This appendix contains the Application for Approval of Electronic Signature for Certification of Materials and Weights.


From:† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ____________________

††††††††††† Name of Weighmaster / Source Name(s) / A-Number / Iowa DOT District

Via:††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† _____________________

††††††††††† Name of Company Officer / Company Name


To:†††††† District Materials Engineer, Iowa DOT

††††††††††† Director of Construction and Materials, Iowa DOT

Subj:††† Electronic Signature Authority for Certifying Truck Tickets

1.†† I have read Federal Code 1020 and Iowa Code 714.8 (following this document) and am aware of the potential penalties for fraud and knowingly tendering a false certification. †I will not knowingly cause or create a false document nor allow others access to my password that would allow them to certify materials. I am also aware of the provisions authorizing secure electronic signature per IM.209 Appendix G.

2.†† My Secure Electronic Signature Authority is granted to me by the Iowa DOT Director of Construction and Materials and represents the authorization by the company officer to certify materials for the company for whom I am employed. Should either of us terminate employment this signature authority shall be revoked. This certificate is valid for five years from the date signed by the Iowa DOT Director of Construction and Materials. This authority can be renewed by review of the Federal and Iowa Codes and resubmission to the Director of Construction and Materials. Violations of these Codes shall be cause for revocation of this authority.


Signature and Date of Weighmaster acknowledging review of Codes.

SIGNATURE††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††† DATE††††††††††††††††††††††††††††††††††

Attach a Sample of Secure Electronic Signature


Authorization to Certify on behalf of the Company: Signature and Date of Company Officer, Title, Date.

SIGNATURE††††††††††††††††††††††††††††††††††††††††††††††††††††††††† †††† TITLE†††††††††††††††††††††††††††††† †† DATE††††††††††††††††††


Signature and Date of Iowa DOT District Materials Engineer

IOWA DOT SIGNATURE†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† DATE††††††††††††††††††††††††††††††††††

Signature and Date of Electronic Signature Authorization: Iowa DOT Director of Construction and Materials

IOWA DOT SIGNATURE†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† DATE††††††††††††††††††††††††††††††††††

Expires Five years from Date of Director of Construction and Materials Signature

Copies to: † District Materials Office

††††††††††††††††††† Geology Section, Central Materials Laboratory


Iowa DOT requirements are based on Iowa Code Section 554(C) Superseded by 554(D)†† Secure Electronic Signature.

1.†† Subject to the provisions of section 554C.303 and 554(D), if, by the application of a qualified security procedure, it can be authenticated that an electronic signature is the signature of a specific person, the electronic signature shall be considered to be a secure electronic signature at the time of verification.

2.†† A qualified security procedure for purposes of this section is a security procedure for identifying a party that meets the following:

A.†† Authorized by, and implemented in accordance with the requirements of IM 209 Appendix G.

B.†† Previously agreed to by the parties to an agreement and implemented in accordance with the terms of the agreement.

C.† Authorized by the responsible Company Officer to act on behalf of the Company and being capable of creating a secure electronic signature that meets all of the following conditions:

(1)†† Is unique to the signer within the context in which it is used.

(2)†† Can be used to promptly, objectively, and automatically identify the person signing the electronic record.

(3)†† Is password protected and assignable to only that person with the authority given by the Company Officer.

(4)†† Was reliably created by such identified person.

(5)†† Is linked to the electronic record to which it relates in a manner which ensures that if the record or signature is changed the electronic signature is invalidated, provided that the security procedure is implemented in a manner required by the certification.

(6)†† Acceptable security systems shall meet the provisions of NTEP or NIST Handbook 44.


Crimes and Criminal Procedure 18 USC Section 1020

1020. Highway projects

Whoever, being an officer, agent, or employee of the United States, or of any State or Territory, or whoever, whether a person, association, firm, or corporation, knowingly makes any false statement, false representation, or false report as to the character, quality, quantity, or cost of the material used or to be used, or the quantity or quality of the work performed or to be performed, or the costs thereof in connection with the submission of plans, maps, specifications, contracts, or costs of construction of any highway or related project submitted for approval to the Secretary of Transportation; or

Whoever knowingly makes any false statement, false representation, false report, or false claim with respect to the character, quality, quantity, or cost of any work performed or to be performed, or materials furnished or to be furnished, in connection with the construction of any highway or related project approved by the Secretary of Transportation; or

Whoever knowingly makes any false statement or false representation as to a material fact in any statement, certificate, or report submitted pursuant to the provisions of the Federal-Aid Road Act approved July 11, 1916 (39 Stat. 355), as amended and supplemented,

Shall be fined under this title or imprisoned not more than five years, or both.

Iowa Code Section 714.8 Fraudulent practices defined.

A person who does any of the following acts is guilty of a fraudulent practice:

1.†††† Makes, tenders, or keeps for sale any warehouse receipt, bill of lading, or any other instrument purporting to represent any right to goods, with knowledge that the goods represented by such instrument do not exist.

