Fillable Traffic Signal Approval Application for (City of Allentown)

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Traffic Signal Approval Application for (City of Allentown)

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BROWSE CITY OF ALLENTOWN (PA) FORMS

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Municipal Contact's Name : Title :
A - Applicant's (Municipal) Contact Information
Municipal Name :
Municipal Address :
Municipal Phone Number : Alternative Phone Number :
E-mail Address :
Municipal Hours of Operation :
B - Application Description
Location (intersection) :
Traffic Control Device is :
NEW Traffic Signal EXISTING Traffic Signal
Type of Device (select one) :
Traffic Control Signal
(MUTCD Section 4D, 4E, 4G)
Flashing Beacon
(MUTCD Section 4L)
School Warning System
(MUTCD Section 7B)
Other :
Is Traffic Signal part of a system? :
If YES, provide locations of all signalized intersections in system.
Explain the proposed improvements :
NO YES
Associated with Highway Occupancy Permit (HOP)?:
If YES, HOP Application # :
C - Maintenance and Operation Information
Maintenance and Operations are typically performed by? :
Application for
Traffic Signal Approval
TE-160 (6-12)
Please Type or Print all information in Blue or Black Ink
Sheet 1 of 5
DEPARTMENT USE ONLY
County :
Engineering District :
Department Tracking # :
Initial Submission Date :
Phone # :
Other :
Alternative Phone # :
E-mail :
Maintenance and Operations Contact Name : Company/Organization :
Municipal Personnel Municipal Contractor Municipal Personnel & Contractor
(Permit Number) :
YES NO
System Number (if applicable) :
D - Attachments Listing
Municipal Resolution (required)
Traffic Signal Permit
Warrant Analysis
Crash Analysis
Letter of Financial Commitment
Location Map
Photographs
Straight Line Diagram
Capacity Analysis
Condition Diagram
Traffic Volumes / Pedestrian Volumes
Turn Lane Analysis
Turn Restriction Studies
Other :
Traffic Signal Study
Traffic Impact Study (TIS)
E - Applicant (Municipal) Certification
Application for
Traffic Signal Approval
TE-160 (6-12)
Please Type or Print all information in Blue or Black Ink
Sheet 2 of 5
DEPARTMENT USE ONLY
County :
Engineering District :
Department Tracking # :
Initial Submission Date :
The applicant desires to own, operate, and maintain the traffic control device in the location indicated above; and the Vehicle Code
requires the approval of the Department of Transportation (“Department”) before any traffic signals may be legally erected or
modified. A signed Application for Traffic Signal Approval (TE-160) must be submitted in conformance with the instructions
provided by the Department, and a Traffic Signal Permit must be issued, before any work can begin.
If the Department approves a traffic signal after a traffic engineering study and engineering judgment indicates the need, the traffic
signal shall be installed, owned, operated, and maintained within the parameters indicated in the Vehicle Code and the
Department's regulations relating to traffic signs, signals, and markings. The Department may direct appropriate alterations to the
design or operation (including, but not limited to, hours of operation) of the traffic signal, or require removal of the traffic signal, if
traffic conditions or other considerations necessitate alteration or removal.
All items associated with the traffic control device (geometric features, signs, signals, pavement markings, pedestrian
accommodations, and other traffic control device associated items) are the applicant's responsibility. The Traffic Signal Permit will
then document all of the items associated with operation of each traffic control device. The applicant, at its sole expense, shall
provide the necessary inspection, maintenance, and operation activities in conformance with the Department's Publication 191 or
as otherwise agreed to by the Department. The applicant shall perform the preventative and responsive maintenance
requirements and recordkeeping in accordance with the exhibits specified below. If the applicant fails to provide the required
inspection, maintenance, or operation services within thirty (30) days of receipt of written notice from the Department, the
Department shall have the right to perform the required inspection, maintenance, or operation services in the applicant's stead and
the applicant shall reimburse the Department for all costs incurred. Federal- and/or state-aid participation may be withheld on all
future projects if the applicant fails to demonstrate to the Department the ability to provide all required maintenance and
operation services. The applicant certifies that it has funds available and committed for the operation and maintenance of the
traffic control device and that it will make available sufficient funds for all required future inspection, maintenance, and operation
activities.
