic Stabilized Subbase or Base CourseTest FORMTEXT ?????Cement (Portland or Blended)(List or Test) + Bill of Lading FORMTEXT ?????Fly AshList or Test FORMTEXT ?????LimeCert. & Manufacturers’ Test Results representing mat’l delivered to be provided prior to or with 1st load FORMTEXT ?????Modified Soil with Lime, Portland Cement, Portland Blast-Furnace Cement, or Fly AshTest FORMTEXT ?????Lime Stabilized Subbase or Base CourseTest FORMTEXT ?????Soil-Cement Base CourseTest FORMTEXT ?????Steel & CastingCast Frames & Grates/LidsCert or LA 15 FORMTEXT ?????Cast Manhole StepsCert or LA 15 FORMTEXT ?????Deck DrainsCert or LA 15 FORMTEXT ?????Gabions, Slope MattressCert or LA 15 FORMTEXT ?????Pipe CasingLA 15 or IL OK or Test FORMTEXT ?????Steel Frame & GratesCert or LA 15 FORMTEXT ?????Steel, MiscellaneousAnchor BoltsBMPR or LA 15 or IL OK FORMTEXT ?????Steel, ReinforcingDowel Bars – black or epoxy coatedList + Cert FORMTEXT ?????Dowel Bar Assembly (Only)List + Cert FORMTEXT ?????Pavement Fabric & Wire MeshList + Cert FORMTEXT ?????Prestressing StrandBMPR FORMTEXT ?????Reinforcing Bar – black or epoxy coatedList + Cert + Mark FORMTEXT ?????Rebar Splicers – black or epoxy coatedList + Cert; Test if > 100 FORMTEXT ?????Steel, StructuralFastenersBMPR or LA 15 or IL OK FORMTEXT ?????Structural SteelBBS 59 + Cert FORMTEXT ?????Stud Sheer Connectors(Mark + Cert) or LA 15 FORMTEXT ?????Temporary ItemsSee Sections 100, 500Vis. Exam FORMTEXT ?????Except Reflective MaterialSee Paint, Pavement Marking & Signing requirementsWaterproofing MaterialsAsphalt Emulsion (Art. 1060.08)(List or Test) + Bill of Lading FORMTEXT ?????Membrane System (Art. 1061)Coal-Tar Pitch Emulsion & PrimerLA 15 or Test FORMTEXT ?????Fabric, GlassLA 15 or Test FORMTEXT ?????Reflective Crack Control (Art. 1062)Reinforcing FabricMark or Cert or LA 15 FORMTEXT ?????Fiberglas Repair System (Art. 1063) Fiberglas FabricLA 15 or Test FORMTEXT ????? Bit. AdhesiveLA 15 or Test FORMTEXT ?????The material from the producers or suppliers is approved contingent upon appropriate Evidence of Inspection as outlined above and in accordance with the Department’s Project Procedures Guide at website no condition are materials to be incorporated into a contract without appropriate Evidence of Inspection.Award Date: FORMTEXT ?????Execution Date: FORMTEXT ?????Starting Date FORMTEXT ?????R.E. FORMTEXT ?????Contact Person for Material Discrepancies FORMTEXT ?????Phone FORMTEXT ?????Location: FORMTEXT ?????District Materials Engineer ................
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