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DEVELOPMENT SERVICES DEPARTMENT a ge Roa EL MIRAGE EI Mirage, AZ, 85335 Arizona Phone: 623-876-2974 GRAND HERITAGE, BRIGHT FUTURE! www.elmirageaz.gov SPEED CUSHION REQUEST FORM Residents may begin the process for requesting speed cushions through the El Mirage Engineering Division. Please read the “City of El Mirage Speed Cushion Installation Program" on pages 1 and 2 to determine if your street is eligible and for the full process and requirements. The Engineering Division will review and approve/deny the request. e Staff will have a traffic study performed on the street to determine vehicle speeds and volumes. Local and collector streets with 85th percentile speeds at least 5 miles per hour above the posted speed limit and volumes over 400 vehicles per day may qualify. e Ifwarrants are met, a Traffic Engineer will prepare a report and exhibit that will determine preliminary speed cushion locations. Staff will review the locations with emergency service departments and other affected agencies. Staff will create and send the Requestor a petition with the addresses required to collect signatures. 60% of properties within the Petition Area must sign and indicate "YES" for the request to be completed. Please complete the information below: Requested Street to be Considered: El Mirage Road from Well St to End St Wells Street Nearest Cross Street: Annie Ansell , 14414 N. El Mirage Road Contact Name: Addres: 623-249-3812 dcc.annie@gmail.com Phone Number: Email Address: I understand this request will be processed according to the procedures detailed in the "City of El Mirage Speed Cushion Installation Program". I agree to be the contact person for the above request. Signature of Applicant yz = Conaehf Date 2 3/ JOS Please send the completed form to: City of El Mirage Development Services Department — Engineering Division Re: Speed Cushion Request 10000 N. El Mirage Road El Mirage, AZ 85335 For Office Use Only (APPROVED [J] DENIED