/ Materials Source List
Pre-Con Date
Contractor Nameand Address: / Contract
County
Section
Route
Job No.
District
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.
Material
/ Evidence of Inspection
As taken from the Project Procedure Guideat website
/
Producer/Supplier

Adhesives

Bonding epoxy / Cert or Mark
Chemical adhesive (Dowel &Tiebar) / List
Glass Capsule for AnchorBolts / List
Aggregate
For Mixtures & Granular Use / List + Tick.
Lightweight, for P. C. Concrete / Cert
Riprap, Concrete / List + Tick.
Riprap, Stone / List + Tick.

Bridge Bearing Pads

Elastomeric (Whole Pad) / Cert or LA 15 or (*BMPR)
Fabric / LA 15 or Test
Pot, Floating Bearings / BMPR

Bituminous Materials

PG Asphalt Binder / (List or Test) + Billof Lading
Road Oil & Cutback Asphalt / (List or Test) + Billof Lading
Emulsified Asphalt / (List or Test) + Billof Lading

Hot Mix Asphalt

Hot Mix Asphalt(QC/QA)

/ Daily Plant Report + Tick. + Test

Block/Brick

Clay or ShaleBuilding Brick

/ Test

Clay or Shale Paving Brick

/ Test

ConcreteBuilding Brick

/ List

Concrete Paver

/ List

Precast Block Revetment Mat

/ List

Precast Articulated BlockRevetment Mat

/ List

Segmental Concrete Block Walls(Retaining Wall)

/ List

Concrete Masonry Units forBuildings/CatchBasin/Manhole/Inlet/Valve Vault

/ List

Bridge Rail

Railing

-Structural Steel

/ BMPR or LA 15 or Test

-Aluminum, Steel, Stainless Steel

/ Cert or LA 15

Post, Anchoring Device

/ Cert or LA 15

Cementitious Materials

Cement
-Calcium Aluminate / Test
- Portland or Blended / (List or Test) + Bill of Lading
-Rapid Hardening / List
Finely Divided Minerals - Fly Ash,Ground Granulated Blast Furnace Slag, Microsilica, High-Reactivity Metakaolin / List or Test

Chemicals/Admixtures

HMA-Anti-strip Additive forBituminous Mixtures

/ List

HMA- Asphalt Truck Release Agent

/ List
Calcium Chloride (Dry, Liquid)

- Dust Palliative

/ Test

- PCC – Calcium Chloride Accelerator

/ Cert

CLSM- Air Entraining Admixture

/ List

PCC-Corrosion Inhibitor

/ List

PCC-Latex Emulsion

/ Cert

PCC-Air-Entraining Admixture

/ List

PCC-Type A-G Admixtures

/ List

PCC–Rheology Modifying Admixture

/ List

PCC–Viscosity Controlling Admixture

/ List

PCC-Membrane CuringCompound

/ LA 15 or IL OK or Test

PCC-Membrane Curing Compound/Linseed Oil Emulsion

/ LA 15 or IL OK or Test

Concrete Seat Sealer

/ List

Protective Coat (Linseed Oil/Petroleum Spirits)

/ LA 15 or IL OK or Test

Rock Salt, Sodium Chloride

/ Test

Water, for concrete, mortar, or curing

/ Potable Source or Test

Weed Killer

/ Mark or Vis
Concrete
Polymer Concrete / List
Portland Cement Concrete- other than QC/QA / Daily Plant Report + Tick. (Tick. not req’d for volumetric mixer) +Test
Portland Cement Concrete / Daily Plant Report + Tick. (Tick. not req’d for volumetric mixer) + Test
CAM II- Cement Aggregate Mixture / Daily Plant Report + Tick. (Tick. not req’d for volumetric mixer)
CLSM-Controlled Low –StrengthMaterial / Daily Plant Report + Tick. (Tick. not req’d for volumetric mixer) + Test
Non-Shrink Grout / List
Shotcrete, High Performance / List + Test
Thin Polymer Overlay System forBridge Decks / List
PCC – Curing Blanket – Burlap,Burlap/Poly, Waterproof Paper, WhitePoly, Cotton Mat / Vis. Exam

Concrete, Precast

Architectural Products / List
Bridge Beams / List + Mark
Bridge Slabs / List+ Mark
Bridge – Three Sided Structure / List + Mark
Drainage Products / List + Mark
Noise Abatement Wall / List
MSE Retaining Wall / List
Modular Retaining Wall / List
Traffic Barrier / List + Mark
R.O.W., Drainage, Section, and Permanent Survey Markers / List
Headwall / List
Bumper Blocks (Wheel Stops for Cars) / List
Picnic Table, Trash Receptacle, Planter / List
Splash Blocks / List

