APPLICATION FOR PRODUCT EVALUATION(03924)
INSTRUCTIONS TO APPLICANT:
Answer all questions. If a question is not applicable, enter “N/A”
Product has to be re-evaluated every 5 years
UDOT will notify the applicant about the evaluation decision within 45 days after all the required documents and data are received.
* Required
Check the boxes below for the documents which are attached in your application: Please email all documents to
udotapl@utah.gov
*
Manufacturer’s product data sheets
Installation instructions
Independent laboratory testing results(Testing Results dated over 5 years from this submittal date are not accepted)
Materials safety data sheets
Limitations for use and or maintenance of the product
Required
1. Product Name
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Your answer
2. Product Description
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Your answer
3. Manufacturer Company Name
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Your answer
4. Manufacturer Contact Name
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Your answer
5. Manufacturer Address
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Your answer
6. Manufacturer Phone #
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Your answer
7. Manufacturer Email
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Your answer
8. Manufacturer Website
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Your answer
9. Distributor Company Name
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Your answer
10. Distributor Address
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Your answer
11. Distributor Contact
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Your answer
12. Distributor Contact Phone #
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Your answer
13. Distributor Contact Email
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Your answer
14. Distributor Website
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Your answer
15. Has the product previously been submitted to UDOT for evaluation?
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Yes
No
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