RAM Blank Form

DOT Form 350-071 Revised 03/2018

Request for Approval of MaterialContract Number FA Number SR Date

Section / Title of Project County

Contractor Subcontractor

This form shall be completed prior to submittal. If this form is not compete at time of submittal it may be returned for information that was omitted.

For WSDOT Use OnlyRAM #

Bid Item No.

Material or Product/Type

Name and Location of Fabricator, Manufacturer or Pit Number

PE/QPL Code Hdqtr./QPL Code

Project Engineer Date State Materials Engineer Date

Acceptance Action Codes for use by Project Engineer and State Materials Laboratory1. Acceptance Criteria: Acceptance based upon “Satisfactory” Test Report for samples of materials to be incorporated into project.2. Acceptance Criteria: Mfg. Cert. of Compliance for ‘Acceptance’ prior to use of material.3. Acceptance Criteria: Catalog Cuts for ‘Acceptance’ prior to use of material. Catalog Cut Approved Yes No4. Acceptance Criteria: Submit Shop Drawings for ‘Approval’ prior to fabrication of material.5. Acceptance Criteria: Only ‘Approved for Shipment’, ‘WSDOT Inspected’ or ‘Fabrication Approved Decal’ material shall be used.6. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action.8. Source Approved:

9. Approval Withheld: Submit samples for preliminary evaluation.10. Approval Withheld:11. Miscellaneous Acceptance Criteria.Remarks:

State Materials Engineer Distribution

Contractor Region Materials General File Signing Inspection

State Materials Lab Other

Fabrication Inspection MS 47365

GD-089 Received3/5/2021

N/A

CITY OF BOTHELL DEPARTMENT OF PUBLIC WORKS

SUBMITTAL REVIEW

SR 522 Stage 3 Improvements

No Exceptions Taken ____ Approved as Noted ____

Amend and Resubmit ____ Rejected ____

Important Notice; This review does not relieve the contractorfrom its liability to comply and conform with the Plans,

Specifications, and Contract Documents.

____________________________ ____________ Signature Date

3/5/21

Kenmore PM

3/8/21

City of Bothell

1601 5th Avenue, Suite 1600Seattle, WA 98101206.622.5822www.kpff.com

JURISDICTION:CITY OF BOTHELL

JURISDICTION:CITY OF KENMORE

Arrow Board

*Not to scale

80TH PLNE

Signs will be placed before 80TH PL NE

RWAW-20-1

RWAW-20-1

RWAW-20-1

Right LaneEnds

Right LaneClosed Ahead

W9-1

Dog Leg Left

W9-2

Work Zone

Begin Work Zone

Enclose west endwith lit chan devices

REQUIREMENTS:*Signs, Devices and spacing shall conform to the MUTCD.*Coordinate/facilitate all driveway access.*Maintain 10' minimum vehicle travel lane widths.*Maintain 4' sidewalk widths. Sidewalks are either open ornot open. A sidewalk is closed when a minimum of 4'cannot be maintained. *Priority access shall be provided to emergency vehicles.*Notify Metro of bus route/stop impacts: 206-477-1140

Use warning lightson delineationdevices during nightand periods oflimited visibility

Add chan devicesfor bus exit

Add PCMS boardwith messaging24/7 during closure

PCMS Board

City of Bothell




RFI 27 Response 7/1/19

Limits to be determinedin field by City Inspector.

Work Zone

*Not to scale

Arrow Board

Work Zone


City of Bothell




*Not to scale*Not to scale

Arrow Board

Work Zone


City of Bothell




*Not to scale*Not to scale

Arrow Board

Work Zone


City of Bothell




*Not to scale

Arrow Board

Work Zone

*Not to scale

Arrow Board

Work Zone


City of Bothell




*Not to scale

Arrow Board

Work Zone

*Not to scale

Arrow Board

Work Zone

PrivateDrivewayEntrance

End of WorkZone. 4Lanes ofTraffic


City of Bothell




*Not to scale

Arrow Board

Work Zone

*Not to scale

Arrow Board

Work Zone

End of WorkZone. 4Lanes ofTraffic


City of Bothell




*Not to scale

Arrow Board

Work Zone

*Not to scale

Arrow Board

Work Zone


City of Bothell




*Not to scale

Arrow Board

Work Zone

*Not to scale

Arrow Board

RWAW-20-1

Work Zone
