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CITY AND COUNTY OF BROOMFIELD Engineering Division [PHONE REDACTED] One DesCombes Drive, Broomfield, CO 80020 E-MAIL: [EMAIL REDACTED] EXCESS SIZE & WEIGHT PERMIT Fax: [PHONE REDACTED] APPLICANT Applicant’s Name: Permit No. Vehicle Trailer Vehicle Size Including Vehicle Weight Including Type of Travel Route Within City/County (Attach map indicating travel route within City and County Limits) Date/Time of (Minimum 24 hour notice) Address Moving Moving Indicate the type and quantity of traffic control devices for this In applying for this permit, I certify that my company and vehicle operators are familiar with the provisions of the rules and regulations of the Broomfield Municipal Code, Section 10.04.050 Model Traffic Code, applicable to excess size and weight vehicles. PERMIT (VALID ONLY WHEN SIGNED) The above named is authorized to move the vehicle above described by the route and at the time requested, subject to the following special requirements: 1. Applicant shall notify the Police Department at (303) 438-6432, a minimum 24 hours prior to a move, before entering the City and County so that an escort may be provided. 2. Applicant shall provide flagmen, pilot cars, red flags and/or wide load signs as instructed. 3. Applicant shall have valid Colorado Department of Transportation permit for travel on any State Highways within the City and County. 4. Applicant shall be financially responsible and shall pay for any damages to public or private property incurred during this movement. 5. ISSUED AND APPROVED Engineering/Engineering Permit Style Sheets/Excess Size & Weight Revised: 1/30/13