Pre-Emption Opticom Detector: Manufacturer: □ Global Technologies □ Other __________________ □ 721 □ Other ______________________________________ Opticom Discriminator Manufacturer: □ Global Technologies □ Other __________________ Model: □ 762 □ 764 □ Other ____________________ Ethernet Switch Manufacturer: □ None □ CISCO □ Other _______________________ Utility Protector Manufacturer: □ None □ □ Other ___________________ SDLC Device Manufacturer: □ None □ Wavetronix □ Other ___________________ Detection System Manufacturer: □ None □ Wavetronix □ Other ___________________ Model: □ Advance □ Presence CCTV Camera Manufacturer: □ None □ AXIS Communications □ Other ________________________ Model Type: □ Dome □ Quad □ Other ________________________ Pedestrian Pushbuttons Type: □ Standard □ Audible Manufacturer: □ Polara □ □ ____________________ Model: □ 4 wire □ 3 wire □ 2 wire Signal Head Information: Vehicular Heads Manufacturer: □ Eagle □ Econolite □ McCain □ Other ___________________ Material: □ Polycarbonate □ Other________________ □ Black □ Yellow Pedestrian Heads Manufacturer: □ McCain □ Siemens □ Other ___________________ Type: □ Countdown/Hand/Man LED
Material: □ Polycarbonate □ Other________________ Color: □ Black □ Yellow Illuminated Street Name Signs Manufacturer: □ Southern Mfg □ Other ___________________ □ Black □ Other ___________________ Blank Out Message Signs Manufacturer: □ M-Systems Inc. □ Other ___________________ Color: □ Black □ Other ___________________ Signal Pole Information: Type: □ Decorative Signal Pole Only □ Decorative Signal/Light Pole □ Standard Signal Pole Only □ Standard Signal/Light Pole Manufacturer: □ Union Metal □ Valmont □ Other________________ Material: □ Steel Shape: □ Round □ Fluted Finish: □ Galvanized □ Black □ Dk Green □ Dk Bronze □ Other ____________________ Mounting Height Choices: (No Lum), 30’, 35’, or 40’ Pole Length Choices: 20.5’ (No Lum), 27’ (for 30’ MH), 32’ (for 35’ MH) or 37’ (for 40’ MH) Pole No. Mounting Height Pole Length Bolt Circle Diameter Base Square Plate Dimensions Signal Pole Base Information: Type: □ □ □ Contour □ None Finish: □ Black □ Dk Green □ Dk Bronze
Mast Arm Information: Manufacturer: □ Union Metal □ Valmont □ Millerbernd Material: □ Steel Shape: □ Round □ Fluted Finish: □ Galvanized □ Black □ Dk Green □ Dk Bronze □ Other ______ Pole No. Mast Arm No. 1 Length Mast Arm No. 1 Sq. Plate Dim. Mast Arm No. 1 Bolt Pattern Dim. Mast Arm No. 2 Length Mast Arm No. 2 Sq. Dim. Mast Arm No. 2 Bolt Pattern Dim. Pedestal Pole Information Manufacturer: □ Component Products □ Pelco □ Gades Sales Material: □ Spun Aluminum □ Steel Shape: □ Round □ Fluted Finish: □ Natural Aluminum □ Black □ Dk Green □ Dk Bronze Pedestal Pole Base Information: Type: □ □ □ Contour □ Std Cast Aluminum Finish: □ Natural Aluminum □ Black □ Dk Green □ Dk Bronze Push Button Pole Information Manufacturer: □ Frey □ Other________________ Material: □ Aluminum Shape: □ Round Finish: □ Anodized □ Black □ Dk Green □ Dk Bronze
Push Button Pole Base Information: Type: □ Cast Aluminum Finish: □ Natural Aluminum □ Black □ Dk Green □ Dk Bronze Push Button Pole Foundation Information: Type: □ Concrete Finish: □ None Luminaire Information: □ Check if Not Applicable Style: □ Cobra □ Residential □ Decorative □ Other_______________ Housing Manufacturer: □ American Electric □ General Electric □ Cooper □ __________________ Finish: □ Black □ Dk Green □ Dk Bronze □ Gray Mounting: □ Simple Arm □ Truss Arm □ Other _________________ Arm Length: □ 6ft □ 8ft □ 10ft □ 12ft □ 15ft Lamp Type: □ HPS □ LED Lamp Manufacturer: □ Sylvania □ General Electric Watts (LED Class Equivalent): □ □ 100 (E) □ 150 (D) □ 250 (C) □ 400 (A) Volts: □ 120 □ 208 □ 240 Drive Current (LED only): □ □ 700mA □ Other __________ Cobra Head LED Fixture Photo Cell Control: □ None □ 7-pin □ 3-pin Remote Monitoring Device Manufacturer: □ _________________