The URL can be used to link to this page

Home My WebLink AboutDOT Site-Specific TSIP Applications (3) - 8.4.2025 Docusign Envelope ID:3BF8B35F-FDOE-488A-BO86-2EEO301F75BF Rev. 07/23 IOWA DOT Application for SITE-SPECIFIC TSIP FUNDS GENERAL INFORMATION DATE: 7/31/25 Traffic Signalization of 1St St (US63) and Sycamore Street Location / Title of Project Intersection Applicant City of Waterloo — Traffic Operations Department Contact Person Tina Schellhorn Title Associate Traffic Engineer Complete Mailing Address 625 Glenwood St. Waterloo, Iowa 50703 Phone (319)291-4440 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 $ 251,000 Total Project Cost $ 251,000 Safety Funds Requested $ 251,000 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/ . � SI_125461 US63 & Sycamore St El ® High Medium Li ❑ Docusign Envelope ID:3BF8B35F-FDOE-488A-8086-2EE0301 F75BF 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 City of Waterloo, Iowa DocuSigned by: Signed: ic-��n, Aa� 8/4/2025 Signature Date Signed Quentin Hart Printed Name Signed by: Attest: F Fdd& 8/4/2025 igna ure Date Signed Kelley Felchle Printed Name Docusign Envelope ID:3BF8B35F-FDOE-488A-BO86-2EEO301F75BF OC410WADOT Application for SITE-SPECIFIC TSIP FUNDS GENERAL INFORMATION DATE: 7/31/25 Location / Title of Project Burton & Parker Left Turn Lane Mast Arm Applicant City of Waterloo — Traffic Operations Department Contact Person Tina Schellhorn Title Associate Traffic Engineer Complete Mailing Address 625 Glenwood St Waterloo, Iowa 50703 Phone (319)291-4440 E-Mail Tina.schelIhorn@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 $ 37,000 Total Project Cost $ Safety Funds Requested $ 37,000 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:Hper.iowadot.gov/ Potential for Crash Reduction (PCR) Information �ntersection ID WCR- PCR- 90 or Segment ID (1234) High � Medium value value 2849 Broadway Street and Burton Avenue ® ❑ high negliga ble ❑ ❑ Docusign Envelope ID:3BF8B35F-FDOE-488A-8086-2EE0301 F75BF 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, Iowa DocuSigned by: Signed: mac- V, Aavf 8/4/2025 gnafurce'449 Date Signed Quentin Hart Printed Name Signed by: Attest: UltyFdd& 8/4/2025 Signa ure Date Signed Kelley Felchle Printed Name Docusign Envelope ID:3BF8B35F-FDOE-488A-BO86-2EEO301F75BF OC410WADOT Application for TRAFFIC CONTROL DEVICE TSIP FUNDS GENERAL INFORMATION DATE: 7/31/2025 Location / Title of Project Waterloo — Temporary Traffic Control Device Applicant Waterloo Traffic Operations Contact Person Tina Schellhorn Title Associate Traffic Engineer Complete Mailing Address 625 Glenwood St. Waterloo, Iowa 50703 Phone (319)291-4440 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 $ 61,075 Total Project Cost $ 61,075 Safety Funds Requested $ 50,000 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:Hper.iowadot.gov/ ❑ ❑ ❑ ❑ Docusign Envelope ID:3BF8B35F-FDOE-488A-8086-2EE0301 F75BF 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, Iowa DocuSigned by: Signed: 6ko-fiv, Aavf 8/4/2025 Signature Date Signed Quentin Hart Printed Name Signed by: Attest: �` Fdd& 8/4/2025 igria�ure64AB Date Signed Kelley Felchle Printed Name