Attachment D
Steel Cutting Edge Exemption Request Form
This form must be in the designated vehicle while in operation.
Depot No. ________________________
I,
, of
,
Owner’s Name
Company Name
request to use a composite cutting edge for the purposes of plowing along
for the 2014–2016 Snow & Ice seasons.
Route Number/ Street Name
This exemption shall apply to the following vehicle:
Reg. Number:
Make/Model:
Vendor Code:
Year:
This exemption is necessary based on the following reasons:
(Describe safety and or operational reasons for the request)
Describe the proposed cutting edge:
I agree that based on performance this exemption can be rescinded at any time.
Signature
Name (Print)
Date
I, or my designee, have reviewed this request and approve it based on the above reasons.
District Highway Director
Signature
Date