Sample Form Ndot 075-005 - Nevada Department Of Transportation

ADVERTISEMENT

NEVADA DEPARTMENT OF TRANSPORTATION
Requirements and Guidelines for Viewing Public Records
Per your request, we are providing you access to view NDOT public records. We ask that you
cooperate with these guidelines and the assigned NDOT staff representative. Our representative will
monitor your inspection of records and will provide administrative assistance only. By your initials and
signature below, you indicate that you understand and agree to the following.
Initials: ____ By providing access to these records, neither the State of Nevada nor NDOT waives
any of their rights to any confidential or privileged matter contained therein whether previously
disclosed or not. If confidential or privileged matter is later identified, the requestor agrees to return to
the Department all copies of identified confidential or privileged document(s) immediately.
Initials: ____ These materials are public property and oftentimes contain critical, original or one-of-
a-kind records essential to State and NDOT business. Please handle the NDOT materials provided
with care and respect. Do not mark on or alter any documents in any way and do not modify or
dismantle the files. The integrity of the filing system must also be preserved so records can be
returned to the proper office in the manner originally received.
Initials: ____ Please coordinate your departure and return from the office provided with the NDOT
staff representative. You may not leave with any original NDOT records. Any subsequent viewing
days must be coordinated with the NDOT staff representative.
Initials: ____ The NDOT staff representative will arrange for any copying. Please identify materials
you would like copied with post-it type notes but do not remove existing staples and paperclips or
otherwise modify the way the records are organized or presented. Do not use paperclips, clamps,
marking of any kind, scissors or anything else that might damage the materials.
Initials: ____ The undersigned agrees to pay all fees and costs associated with his/her Public Records
Request (as described in the attached fee schedule). Depending upon the volume and time involved,
you may be required to pay before any copies are provided.
Date: ________ Name (Printed): _____________________________ Signature: ____________________
Mailing Address: ______________________________________________________________________
The following information is optional:
Organization/Business: ________________________ Phone: __________ E-mail: _________________
Fax: ___________ Citizenship: _____________ State/Driver’s License #: _________________________
Purpose of Request: ____________________________________________________________________
Staff Use Only
NDOT’s Representative’s Name (Printed): _____________________ Signature: ____________________
Division/District: ______________________________________________ Phone: __________________
NDOT 075-005 REV. 7-08

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go