Attachment C ADOT Event Application Materials.pdf

Please fill in the following:
1. Name of the event and give a brief description of what the event entails
2. Enter the State Route or Highway to be used (i.e. I-10, B-19, SR 84, etc.)
3. In the "In or near" section, enter the closest town or city to where the special event will take
place
4. Beginning milepost (or kilometer post) and ending milepost (or kilometer post).  A milepost
(or kilometer post) is a green and white sign panel with the word “MILE” (or “KM”) at the top
and the associated mile (or kilometer) displayed beneath
5. Time the event will start and the time the event will end
6. Name of responsible individual applying for permit (Applicant).  If you are applying on
behalf of an organization you must have signature authority for that organization
7. Applicant’s title and phone number
8. Name of the organization that is hosting the event
9. Applicant’s address and email address
10. Signature of the applicant, and the date of signing
11. Submit the completed application to the District where your event will take place. Please see
page two of the instructions for a state map with District boundaries:
INSTRUCTIONS FOR SUBMITTING A SPECIAL EVENTS PERMIT APPLICATION
To use Arizona Department of Transportation Highway Right-of-Way for a Special Event, a Special Event Permit 
is required. The following instructions will assist you in the completion of your permit application.
Northcentral District Permits Office                                                              
1801 S. Milton Road
                                              
P.O. Box 2717
Flagstaff, AZ 86001
Phone: 928.774.1491
Central District Permits Office
2140 W. Hilton Avenue 
Phoenix, AZ 85009
                             
Phone: 602.712.7522  
Fax: 602.256.9513
Southeast District Permits Office
2082 US Highway 70
Safford, AZ 85546
Phone: 928.432.4900
Northeast District Permits Office                                                             
2407 Navajo Blvd.
                                                
Phone: 928.524.5400
                                  
Fax: 928.524.5454
                                                 
Southwest District Permits Office
2243 E. Gila Ridge Road 
Yuma, AZ 85365
Phone: 928.317.2100
Fax: 928.317.2107
Northwest District Permits Office
1109 E. Commerce Drive
Prescott, AZ 86305
Phone: 928.777.5861
Southcentral District Permits Office
1221 S. Second Avenue
Tucson, AZ 85713
Phone: 520.388.4200
Fax: 520.388.4222
MAP WITH DISTRICT BOUNDARIES IS PROVIDED ON NEXT PAGE TO ASSIST YOU IN 
FINDING THE DISTRICT WHERE YOUR EVENT WILL TAKE PLACE; WHERE THE EVENT 
TAKES PLACE IS THE DISTRICT TO SEND YOUR APPLICATION TO FOR PROCESSING.
Attachment C

!"b$
!"c$
?
Ó
?
¹
?
Å
?
Û
I¤
?
ó
?
÷
?
i
?
ã
?
`
?
Ä
?
ø
?
a
?
Ë
?
Ë
Iv
Iv
Iv
?
ô
?
ù
?
g
?
æ
?
Æ
?
ü
?
Ì
?
Þ
?
È
!"`$
!"`$
!"a$
!"a$
!"c$
!"d$
!"e$
!"e$
!"e$
!"e$
?
Ñ
?
í
?
Ó
?
Ê
I¦
I¦
I¦
I¦
I¦
!"a$
?
È
?
È
?
ê
?
ë
?
Ø
?
Ê
?
×
?
×
K
²
?
º
?
º
?
º
?
¹
?
Ï
?
Ï
?
Ð
?
Ð
?
Ð
?
Ú
?
Ý
?
Ý
K
¬
?
ö
?
ö
?
ö
?
û
?
þ
?
Í
?
Í
?
Í
?
Â
?
¿
I}
I}
I}
I|
I|
?
Ò
?
Ò
Iz
Iz
Iz
?
¼
?
½
?
Ä
?
Ä
?
Ä
?
Ä
?
Ù
?
Ù
?
Ù
?
À
Iy
K
²
?
f
Iv
Iv
Iv
Iv
Iv
?
ô
?
ô
?
ô
?
ô
I¥
I¥
I¥
I¥
I¥
?
Ü
?
c
?
å
?
í
?
ý
?
Æ
?
Ð
Iv
?
¾
?
d
?
Á
!"a$
?
»
!"a$
I¡
?
ï
?
Ð
?
¸
?
ÿ
!"e$
?
ô
I¦
I¡
I¡
!"`$
?
¾
K
²
?
È
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
!H
Ajo
Why
Page
Yuma
Pine
Mesa
Heber
Globe
Young
Valle
Leupp
Eagar
Sedona
Chinle
Tucson
Ganado
Bisbee
Benson
Parker
Payson
Topock
Duncan
Sasabe
Kingman
Kayenta
Phoenix
Nogales
Willcox
Cameron
Winslow
Douglas
Safford
Clifton
Wikieup
Picacho
Sanders
Sonoita
Seligman
Ash Fork
Holbrook
Show Low
Florence
Fredonia
St Johns
Prescott
Williams
Surprise
Chambers
Congress
Hillside
Superior
Maricopa
San Luis
Sunizona
North Rim
Tuba City
Lukeville
Flagstaff
Snowflake
Gila Bend
Tombstone
Clarkdale
Roosevelt
Winkelman
Ehrenberg
New River
Quartzsite
Wickenburg
Camp Verde
Jacob Lake
Window Rock
Littlefield
Second Mesa
Indian Pine
Casa Grande
Grand Canyon
Sierra Vista
Green Valley
Mexican Water
Peach Springs
Bullhead City
Colorado City
Bitter Springs
Cordes Junction
Oracle Junction
Hannigan Meadow
Lake Havasu City
Arizona Department of Transportation
Engineering and Maintenance Districts
Prepared by: 
Arizona Department of Transportation
Multimodal Planning Division
Transportation Analysis GIS Section
602.712.7333  
  October, 2015
Note:
The State of Arizona makes no claims concerning
the accuracy of this map nor assumes any liability
resulting from the use of the information herein.
0
50
100
25
Miles
Central
Northcentral
Northeast
Northwest
Southcentral
Southeast
Southwest
!H
Cities and Towns
State Highway System µ
Central
Northcentral
Northeast
Northwest
Southwest
Southcentral
Southeast

