Equipment Loan Request Form - LTAP Colorado Local Technical Assistance Program

This form is used if you would like to request equipment through our loan program. If you would like to submit a question or request transportation related assistance, visit our Technical Assistance Solutions page.

*Required field(s) are indicated by an .**

* First Name	Middle Initial
* Last Name
Title
* Agency
Address
City
State	Country
Zip
Phone	Please enter only numbers, no hyphens or parenthesis.
* Email
Borrow the following:	Sign Retroreflectometer ONLY
	Sign Retroreflectometer WITH Extension Pole Kit
	Pavement Marking Retroreflectometer
	Illuminated Pocket Microscope
	Safe Curve Speed Indicators (Ball Bank Indicators/Slopemeter)
	Survey and Grade Checking Equipment
Non-nuclear Asphalt Density Gauge	Non-nuclear Asphalt Density Gauge
Feel free to provide any additional details, requests or questions.
* Terms - Must Acknowledge	There is no cost to borrow this equipment. However, your agency is responsible for ensuring its security and is responsible for paying for repairs or replacement in the event that the equipment gets damaged. All local agencies will be required to sign a Loan-Borrow Agreement on-site and meet LTAP staff to exchange the equipment. CO LTAP staff will show you how to install and properly use the equipment. When your loan period is complete, you will need to meet LTAP staff to return the equipment.

	Check if you're not a robot.