REQUEST FOR PRODUCT CONSIDERATION

Effective Date: 07/01/2015

Document Identifier: QF-72-01-1

Approved/Issued by: Jeff Morgan, Product Certification Manager

Printed copies are for reference only; they are not controlled. Latest version is on-line.

REV. / DATE / DESCRIPTION / AUTHORED BY /
1.0 / 03/21/2011 / Initial entry of latest published request for product consideration into SharePoint for document control. / David Bremer
2.0 / 03/22/2011 / Adding fields to utilize RFPC for device changes and removing language for hard copy submittal. / David Bremer
3.0 / 07/27/2011 / Formatting only. / David Bremer
4.0 / 05/25/2012 / Added province, country, confidentiality statement and removed identification of major components in device/description of manufacturing activities. / Armelle Burleson
5.0 / 10/08/2012 / Changed “address” to “manufacturer address”. / Armelle Burleson
6.0 / 01/15/2013 / Revised document identifier for compatibility with revised quality manual based on ISO 17065 standard / Armelle Burleson
7.0 / 04/04/2013 / Removed “FDOT Only” section. / David Bremer
8.0 / 07/25/2013 / Removed requirement for PDF format. / Armelle Burleson
9.0 / 01/14/2014 / Replaced FDOT logo with latest approved one. / Armelle Burleson
10.0 / 08/21/2014 / Included revised language from the Legal Office regarding confidentiality. / Armelle Burleson
11.0 / 09/29/2014 / Changed e-mail address for email completed RFPC and removed references to TEOO. / Armelle Burleson
12.0 / 10/22/2014 / Revised document approver title. / Kelli Moser
13.0 / 06/10/2015 / Revised to notate APL listing company at top. / David Bremer

Florida Department of Transportation

Page 1 of 1 Form QF-72-01-1 Effective 07/01/2015

Florida Department of Transportation

Approved Product List (APL)

Request for Product Consideration

This completed application and attached product literature serves to request that the Florida Department of Transportation consider the product described herein for use on the streets and highways of the state. Submit one application for each product series.

I.  PRODUCT INFORMATION

Product Name: Model:

Company (to be listed on the APL): Applicant:

E-mail: Phone:

Proposed Use:

Benefits to FDOT:

Major Components of Device:

For modifications to a product currently listed on the APL, provide the approval number:

For modified APL products, list and summarize all changes:

II.  MANUFACTURING FACILITY INFORMATION

Manufacturer Name: _

Is manufacturing facility currently ISO 9001 certified?

Contact Person: E-mail:

Manufacturer Address: Phone:

City: State/Province:

Zip: Country:

Manufacturer Website:

The RFPC package MUST be submitted electronically.
The following product literature MUST be included with the submittal and include at a minimum:

Manufacturer’s product specifications
Drawings and cut sheets
Product design change documents (for modifications to existing approved products)

Please review Florida Statutes (F.S.) regarding public records and the exemptions applicable to public records requests that concern trade secrets. When submitting information to the Department, the applicant has waived any applicable trade secret exemption concerning any document that is not clearly marked as a “trade secret” or “confidential”. For documents so marked, the Department will notify the applicant if a request is made so that the applicant may take steps to protect its asserted trade secret. By signing below, the applicant understands and agrees to abide by the restrictions of this paragraph.

Please submit this application to:

Florida Department of Transportation

Page 1 of 1 Form QF-72-01-1 Effective 07/01/2015