Form TL-9501A "Noise/Sound Barrier New Product Submittal Form" - California

What Is Form TL-9501A?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form TL-9501A by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form TL-9501A "Noise/Sound Barrier New Product Submittal Form" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 1 of 3
NOISE/SOUND BARRIER NEW PRODUCT SUBMITTAL FORM
TL-9501A (REV 10/2017)
For Caltrans Internal Use Only
Tracking Number:
Date Received:
The Noise/Sound barrier New Product Submittal Form (NPSF) provides the California Department of Transportation (Caltrans) with information
regarding noise/sound barrier products submitted for evaluation. Please answer all questions thoroughly and fill in all fields (if not
applicable, write N/A).
A Noise/Sound Barrier New Product Submittal Package (NPSP) must be submitted for each new product (one NPSP per new product) and
must include the following: (1) Noise/Sound Barrier New Product Submittal Form, (2) material specifications, (3) photographs with close-up
views, (4) design calculations per LRFD, (5) design plans and detail sheets, (6) test data, (7) Safety Data Sheet (SDS), if required, (8) Quality
Control Plan, if applicable, (9) product specimen, (10) installation instructions, (11) product maintainability including graffiti removal, and (12)
and other pertinent information. Incomplete Noise/Sound Barrier New Product Submittal Packages will not be considered and will be discarded
after 30 days.
E-Mail Noise/Sound Barrier New Product Submittal Form to the following address:
New.Products@dot.ca.gov
Attention: New Products Desk
California Department of Transportation
Materials Engineering and Testing Services
5900 Folsom Boulevard
Sacramento, CA 95819
PRODUCT IDENTIFICATION:
Manufacturer's Product/Process Trade Name:
Manufacturer's Model/ID Number:
Generic Name:
PRODUCT MANUFACTURER:
Company Name:
Telephone No.:
Fax No.:
Address:
City/State/Zip Code:
E-mail Address:
Web Page URL:
PRODUCT SUBMITTED BY (Distributor, Vendor, Manufacturer's Representative):
Company Name:
Contact (
Caltrans correspondence will be
:
addressed to the contact person listed here)
Title:
Telephone No.:
Fax No.:
Address:
City/State/Zip Code:
E-mail Address:
Web Page URL:
Background Description
of Company:
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 1 of 3
NOISE/SOUND BARRIER NEW PRODUCT SUBMITTAL FORM
TL-9501A (REV 10/2017)
For Caltrans Internal Use Only
Tracking Number:
Date Received:
The Noise/Sound barrier New Product Submittal Form (NPSF) provides the California Department of Transportation (Caltrans) with information
regarding noise/sound barrier products submitted for evaluation. Please answer all questions thoroughly and fill in all fields (if not
applicable, write N/A).
A Noise/Sound Barrier New Product Submittal Package (NPSP) must be submitted for each new product (one NPSP per new product) and
must include the following: (1) Noise/Sound Barrier New Product Submittal Form, (2) material specifications, (3) photographs with close-up
views, (4) design calculations per LRFD, (5) design plans and detail sheets, (6) test data, (7) Safety Data Sheet (SDS), if required, (8) Quality
Control Plan, if applicable, (9) product specimen, (10) installation instructions, (11) product maintainability including graffiti removal, and (12)
and other pertinent information. Incomplete Noise/Sound Barrier New Product Submittal Packages will not be considered and will be discarded
after 30 days.
E-Mail Noise/Sound Barrier New Product Submittal Form to the following address:
New.Products@dot.ca.gov
Attention: New Products Desk
California Department of Transportation
Materials Engineering and Testing Services
5900 Folsom Boulevard
Sacramento, CA 95819
PRODUCT IDENTIFICATION:
Manufacturer's Product/Process Trade Name:
Manufacturer's Model/ID Number:
Generic Name:
PRODUCT MANUFACTURER:
Company Name:
Telephone No.:
Fax No.:
Address:
City/State/Zip Code:
E-mail Address:
Web Page URL:
PRODUCT SUBMITTED BY (Distributor, Vendor, Manufacturer's Representative):
Company Name:
Contact (
Caltrans correspondence will be
:
addressed to the contact person listed here)
Title:
Telephone No.:
Fax No.:
Address:
City/State/Zip Code:
E-mail Address:
Web Page URL:
Background Description
of Company:
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 2 of 3
NOISE/SOUND BARRIER NEW PRODUCT SUBMITTAL FORM
TL-9501A (REV 06/2017)
PRODUCT INFORMATION:
Outstanding features or advantages of product:
General composition of material (include complete technical data):
Does product utilize recycled materials? (Indicate yes or no, and if applicable, list recycled materials.)
