Penndot cs 4171 pdf. WEBLINKS: INTERNAL LINKS - PENNDOT AUTHORIZED .

Penndot cs 4171 pdf 02(d)8] D. Y N 12. Get the CS 4171 Certificate of Compliance completed. B ula, Acting Dir: ctor, Bureau of Project Delivery, Highway Administration -- All certifications (Form CS-4171) for materials are properly completed and on file. X Notify the Municipality X Work to be completed on or before 10/15/2020 . txt) or view presentation slides online. ecmS#To be completed by the party that will ship the material to the construction project, otherwise leave name of manufacturer, faBricator, coater, precaSter or proDucer- Check appropriate box Attach this completed form to the CS-4171, Certificate of Compliance, to accompany the shipment to the project. † Verify that the Fabricator has Form CS-430, Notification of Inspection (NOI) for the job before production begins. 03(b)3 for more detailed information regarding CS-4171 responsibilities. B. Certifications completed on CS-4171(10-22) for steel shells and reinforcement. gov" at the end of the address. www. After 10/15/2020 Liquidated damages apply at the rate of $ 870. X Roadway to be power broomed by (contractor Jul 7, 2024 · Call the PennDOT IT Service Desk at: (717) 783-8330 or toll free at (855) 783-8330. RICHARDS Melissa J. [Sect. Material received from an approved Bulletin 15 and/or 42 suppliers or approved by LTS testing. It is understood that: (1) Bituminous materials will be purchased weight or converted gallons at 60 F. Roadway to be power broomed by (contractor This Contract is subject to Pennsylvania Human Relations Act 222 conditions. Certifications for nuts, bolts, washers, and other fasteners on CS-4171 with supporting documentation. 05(c) Do whatever you want with a CS-4171 (8-16): fill, sign, print and send online instantly. Y N 10. How to edit Cs 4171 in PDF format online. Get penndot cs 4171 forms eSigned straight from your mobile device following these six tips: 1. 2(a)1] B. 3(b)2] C. Certifications for other materials on CS-4171. 1983 Waiver for Manufactured Products “Active” Reuation -eval Required Coordination with AASHTO. 1005. Get the Cs 4171 completed. According to Pub. To fill out CS 4171, you need to follow the instructions provided by your institution or professor. _____ sec. Concrete Inspectors Daily Record Book (CS-472) or MC-CID App properly completed. 00 DOCUMENTATION -- POM B/7/10 & SECTION 704 -- Documentation applicable to this operation is current, properly completed and on file. Steel Products with In-Plant Inspection – Fabricated structural steel or precast & prestressed concrete products that received Department in-plant inspection and inspection stamp. In lieu of providing Form CS-4171 with each delivery, awarded Suppliers must adhere to the following: This Contract is subject to Pennsylvania Human Relations Act 222 conditions. † Verify that the Fabricator has approved standards and either “Accepted” or “Accepted as Noted” shop A. Form Cs-4171 Is Often Used In Pennsylvania Department Of Transportation, Pennsylvania Legal Forms, Legal And United States Legal Forms. Y N 13. Based on feedback regarding the May 1, 2022 · Download Fillable Form Cs-4171b In Pdf - The Latest Version Applicable For 2024. Material test results. Completion of CS-4171 Certification. 2. 03(b)2] Download Fillable Form Cs-4171b In Pdf - The Latest Version Applicable For 2025. Daily order and releases. A manufacturer submits an application (CS-4170) through the PennDOT website. Ensure fabricator submits samples 4 weeks prior to begin coating on the project. More than three-quarters of PennDOT's annual budget is invested in Pennsylvania's approximately 122,000 miles of state and local highways and 32,000 state and local bridges. 102. 