C. Average Daily Vehicle and Train Volumes

Autos		Freight Trains
School Buses		Passenger Trains
Passenger Buses		Light Rail Trains
Hazmat Trucks
TOTAL VEHICLE COUNT		TOTAL TRAIN COUNT
Date of Count(s)		Date of Count (s)

D. Costs and Contributions

Please fill in the following worksheet to determine the total project costs.

Right-of Way allowance............................$________________

Preliminary Engineering............................$________________

Construction Engineering..........................$________________

Total Engineering ............................ $_______________________

Bridge Construction.................................. $________________

Railroad Work........................................... $________________

Highway Approaches & Connections.....$________________

Utility Relocation....................................... $________________

Contingencies............................................ $________________

Removing Existing Crossing................... $________________

Total Construction Costs.................. $_______________________

TOTAL PROJECT COST $______________________

ALLOCATED SHARE FROM STATE FUND: $______________________

Contributions:

City	$
County	$
Railroad	$
Other (specify)	$

E. Accident History Data

Total Number of Trains vs. Vehicle and Pedestrian Accidents *
Source	Date	Killed	Injured
Source	Date	Killed	Injured
Source	Date	Killed	Injured
Source	Date	Killed	Injured

* List all accidents separately from October 21, 2001 to October 21, 2011. For each accident specify the accident date, the number of fatalities and injuries.

F. Blocking Delay and Speed Limits

Total Blocking Delay	min.
Number of Observed Delays
Information Provided by:	Railroad [ ] Observation [ ]
Date Delays Verified
Posted Vehicle Speed Limit	mph
Train Speed Limit at Crossing	mph

G. Crossing Geometrics

Track Skewed Angle = _______	Is there a parallel road to the track? Yes [ ] No [ ]
No. of Tracks = _______	Are there traffic signals within 50'? Yes [ ] No [ ]
Elevated Surface Profile Direction: _________	Is there an entrance/exit within 150'? Yes [ ] No [ ]
Height: _________ in. Direction: _________	Is there a raised median? Yes [ ] No [ ]
Height: _________ in.	Is there curvature on the road or track? Yes [ ]No [ ]

H. Other Information / Attachments

Did you enclose an 8 1/2" x 11"location map?	Yes [ ] No [ ]
Did you enclose an 8"x10" photo of each crossing's approach?	Yes [ ] No [ ]
Did you attach a brief Community Impact evaluation?	Yes [ ] No [ ]

I. Declaration

I, _________________________, declare under penalty of perjury that the information on this form is true and correct to the best of my knowledge. The information has been verified by me or under my supervision and is the most current information available.

Signature: ____________Title: __________________ Date: __________

Introduction: By July 1 of each year, the California Public Utilities Commission (Commission) is required to establish and furnish to the California Transportation Commission a priority list of railroad grade separation projects most urgently in need of separation. Nominations of grade separation projects must be submitted on the GSN-1 Form by October 21, 2011, in the Commission's OII. All nominations are reviewed and taken into consideration for the development of the Commission's Priority List. Incomplete and late-filed applications will not be processed or included in the Priority List. Please follow the instructions below to complete the application. Should you need assistance with this form please contact Rosa Muñoz at (213) 576-7078 or at rosa.munoz@cpuc.ca.gov .

INSTRUCTIONS:

A. INFORMATION ABOUT THE NOMINATING PARTY:

In the spaces provided, enter name, address, e-mail address and contact person along with contact's title and phone number. Please include two contacts. If you have hired a consultant to process the nomination, please provide the consultant's company name and phone number in the "Alternate" section.

B. CROSSING LOCATION AND PROJECT TYPE:

Provide the PUC and DOT crossing identification numbers for the project along with the street location, city, county and zip code of the crossing and the name of the railroad(s) company operating the tracks. If the project involves the construction of a new grade separation at a site where there is no existing at grade crossing, then enter "NEW" for the PUC Crossing Number. Also specify the type of project the grade separation proposal involves with respect to train traffic. For example, if a bridge is to be built where the roadway goes over the tracks, the project is an "OVERPASS". If a bridge is to be built where roadway goes underneath the tracks, then the project is an "UNDERPASS".

NOTE: If your project involves more than one crossing, list each crossing separately in part B of GSN-1 form and answer "Yes" to the Consolidation question under Project Type.

C. AVERAGE DAILY VOLUME:

For all categories specified in this section, provide the vehicle and train count of a typical day. In the "AUTOS" category, specify the total number of vehicles flowing through the crossing that are not specified in the other categories. For example: all automobiles, pick-up trucks, vans, limos, 4WD Vehicles, etc should be counted in the "AUTOS" category. Count school buses, passenger buses, and hazardous-material trucks separately.

For the train counts specify the total number of trains that use the crossing into three categories: Freight Trains (UPRR, BNSF Railway, Short Lines, etc.), Passenger Trains (Amtrak, Metrolink, Caltrain, etc.), and Light Rail Trains (San Diego Trolley, VTA, etc.).

Include the date when the count(s) was (were) taken. This date should be within the last year of filing the application. If a later dated vehicle count is used, then specify in the affidavit that the vehicle count is an accurate representation of current traffic flow.

