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Road Use Application for Special Events Virginia Department of Transportation Attn: Permits Department 41 Lawson Road1 S.E. Leesburg,VA 20175 Telephone: (703)737-2027 Fax: (703)771 -2528 Information: wishing to secure authorization for roadway usage shall complete the attached form. This is a three-step authorization process: The County of Loudoun Office of Emergency Management authorizes first, the Virginia State Police and/or Loudoun County Sheriffs Office second and final approval is released by VDOT. All conditions and provisions specified by the County or Loudoun Office of Emergency Management shall be strictly followed. Should the event be cancelled or postponed, the event organizers shall notify The County of Loudoun Office of Emergency Management, VDOT, the Virginia State Police and/or Loudoun County Sheriffs Office. Jf your road use application Is not approved by VDOT, comments will be provided by VDOT, then VDOT and the Virginia State Police and/or Loudoun County Sheriffs Office wlll work with if requested, to investigate alternatives. 1. The application shall Include a street map detailing the proposed location of the event and indicating any proposed road closure. The VDOT application fee Is $100.00. All checks or money orders should be made payable to Treasurer of Virginia. 2. An application for Road Use Authorization shall be submitted to VDOT at the above address at least 60 calendar days prior to the scheduled date of the event. 3. The application with a self addressed envelope shall be mailed to the Virginia State Police and/or Loudoun County Sheriffs Office at least 45 calendar days prior to the scheduled date of the event. Loudoun County Sheriffs Office and Virginia State Police addresses and phone numbers are attached. Requirements for Applicant: 1. If trails are available along proposed routes for hike, bike, and run events then trails shall be used not roadways. 2. Road closures on four-lane divided roadways shall not be longer than 15 miles. Varlable message signs shall be posted up to two weeks prior to the event to advise the traveling public if required. 3. Request lo close a street for a block party shall Include the signatures of all persons affected by the road closure and/or HOA President. 4. Prior year's approval of annual events does not guarantee approval of this year's event. 5. All traffic controls shall be coordinated by the applicant, to Include variable message boards, cones, barricades, and signage as deemed necessary. Liability: Issuance of an authorization letter by the Virginia Department of Transportation does not relieve the organizers, group, company, participants, parties to or sponsor(s) of the event from any civil or criminal liability resulting from accident, Injury, or negllgence. The Virginia Department of Transportation accepts no liability expressed or Implied in connection with this authorization. Applicants shall at all times Indemnify and save harmless the Commonwealth Transportation Board members of the Board, the Commonwealth and all Commonwealth employees, agents, and offices, from responsibility, damage, or liability arising from the exercise of the privileges granted in such permits to extent by law. ---PAGE BREAK--- Agency Contact Numbers and Priority List for Approval AGENCY FIRST STEP: Visit our website to complete an online special events form and email/fax your proposed route map for review. Should you have questions regarding the process, please feel free to contact our office. Mark Elie, Special Events Coordinator Loudoun County Office of Emergency Management 801 Sycolin Road SE Suite #100 Leesburg, Virginia 20175 (703)737.8919 (office) (703)779.0012 (fax) [EMAIL REDACTED] (email) www (website) SECOND STEP: If you have contracted for Maintenance of Traffic and other accommodations you need to contact the Loudoun County Sheriffs Office to review your application. Jessica Shugars, Event Coordinator Loudoun County Sheriffs Office 803 Sycolin Road SE Leesburg, Virginia 20175 (703)737.8157 (office) (703)771.5577 (fax) !!OV ( email) THIRD and FINAL STEP: After coordinating with Loudoun County Office of Emergency Management and Sheriffs Office, you will contact VDOT and proceed with signature and final application. Hours of Operation are Monday through Friday 8:30 a.m. to 11 :00 a.m.; closed noon to I :00 p.m.; Reopen at I :00 p.m. until 2:30 p.m. Scott Brodbeck, VDOT Permits Virginia Department of Transportation 41 Lawson Road SE Leesburg, Virginia 20175 (703)737.2033 (office) (703 )771.2588 (fax) [EMAIL REDACTED].!WV (email) ---PAGE BREAK--- VDOT LEESBURG RESIDENCY PERMITS OFFICE EVENT PERMIT COMMENT FORM STEP County of Loudoun of Emergency Notification of Information Provided By Auplicant Applicant: Dale Received: Date of Event: Nameffitle: Date: Comments: STEP Ji'or Virginia State Police and Loudoun CounCy Shca·ifrs Office cc: Loudoun County Bon rd Of Supervisors Applicnnt: Date Received: 0 o cs Event Require Officers to Monitor Traffic? YES NO Number of Officers Required? _ Does Event Require Officers to Control Traffic? YES_ NO Number of Officers Required? _ WiU Permittee Be Billed for Cost of Officers? YES_ NO Comments: Signature: _ Nameffitle; Date Returned to VDOT: AFTER ACTf ON REPORT Comments: Nameffitle: Date: ---PAGE BREAK--- STEP Virginia Dep1wtment of Applicntion for Road Use AuthorizRtiou Plensc Print Clearly or Type Date of Applicntion:. _ Type or Dale of Event: _ Inclement Weather Date:. _ Beginning Time: _ Ending Estimmed Number of Participants: Estimated Number of Vehicles; _ Sponsored _ Name Work# Address Home/I City, Stole, Zip Code Email Address Slate reason for event and necessity for utilizing the roadway. (Use additiunal J>agcs if needed) List stnte moinloined roadways lo be used. a map routes. Certification by I have read and shall comply wilh lhc guidelines for Road Use Authorization. Signature. _ For VDOT USE only: Sigñturc Da1,: _ N11111c/fitlc \1001· appro,·al wllh lhe follo11lng I) Traffic conlrol ,,ill ht coordinutcd wllh 1l1c Virginia Slate rolkc illlw'or Loudoun Sheri fTs Office nl nil during Ilic cnti,c event and inlmuplion to lrallk flow to be kept to a minirnum 2) Aclivilics shall be coordinaled wiLh Ilic Loudoun Coon\)' Dcpi111mcnt of Emergency lhc Virginia Slate Police and/or LouJou11 County Office. J} T11c is 10 be publicized iii both the loc:11 and radio slalions to infonn 111,: ua,•cling public 4) If rcquiri:d hy police oll p3llicipanl.t sl1all stay ns close lo the right edge oflhc pavement as pMsiblc and remain in single file lo Ilic possible and wear colored clothing in order to be Cil:lily seen by 1hc 1ravcli11g public. S) The Virginia no linbility or implied in conncc1io11 wil.h 1lns nu1boriz:11io11 Ap11licnnis 10 11·hum 11crmits we issued shall at all limes indemnify and suve harmless the l'ommonwcahh Tr.t1upor1ation Additional Comments;.__ April 2017