704. Tip reinforcement, tip attachment and splice details accepted by the Structure Control Engineer. r Steel Products and Products Containing Steel with In-Plant Inspection by the Department or a Department Representative - For 100% US steel products where in-plant inspection has verified that the steel was melted and manufactured in the United States, only Form CS-4171 is required. A copy Level 1 Standard Certification Ship on Certificationwith Form CS-4171* None Level 2 Standard Certification - Reduced Ship on with Form CSCertification-4171* See below Level 3 Lot Approval Certification Ship only after Material Lot Approvalusing Modified Certification, with Form CS-4171* See below %PDF-1. The contractually required certificated and/or documents, as noted on the attached list, must be furnished and completed in order to prepare the project for final acceptance. Form Cs-4171 Is Often Used In Pennsylvania Department Of Transportation, Pennsylvania Legal Forms And United States Legal Forms. 1 of the Project Office Manual (POM, Pub 2) further clarifies the “Buy America” requirements and waiver request procedures. 01). 3. 01 & 106. [106. Certificate of Compliance on Form CS-4171 for acceptance of small quantities. Certificate of Compliance . Materials received from an approved Bulletin 15 and/or 42 suppliers or approved by LTS testing. Ch. us PennDOT website -www. (POM B/6/3-1) D. pdf), Text File (. Producers must maintain all Only Form CS-4171 is required. X Notify the Municipality 5 working days prior to start of project. Follow this straightforward guideline redact Penn dot cs 704 in PDF format online at no cost: penndot cs-4171 (2-22) penndot ecms penndot tr-4276a penndot cs-4347 9. _____ (PennDOT) 4. Download your modified document, export it to the cloud, print it from the editor, or share it with others The CS-4171 form, a certificate of compliance issued by the Pennsylvania Department of Transportation (PennDOT), is a critical document in this process. f Soil Amendments CS-4171 Contact Full Circle for signed form Bulletin 15 Listing 867. Cs 4171 Edit Cs 4171. No paper. 8 In POM Section C. r Unidentified Steel Attach supporting documentation including invoices bills of lading and mill test reports that positively identify that the steel was melted and manufactured in the United States. Certifications for other materials on CS-4171(10-22). No registration required. airSlate SignNow has paid close attention to iOS users and developed an application just for them. Certifications properly completed on CS-4171 for guide rail, guide rail components and rebar, along with Bills of Lading and Invoices. Try Now! CS-4171 12-15 www. • New eCAMMS Auto-generated CS-4171 for aggregate and concrete • Update to form CS-4171 and CS-4171LA • PennDOT Forms & Pubs Website (www. Each day's shipments of each aggregate size certified to each project shipped. CS-4171 Form Attach this completed form to the CS-4171, Certificate of Compliance, to accompany the shipment to the project. Easily fill out PDF blank, edit, and sign them. CS-4171 (3-19) certificate of compliance. A completed Form CS-4171, “Certificate of Compliance” must be submitted, with each shipment of material to the project. FILL OUT COMPLETELY Original to be retained with project records. Get your legally compliant document in PDF or Word format. After completing the Certificate of Compliance form CS-4171LA, maintain the original at your company’s location. penndot. CS-4171: CS-4171- Certificate of Compliance Link CS-4171F: If you have any questions or comments, please call the PennDOT IT Service Desk at 855-783-8330 and Form CS-4171 (PDF), Certificate of Compliance must be provided to the Department project inspection staff. us Bureau of Project Delivery | 81 Lab Lane | Harrisburg, PA 17110-2543| 717-787-7150 December 13, 2011 Kevin F. The PennDOT Certified Aggregate Technician-in-Training status is only valid from the date of issuance by the DME/DMM until the date of the last scheduled Aggregate Technician Certification Course in the same year and will be acceptable in all Districts for that period. r. • Form CS-4171, Certificate of Compliance, has been modified to include check boxes for 3 of 6 d. Enter ‘Date’ Material (s) shipped. Download Fillable Form Cs-4171 In Pdf - The Latest Version Applicable For 2024. Save time by filling it out online and saving as a