The applicant shall indemnify, save harmless and, defend (if requested) the Commonwealth of Pennsylvania, its agents,
representatives, and employees from and against any damages recoverable under the Sovereign Immunity Act, 42 Pa. C.S. §§
8521-8528, up to the limitations on damages under said law, arising out of any personal injury or damage to property which is
finally determined by a court to be caused by or result from acts or omissions of the applicant and for which a court has held
applicant, its officials, or employees to be liable. This provision shall not be construed to limit the applicant in asserting any rights
or defenses. Additionally, the applicant shall include in any contracts into which it enters for maintenance, operation, or inspection
of the traffic control device this same obligation to indemnify the Commonwealth and its officers, agents, and employees; and it
shall require its contractor(s) to provide public liability insurance coverage, naming the Commonwealth and the applicant as
additional insureds for bodily injury, including death and property damage, in the minimum amounts of $500,000 per person,
$1,000,000 per occurrence, it being the intention of parties to have the contractor fully insure and indemnify the Commonwealth
and the applicant.
The applicant shall comply with the study and ordinance requirements of 75 Pa. C.S. § 6109. The applicant submits this application
with the intention of being legally bound.
Neither this application nor any Traffic Signal Permit creates any rights or obligations with respect to parties other than the
applicant and the Department. Third parties may not rely upon any representations made by either the applicant or the
Department in connection with the submission or approval of this application or any work permitted or approved that is related to
this application, as regards either payment of funds or performance of any particular item of maintenance precisely as specified.
The applicant agrees to comply with the attached Exhibits:
· Exhibit “A”: Preventative and Response Maintenance Requirements (Sheet 3 of 5 )
· Exhibit “B”: Recordkeeping (Sheet 4 of 5 )
· Exhibit “C”: Signal Maintenance Organization (Sheet 5 of 5 )
Printed Municipal Contact Name :
Signed By :
Title of Signatory :
Date :
Witness or Attest :
Title of Witness or Attester:
Exhibit "A":
Preventative and Response Maintenance
Requirements
TE-160 (6-12)
Preventive Maintenance
Response Maintenance
Response Maintenance Schedule
The APPLICANT or its contractor will provide preventive maintenance for each individual component of the traffic signal installation
covered by this application at intervals not less than those indicated in the Preventive Maintenance Summary, PA DOT
Publication 191, current version. This is the recommended level of maintenance to keep the intersection control equipment and
signals in mechanically, structurally and aesthetically good condition.
The APPLICANT or its contractor will provide response maintenance in accordance with the provisions of the Response Maintenance
Schedule. It encompasses the work necessary to restore a traffic signal system to proper and safe operation. Includes Emergency
Repair and Final Repair.
FINAL REPAIR:
Repair or replace failed equipment to restore system to proper and safe operation in accordance with permit within a 24-hour period.
EMERGENCY REPAIR:
Use alternative means or mode to temporarily restore system to safe operation within a 24-hour period. Final repair must then be
completed within 30 days unless prohibited by weather conditions or availability of equipment.
KNOCKDOWNS
Support - Mast arm
Support - Strain pole
Span wire/tether wire
Pedestal
Cabinet
Signal heads
EQUIPMENT FAILURE
Lamp burnout (veh. & ped.)
Local controller
Master controller
Detector sensor
- Loop
- Magnetometer
- Sonic
- Magnetic
- Pushbutton
Detector amplifier
Conflict monitor
Flasher
Time clock
Load switch/relay
Coordination unit
Communication interface, mode
Signal cable
Traffic Signal Communications
Traffic Signal Systems
Engineering District :
Sheet 3 of 5
DEPARTMENT USE ONLY
County :
Department Tracking # :
Initial Submission Date :
TYPE OF REPAIR PERMITTED
Emergency or Final
Emergency of Final
Final Only
Emergency or Final
Emergency of Final
Final Only
Final Only
Emergency or Final
Emergency or Final
Emergency or Final
Emergency or Final
Emergency or Final
Emergency or Final
Emergency or Final
Emergency or Final
Final Only
Final Only
Emergency or Final
Final Only
Emergency or Final
Emergency or Final
Final Only
Final Only
Final Only
Exhibit "B":
Recordkeeping
TE-160 (6-12)
Recordkeeping
Accurate and up-to-date recordkeeping is an essential component of a good traffic signal maintenance program. In recognition of this
fact, the APPLICANT must prepare, retain, and make available to the COMMONWEALTH, on request, a record of all preventive
and response maintenance activities performed on the traffic signal equipment covered by this application.
