Form TL-9501 "New Product Evaluation Submittal Form" - California

What Is Form TL-9501?

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 July 1, 2018;
  • 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-9501 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-9501 "New Product Evaluation Submittal Form" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
Page 1 of 3
NEW PRODUCT EVALUATION SUBMITTAL FORM
TL-9501 (REV 07/2018)
For Caltrans Internal Use Only
Do not use this form if your product meets current AML criteria or current Caltrans
Tracking Number:
specifications. Refer to the Product Evaluation Program website for instructions.
Date Received:
Use this form only for a product:
1. that would meet the intended use of a Caltrans specification, but not all of the requirements in that specification
2. not covered under current Caltrans specifications or Authorized Material List (AML) criteria and would enhance the State’s transportation
system
Submit this form for each product to be evaluated. Do not include samples or specimens. You will be notified if samples are required. An
incomplete submittal will not be considered and will be discarded after 30 days.
Please answer all questions thoroughly and fill in all fields. If not applicable, write N/A.
E-mail your submittal to the following address:
New.Products@dot.ca.gov
VENDOR INFORMATION
Company Name:
Contact Person:
Telephone No.:
Address:
City/State/Zip Code:
Email Address:
Web Site:
PRODUCT INFORMATION
Only fully developed products that are commercially available are eligible for evaluation.
Product Name:
Product Manufacturer:
Does your product meet the Authorization Criteria for an existing Authorized Material List?
Yes
No
If yes, STOP. Please submit your product using the Authorized Material List Submittal Form (TL-9502).
If your product includes several components, list the manufacturer of each component:
List the intended use of your product:
General composition of product:
Is the product made with recycled materials? And/or sustainable production practices? Explain:
Product limitations:
Alternate use for what existing product(s)?
Advantages over currently used product(s)?
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
NEW PRODUCT EVALUATION SUBMITTAL FORM
TL-9501 (REV 07/2018)
For Caltrans Internal Use Only
Do not use this form if your product meets current AML criteria or current Caltrans
Tracking Number:
specifications. Refer to the Product Evaluation Program website for instructions.
Date Received:
Use this form only for a product:
1. that would meet the intended use of a Caltrans specification, but not all of the requirements in that specification
2. not covered under current Caltrans specifications or Authorized Material List (AML) criteria and would enhance the State’s transportation
system
Submit this form for each product to be evaluated. Do not include samples or specimens. You will be notified if samples are required. An
incomplete submittal will not be considered and will be discarded after 30 days.
Please answer all questions thoroughly and fill in all fields. If not applicable, write N/A.
E-mail your submittal to the following address:
New.Products@dot.ca.gov
VENDOR INFORMATION
Company Name:
Contact Person:
Telephone No.:
Address:
City/State/Zip Code:
Email Address:
Web Site:
PRODUCT INFORMATION
Only fully developed products that are commercially available are eligible for evaluation.
Product Name:
Product Manufacturer:
Does your product meet the Authorization Criteria for an existing Authorized Material List?
Yes
No
If yes, STOP. Please submit your product using the Authorized Material List Submittal Form (TL-9502).
If your product includes several components, list the manufacturer of each component:
List the intended use of your product:
General composition of product:
Is the product made with recycled materials? And/or sustainable production practices? Explain:
Product limitations:
Alternate use for what existing product(s)?
Advantages over currently used product(s)?
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
NEW PRODUCT EVALUATION SUBMITTAL FORM
TL-9501 (REV 07/2018)
How does the use of this product aid Caltrans in complying with any safety or environmental regulations?
What year was product introduced into the market?
What is the approximate material cost per unit?
Estimated delivery and installation cost. List assumptions for determining this figure (distance, equipment, etc.):
Required or recommended inspection, maintenance, or servicing intervals to ensure continued performance of product:
Life expectancy of product before falling below 100% effectiveness. List assumptions for determining life expectancy:
Is special equipment needed to install or place new product? Is this equipment proprietary?
ADDITIONAL INFORMATION
Has this product been evaluated previously by Caltrans? When and under what product name? What has changed?
Has your product been evaluated by NTPEP? If so, what date was your product evaluated and was your product included in the APEL?
List references of other state DOTs or agencies where your product has been used?
PRODUCT MEETS THE FOLLOWING SPECIFICATIONS
Yes
No
Does your product fully meet the requirements of an existing Caltrans specification?
If yes, STOP. No evaluation is required. You may market your product to Contractors who bid on Caltrans projects.
If no, identify the applicable section(s) of the Caltrans specifications your product falls under.
2018 Standard Specifications
Section(s):
Required: Attach a copy of your proposed specification changes in
2015 Standard Specifications
your submittal package.
Other:
List the requirements of the Caltrans specification your product currently complies with:
Yes
No
Does your product meet the requirements of an outside agency?
If yes, please list the specification reference below and add any additional notes as necessary.
Note: Including references to specifications from outside agencies facilitates the incorporation of new products into Caltrans projects.
Agency
Specification Number
AASHTO
ASTM
FHWA
Other DOT's (specify DOT)
Other Nationally Recognized Agency (specify Agency)
Notes:
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
NEW PRODUCT EVALUATION SUBMITTAL FORM
TL-9501 (REV 07/2018)
LIST NATIONAL STANDARD TEST METHODS USED AND INCLUDE TEST DATA
ASTM
AASHTO
Other Nationally Recognized Agency
(specify Agency)
NEW PRODUCT SUBMITTAL PACKAGE CHECKLIST
1. New Product Evaluation Submittal Form
2. Product literature (brochures, cut sheets, specifications, etc.)
3. Test data
4. Safety Data Sheet (SDS), if required
5. Quality control plan
6. Contact or reference list, if applicable, identifying other entities that have used the product
7. Other pertinent information
8. Include suggested specification language
9. Product warranty, if applicable
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, or products to be considered in the AML, 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 departmental priorities, performance, and
compliance with health, safety, and environmental regulations.
2. All new products will first be subject to a "priorities assessment" by an impartial panel including ultimate users. Products that pass the initial
assessment will be evaluated as described in Product Evaluation Guidelines.
3. The evaluation of a product is not a commitment by Caltrans to purchase, recommend, or specify the product, regardless of performance.
4. The manufacturer may be required to provide installation, be present for installation, and/or to lend assistance to those involved with the
installation. The manufacturer may also be required to provide materials and equipment required for the installation.
5. Data resulting from 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.
6. The submitter agrees to accept the return of any products or samples, for disposal, after the completion of the evaluation.
7. If a Safety Data Sheet is required, the SDS must provide full disclosure of all hazardous ingredients. Full disclosure also includes disclosure
of chemical components used in the formation of products, including products that may be defined as an "Article" under 29 CFR 1910.1200.
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.
Print
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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