ENGINEERING DEPARTMENT   

8401 W. Monroe, Peoria, Arizona  85345
Phone:  623-773-7210
Fax:  623-773-7248


Traffic Control Plan Submittal Form
Project Name/Number: __________________________ Permit Number: __________________

Project Location: _______________________________________________________________

Project Inspector: _______________________________________________________________

Description/Phase of Construction: _________________________________________________

_____________________________________________________________________________

Start Date: ______________________________ Expiration Date: ________________________

Contractor: ________________________________ Contact Person: ______________________

Office Number: (       )_______________________ Fax Number: (       )_____________________

Cell Number: (       )________________________ 24 hr Number: (       )____________________

Barricade Company:  _________________________ Contact Person: _____________________

Office Number: (   )____________________ Fax Number: (  )_____________________

Peoria General Notes:

1. Traffic/Pedestrian control shall comply with the (Latest Editions) to MUTCD 
   part 6, City of Phoenix Barricade Manual, MAG Section 401, City of Peoria 
   Infrastructure Guide, or any special conditions required by the City of Peoria.
2. A copy of the accepted Traffic Control Plans (TCP) shall be on-site at all times 
   during construction and available for review by the City of Peoria.
3. Traffic diversions onto any unimproved shoulder shall be maintained for dust 
   control and shall maintain a safe drivable surface at all times.
4. All traffic control flaggers shall be properly trained, equipped and competent.
5. Trench plating shall be required and installed per the City of Peoria standard 
   detail # 149.
6. VMS boards are required per the City of Peoria Infrastructure Guide.
7. Law enforcement officers shall be required when any part of the TCP extends to 
   within 300’ ft of a signalized intersection. Officers may be required for 
   non-signalized construction areas at the discretion of the City of Peoria.
8. Three (3) working days notice is required for TCP review.
9. All line items on this form must be completed; This form is to be submitted 
   with the TCP.
10.The submitter/designer of this TCP shall be IMSA or ATSSA certified.
11.The Project Superintendent is responsible for ensuring that all TCP setups 
   and removals meet designated time restrictions.
12.A TCP may be required for shoulder work at the discretion of the City of Peoria.
13.Failure to maintain TCP setup / 24 hour emergency contact person could result 
   in penalty per City of Peoria Code section 23-8, Ordinance # 01-181 Dangerous 
   Construction Practices.

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   Accepted By 							Date             

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