The APPLICANT shall establish a separate file for each installation and keep its records in the municipal building, signal
maintenance shop, or other weather-protected enclosure.
At a minimum, the following records will be kept by the APPLICANT or its contractor for each traffic signal. These forms can be
found in Section 10.0, Maintenance Record Forms, PA DOT Publication 191, current version.
FORM 1 - Master Intersection Record
This form, which lists all maintenance functions performed at the intersection, should be updated within one day of the activity but
no more than one week later.
FORM 2 - Response Maintenance Record
Each time response maintenance is required at the intersection, this form is to be completed. Once the pertinent information is
transferred to the master intersection record, this form is to be placed in the intersection file.
FORM 3 - Preventive Maintenance Record
This form will be used to provide a record of the preventive maintenance activities performed at each intersection. The date, the
activities performed, and the signature of the person in charge of the work must be recorded in the form.
This form may be kept at the intersection, if it is adequately protected from the weather. Form 1 must be updated at the central file,
however, to reflect the date and activity.
Engineering District :
Sheet 4 of 5
DEPARTMENT USE ONLY
County :
Department Tracking # :
Initial Submission Date :
Exhibit "C":
Signal Maintenance Organization
TE-160 (6-12)
Budget Requirements
The APPLICANT agrees to provide, in its annual operating budget, dedicated funds which are sufficient to cover the cost of the
personnel, training, contractors (if utilized) and specialized maintenance equipment which are required, by virtue of this application.
The APPLICANT agrees to abide by all guidance provided in PA DOT Publication 191..
In order to properly maintain the traffic signal equipment covered by this applicant, the APPLICANT agrees to provide, as minimum,
the following staff throughout the useful life of equipment. The APPLICANT agrees to abide by all guidance provided in PA DOT
Publication 191.
Traffic Engineer - The administrative position which has prime responsibility for the proper operation of traffic signal equipment.
The principal function of this position is the supervision and control of subordinate personnel and the planning of their activities to
ensure adequate preventive and response maintenance programs.
Minimum Position Requirements
1. A thorough understanding of traffic signal design, installation and maintenance.
2. A working knowledge of the interaction between the following traffic characteristics: Intersection geometry, traffic flow theory,
control type (fixed time, actuated, etc.), signal phasing and timing, and interconnection.
3. An ability to supervise subordinate personnel effectively in the assignment of their work.
4. Possession of a college degree in engineering, which includes course work in traffic engineering.
5. Either four years experience in the field of traffic engineering or its equivalent in graduate college work.
Signal Specialist - The individual responsible for the diagnostics and repair of all traffic signal equipment including solid state
equipment.
Minimum Position Requirements
1. Extensive training and troubleshooting skills in electronics and software.
2. Ability to repair modules in the shop and to design test equipment needed to diagnose and repair a problem.
3. Ability to make design and modifications to implement or omit special functions.
4. Ability to implement a recordkeeping system to include maintenance activities, inventory control and identification of recurring problems.
5. Ability to perform all tasks required of a signal technician.
Signal Technician - Individual responsible for the operation and maintenance of traffic signals and electromechanical equipment.
Minimum Position Requirements
1. Ability to perform response maintenance on solid state equipment up to the device exchange level.
2. Capability to diagnose a vehicle loop failure and initiate corrective action.
3. Ability to tune detector amplifiers.
4. Ability to follow wiring schematics, check and set timings from plan sheet and check all field connections.
5. Ability to perform preventive maintenance on all equipment and to maintain accurate records of all work perform.
Engineering District :
Sheet 5 of 5
DEPARTMENT USE ONLY
County :
Department Tracking # :
Initial Submission Date :
Personnel Classifications
Training
The APPLICANT agrees to secure training in order to upgrade the ability of its present staff to properly perform the required
maintenance functions. The APPLICANT agrees to abide by all guidance provided in PA DOT Publication 191.
Check off all documents which will be submitted along with this application. Note that a Municipal Resolution, authorizing the municipal contact to
submit and sign the application, is a required document.
A sample Municipal Resolution has been provided on the next page.
Maintenance and Operations are typically performed by?: Please indicate if maintenance and operation will be performed by Municipal Personnel
or through Contract Services.