FOR DEPARTMENT USE ONLY:

Arizona Department of Transportation  
Special Event Checklist 
To be submitted with the permit application and proof of insurance 
1.
What type of event are you applying for (i.e. parade, bike event, marathon, etc.)?  
2.
What date and time will the event take place?  
3.
What is the estimated number of participants?
 
a.)  Will there be anyone under 18 years of age participating? Yes  
No 
 
b.)  (If yes to "a") what is the age range of the participants? 
 
c.)  (If yes to "a") in what capacity will minors be participating? _
 
____
 
4.
Description of occupied or affected portion of roadway/right:
a.)   Will there be any disruption of traffic during event? _
 
b.)  What part of roadway will be affected, (i.e. shoulder, lane)? 
 
c.)   Will there be any road closure, lanes closures, or both? 
 
d.)  Will traffic be detoured? Yes 
 No 
 If yes, then how? 
 ___
 
5.
Professional signed Traffic Control Plan should include:
a.) Event route with mile posts, streets, major intersections & railroad crossings. Detouring of traffic.
b.) Location of traffic control officials and their affiliation.
c.) Staging areas and list of equipment placed there.
d.) Rest or Break areas, Aid Stations and activities at these locations (water, medical, etc.).
e.) Who is responsible for setting up and removing the traffic control?
f.) Identify beginning and ending points.
g.) Identify all accesses that will be disrupted. Notification to all parties affected by the event is required. Submit
copies with the application. 
6.
Will Law Enforcement be used for this event? Yes 
 No  
.
7.
Provide names & mobile numbers of the event officials in charge of the event and traffic control compliance during
the event.  
8.
Is there written concurrence from the proposed Law Enforcement working the event. Yes 
 No  
9.
Will there be automobiles used in the event? Yes 
 No  
. If yes:
a) Are the automobiles privately owned or belong to the event?  
10. Will the entire event be utilizing volunteers? Yes _
 No _
 Are Volunteers signing waivers?  Yes 
 No  
If not, how many paid employees will there be (excluding law enforcement)?  
11. Is there an emergency response plan in place? Yes 
 No _ 
a.)   Will there be emergency response vehicles present? Yes _
 No 
 How Many? _
 
b.)  Will there be aid stations set up along the route? Yes _
 No 
 How Many? _
 
c.)   How will emergencies be communicated (i.e. cell phone, amateur radio)? 
 
12. Will there be spectators watching the event? Yes
 No 
 If yes, will they be in a designated area and parking
off of ADOT's right of way? Yes _
 No _
 If yes please indicate parking area on route map; as parking in
ADOT right of way is not allowed.
13. How many years has this event taken place? 
 Have there been any serious incidents, injuries or losses. Yes
 No
 (If so, please describe)_ 
14. What provisions are in place to ensure that participants and staff are off of the road at the end of the event?
 
What Media outlets will be used to notify drivers (i.e. paper, radio, message boards)? _
 
____
 
Submit this questionnaire along with the Special Event Permit application, Insurance and other supporting 
documentation to the District Permits Office.  Once submitted, ADOT Risk Management will be in contact with you if 
there are any questions regarding insurance coverage for your event.