Concrete, PrecastPrestressed (Except Piling)

Prestressed Products / IL OK

Concrete Repair

Mortar, Polymer Modified Portland Cement / List
Rapid Hardening Cementitious Material / List

Electrical

Cable, unit duct / Mark or LA15
Conduit
- Aluminum, plastic / Mark or Cert or LA 15
- Steel / LA 15 or (Cert + Mark)
Detector Loop / LA 15 or Mark
Fiber Optic Cable / Mark or Cert or LA 15
Ground Rod / LA 15 or Cert.
Wire, Span or Tether / LA 15 or Test

Fencing

Fabric, Post, Wire / Cert or LA 15
Glare Guard, Slats / Vis

Guard Rail

Cable for Road Guard / LA 15 or IL OK or Test
Fasteners / (Mark + Cert.) or Test
Steel Plate & Accessories / List + Cert
Steel Post / Cert. or LA 15
Traffic Barrier Terminal End Section / NCHRP 350 Pdts.= (List + Cert)or LA 15; Pdts. Not covered by NCHRP 350 = Cert or LA 15
Wood Posts, Plank / Mark or Cert. or LA 15
High Tension Cable Median Barrier / (List + Cert) or LA 15

Joint Fillers & Sealers

Mastic for Precast Concrete Pipe / Cert or LA 15
Cold- Poured Sealer / LA 15 or IL OK
Hot- Poured Sealer / LA 15 or IL OK
Polysulfide Sealer / Mark (if it contains spec. info) or Cert. or LA 15
Asphalt Fillers
-PAF / LA 15 or IL OK or Test
-Fiber – Modified (Pavement Preserv.) / Cert
Preformed- Bituminous, cork, foam, fiber, plastic / LA 15 or IL Ok or Test
Preformed Elastomeric Compression / LA 15 or IL Ok or Test
Preformed Neoprene, EPDM / LA 15 or IL OK or Test
PCC- Silicone / Cert or Mark (if it contains spec. info.) or LA 15
Water Seal, PVC / LA 15 or Test

Landscaping

Agricultural Lime (Dept of Ag. Prog.) / List + Tick.
Excelsior Blanket / Cert or LA15
Fiber Mat / Mark or Cert
Fertilizer / Cert (bulk) or Mark (bags)
Mulch
- Straw / Vis
- Paper, Wood cellulose / Mark or Cert
Asphalt coated straw
- Emulsified Asphalt / (List or Test) + Bill of Lading
- Straw / Vis
Compost / Cert
Peat Moss / Cert. or IL OK or LA15
Seed, Sod / Cert. or IL OK or LA15
Trees, Shrubs, Plants / Vis

Lighting & Signals

Controllers & Cabinets / Vis.Compared to Approved Submittals + Cert
Lamps, Luminaries & Ballast / Vis.Compared to Approved Submittals + Cert
Traffic Signal Components / Vis.Compared to Approved Submittals + Cert
Break-Away Support / Vis.Compared to Approved Submittals + Cert
Poles
- Steel, Aluminum / Cert or IL OK
- Wood / Mark
Mast Arm Assemblies / Cert.
CompositeHandholes and Gulfbox / Cert

Lumber/Timber

Treated or Untreated Lumber / Cert. or Mark
Metal Products, Misc.
Aluminum Drains / Cert. or Mark or LA 15
Copper Water Pipe / Mark
Name Plate / LA 15 or Vis.
Rodent Shield / Vis.
Survey Markers / LA 15 or Vis.

Miscellaneous

Manhole Step, Plastic / Cert or LA 15
Geotextile Fabric – French Drain, Ground Stabilization, Pipe Underdrain, Rip Rap, Silt Filter Fence & Weed Barrier / Mark or Cert or LA15
Concrete Revetment Mat Fabric / List

Paint

Bridge Paint & Primer / Test (Approved Lot)
Pavement Marking Paint / LA 15
Epoxy Pavement Marking Ln. / LA 15 or Test
Preform Plastic Pav. Marking Ln. / LA 15 or Test

Pavement Marking

Glass Beads / LA 15 or IL OK
Raised Pavement Marker / List
Temporary Pavement Tape / LA 15 or (IL OK + Batch/Lot Number)
Thermo Letters & Symbols / Cert. or LA 15
Thermoplastic-Granular Block / LA 15 or IL OK
Thermoplastic Tape / LA 15 or IL OK

