Application Form for Traffic Safety Enforcement

This is an application for funds to conduct overtimetraffic safety enforcement services and to request enforcement equipment in federal fiscal year 2017(October 1, 2016 – September 30, 2017).

Please submit this application form to the North Dakota Department of Transportation Traffic Safety Officeby5 PMCST on Friday, June 26, 2016. Completed applications must be submitted to the attention of Lori Malafavia email at r mail at:North Dakota Department of Transportation, Traffic Safety Office, Attn: Lori Malafa, 608 E. Boulevard Ave., Bismarck, ND 58505-0700

AGENCY NAME:

ENFORCEMENT COORDINATOR

Name: Title:

Address:

City: Zip Code:

E-Mail: Phone: Fax:

ENFORCEMENTBUDGET

Please provide the estimated number of hours and the estimated budget the agency would need to conduct traffic enforcement for the period of October 1, 2016- September 30, 2017 for occupant protection, impaired driving, underage drinking (compliance checks, server training, shoulder tap and etc.) and distracted driving.

Enforcement Area / Estimated Number ofOT Hours / Estimated Hourly OT Rate / Total Estimated OT Requested
Seat Belt
Impaired Driving
Underage Drinking
Distracted Driving

Will you request reimbursement for mileage associated with conducting enforcement activities?

YesNo

If yes, please complete the following:

Enforcement Area / Estimated Number of Miles / Mileage Reimbursement Rate / Total Amount
Seat Belt / .54
Impaired Drinking / .54
Underage Drinking / .54
Distracted Driving / .54

EQUIPMENT REQUESTS

Complete the following for Radar/LIDAR equipment requests. If awarded, it is based on a 75/25 percent match. NDDOT paying the larger match up to $1,500.00 per unit.

Radar Quantity $

LIDAR Quantity $

Complete the following request for video cameras. If awarded, the maximum funded is $4,000.00 per unit.

Surveillance Camera(s) Digital VideoQuantity $

For each piece of equipment requested, please provide the following information.

Equipment / Number of Units Currently in Use / Make / Model / Year
Radar
LIDAR
Surveillance Cameras

How many vehicles does your department use for traffic enforcement?

How many officers are on the roadway for a typical shift working traffic enforcement?

If requesting equipment, please provide the number of equipment items purchased in the past five years:

Equipment / With Funds Through the Office of Traffic Safety / With Funds From Your Agency Budget
Radar
LIDAR
Surveillance Cameras

AUTHORIZING OFFICIAL OF APPLYING AGENCY

Name: Title:

Signature:

*An electronic signature is acceptable if you wish to submit the application via email.