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NEW JERSEY DEPARTMENT OF TRANSPORTATIONITS ASSET MANAGEMENT SYSTEM [DYNAMIC MESSAGE SIGN SITE] ITS-100-0014-Rev 2 Dec 2017 Project Name: FORMTEXT ?????Project Manager: FORMTEXT ?????Designer: FORMTEXT ?????Fed. Project Number: FORMTEXT ?????Contract Number: FORMTEXT ?????UPC No: FORMTEXT ?????DP No: FORMTEXT ?????Site Identification NameRoute:000 FORMDROPDOWN Mile Marker: FORMTEXT 000.00Direction/Lane:? FORMDROPDOWN ????Letter: FORMDROPDOWN SITE INFORMATION Facility Owner: FORMTEXT ?????Latitude: FORMTEXT ?????County: FORMTEXT ?????Longitude: FORMTEXT ?????Municipality: FORMTEXT ?????Serving Area(Zone): FORMTEXT ?????Turf Pavers:? Yes ? NoSafety Barriers:? Yes ? NoGeo Coded Site Image file name attached: FORMTEXT ?????Distance from edge of pavement (ft): FORMTEXT ?????Portable Device:? Yes ? NoTD Number: FORMTEXT ?????Lane closure required:? NO ? FORMDROPDOWN Bucket Truck Required:? NO ? FORMDROPDOWN Site Installed Date(MM/DD/YYYY): FORMTEXT ?????Site Acceptance Date(MM/DD/YYYY): FORMTEXT ?????DMS CabinetCabinet Location (Latitude): FORMTEXT ?????Cabinet Location (Longitude): FORMTEXT ?????Cabinet Size(LxWxD):L in FT) FORMTEXT ????? x (W in FT) FORMTEXT ????? x(D in FT) FORMTEXT ?????Cabinet Mount type: FORMTEXT ?????Installed Filter:? Yes ? NoNumber of Filters: FORMTEXT ?????If HeatedFilter Dimensions:(H in FT) FORMTEXT ????? x (L in FT) FORMTEXT ????? x(W in FT) FORMTEXT ?????Make: FORMTEXT ?????Cabinet Access Type: FORMTEXT ?????Model: FORMTEXT ?????Skirt height, if Provided: FORMTEXT ?????Serial Number: FORMTEXT ?????Located in Clear Zone:? NO ? FORMDROPDOWN DMS ControllerManufacturer: FORMTEXT ?????Software version: FORMTEXT ?????Model: FORMTEXT ?????IP Address: FORMTEXT ?????Serial port details: FORMTEXT ?????MAC Address: FORMTEXT ?????Serial Number: FORMTEXT ?????Warranty: FORMTEXT ?????UPS Manufacturer: FORMTEXT ?????UPS Model: FORMTEXT ?????List all cards in the controller: FORMTEXT ?????Ethernet ports: FORMTEXT ?????DMS Display Device Id: FORMTEXT ?????Serial Number: FORMTEXT ?????DMS Name: FORMTEXT ?????DMS Use: FORMTEXT ?????Display panel/Bulb/LED Manufacturer: FORMTEXT ?????Display Panel/Bulb/LED Model: FORMTEXT ?????Display panel/Bulb/LED Quantity: FORMTEXT ?????Display Type:? LED ? Fiber Shutter ? Flip Disk ? OtherDMS Display Matrix:? Full FORMTEXT ?????? Line Number of Lines: FORMTEXT ?????Characters: FORMTEXT ?????? CharacterNumber of Lines: FORMTEXT ?????Characters: FORMTEXT ?????Installed Filter:? Yes ? NoNumber of Filters: FORMTEXT ?????Filter Type:? Paper ? Fabric ? Metal ? OthersFilter Dimensions:(H in FT) FORMTEXT ????? x (L in FT) FORMTEXT ????? x(W in FT) FORMTEXT ?????Date Installed (MM/DD/YYYY): FORMTEXT ?????Warranty Start Date (MM/DD/YYYY): FORMTEXT ?????End of life (YYYY): FORMTEXT ?????Warranty End Date(MM/DD/YYYY): FORMTEXT ?????Verified Date (MM/DD/YYYY): FORMTEXT ?????DMS Structure DMS Mount Type :? Ground Mount ? Bridge Mount ? Pole ? Cantilever Mount ? Overhead Span Mount ? Butterfly ? MiscellaneousDistance to edge of shoulder (Ft): FORMTEXT ?????DMS Structure Lat: FORMTEXT ?????DMS Structure Long: FORMTEXT ?????Mount Structure Number: FORMTEXT ?????Located in Clear Zone:? Yes ? NoMount Structure Length: FORMTEXT ?????Bucket Truck Required:? Yes ? NoFoundation Type:? Concrete? Steel Housing Access:? Front ? Full Matrix ? Line MatrixElectricalElectrical Job Number: FORMTEXT ?????Meter Cabinet Lat: FORMTEXT ?????Power Source? Load Center No? Pole Number FORMTEXT ????? FORMTEXT ?????Meter Cabinet Long: FORMTEXT ?????Electric circuit name: FORMTEXT ?????Meter Cabinet Size: FORMTEXT ?????Meter Number /Account Number: FORMTEXT ?????Power Company: FORMTEXT ?????Power Requirement: FORMTEXT ?????Surge Suppressor: FORMTEXT ?????Project Installed under: FORMTEXT ?????Manufacturer’s name: FORMTEXT ?????Installer: FORMTEXT ?????Handover date to NJDOT (MM/DD/YYYY): FORMTEXT ????? Communication? Fiber? Wireless? ISPIf ISP ServiceISP Name: FORMTEXT ?????Service Type: FORMTEXT ?????Pole No: FORMTEXT ?????Service Details (Static IPs, Bandwidth etc): FORMTEXT ?????Account No: FORMTEXT ?????PO Box: FORMTEXT ?????ISP Service Handover date to NJDOT (MM/DD/YYYY): FORMTEXT ?????Network Backhaul If Fiber or Wireless (NJDOT Network)Device: FORMTEXT ?????Firmware version: FORMTEXT ?????Model: FORMTEXT ?????Backhaul Ethernet Switch/Device IP: FORMTEXT ?????Serial no: FORMTEXT ?????Device Mac ID: FORMTEXT ?????Software version: FORMTEXT ?????Subnet Mask: FORMTEXT ?????Subnet Mask: FORMTEXT ?????Default Gateway IP: FORMTEXT ?????I Hereby Certify That All of the Above Information Is Accurate As Constructed to the Best of My Knowledge.Submitted By: FORMTEXT ????? Date: FORMTEXT ????? Contractor’s Number: FORMTEXT ????? Contractor: FORMTEXT ????? ................
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