Mass.Gov



MassDOT Highway DivisionQCML PRODUCT EVALUATION APPLICATIONProducts covered by the Standard Specifications shall be submitted for inclusion on the QualifiedConstruction Materials List (QCML), according to the instructions listed at MassDOT Highway Division web pages: (Product Submission Instructions).John Grieco, P.E.Director of Research & MaterialsMassDOT Highway Division5 Macadam RoadHopkinton, MA 01748Upon receipt, the completed application will be reviewed by the Materials Management Quality Assurance Program Engineer and distributed to the New Product Evaluation Committee for further review. When the committee has reviewed the application, and made a determination, the applicant will be notified as to the results of MassDOT Highway Division’s evaluation. The applicant may withdraw their product application from the evaluation process at any time by submitting a written request to the above address.Application for Evaluation of: Date:_________________________________________________________________Brief Description:______________________________ Applicant Name: Title: Representing: ________________________________________________________________________________ Phone / Email: Supplier Name: Address: Web Address: Contact: Phone / Email: Manufacturer: Address: Web Address: Contact: Phone/fax/email: 1, Use9144004387850091440069024500Recommended uses: 914400-225425002. Background9144004368800091440069024500Briefly describe the manufacturer and product background: ` 914400-225425003. DescriptionFeatures/advantages: 914400-7048500Specifications: 914400-7048500Composition: 914400-7048500Installation Method/Instructions: 914400-717550091440043243500Special tools: 914400-7048500Special equipment: 914400-7048500Warrantee: 914400-717550091440043243500Availability: 91440046101000Samples available:4. Standards9144006400800091440089154000Does the product meet any generally accepted industry standards, requirements, or specifications including those from AASHTO, ASTM, FHWA and MassDOT Highway Division?914400-47688500914400-225425005. Previous Uses, Research, Evaluations91440084074000914400109347000List agencies (with contacts) that have used, evaluated, or conducted research on the product. Include the use was experimental or routine, how long it was used, and if test results or reports are available.914400-47879000914400-225425006. CostsApproximate cost including all labor, materials, and equipment necessary to complete the work: 914400-2159000Royalty cost: 7. MassDOT Highway Division contacts91440043815000List anyone in MassDOT Highway Division who has been contacted about this product.9144004114800091440066294000914400915670009144001168400008. Additional Comments ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download