Fillable Massachusetts Department of Transport Qualified Traffic Control Equipment Submission Form for Signal Posts, Bases, and Pedestals

Fill Online, Printable, Fillable, Blank Massachusetts Department of Transport Qualified Traffic Control Equipment Submission Form for Signal Posts, Bases, and Pedestals Form

Use Fill to complete blank online COMMONWEALTH OF MASSACHUSETTS (MA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Massachusetts Department of Transport Qualified Traffic Control Equipment Submission Form for Signal Posts, Bases, and Pedestals

On average this form takes 19 minutes to complete

The Massachusetts Department of Transport Qualified Traffic Control Equipment Submission Form for Signal Posts, Bases, and Pedestals form is 3 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 76 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Qualified Traffic Control Equipment Submission Form for
Signal Posts, Bases, and Pedestals
Submission Instructions: Please submit one application per product. Catalogue cuts shall be included as
attachments. If applicable, NEMA test results from an independent test lab shall be submitted to ensure
compliance. All other testing results or certifications which may assist in evaluation may also be included. All
equipment shall comply with the latest editions of Section 815 - Traffic Control Signals of the Standard
Specifications, including Supplemental and Interim editions, NEMA, the Massachusetts Electrical Code, and
applicable Underwriters Laboratories standards. Upon evaluation MassDOT Highway Division will contact you.
Part A. Applicant Information
Today's Date
Name
Company
Address
City, State ZIP
Phone
Email
Part B. Basic Product Information
Name or Model #
Descript
ion
Link to product cutsheet
Product Type
Post Base Pedes
tal
Other:
Part C. Technical Product Information
Product Material
Steel Cast I
ron Aluminum
Other:
Product Finish
Bru
shed Galvanized
Painted (colors):
Other:
Base Shape
Sq
uare Octagonal n/a
Other:
Threaded? Yes No n/a
Technical Notes (if necessary):
Application Revision: November 12, 2014 Signal Post, Base, and Pedestal Application
Qualified Traffic Control Equipment: http://goo.gl/OS7o5N Page 1 of 3
Part D. Product Use
Has this product, or one similar, been previously submitted to MassDOT? Yes No
If Yes, please explain:
Is this a replacement product for one currently approved by MassDOT? Yes No
If Yes, please explain:
Is this product currently in use in Massachusetts? Yes No
If Yes, please explain:
State DOTs that have
approved this product:
Is this product in commercial production? Yes No
If Yes, for how long?
If No, please explain:
Have there been any recalls on this product? Yes No
If Yes, please explain:
Recommended Routine Maintenance Program (if applicable):
Warranty Information:
Application Revision: November 12, 2014 Signal Post, Base, and Pedestal Application
Qualified Traffic Control Equipment: http://goo.gl/OS7o5N Page 2 of 3
Part E. Contact Information
Supplier/
Distributer
Contact Title
Company
Website
Addr
ess City, State ZIP
Email Phone
Manufacturer
Con
tact Title
Company
Website
Address
City, State ZIP
Em
ail Phone
Reference #1
Contact Title
Agency
Email Phone
Reference #2
Contact Title
Agency
Email Phone
(This space may be used to provide additional information)
Applications may be submitted to james.danila@dot.state.ma.us or by mail to:
Jim Danila, P.E., Assistant State Traffic Engineer
Traffic and Safety Engineering Section, MassDOT Highway Division
10 Park Plaza, Room 7210
Boston, MA 02116
Application Revision: November 12, 2014 Signal Post, Base, and Pedestal Application
Qualified Traffic Control Equipment: http://goo.gl/OS7o5N Page 3 of 3
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Massachusetts Department of Transport Qualified Traffic Control Equipment Submission Form for Signal Posts, Bases, and Pedestals

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 13 May 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document