ready-to-print PDF. Penndot Form Cs 4401. ECMS specific help desk staff are available Monday through Friday from 8 AM through 4:30 PM, excluding state holidays. us eCAMMS District Users CS-4171 Certificate of Compliance and/ or TR-465 Daily Bituminous Mixture Certification required for all materials. Material within Publication 447 is only intended to be used by municipalities on ice- and snow-covered pavement surfaces and is produced by suppliers listed within the current publication, Section MS-0450-0001. Fill Out The Supplemental Certification Steel Products Containing Foreign Steel - Pennsylvania Online And Print It Out For Free. Fill Out The Certificate Of Compliance For Daily Asphalt Mixtures - Pennsylvania Online And Print It Out For Free. www Call the PennDOT IT Service Desk at: (717) 783-8330 or toll free at (855) 783-8330. Download a blank fillable Form Cs-4171 - Certificate Of Compliance in PDF format just by clicking the "DOWNLOAD PDF" button. CS-4171 (10-22). D. Original to be retained with project records. PennDOT CS-4171 material certifications shall be provided for each precast element manufactured, and any PennDOT LTAP technical INFORMATION SHEET #164 SPRING/2024 400 North Street, 6th Floor Harrisburg, PA 17120 1-800-FOR-LTAP • FAX (717) 783-9152 ltap@pa. Certificate of Compliance for Daily Bituminous Mixtures . (CS-4171) to indicate that the material meets current PennDOT specifications. Producers must maintain all Do whatever you want with a CS-4171 (3-19): fill, sign, print and send online instantly. 3 -- Documentation § Epoxy coated or galvanized reinforcement steel requires the submission of supplemental certification Form CS-4171C (Epoxy Coating or Galvanizing Facility) and/or Form CS-4171F (Fabrication Facility). state. 408), except bidders need not be prequalified by PennDOT (Sec. Plant summary. Notify the Municipality 5 working days prior to start of project. 6. Get penndot cs 4171 signed right from your smartphone using these six tips: Type signnow. Before sharing sensitive or personal information, make sure you're on an official state website. The Producer maintains the original Form CS-4171 and provides a copy of Form CS-4171 with each direct shipment to the project. A copy of Attach this completed form to the CS-4171, Certificate of Compliance, to accompany the shipment to the project. Header 1. [Sect. Form Cs-4171la Is Often Used In Pennsylvania Department Of Transportation, Pennsylvania Legal Forms, Legal And United States Legal Forms. Try Now! Bulletin 15 - Free ebook download as PDF File (. In a matter of seconds, receive an electronic document with a legally-binding eSignature. A. ON HAND Reference: Pub. Air meter calibrated within 2 weeks, and recorded in the Concrete Inspectors Daily Record Book orMC-CID App. For products where in-plant inspection A. Form CS-4171 is enclosed and may be duplicated as needed, or accessed on the PennDOT web site at the following address: 1 PART 1 - INSPECTION OF PR ESTRESSED / PRECAST CONCRETE PRODUCTS & CONCRETE PIPE SECTION I – INTRODUCTION The purpose of this publication is to outline general guidelines for the consultant inspectors and PAYMENT AUTHORIZATION FOR MATERIAL STORED OR . 2(c) and AASHTO M157] G. 9. InStructionSrefer to publication 2, project office manual, Section for additional guidance in completing this countY, lr/Sr, Sec/SeG. Straight-line charts. OS-2 (11-08) www. Material Identification and Quantity, Lot Number, ASTM & AASHTO Specification Reference, Buy A. 06. dot. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content. 408, Section 110. Material may not contain metal, glass, PennDOT is Working for You. CS-4171 Certificate of Compliance and/ or TR-465 Daily Bituminous Mixture Certification required for all materials. Calibrate Equipment Y N 14. Certifications (CS-4171, CS-4171C, CS-4171F & CS-4171LA) on file for the precast panels, soil reinforcing elements, precast coping, reinforcing steel, structure backfill aggregate, geotextile, impervious membrane & mortar. However, here are the general steps you can take to complete the form: 1. PUB 23 - MAINTENANCE MANUAL. Material received from an approved Bulletin 15 or 42 supplier, or approved by LTS. 1. Construction Specifications Aggregate Producers . This Contract is subject to the non-discrimination in Employment/Contract Compliance Regulations Conditions. Daily asphalt certification. 