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Clean Pavement Initiative Commitment Form - Professionals

  1. Clean Pavement Initiative Professional Commitment Form
  2. Professional Contact Information
  3. Clean Pavement Commitment
    By checking this box, I agree to offer asphalt-based sealant (i.e. asphalt emulsion) as an option to my customers and educate them by providing the Clean Pavement Initiative program brochure supplied by the City. I also agree to provide annual data to the City on the amount of coal-tar based and asphalt-based sealant applied in Springfield so the effectiveness of this program can be tracked over time. This voluntary commitment does not prevent the sale or use of other types of sealant.
  4. Once you have submitted this form, City staff will follow up with you to supply brochures for your use.
  5. Leave This Blank:

  6. This field is not part of the form submission.