HomeMy WebLinkAboutIDOT Vision Zero Workshop - 7/30/2018C410WADOT
Application for SAFETY STUDY
TSIP FUNDS
GENERAL INFORMATION
Location / Title of Project Vision Zero Works
Applicant City of Waterloo
Contact Person Mohammad Elahi
Complete Mailing Address
Phone (319) 291-4440
(Area Code)
DATE: 8/2/2018
625 Glenwood Street
Waterloo, Iowa 50703
Title Traffic Enaineer
Rev. 5/18
E -Mail Mohammad.elahi@waterloo-ia.org
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 Title
Complete Mailing Address
Phone
(Area Code)
E -Mail
PLEASE COMPLETE THE FOLLOWING PROJECT INFORMATION:
Funding Amount
Total Safety Cost $ 6,800
Total Project Cost $ 6,800
Safety Funds Requested $ 6,800
Does this project appear on a Safety Improvement Candidate List or is there a safety
study recommendation for this project?
❑Yes — Explain
®No
Rev. 5/18
APPLICATION CERTIFICATION FOR PUBLIC AGENCY
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 public agency(ies). I understand the attached
resolution(s), where applicable, binds the participating public agency(ies) to assume
responsibility for any additional funds, if required, to complete the project. In addition, the
participating public agency(ies) agrees to maintain any new or improved public streets or
roadways for a minimum of five years.
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:
Signature Date Signed
Printed Name
Attest:
Signature Date Signed
AOL
Printed ame