8, the requirement for a completed certification form CS-4171 for temporary barrier has been removed to be consistent with Pub 408, Section 901. 00 DOCUMENTATION -- POM B/7/6 -- Documentation applicable to this operation is current, properly completed and on file. gov CERTIFICATE OF COMPLIANCE INSTRUCTIONS Refer to Publication 2 Project Office Manual Section B. X CS-4171 Certificate of Compliance and/ or TR-465 Daily Bituminous Mixture Certification required for all materials. r Steel Products and Products Containing Steel with In-Plant Inspection by The purpose of CS-4171 - PennDOT is to ensure compliance with highway use tax regulations and to report mileage driven in Pennsylvania. 1 Compost Blanket CS-200 N/A Section 106. 00 PROJECT OFFICE DOCUMENTATION --POM, PTM & SECTION 704 --Documentation applicable Local, state, and federal government websites often end in . Certification for pipe on CS-4171 and contains the required information to properly identify eachsection of pipe. true manufacturer (Line 2) and the approved material (Line 5) as it is listed in Bulletin # 15 under . Open and complete your form directly in your browser faster than ever before with the editor toolkit. 2. Documentation of failures and action required according to their Quality Control Plan. Supplemental certifications from the fabricator and the coater (CS-4171C (2-22) and CS-4171F (2-22)) for epoxy coated rebar. Batcher-mixer slip (CS-4220) and concrete delivery tickets properly prepared. After completing the Certificate of Compliance form CS-4171, maintain the original at your company’s location. Examples have been updated with the new Form CS-4171 (11-11). & 5. Aggregate shipped to asphalt and cement concrete plants certified yearly for quality requirements as specified in Section 106. Cs 4171 2015 2019 form pdf. Refer to Publication 2, Project Office Manual, Section B. (2) Supplier must furnish Form CS-4171, CERTIFICATE Form CS-4171 is completed by the manufacturer, fabricator, or producer (Producer) of Bulletin material provided to the project. us 2016 Summary of Section 409 Lot Payments CS-4171 Generate and Save & History. Try Now! Prices (Attachment 1) in accordance with the current PennDOT Specifications (Pub. 2 Only Form CS- 4171la is Products and Products Containing Steel with In-Plant Inspection by the Department or a Department Representative - For 100% US steel products where in-plant inspection has verified that the steel was melted and manufactured in the United States, only Form CS- 4171la is required. CS-101A Construction Field Site IT Equipment Request Form . CS-5 Pile Hammer Data . Required data entered in plant book. In lieu of providing Form CS-4171 with each delivery, awarded Suppliers must adhere to the following: (PennDOT) 3. gov) • DocuSign forms CS-4171 and CS-4171LA • Template Oct 1, 2022 · Download Fillable Form Cs-4171la In Pdf - The Latest Version Applicable For 2025. Our records, attesting to this statement, are open for inspection by a Department Representative for not less than THREE years from the date of shipment. CERTIFICATE OF COMPLIANCE FOR DAILY ASPHALT MIXTURES CS-4171 12-15 www. gov. C. Only Form CS-4171 is required. Private Label Companies who complete the Certificate of Compliance form CS-4171 must identify the true manufacturer (Line 2) and the approved material (Line 5) as it is listed in Bulletin # 15 under that manufacturers listing. After 10/31/2017 Liquidated damages apply at the rate of $ 870. : SR/SECTION: TYPE OF CONSTRUCTION: Embarkment/Fill Subgrade Subbase Structure Backfill Pipe Backfill Download a blank fillable Form Cs-4171b - Certificate Of Compliance For Daily Bituminous Mixtures in PDF format just by clicking the "DOWNLOAD PDF" button. 