Type of Contract: Project No.:
Contractor: CSJ:
Engineer: County:
To accompany Estimate No.: For Period from:   to:

Material Date Received Bill of Lading # Qty Shipped (show units) Inspected/Tested by Lab No./Shipment ID. Notes

NOTE: All Materials received for this contract are to be recorded on this form. Group like materials and show individual quantities for the month or period. If materials are inspected by the Engineer show "AE" in the fifth column, otherwise show the laboratory initials. In the sixth column, show the laboratory report number. For the paint shipments, show batch or lot numbers. If reports have not arrived at the time the estimate is submitted, make entry showing material received and the laboratory will be entered on this form at the District's office. If no materials are received during period, note on this form and forward with estimate.

Approved:  (Project Engineer)      Date:

ONE COPY of this form must be submitted to the Contractor with the Final Estimate

Exhibit 3.-TXDot Form 252-Contract Time Statement Rev 05-27-15
BOD 06-23-15