The shaded area is for FDOT use only.
Date received:
Reviewed by:
Date reviewed:
Florida Department of Transportation
Traffic Engineering and Operations Office
Traffic Engineering Research Laboratory
Approved Product List Application
This application is to be used for the submittal and evaluation of products contained on the FDOT
Approved Product List (APL). Submit one application for each device series.
I. DEVICE INFORMATION
Device Name:
Model:
Description of major components:
List of material required for operation (hardware, software, firmware, cables, etc.):
Recommended Use:
II. MANUFACTURER INFORMATION
Device Manufacturer:
FEID:
Contact Person:
Title:
Address:
Phone:
City:
State/Province:
Zip:
Country:
E-mail:
Manufacturer Website:
Manufacturing facility physical address (if different from above):
Contact Person:
Title:
Address:
Phone:
City:
State/Province:
Zip:
Country:
Parent Company (if different from Manufacturer):
III. REPRESENTATIVE INFORMATION (if different from Manufacturer Information)
Authorized Representative Company:
Contact Person:
Title:
Address:
Phone:
City:
State/Province:
Zip:
Country:
E-mail:
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FDOT Traffic Engineering and Operations Office
Approved Product List Application - 10-25-2012
IV. CONFORMANCE TO STANDARDS AND SPECIFICATIONS
Applicable sections for MUTCD, MSTCSD or SSRBC MUST be identified.
Submitted device meets (fill in all that apply):
Section
of the MUTCD (FHWA Manual on Uniform Traffic Control Devices)
Section
of the MSTCSD (FDOT Minimum Specifications for Traffic Control Signals and Devices)
Section
of the SSRBC (FDOT Standard Specifications for Road and Bridge Construction)
Independent test lab and report(s) submitted meet Section A601-3 of the MSTCSD
Each application MUST be accompanied by a manufacturer-supplied compliance matrix that notes the
submitted device complies with the specification sections cited above. Existing FDOT compliance
matrices can be found at (www.dot.state.fl.us/trafficoperations/Traf_Sys/terl/apl4.shtm). Vendor must
develop a matrix for their product if one does not exist.
The following MUST be included with this application:
 Manufacturer’s device specifications
 Electronic image of device (provided via CD, memory stick or e-mail)
 Device drawing or cut sheets
 Assembly and installation instructions
 Operation manual
 Material Safety Data Sheet (MSDS) if applicable
 Warranty information
 Trouble-shooting and service manual
 Compliance matrix
 Circuit board schematics or block diagrams if applicable
 Parts list
 Test data as required in compliance matrix
The documentation package MUST be neatly organized in a binder and include tab-separated
sections as listed above. The binder must also contain a CD or other storage device that includes all
contents in an electronic format (.PDF preferred).
Note: Do not send devices with this application. You will be notified and requested to send devices
for evaluation after Department review of this submittal. FDOT reserves the right to retain the
device as long as it is listed on the APL.
V. ADDITIONAL INFORMATION
Will this product replace an existing approved product from your company? (existing product will be
removed from APL upon listing of the submitted product)
If yes, provide existing product’s name:
Existing APL #:
If yes, explain why device is being replaced:
Has this product been approved, or is it currently under evaluation by any other state DOT or national
testing lab?
If yes, list location and evaluating agency:
Unit Retail Price: $
Any other pertinent information regarding product or manufacturer:
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FDOT Traffic Engineering and Operations Office
Approved Product List Application - 10-25-2012
VI. SIGNATURE
The FDOT will not consider any device for APL evaluation until this form and all required attachments are
complete and this form is signed by an authorized official of the device manufacturer and received at the
address below:
Florida Department of Transportation
State Traffic Engineering and Operations Office
Traffic Engineering Research Laboratory
2612 Springhill Road
Tallahassee, Florida 32305
Attention: APL Submittal
By signing below, the authorized official certifies that all information provided in the application
submittal is correct.
By submitting this application, the applicant represents that to the best of his or her knowledge and
belief, the product for which approval is sought is not the subject of the patent or other intellectual
property rights of another party and if so, has obtained the right for such use by suitable legal agreement
with the patentee or owner of the copyright. The applicant in all cases agrees that, after approval of its
product by the Department, the applicant shall indemnify, defend, and hold harmless the Department
from all claims, damages, costs, and expenses for infringement by reason of the use, or prescription of
use, of the applicant’s product on any Department projects.
I have read this application and attest that the device submitted by me for approval currently meets all
specifications as identified in section IV of this application.
Signed:
Title:
Printed Name:
Date:
Please review Florida Statutes (F.S.) available on-line (specifically, chapters 119 and 688, sections 334.049, 812.081,
815.04, 815.045, F.S.) regarding public records, exemptions from public records requests for information meeting
the trade secret definition and identification of such information. In original or supplemental submissions, please
mark as “confidential” any information meeting the trade secret definition before submitting it to the Florida
Department of Transportation.
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FDOT Traffic Engineering and Operations Office
Approved Product List Application - 10-25-2012