Official Website - Surprise, Arizona

Barricade Provider Services Information Form

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1. Barricade Company Information This section is complete This section is incomplete
2. Contractor Information This section is complete This section is incomplete
3. Restriction Information This section is complete This section is incomplete
4. Terms & Agreement This section is complete This section is incomplete

Barricade Company Information

Company Name:*
Company Phone Number:*
Contact First Name:*
Contact Last Name:*
Cell Phone Number:*
Contact Email*
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Contractor Information

Company Name:*
Company Phone Number:*
Contact First Name:*
Contact Last Name:*
Cell Phone Number:*
Contact Email*
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Restriction Information

City of Surprise Permit Number:*
Traffic Control Plan
Please include your Traffic Control plan in a PDF format if applicable.
Civil Inspector First Name*
Civil Inspector Last Name*
Restriction Start & End Date*
Restriction Start & End Date Start Date
—
Restriction Start & End Date End Date
Please indication the restriction date range.
Restriction Start & End times
Restriction Start & End times Start Time
—
Restriction Start & End times End Time
Please indicate the restriction start and stop times
Work Location*
Description of Work or Event*
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Terms & Agreement

General Notes:
<ul> <li>All work hours are 8:30am to 3:30pm unless prior written approval is given. Bell Rd is a case by case basis.</li> <li>Two (2) working days notice is required for all Traffic Control Plan reviews.</li> <li>An off-duty Surprise officer shall be present for any construction activity that occurs within 150’ of a signalized intersection.</li> <li>Any open trench or other type of excavation left overnight shall be covered and have “OPEN TRENCH” signs in place.</li> <li>Steel plates shall be flush with the surface and pinned or welded when the speed limit is 35 MPH or greater.</li> <li>"BUMP" signs shall be installed for all steel plates in the roadway.</li> <li>Traffic control flaggers shall be certified, properly equipped with two way radios and "STOP/SLOW" paddles.</li> </ul>
- All work hours are 8:30am to 3:30pm unless prior written approval is given. Bell Rd is a case by case basis.
- Two (2) working days notice is required for all Traffic Control Plan reviews.
- An off-duty Surprise officer shall be present for any construction activity that occurs within 150’ of a signalized intersection.
- Any open trench or other type of excavation left overnight shall be covered and have “OPEN TRENCH” signs in place.
- Steel plates shall be flush with the surface and pinned or welded when the speed limit is 35 MPH or greater.
- "BUMP" signs shall be installed for all steel plates in the roadway.
- Traffic control flaggers shall be certified, properly equipped with two way radios and "STOP/SLOW" paddles.
Terms & Conditions*
All persons requesting a right-of-way and/or traffic control permit with the City of Surprise shall follow all guidelines set forth in the City of Surprise Temporary Work Zone Traffic Management Policy. Read the Temporary Work Zone Traffic Management Policy
1. I have read and agree to follow the Temporary Work Zone Traffic Management Policy.

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