Form DPS-691-C-3 "Request Form and Cancellation Form - State Police Traffic Control Services" - Connecticut

What Is Form DPS-691-C-3?

This is a legal form that was released by the Connecticut Department of Emergency Services and Public Protection - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2013;
  • The latest edition provided by the Connecticut Department of Emergency Services and Public Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DPS-691-C-3 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Emergency Services and Public Protection.

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Download Form DPS-691-C-3 "Request Form and Cancellation Form - State Police Traffic Control Services" - Connecticut

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REQUEST FORM AND CANCELLATION FORM
STATE POLICE TRAFFIC CONTROL SERVICES
Instructions: All Requests for State Police Traffic Control Services at DOT highway construction sites, for jobs for which the direct DOT-
DESPP reimbursement payment method will be used, must be made using this form.
The form must be submitted to the DESPP Special Duty Overtime Coordinator via Facsimile: 860-706-1407/E-mail:
specduty.clerk@ct.gov) between regular business hours 0730 hours through 1730 hours, Monday through Friday (except holidays).
Requests must be submitted at least five (5) business days in advance.
There is no guarantee that any request made with less than 24 hour notice to the start of the job can be accommodated.
Any request for services submitted to DESPP after 1730, will not be scheduled until the following business day except in the case of an
emergency.
In the event of an emergency requiring services during normal business hours please contact the Special Duty Office at 860-
685-8420. After normal business hours for the current day and prior to the start of the next business day, a request must be
submitted to the State Police Message Center via E-mail
dps.messagecenter@ct.gov
or facsimile: 860-685-8346. DOT must
also submit the request to the DESPP Special Duty office at the same time via facsimile or email. This will be subject to the
OPA rate of $114.79 Trooper or $149.02 Sergeant.
DESPP cannot guarantee the availability of State Police personnel for requests not submitted in a timely manner.
This form shall be used for the cancellation of any Request for State Police Traffic Control Services. See Instructions in Section II,
regarding cancellation.
Requests must be made in military time. (Example: 1:00 PM = 1300 hours – 8:00 PM = 2000 hours)
Is This a New Job?
Yes
Ongoing
REQUEST DATE:_____________________________________
I. PROJECT INFORMATION:
DOT District/Unit:
DOT Project Identifier No:
Town in Which Job is Located:
Job Location/Meeting Location:
Special Instructions:
Contractor’s Name:
Name & Title of Contact Person (print):
Contractor’s Cellular Telephone No.
Contractor’s Contact Person E-mail address :
Name & Title of DOT Contact Person (Print)
Email Address/Phone No.
DOT Authorization Person (Name/Title)
DOT E-mail Address of Contact Person:(must be an @ct.gov contact)
II. REQUEST OR CANCELLATION FOR STATE POLICE TRAFFIC CONTROL SERVICES:
Cancellation Procedures: To cancel a request for services or any portion thereof, the applicable cancellation boxes must be checked and then re-
submit the form to DESPP, with all sections completed. For cancellations between 0730 hours through 1730 hours, Monday through Friday
(except holidays), submit to the DESPP Special Duty Coordinator by facsimile to 860-706-1407 or e-mail to the specduty.clerk@ct.gov;
for cancellations at all other times and holidays, submit to the State Police Message Center by facsimile to 860-685-8346 or e-mail to the
dps.messagecenter@ct.gov. Any cancellation made without at least twenty-eight (28) hours advance notice will result in a charge for four
(4) hours minimum pay for each Trooper/Sergeant assigned to the project.
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DPS-691-C-3 (Revised 07/2013)
REQUEST FORM AND CANCELLATION FORM
STATE POLICE TRAFFIC CONTROL SERVICES
Instructions: All Requests for State Police Traffic Control Services at DOT highway construction sites, for jobs for which the direct DOT-
DESPP reimbursement payment method will be used, must be made using this form.
The form must be submitted to the DESPP Special Duty Overtime Coordinator via Facsimile: 860-706-1407/E-mail:
specduty.clerk@ct.gov) between regular business hours 0730 hours through 1730 hours, Monday through Friday (except holidays).
Requests must be submitted at least five (5) business days in advance.
There is no guarantee that any request made with less than 24 hour notice to the start of the job can be accommodated.
Any request for services submitted to DESPP after 1730, will not be scheduled until the following business day except in the case of an
emergency.
In the event of an emergency requiring services during normal business hours please contact the Special Duty Office at 860-
685-8420. After normal business hours for the current day and prior to the start of the next business day, a request must be
submitted to the State Police Message Center via E-mail
dps.messagecenter@ct.gov
or facsimile: 860-685-8346. DOT must
also submit the request to the DESPP Special Duty office at the same time via facsimile or email. This will be subject to the
OPA rate of $114.79 Trooper or $149.02 Sergeant.
DESPP cannot guarantee the availability of State Police personnel for requests not submitted in a timely manner.
This form shall be used for the cancellation of any Request for State Police Traffic Control Services. See Instructions in Section II,
regarding cancellation.
Requests must be made in military time. (Example: 1:00 PM = 1300 hours – 8:00 PM = 2000 hours)
Is This a New Job?
Yes
Ongoing
REQUEST DATE:_____________________________________
I. PROJECT INFORMATION:
DOT District/Unit:
DOT Project Identifier No:
Town in Which Job is Located:
Job Location/Meeting Location:
Special Instructions:
Contractor’s Name:
Name & Title of Contact Person (print):
Contractor’s Cellular Telephone No.
Contractor’s Contact Person E-mail address :
Name & Title of DOT Contact Person (Print)
Email Address/Phone No.
DOT Authorization Person (Name/Title)
DOT E-mail Address of Contact Person:(must be an @ct.gov contact)
II. REQUEST OR CANCELLATION FOR STATE POLICE TRAFFIC CONTROL SERVICES:
Cancellation Procedures: To cancel a request for services or any portion thereof, the applicable cancellation boxes must be checked and then re-
submit the form to DESPP, with all sections completed. For cancellations between 0730 hours through 1730 hours, Monday through Friday
(except holidays), submit to the DESPP Special Duty Coordinator by facsimile to 860-706-1407 or e-mail to the specduty.clerk@ct.gov;
for cancellations at all other times and holidays, submit to the State Police Message Center by facsimile to 860-685-8346 or e-mail to the
dps.messagecenter@ct.gov. Any cancellation made without at least twenty-eight (28) hours advance notice will result in a charge for four
(4) hours minimum pay for each Trooper/Sergeant assigned to the project.
(Revision)
(Revision)
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TIME CHANGE
CHANGE NUMBER
DATE(S)
TIME
TROOPER(S)
CANCEL
OF TROOPERS
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DPS-691-C-3 (Revised 07/2013)