HomeMy WebLinkAboutIowa Department of Transportation-9/4/2012Iowa Department
of Transportation
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Rev. 3/08
Application for TRAFFIC SAFETY FUNDS
GENERAL INFORMATION
Waterloo/ Systemic Safety Improvements at Signalized
Location / Title of Project Intersections on Washington Street
Applicant City of Waterloo
Contact Person Mohammad Elahi Title Traffic Engineer
Complete Mailing Address 408 E. 6th Street
Waterloo, Iowa 50703
Phone (319) 291-4440 E -Mail mohammad.elahi@waterloo-ia.org
(Area Code)
If more than one highway authority is involved in this project, please indicate and
fill in the information below (use additional sheets if necessary).
Co-Applicant(s)
Contact Person
Complete Mailing Address
Title
Phone E -Mail
(Area Code)
PLEASE COMPLETE THE FOLLOWING PROJECT INFORMATION:
Application Type
Funding Amount
Total Project Cost
Safety Funds Requested
Site Specific
Traffic Control Device â
Safety Study â
11
$ $249,800
$ 249,800
Rev. 3/08
APPLICATION CERTIFICATION FOR LOCAL GOVERNMENT
To the best of my knowledge and belief, all information included in this application is true and
accurate, including the commitment of all physical and financial resources. This application
has been duly authorized by the participating local government(s). I understand the attached
resolution(s) binds the participating local government(s) to assume responsibility if any
additional funds are committed, and to ensure maintenance of any new or improved city
streets or secondary roads.
I understand that, although this information is sufficient to secure a commitment of funds, a
firm contract between the applicant and the Department of Transportation is required prior to
the authorization of funds.
Representing the City of Waterloo
Signed:
Attest:
Typed Name
ature
Typed Name
Date Signed