D. COSTS AND CONTRIBUTIONS:

Complete the work sheet to determine the total project costs. Also enter the amount of the costs that are expected from the sources specified on GSN-1 form. Indicate the amount sought from the Section 190 Grade Separation fund either the partial amount needed to fund the project, the maximum state allocation of five million dollars per project, or the amount if applicant is seeking multiple-year funding.

E. ACCIDENT HISTORY DATA

Provide the total number of train versus vehicle and pedestrian accidents that have occurred at the crossing(s) from October 21, 2001 to October 21, 2011 (10-year period). Pedestrian collisions with the train will be considered at the crossing, excluding all suicides. Attach a copy of the law enforcement report for all accidents to the original GSN-1 Form that is not found on the Federal Railroad Administration website: http://safetydata.fra.dot.gov/OfficeofSafety/PublicSite/Crossing/Crossing.aspx. For each accident, specify the location (if more than one crossing is involved with the project), accident date, the number of fatalities, the number of injuries, and the data source.

F. BLOCKING DELAY AND SPEED LIMITS

The blocking delay is the time, in minutes, from when the crossing signals are active until the train clears the crossing and the signals return to their upright position. In this section, specify the requested blocking delay information for a typical day. For example: Three trains use the crossing on a daily basis. The blocking delay is 5 min. for the first train, 3.5 min. for the second, and 7.75 min. for the third train. The total blocking delay is the sum of each delay for a total of 16.25 min.

VEHICULAR & TRAIN SPEED LIMIT: Specify the posted vehicular speed limit in direction of traffic flow that passes through crossing. If no signs are posted then assume 35 mph as the vehicular speed limit in urban areas, for rural areas 55 mph. Also specify the train speed limit at the crossing.

G. CROSSING GEOMETRICS:

Provide the information requested about the physical attributes of existing crossing using the following guidelines:

TRACK SKEWED ANGLE: The skewed angle is the angle measurement, in degrees, from the tracks to the perpendicular of the roadway. Measure the angle using the vertex at the intersection between the curb or edge of roadway and the railroad track. Use the curb or edge of the roadway as an axis and measure the angle to the rail edge nearest to the curb. The track skewed angle is the absolute value of 90_ less the measured angle (i.e. |90_ - measured angle |).

NUMBER OF TRACKS: Specify the total number of tracks at the existing crossing.

ELEVATED SURFACE PROFILE: The elevated surface profile is the change in height from the top of the nearest rail track to the top of the roadway 30-ft. from the tracks. The measurement should be in inches and the direction in which traffic is flowing should be specified as "N" for North, "S" for South, "E" for East and "W" for West.

PARALLEL ROAD TO TRACKS WITHIN 100 ft: Is there an adjacent road running parallel to the track(s)? Mark "Yes" if there is a parallel road, or "No" if there is not.

TRAFFIC SIGNALS WITHIN 50 ft: Are there any traffic signals within 50 feet of crossing? (not the active warning devices at the crossing). Mark "Yes" if there is a traffic signal, or "No" if not.

ENTRANCE / EXIT WITHIN 150 ft: Is there a driveway entrance or exit within 150 ft from crossing? Mark "Yes" if there is a driveway entrance or exit, or "No" if there is not.

RAISED MEDIAN PROTECTION: Is there a raised median protection at the crossing? Mark "Yes" if there is a raised median, or "No" if there is not.

CURVATURE OF ROAD OR TRACK: Is the road and/or track curvature sufficient to impair visibility by vehicular traffic? If highway/roadway visibility is hindered, mark "Yes". If curvature does not interfere with visibility mark "No".

H. ATTACHMENTS

Attach an 8 ½" x 11" location map and an 8" x 10" photograph of the crossing location (one from each approach) showing the entire crossing and pertinent crossing geometrics at least one hundred feet back. Also attach a brief explanation of the community impact including its justification, how it meets transportation planning goals, the potential for emergency vehicle blockage if the crossing is near a hospital, or if the path over the crossing is classified as an emergency vehicle route, is it a school bus or  passenger bus route, location of nearby fire/police station(s), is the crossing part of a designated hazardous material carrier route, a major arterial route; classification as a state highway/route, or describe if no grade-separation crossings are in the city/area.

I. DECLARATION

Please complete the declaration with the information requested and sign.

(END OF APPENDIX 4)

BEFORE THE PUBLIC UTILITIES COMMISSION OF THE STATE OF CALIFORNIA

Investigation for the purpose of establishing a list for the fiscal years 2012-2013 and 2013-2014 of existing crossings at-grade of city streets, county roads or state highways in need of separation, or existing separations in need of alterations or reconstruction in accordance with Section 2452 of the Streets and Highways Code.

Investigation 11-07-XXX (Filed July 30, 2011)

Nomination for Alteration or Reconstruction

Of

Existing Grade Separation

Nomination by _____________________________

Road/Highway
PUC Crossing ID No.
DOT ID No.
Railroad(s)

This packet contains the GSN-2 Form and instructions. - Please carefully read the instructions before completing the form.