Temporary Road Closure

Not for private or benefit

Not for private events or benefit
Applications should be submitted 30 days prior to the event date

Applicant First Name

Applicant Last Name

Name of Organization

City

Zip Code

Phone #

Email Address

Please Confirm Email Address

County Roadway and Location of Event

Between these cross streets

Description of Event

Required With Local Authorities

Coordination is required with local authorities:

Local Municipality

Local Police Precinct

A certificate of liability insurance is required with Nassau County DPW as the certificate holder indemnifying the county against any and all claims arising from the temporary closing of the roadway.

Attach insurance certificate here

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Proposed detour when applicable.

Attach detour proposal here

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**Please note, if applicable, it is required that NICE (Nassau County Inter-County Express) be notified for the temporary rerouting of bus routes**

Road closing equipment including barricades, cones, traffic control, lighting etc, is to be provided by applicant for their own use

Title

* Click and drag your mouse in the box above to draw your signature.

Not for private or benefit

Temporary Road Closure

Insurance Certificate

Detour Proposal

Applicant Signature