00 per calendar day. If a paint is to be sampled, notification will be sent by email, with instructions on which Lot Number(s) are to be sampled. After 12/31/2024 Liquidated damages apply at the rate of $ 870. ECMS specific help desk staff are available Monday through Friday from 8 AM through PM, excluding state holidays. CS-4171 CS-4171B . to provide a Certificate of Compliance (CS-4171) to the municipality for each load. CS-1005, Pile driving log utilized to document field driving information and on file. [Sects. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 16 17 18 19 20 21 22 23 24 Payroll--Certifi-cation For Week Ending Date Received on Project Elapsed Days Date f. 601. 6 %âãÏÓ 46 0 obj > endobj 66 0 obj >/Filter/FlateDecode/ID[24496FAA3AAAEC4CB3C1E0B0D8123CE1>]/Index[46 33]/Info 45 0 R/Length 99/Prev 111487/Root 47 0 R Edit CS 4171 Certificate of Compliance. CS-4171 (8-16) certificate of compliance - PennDOT Home. Form CS-4171 (PDF) must be provided to the Department project inspection staff. All contractually required certificated and/or documents have been furnished and are satisfactory. WEBLINKS: INTERNAL LINKS - PENNDOT AUTHORIZED It is mandatory that a “Certificate of Compliance”, Form CS-4171, be accurately completed and distributed as directed for all approved products shipped to PennDOT projects. pa. 2016 PennDOT LTS Review. f. PennDOT’s Bureau of Project Delivery reviews the application and determines if a specification for the product or process exists. E. 9. Scale checks. Private Label Companies who complete the Certificate of Compliance form CS-4171 must identify the. X Work to be completed on or before 12/31/2024 . www CS-4170 Product Evaluation Certificate of Eligibility CS-4171 Certificate of Compliance CS-4171B Certificate of Compliance for Daily Bituminous Mixtures CS-4171C Supplemental Cert for Epoxy Coated or Galvanized Reinforcement - Coating Facility CS-4171F Supplemental Cert for Epoxy Coated or Galvanized Reinforcement - Fabricating Facility B. Begin with the header section. Liquidated damages apply at Roadway to be power broomedby (contractor X municipality 1. Save or instantly send your ready documents. † Verify that the Fabricator is listed in Bulletin 15 for the product(s) they are going to produce. The paving fabric is placed over the Superpave leveling course, which was done the previous day to allow the roadway to cool prior to applying the cs-4136 (4-11) _____ of _____ punchlist form contract no. 2(b)] D. CS-4171 Form. CS-7 Defective Bituminous Pavement Review CS-8 Issue Escalation Matrix . Material may not contain metal, glass, (CS-4171) to indicate that the material meets current PennDOT specifications. What information must be reported on cs-4171 - penndot? Information such as vehicle identification numbers, date of travel, origin and destination of trip, and total miles driven in Pennsylvania must be Material e-Certifications will be replacing the paper CS-4171 forms effective on all projects let after January 1, 2022. After 8/19/2023 Liquidated damages apply at the rate of$ 870. If you own an iOS device like an iPhone or iPad, easily create electronic signatures for signing a cs 4171 certificates of compliance in PDF format. penndot. Form CS 4171 (PDF), Certificate of Compliance, is Download Fillable Form Cs-4171s In Pdf - The Latest Version Applicable For 2024. On the left is the actual screenshot of the 1983 FHWA Waiver\爀屲Waiver is still “Active”\爀⨀屲All Waivers under the BABA Act are \൒equired to be Re-evaluated\爀⨀屲AASHTO working with all 50 States to develop a list of impacted products\ Form CS-4171 or another acceptable form. G. Exception - If a steel product delivered to a project contains both foreign and US steel, the product is considered to be a US steel product only if at least 75% of the total cost of steel in the product is the cost of US steel (mined Oct 1, 2022 · Download Fillable Form Cs-4171 In Pdf - The Latest Version Applicable For 2025. QA and DQA tests. F. • Section C. † Verify that the Fabricator has approved standards and either “Accepted” or “Accepted as Noted” shop Form CS-901 has been clarified in Item 4, Documentation of Work Zone Traffic Control Compliance Inspections. ecmS#To be completed by the party that will ship the material to the construction project, otherwise leave name of manufacturer, faBricator, coater, precaSter or proDucer- Check appropriate box; manufactured, fabricated Therefore, the airSlate SignNow online application is necessary for filling out and putting your signature on penndot 4171 form on the go. CS-6 Pipe Installation Inspection Form . 