Form MTCE-09 Attachment A "Adopt-A-highway Special Provisions" - California

What Is Form MTCE-09 Attachment A?

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, 2009;
  • 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;
  • Fill out the form in our online filing application.

Download a fillable version of Form MTCE-09 Attachment A by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form MTCE-09 Attachment A "Adopt-A-highway Special Provisions" - California

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ATTACHMENT A (ADOPT-A-HIGHWAY SPECIAL PROVISIONS)
MTCE-09 (REV 07/2009)
1. DEPARTMENTAL CONTACTS:
District Adopt-A-Highway Coordinator (Processes applications, answers questions regarding program policy, maintains program data,
receives contact information changes.)
Name:
Phone:
Address:
Maintenance Supervisor or Designee (Receives five-day advance notice of work, provides additional supplies and equipment throughout
the permit period, arranges for collection of filled litter bags, hazardous materials, and large items.)
Name:
Phone:
Address:
Representative Providing Safety Orientation (Answers safety-related questions, provides initial supply of safety equipment.)
Name:
Phone:
Address:
2. WORK FREQUENCY (Check all that apply):
times per year.
Litter shall be removed a minimum of
calendar days of notification.
Graffiti shall be removed within
Vegetation shall be controlled a minimum of
times per year.
Planting, vegetation control, and other activities shall be performed per permittee's attached plans and schedules.
3. WORK DAYS AND HOURS:
Work shall not be scheduled by any permitee during the holiday periods listed in Special Provisions 10. In addition, work shall not be
scheduled:
Volunteer litter removal groups shall schedule work during the national cleanup events listed in Special Provisions 11 (weather
permitting). In addition, volunteer litter removal groups shall schedule work:
4. SITE ACCESS - Direction 1:
SITE ACCESS - Direction 2:
Walk-on entry and exit points?
YES
NO
Walk-on entry and exit points?
YES
NO
Shoulders for drop-off and pick-up?
Shoulders for drop-off and pick-up?
YES
NO
YES
NO
Space to park off of shoulders?
Space to park off of shoulders?
YES
NO
YES
NO
Comments/Recommendations:
Comments/Recommendations:
5. WORK AREA DESCRIPTION - Direction 1:
WORK PROCEDURES - Direction 2:
Begin:
Begin:
End:
End:
6. WORK PROCEDURES: In addition to the restrictions listed in item 15 of the Special Provisions, work may not be performed in the
following portions of this site:
Direction 1:
Direction 2:
GROUP NAME/CONTRACTOR NAME
ADOPTION TYPE AND LOCATION
ADOPT-A-HIGHWAY COORDINATOR SIGNATURE
DATE PREPARED
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
ATTACHMENT A (ADOPT-A-HIGHWAY SPECIAL PROVISIONS)
MTCE-09 (REV 07/2009)
1. DEPARTMENTAL CONTACTS:
District Adopt-A-Highway Coordinator (Processes applications, answers questions regarding program policy, maintains program data,
receives contact information changes.)
Name:
Phone:
Address:
Maintenance Supervisor or Designee (Receives five-day advance notice of work, provides additional supplies and equipment throughout
the permit period, arranges for collection of filled litter bags, hazardous materials, and large items.)
Name:
Phone:
Address:
Representative Providing Safety Orientation (Answers safety-related questions, provides initial supply of safety equipment.)
Name:
Phone:
Address:
2. WORK FREQUENCY (Check all that apply):
times per year.
Litter shall be removed a minimum of
calendar days of notification.
Graffiti shall be removed within
Vegetation shall be controlled a minimum of
times per year.
Planting, vegetation control, and other activities shall be performed per permittee's attached plans and schedules.
3. WORK DAYS AND HOURS:
Work shall not be scheduled by any permitee during the holiday periods listed in Special Provisions 10. In addition, work shall not be
scheduled:
Volunteer litter removal groups shall schedule work during the national cleanup events listed in Special Provisions 11 (weather
permitting). In addition, volunteer litter removal groups shall schedule work:
4. SITE ACCESS - Direction 1:
SITE ACCESS - Direction 2:
Walk-on entry and exit points?
YES
NO
Walk-on entry and exit points?
YES
NO
Shoulders for drop-off and pick-up?
Shoulders for drop-off and pick-up?
YES
NO
YES
NO
Space to park off of shoulders?
Space to park off of shoulders?
YES
NO
YES
NO
Comments/Recommendations:
Comments/Recommendations:
5. WORK AREA DESCRIPTION - Direction 1:
WORK PROCEDURES - Direction 2:
Begin:
Begin:
End:
End:
6. WORK PROCEDURES: In addition to the restrictions listed in item 15 of the Special Provisions, work may not be performed in the
following portions of this site:
Direction 1:
Direction 2:
GROUP NAME/CONTRACTOR NAME
ADOPTION TYPE AND LOCATION
ADOPT-A-HIGHWAY COORDINATOR SIGNATURE
DATE PREPARED
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.