APPLICATION FOR PRODUCT EVALUATION 02753 Section 2.3 (2025 Standard)

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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 30 days after all the required documents and data are received.

Specification Year *

Check the boxes below for the documents which are attached in your application: *

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 *

2. Product Description *

3. Manufacturer Company Name *

4. Manufacturer Contact Name *

5. Manufacturer Address *

6. Manufacturer Phone # *

7. Manufacturer Email *

8. Manufacturer Website *

9. Distributor Company Name *

10. Distributor Address *

11. Distributor Contact *

12. Distributor Contact Phone # *

13. Distributor Contact Email *

14. Distributor Website *

15. Has the product previously been submitted to UDOT for evaluation? *

Yes

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