Fillable Massachusetts Department of Transport Qualified Traffic Control Equipment Submission Form forPreformed Pavement Markings

Fill Online, Printable, Fillable, Blank Massachusetts Department of Transport Qualified Traffic Control Equipment Submission Form forPreformed Pavement Markings 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 forPreformed Pavement Markings

On average this form takes 19 minutes to complete

The Massachusetts Department of Transport Qualified Traffic Control Equipment Submission Form forPreformed Pavement Markings form is 3 pages long and contains:

  • 0 signatures
  • 2 check-boxes
  • 75 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
Preformed Pavement Markings
Submission Instructions: Please submit one application per product. Catalogue cuts shall be included as
attachments. Other testing results or certifications, such as NTPEP data or FHWA letters, which may assist in
product evaluation may be included. All products shall comply with the latest edition of Section 850 - Traffic
Controls for Construction and Maintenance Operations and/or Section 860 - Reflectorized Pavement Markings
of the Standard Specifications
, including Supplemental and Interim editions. 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 #
Description
Link to product cutsheet
Marking Type
L
ine Arrow/Symbol (White)
Legend Symbol (Multicolor)
Other:
Part C. Technical Product Information
Intended Use Durable Temporary
Marking Material
Color(s)
Available Thicknesses
Available Widths
Contrast Border
Yes (dimensions):
No
Application Temperature
Range
Application Revision: November 4, 2014 Preformed Pavement Markings Application
Qualified Traffic Control Equipment: http://goo.gl/OS7o5N Page 1 of 3
Expected Initial Retroreflectivity Levels
Per ASTM
Yellow Markings
White Markings
Test
Dry
Wet Recovery
Wet Continuous
Application Procedures:
Additional Technical Notes (if necessary):
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 t
his product currently in use in Massachusetts? Yes No
If Yes, please explain:
State DOTs that have
ap
proved 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 N
o
If Yes, please explain:
Warranty Information:
Application Revision: November 4, 2014 Preformed Pavement Markings Application
Qualified Traffic Control Equipment: http://goo.gl/OS7o5N Page 2 of 3
Part E. Contact Information
Supplier/
Distributer
Contact Title
Company
Website
Address City, State ZIP
Email Phone
Manufacturer
Contact Title
Company
Website
Address City, State ZIP
Email 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 4, 2014 Preformed Pavement Markings 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 forPreformed Pavement Markings

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