8-2 with a copy of a signed Certificate of Compliance (CS-4171), a Bill of Lading, and a Certificate of Analysis for bituminous material on the first day of paving and when the batch number changes. _____ s. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania. 3 for additional guidance in completing this Form. Fill Out Completely. 2(c) & 106. CS-110 Payment Authorization for Material Stored or On Hand Private Label Companies who complete the Certificate of Compliance form CS-4171 must identify the true manufacturer (Line 2) and the approved material (Line 5) as it is listed in Bulletin # 15 under that manufacturers listing. _____ item/action date completed Easily complete the Form CS-4171 Certificate of Compliance for Pennsylvania online. Effortlessly add and underline text, insert pictures, checkmarks, and icons, drop new fillable areas, and rearrange or delete pages from your paperwork. (POM B/7/10-1/10-2) It is mandatory that a “Certificate of Compliance”, Form CS-4171, be accurately completed and distributed as directed for all approved products/services shipped to PennDOT projects. Aggregate control i. CS-431 (6-07) INSTRUCTIONS FOR STRUCTURAL MATERIAL TRANSFER FORM This form should be filled and signed by the inspector working at the fabrication shop when fabricated material is transferred to another shop or facility for additional work. 1(d)] 2. Complete a blank sample electronically to save yourself time and money. com in your phone’s browser and log in to your account. us Click on Forms, Publications & Maps D DGS warehouse (PennDOT employees ONLY) APPROVED FOR ISSUANCE BY: LESLIE S. : DISTRICT NO. Fill Out The Certificate Of Compliance - Pennsylvania Online And Print It Out For Free. 2-6 C. It is mandatory that a “Certificate of Compliance”, Form CS-4171, be accurately completed and distributed as directed for all approved products/services shipped to PennDOT projects. Form Cs-4171b Is Often Used In Asphalt Mixture, Pennsylvania Department Of Transportation, Pennsylvania Legal Forms, Legal And United States Legal Forms. Updated 8-12 located at P:/penndot shared/FORMS PennDOT PennDOT's long-range CS-4137 Final Inspection Form CS-4138 Acceptance Certificate CS-4170 Product Evaluation Certificate of Eligibility CS-4171 Certificate of Compliance Pennsylvania (CS-4171) to indicate that the material meets current PennDOT specifications. 1105. H. 03(b)3] B. gov" or "pa. Download your modified document, export it to the cloud, print it from the editor, or share it with other people using a Shareable link or as an email ∙ Copies of the CS-4171(s) Paint sampling/testing shall be performed twice per year and as directed by the SME by each fabricator/coater. Plot test results on straight lines and establish action points. In a matter of minutes, get an digital document with a court-admissible eSignature. 106. Form CS-4171 is to be completed by the party that is shipping approved material to the next destination. (2) Supplier must furnish Form CS-4171, CERTIFICATE Do whatever you want with a certificate of compliance CS-4171 3-19: fill, sign, print and send online instantly. 02 Get the free certificate of compliance for daily bituminous mixtures - PennDOT MANUFACTURED PRODUCTS. Jost CS-4171 Certificate of Compliance and/ or T R-465 Daily Bituminous Mixture Certification required for all materials. Remit copy to District Office. See Pub 408, Section 106. 03(b)3] How to make an electronic signature for the Cs 4171 Certificate Of Compliance on iOS devices. Knowledge of truck loading and weighing procedures. 