Piling

Metal Shell, Steel H, or Steel Sheet or Steel Soldier / Cert. or LA 15 or IL OK
Precast Concrete / List
Precast, Prestressed Concrete / IL OK
Timber / Cert. or Mark or LA 15

Pipe, Culvert & Drain

Cast or Ductile Iron Pipe / Cert. or LA 15
Clay Pipe & Drain Tile / LA 15 or IL OK or Test
Metal Corrugated & Components / Cert. or IL OK or LA 15
Pipe-Plastic, PVC, HDPE-water/sewer / IL OK or LA 15 or Test
Pipe Fittings – PE, PVC / Vis
Pipe Liner, PE, PVC / IL OK or LA 15 or Test
Pipe Underdrain / IL OK or LA 15 or Test
Plastic Deck Drain / Cert
Precast Concrete Pipe or Box Culvert / List + Mark
Underdrain Mat, Wall Drain / LA 15 or Test

Signing

Completed Sign Panels & Standard
-Reflective Sheeting / LA 15 or Test
- Aluminum Sheeting / LA 15 or Test
Post, Break-Away / Cert. or IL OK or LA 15
Posts, Metal & Hardware / Cert or LA 15.
Post, Tubular (round, rectangle) / LA 15 or IL OK or Test
Posts, Steel Delineator / Cert or LA 15
Post, Wood / Mark or Cert or LA 15
Reflector, Delineator, Terminal / Cert or LA 15
Reflector, Prism / Cert or LA 15
Sign Structure, Overhead / BBS 59 + Cert.
Structural Fasteners / BMPR or LA 15 or IL OK
Soil/Modification/Stabilization
CAM – Cement Aggregate Mixture / Test
Topsoil / Test
For IBR
-Fine- Grained Soil / Test
-Coarse- Grained Soil / Test
For Moisture Density
-Fine- Grained Soil / Test
-Coarse- Grained Soil / Test
Pozzolanic Stabilized Subbase or Base Course / Test
Cement (Portland or Blended) / (Listor Test) + Bill of Lading
Fly Ash / Listor Test
Lime / Cert. & Manufacturers’ Test Resultsrepresentingmat’ldelivered to be provided prior to or with 1st load
Modified Soil with Lime, Portland Cement, PortlandBlast-Furnace Cement, or Fly Ash / Test
Lime Stabilized Subbase or Base Course / Test
Soil-Cement Base Course / Test
Steel & Casting
Cast Frames & Grates/Lids / Cert or LA 15
Cast Manhole Steps / Cert or LA 15
Deck Drains / Cert or LA 15
Gabions, Slope Mattress / Cert or LA 15
Pipe Casing / LA 15 or IL OK or Test
Steel Frame & Grates / Cert or LA 15
Steel, Miscellaneous
Anchor Bolts / BMPR or LA 15 or IL OK
Steel, Reinforcing
Dowel Bars – black or epoxy coated / List + Cert
Dowel Bar Assembly (Only) / List + Cert
Pavement Fabric & Wire Mesh / List + Cert
PrestressingStrand / BMPR
Reinforcing Bar – black or epoxy coated / List +Cert + Mark
Rebar Splicers – black or epoxy coated / List + Cert;Test if > 100
Steel, Structural
Fasteners / BMPR or LA 15 or IL OK
Structural Steel / BBS 59 + Cert
Stud Sheer Connectors / (Mark+ Cert) or LA 15
Temporary Items
See Sections 100, 500 / Vis. Exam
ExceptReflective Material / See Paint, Pavement Marking & Signing requirements
Waterproofing Materials
Asphalt Emulsion (Art. 1060.08) / (List or Test) + Bill of Lading
Membrane System (Art. 1061)
-Coal-Tar Pitch Emulsion & Primer / LA 15 or Test
-Fabric, Glass / LA 15 or Test
Reflective Crack Control (Art. 1062)
-Reinforcing Fabric / Mark or Cert or LA 15
Fiberglas Repair System (Art. 1063)
-Fiberglas Fabric / LA 15 or Test
-Bit. Adhesive / LA 15 or Test
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
Under no condition are materials to be incorporated into a contract without appropriate Evidence of Inspection.
Award Date: / Execution Date: / Starting Date
R.E.
Contact Person for Material Discrepancies / Phone
Location:
District Materials Engineer

Printed 11/4/2018Page 1 of 7D5 PI0315 (Rev 7/16/09)