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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 APPLICATION Fax: [PHONE REDACTED] APPLICANT Applicant’s Name & Business: Permit No.: Office Use Telephone If applying for Fleet (10 or more vehicles), how many total vehicles in the Fleet? Vehicle License & If 10 or more vehicles see below Trailer License & Vehicle Weight Including Type of Travel Route Within City/County (Attach map indicating travel route within City and County Limits) Date/Time of (Minimum Notice: 2 Business Days) Address Moving Address Moving Indicate the type and quantity of traffic control devices for this Number of Vehicles Permit Type Fee 9 or Less Vehicles Single Application Per Vehicle $50 Per Application 10 Vehicles (Fleet) One Application Plus Spreadsheet With All Vehicles Listed $500 For Application 11 or More Vehicles One Application Plus Spreadsheet With All Vehicles Listed $500 For Application PLUS $30 PER VEHICLE DATE PAID TOTAL FEE PAID 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 [EMAIL REDACTED], a minimum 24 hours prior to a move, before entering the City and County. 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: 10//27/20