03(b)3] C. The MTD will evaluate the asphalt content in the RAP source material. Fill, sign, and download the document in PDF format for free. Other components/additives incorporated into the mix. In lieu of providing Form CS-4171 with each delivery, awarded Suppliers must adhere to the following: Form CS-4171 is completed by the manufacturer, fabricator, or producer (Producer) of Bulletin material provided to the project. 02 Project specific, locally approved material 868. CS-4171 contains location and date of testing, including the Rotational Capacity Test with R/C Lot Number performed by the manufacturer, and the zinc thickness when galvanized bolts are used. Understand the purpose of CS 4171 and what information you need to provide. CS-101 Inspector’s Field Office and Inspection Facilities . CS-4171- Cer ficate of Compliance Link The form works in a similar fashion to the previous versions without the need to maintain a separate digital signature. PennDOT. On any device & OS. PennDOT CS-4171 material certifications shall be provided for each precast element manufactured, and CHAPTER 2 Certification, PennDOT Form CS-4171, shall be provided with each shipment, unless. 2-3 through C. DATE: CONTRACT NO. 00PROJECT OFFICE DOCUMENTATION --POM, PTM, AND SECTION 1006. A copy of Therefore, the airSlate SignNow web application is a must-have for completing and signing cs 4171 on the go. Jul 22, 2024 · Call the PennDOT IT Service Desk at: (717) 783-8330 or toll free at (855) 783-8330. 2(b), 601. Qualified Products for Construction Producers of Bituminous Mixtures Producers of Ready Mix Concrete Construction Manual . that manufacturers listing. g Mulching CS-4171 Contact Full Circl for signed form Bulletin 15 Listing 808. a Compost Filter Sock (component) CS-200 N/A Section 106. PennDOT Lead Paint Removal Checklist Construction - Section 9073, 9075, 9077, and 9079 B 4 18-1 Form CS-4171, CS-4171C, and CS-4171F B 6 3-1 PK ! ÙvRŽ 6 [Content_Types]. In lieu of providing Form CS-4171 with each delivery, awarded Suppliers must adhere to the following: F. 0 PennDOT SALES STORE (717)787-6746 phone (717)787-8779 fax ra-penndotsalesstore. 00 per calendar day. CS-4171 12-15 www. This phone number is answered 24/7 and is able to handle password resets and other minor issues. The paving fabric is placed over the Superpave leveling course, which was done the previous day to allow the roadway to cool prior to applying the Level 1 Standard Certification Ship on Certificationwith Form CS-4171* None Level 2 Standard Certification - Reduced Ship on with Form CSCertification-4171* See below Level 3 Lot Approval Certification Ship only after Material Lot Approvalusing Modified Certification, with Form CS-4171* See below 805. The CS-4171, CS-4171 LA and CS-4171 F have been modified to allow for a certified 3rd party signature, as per FHWA requirements. Certifications for reinforcement and curing materials on CS-4171. Certifications for other materials related to bridge decks on CS-4171 (10-22). 03(b X CS-4171 Certificate of Compliance and/ or TR-465 Daily Bituminous Mixture Certification required for all materials. makes following the written instructions in the PENNDOT Publication 153 Page 23. Fill Out The Certificate Of Compliance For Locally Approved Non-bulletin Materials - Pennsylvania Online And Print It Out For Free. X Notify the Municipality X Work to be completed on or before 10/31/2017 . Easily add and highlight text, insert images, checkmarks, and icons, drop new fillable fields, and rearrange or delete pages from your document. At PennDOT, we oversee programs and policies affecting highways, urban and rural public transportation, airports, railroads, ports, and waterways. %PDF-1. No software installation. The paving fabric is placed over the Superpave leveling course, which was done the previous day to allow the roadway to cool prior to applying the Complete Penndot Cs 4171 online with US Legal Forms. Mobile mixers charged less than 6 hours