Maintenance and Operations Contact Name: Provide the primary maintenance contact name for the individual that is (or will be responsible) for
the maintenance and operation of the traffic signal.
Company/Organization: Provide the name of the company/organization with which the primary maintenance contact is affiliated.
Phone #: Provide the phone number for the primary maintenance contact.
Alternative Phone #: Provide an alternative phone number for the primary maintenance contact or affiliated company/organization.
E-mail: Provide the e-mail address for the primary maintenance contact.
Application
Instructions
TE-160 (6-12)
A - Applicant's (Municipal) Contact Information
Municipal Contact's Name: Provide the municipal contact name that is (or will be responsible) for the traffic signal. Typically this is either the
Municipal Manager or Roadmaster.
Title: Provide the title of the municipal contact name.
Municipal Name: Provide the official municipal name.
Municipal Address: Provide the full address of the municipal building.
Municipal Phone Number: Provide the municipal phone number of the municipal contact.
Alternative Phone Number: Provide an alternative phone number of the municipal contact.
E-mail Address: Provide the e-mail address of the municipal contact.
Municipal Hours of Operation: Please provide the municipalities normal operating hours (i.e. Monday-Thursday 9 AM - 2 PM)
B - Application Description
Location (intersection): Please provide a detailed location of the device or devices being considered for approval.
Please include any State Route and/or local road names in your description.
Traffic Control Device is: (Please select one of the two following categories)
NEW Traffic Signal: This item should be selected when requesting approval of a traffic signal that is currently not in operation at the device
location indicated above.
EXISTING Traffic Signal: This item should be selected when requesting approval to make a modification or update to an existing traffic signal.
(Permit Number): Please provide the traffic signal permit number.
Type of Device (select one): (Please select one of the four following categories)
Traffic Control Signal: As defined in federal Manual on Uniform Traffic Control Devices (MUTCD) Sections 4D, 4E, and 4G. When
selecting this category this is the typical red/yellow/green and pedestrian signal indications
Flashing Beacon: As defined in federal Manual on Uniform Traffic Control Devices (MUTCD) Section 4L. When selecting this category, this is
typically either the flashing yellow/red signal at an intersection and/or the flashing yellow warning sign.
School Warning System: As defined in federal Manual on Uniform Traffic Control Devices (MUTCD) Section 7B. When selecting this category, this
is typically the flashing school warning sign with a 15 mph indication.
Other: When selecting this category, this pertains to all other permitted electrically powered traffic control devices approved by the Department.
Is Traffic Signal part of a system?: Check off the appropriate box, either YES or NO. If YES, please fill in the System Number (if applicable): line.
Explain the proposed improvements: Provide a description of the proposed improvements to the intersection. This may be as complex as
installing and/or upgrading a traffic signal or as non-complex as placement of a new traffic sign to supplement an existing traffic signal.
Associated with Highway Occupancy Permit (HOP)?: Check off the appropriate box, either YES or NO. If YES, please fill in the Application #: line.
C - Maintenance and Operation Information
E - Applicant (Municipal) Certification
Printed Municipal Contact Name: Please print the name of the municipal contact person signing the application.
Date: Please provide the date on which the application was signed.
Signed By: Please provide the signature of the named municipal contact.
Title of Signatory: Please provide the title of municipal contact.
Witness or Attest: Please provide the signature of the person witnessing or attesting the signature.
Witness or Attester: Please provide the title of the person witnessing or attesting the signature.
D - Attachments Listing
(designate official title)
(Name of MUNICIPALITY)
(Name of governing body)
BE IT RESOLVED, by authority of the
RESOLUTION
of the County, and it
is hereby resolved by authority of the same, that the
of said MUNICIPALITY is authorized and directed to submit the attached Application for Traffic
Signal Approval to the Pennsylvania Department of Transportation and to sign this Application on behalf of
the MUNICIPALITY.
ATTEST:
(Official Title)
(Signature and designation of official title) (Signature and designation of official title)
By:
(Name)
(Name of MUNICIPALITY)
I,
,
of the
, do hereby certify that the foregoing
(Name of governing body and MUNICIPALITY)
is a true and correct copy of the Resolution adopted at a regular meeting of the
(Name of governing body)
, held the day of , 20
.
,
DATE:
(Signature and designation of official title)
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Traffic Signal Approval Application for (City of Allentown)

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Completed 12 January 2021

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