HomeMy WebLinkAboutIDOT Snow Protection Grant App - 8.5.2024Rev. 07/23
IOWADOT
Application for SITE -SPECIFIC
TSIP FUNDS
GENERAL INFORMATION DATE: July 29, 2024
SYSTEMIC RED TRAFFIC SIGNAL FACE PROTECTION
Location / Title of Project AGAINST SNOW
Applicant City of Waterloo
Contact Person Tina Schellhorn Title Associate Traffic Engineer
Complete Mailing Address 625 Glenwood St
Phone (319)291-4440
Waterloo, IA 50703
E-Mail Tina.schellhorn@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 Title
Complete Mailing Address
Phone E-Mail
(Area Code)
PLEASE COMPLETE THE FOLLOWING PROJECT INFORMATION:
Funding Amount
Total Safety Cost $
Total Project Cost $
Safety Funds Requested $
242,450.00
242,450.00
221,250.00
Additional Project Safety Documentation (when available):
❑ Project information sheet(s) or "Risk Score">50% from County/City's Local Road Safety Plan
❑ FHWA SS4A Safety Action Plan or similar comprehensive transportation safety plan
Iowa DOT TEAP Study or similar analysis and concept
❑ Project intersection or segment with High or Medium PCR Level (PCR-All or PCR-Severe) from
the Iowa DOT Potential for Crash Reduction (PCR) web -based map tool https://per.iowadot.gov/
Potential for Crash Reduction (PCR) Information
tersection ID
(1234567890)
or Segment ID (1234)
ev- eve
High Medium
Rev. 07/23
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
Signed:
Attest:
City of Waterloo
Quertan 1-(At
Signature
Quentin Hart
Printed Name
Aim& yy
Signature
Nancy
Printed Name
8/5/2024
Date Signed
8/5/2024
Date Signed