prior to material mixing unless approved by the Representative e. It serves as a guarantee from the supplier that the materials shipped to a project adhere to PennDOT's specifications, as outlined in Publication 408 and various bulletins detailing material Easily fill out and download the Form CS-4171 LA Certificate of Compliance for Locally Approved Non-bulletin Materials - Pennsylvania. Start by reading the instructions on the form carefully. Form CS-4171 is to be included with each delivery as referenced in the specifications of the contract and PennDOT Publication 408 g. Y N 11. Maintenance and Operations for a variety of highway safety needs. 408 Section 106. 03(b)3 using Form CS-4171 or another acceptable The contractor proposes to furnish and deliver all materials ( including Form CS-4171, CERTIFICATE OF COMPLIANCE and/ or TR-465 DAILY BITUMINOUS MIXTURE CERTIFICATION ) and to do and perform all work on the following project as more specifically set forth in the Schedule of Prices (Attachment), in accordance with drawings Pennsylvania’s pavements and structures, and to comply with Federal Highway Administration (FHWA) guidelines for concrete acceptance testing, the Pennsylvania Department of Transportation (PennDOT) has determined that anyone who is involved in the acceptance process for Portland Cement Concrete (PCC) on PennDOT projects must Complete PA CS-4171 2015 online with US Legal Forms. Work to be completed on or before 8/19/2023 . 5. Photo courtesy of ISMF LLC. Form CS-4171 must be f. xml ¢ ( ÄTËNÃ0 ¼#ñ ‘¯(qé !Ô´ G@jù o «‰my—Òþ=kS ªúPÔJ\ò°½3³³òŒ&«®Í– Ð8[Šëb 2°•ÓÆÖ¥x›=å Prices (Attachment 1) in accordance with the current PennDOT Specifications (Pub. Form CS 4171 (PDF), Certificate of Compliance, is with a copy of a signed Certificate of Compliance (CS-4171), a Bill of Lading, and a Certificate of Analysis for bituminous material on the first day of paving and when the batch number changes. The manufacturer, fabricator, precaster, or producer is required to maintain files of supporting receipts and mill certifications at their facility, for a period of not less than 3 years from the date of the project shipment. CS-110 Payment Authorization for Material Stored or On Hand Level 1 Standard Certification Ship on Certificationwith Form CS-4171* None Level 2 Standard Certification - Reduced Ship on with Form CSCertification-4171* See below Level 3 Lot Approval Certification Ship only after Material Lot Approvalusing Modified Certification, with Form CS-4171* See below Complete PA CS-4171 2013 online with US Legal Forms. OfficeManual. CS-4171F - Supplemental Cer fica on for Epoxy Coated or Galvanized Reinforcement Steel- Fabrica on Facility Link The form works in a similar fashion to the previous versions without the need to maintain a separate requirements of the Pennsylvania Department of Transportation. Open the file in any PDF-viewing software. Certifications for bedding aggregate and backfill aggregate on CS-4171 for each day’s shipment. 7 %âãÏÓ 28871 0 obj >stream hÞÌ[ë Ü6’ï?¥q À“ˆo2X,0~'ˆcÓÄw·» zºÛãÙÌ Ó=vœ û§ß]U‘”HJ”Ô3Iv×Ø ¥–Ī_=X,V to provide a Certificate of Compliance (CS-4171) to the municipality for each load. Easily download and fill out the Form CS-4171LA Certificate of Compliance for Locally Approved Non-bulletin Materials - Pennsylvania. Mix Containing more than 15% RAP. gov C. Quality Control Plan reviewed and on file. If not, it surveys the Bureau of Municipal Services and PennDOT districts for interest in the product’s use. Geotextile rolls must be stored off the ground and adequately covered to protect them. Project summary. a. Securely download your document with other editable templates, any time, with PDFfiller. Notify the Municipality five working days prior to start of project, Work to be completed on or before After the rate of $ 870. www Private Label Companies who complete the Certificate of Compliance form CS-4171LA must identify the true manufacturer (Line 2) and the locally approved material (Line 5). zab bvedeb quwno pzpq piqwuno hsbf ltkxw kvu xll qsfgvs