Approximate cost per square foot (assume 1000' long X 16' high):
Foundation cost per linear foot (assume 1000' long X 16' high):
Average annual maintenance cost per square foot (assume 20-year life):
Is product currently available? What year was product introduced?
Does this product speed up construction activities? If yes, how?
PRODUCT USAGE:
Location(s) of field installations, if applicable:
Has product been approved for use by other transportation authorities or agencies? If yes, which ones?
ADDITIONAL INFORMATION:
Has product been evaluated previously by Caltrans? Under what product name?
Who suggested Caltrans be contacted?
Name(s) of Caltrans employee(s) with whom discussions have been held:
PRODUCT MEETS THE FOLLOWING SPECIFICATIONS:
Yes
No
Agency
Specification Number
Caltrans
AASHTO
ASTM
Other DOT's (specify DOT):
Other Nationally Recognized Agency (specify Agency):
PRODUCT TEST DATA:
Yes
No
Agency
AASHTO
ASTM
Caltrans
Other Nationally Recognized Agency (specify Agency):
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 3 of 3
NOISE/SOUND BARRIER NEW PRODUCT SUBMITTAL FORM
TL-9501A (REV 06/2017)
NEW PRODUCT SUBMITTAL PACKAGE CHECKLIST
1. Noise/Sound Barrier New Product Submittal Form
2. Material specifications for important components of the product
3. Photographs with close-up views
4. Design calculations per LRFD, signed by a Civil Engineer registered in California
5. Design plans and detail sheets, signed by a Civil Engineer registered in California
6. Test data
7. Safety Data Sheet (SDS), if required
8. Quality control plan, if product utilized recycled materials
10. Installation instructions
11. Product maintainability including graffiti removal
12. Other pertinent information
THE FOLLOWING CONDITIONS APPLY FOR ALL NEW PRODUCT EVALUATIONS:
1. The California Department of Transportation (Caltrans) policy is to ensure the objective, impartial, and consistent evaluation of new
products for use in the construction, maintenance, and operation of the State's transportation system. New products are defined as fully
developed and marketable products that have not been previously evaluated by Caltrans and for which Caltrans specifications do not exist.
All new products are evaluated on the basis of need, performance, cost-competitiveness, and compliance with health, safety, and
environmental regulations.
2. All new products will first be subject to a "needs assessment" by an impartial panel including ultimate users. Products which are accepted
will be evaluated in accordance with applicable laboratory testing and/or field evaluation criteria designed to provide a true test of products
stated characteristics and application. Such criteria shall be determined by Caltrans staff.
3. The evaluation of a product is not a commitment by Caltrans to purchase, recommend, or specify the product, regardless of performance.
4. For some products, the manufacturer or representative may be requested to be present at the test site for product installation to lend
assistance and to provide expertise to those involved with the installation. The manufacturer will also provide any special equipment
necessary for the installation, provided Caltrans does not supply such equipment.
5. Caltrans may prepare a summary report upon completion of a suitable evaluation period. This period will be one, which, in the view of the
evaluating staff, provides adequate product exposure to its functional environment.
6. Data resulting from field evaluations is considered public information and will not be considered privileged. As authorized by the signature
below, all information developed during this product evaluation may be released by Caltrans.
7. Upon approval by Caltrans, the manufacturer or representative consents to posting product design drawings on the Authorized Materials
List (AML) on the Caltrans New Products Website. The drawings shall be in a non-editable format.
8. The submitter agrees to accept the return of any products or samples, for disposal, after the completion of the evaluation.
9. Product evaluations require commitments of time and resources by Caltrans. Therefore, it is the applicant's responsibility to comply with the
policy stated herein in order for Caltrans to administer requests uniformly and impartially. Deviations from this policy may cause delay or
rejection of request.
SIGNATURE:
Submitted by (print name):
Title:
Signature:
Date:
If you have questions regarding the submittal of your product,
please contact the New Products Desk at:
New.Products@dot.ca.gov
or (916) 227-7073.
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
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