State of Georgia s8

01/26/17 (For Official Use Only) NPE # Date Received Payment Received NEW PRODUCT EVALUATION (NPE) FORM STATE OF GEORGIA DEPARTMENT OF TRANSPORTATION The Department will evaluate only those new products which have the potential to fulfill a real need, economically provide a satisfactory level of service, and are not covered by existing specifications. ( 2 COMPLETED FORMS & ADDITIONAL INFORMATION, 1 COPY OF CHECK OR MONEY ORDER, 1 DIGITAL COPY OF ALL INFO ON FLASH DRIVE MUST BE SUBMITTED AND THE REQUIRED FEE WITH A COPY OF NPE FORM MUST BE SUBMITTED {SEE DETAILS AT BOTTOM OF FORM})

Product must fall under one of these items: **Which item below does your product meet? □ No Existing GDOT Specification □ Product falls outside of current GDOT specification Details:

If product does not meet one of these items or is covered by the specifications, then please call the New Product Evaluation Engineer at 404-608-4810 or email at [email protected].

Date: ______Trade Name: Manufacturer: Internet Address: ______Toll Free # (____)______Contact Person: Phone # ( ) Email: ______Fax # ( ) Address: Street or P.O. Box City State Zip Code ****************************************************************************** Represented by: Address: Street or P.O. Box City State Zip Code Internet Address: ______Toll Free # (____)______Contact Person #1: Phone # ( ) Email: ______Fax # ( ) Contact Person #2: Phone # ( ) Email: ______Fax # ( )

http://www.dot.ga.gov/PS/Materials/ProductSubmissions Page 1 of 3 NPE FORM Patented in U.S.: Yes No Applied for:

If yes, Patent No.(s) (Attach a copy of patent (s) )

Patented in other countries: Yes No Applied for If Yes, attach information.

Material Manufactured in what country?

Product Description:

Recommended or primary use:

Alternate or secondary use:

Outstanding features or advantages / disadvantages:

Material composition (Generic description):

Alternate or comparable to what existing material or product:

Meets requirements of following specifications:

AASHTO: ASTM: Fed. Spec:

Availability: Seasonal? Yes No Delivery at site days after receipt of order. Are quantities limited? Yes No

New on Market? Yes No Date introduced

Estimated cost of material per unit: Will special equipment be required to install product? Yes No

If yes, manufacturer / supplier will furnish the special equipment and install the material.

Are educational courses or films available? Yes No http://www.dot.ga.gov/PS/Materials/ProductSubmissions Page 2 of 3 NPE FORM

Has this proposal been made previously? Yes No

Background description of company offering this proposal

Manufacturer / Supplier shall attach the following information to this form in order to substantiate, verify or clarify its contents. Yes No Specifications ______Drawings, sketches, pictures ______Warranty ______Installation instructions ______Material Safety Data Sheet ______Product / Material literature ______Test data sheets ______

Field test sites in the following locations: State Contact Person Telephone Number ______

Additional Information:

1) Send 2 Completed NPE Forms and additional Attention: New Products Evaluation Committee information, 1 copy of check or money order, 1 2) Send $100 fee and copy of NPE form to: digital copy of all info on flash drive to:

Georgia Department of Transportation Office of Materials and Testing Georgia Department of Transportation 15 Kennedy Drive P.O. Box 117136 Forest Park, GA 30297-2599 Atlanta, GA 30368-7136

If you have any questions, then please contact the New Product Evaluation Engineer at 404-608-4810.

http://www.dot.ga.gov/PS/Materials/ProductSubmissions Page 3 of 3