2.†††† Knowingly attaches or alters any label to any goods offered or kept for sale so as to materially misrepresent the quality or quantity of such goods, or the maker or source of such goods.

3.†††† Knowingly executes or tenders a false certification under penalty of perjury, false affidavit, or false certificate, if the certification, affidavit, or certificate is required by law or given in support of a claim for compensation, indemnification, restitution, or other payment.

4.†††† Makes any entry in or alteration of any public records, or any records of any corporation, partnership, or other business enterprise or nonprofit enterprise, knowing the same to be false.

5.†††† Removes, alters or defaces any serial or other identification number, or any owners' identification mark, from any property not the person's own.

6.†††† For the purpose of soliciting assistance, contributions, or other thing of value, falsely represent oneself to be a veteran of the armed forces of the United States, or a member of any fraternal, religious, charitable, or veteranís organization, or any pretended organization of a similar nature, or to be acting on behalf of such person or organization.

7.†††† Manufactures, sells, or keeps for sale any token or device suitable for the operation of a coin-operated device or vending machine, with the intent that such token or device may be so used, or with the representation that they can be so used; provided, that the owner or operator of any coin-operated device or vending machine may sell slugs or tokens for use in the person's own devices.

8.†††† Manufactures or possesses any false or counterfeit label, with the intent that it is placed on merchandise to falsely identify its origin or quality, or who sells any such false or counterfeit label with the representation that it may be so used.

9.†††† Alters or renders inoperative or inaccurate any meter or measuring device used in determining the value of or compensation for the purchase, use or enjoyment of property, with the intent to defraud any person.

10.†† Does any act expressly declared to be a fraudulent practice by any other section of the Code.

11.†† Removes, defaces, covers, alters, or destroys any component part number as defined in section 321.1, vehicle identification number as defined in section 321.1, or product identification number as defined in section 321.1, for the purpose of concealing or misrepresenting the identity or year of manufacture of the component part or vehicle.

12.†† Knowingly transfers or assigns a legal or equitable interest in property, as defined in section 702.14, for less than fair consideration, with the intent to obtain public assistance under chapters 16, 35B, 35D, and 347B, or Title VI, subtitles 2 through 6, or accepts a transfer of or an assignment of a legal or equitable interest in property, as defined in section 702.14, for less than fair consideration, with the intent of enabling the party transferring the property to obtain public assistance under chapters 16, 35B, 35D, and 347B, or Title VI, subtitles 2 through 6. A transfer or assignment of property for less than fair consideration within one year prior to an application for public assistance benefits shall be evidence of intent to transfer or assign the property in order to obtain public assistance for which a person is not eligible by reason of the amount of the person's assets. If a person is found guilty of a fraudulent practice in the transfer or assignment of property under this subsection the maximum sentence shall be the penalty established for a serious misdemeanor and sections 714.9, 714.10 and 714.11 shall not apply.

13.†† Fraudulent practices in connection with targeted small business programs.

a.†† Knowingly transfers or assigns assets, ownership, or equitable interest in property of a business to a woman or minority person primarily for the purpose of obtaining benefits under targeted small business programs if the transferor would otherwise not be qualified for such programs.

b.†† Solicits and is awarded a state contract on behalf of a targeted small business for the purpose of transferring the contract to another for a percentage if the person transferring or intending to transfer the work had no intention of performing the work.

c.†† Knowingly falsifying information on an application for the purpose of obtaining benefits under targeted small business programs.

A violation under this subsection is grounds for decertification of the targeted small business connected with the violation. Decertification shall be in addition to any penalty otherwise authorized by this section.

14.†† Makes payment pursuant to an agreement with a dealer or market agency for livestock held by the dealer or market agency by use of a financial instrument which is a check, share draft, draft, or written order on any financial institution, as defined in section 203C.1, if after seven days from the date that possession of the livestock is transferred pursuant to the purchase, the financial institution refuses payment on the instrument because of insufficient funds in the maker's account.

This subsection is not applicable if the maker pays the holder of the instrument the amount due on the instrument within one business day from a receipt of notice by certified mail from the holder that payment has been refused by the financial institution.

As used in this subsection, "dealer" means a person engaged in the business of buying or selling livestock, either on the person's own account, or as an employee or agent of a vendor or purchaser. "Market agency" means a person engaged in the business of buying or selling livestock on a commission basis.

15.†† Obtains or attempts to obtain the transfer of possession, control, or ownership, of the property of another by deception through communications conducted primarily by telephone and involving direct or implied claims that the other person contacted has won or is about to win a prize, or involving direct or implied claims that the other person contacted may be able to recover any losses suffered by such other person in connection with a prize promotion.

16.†† Knowingly provides false information to the treasurer of state when claiming, pursuant to section 556.19, an interest in unclaimed property held by the state, or knowingly provides false information to a person or fails to disclose the nature, value, and location of unclaimed property prior to entering into a contract to receive compensation to recover or assist in the recovery of property reported as unclaimed pursuant to section 556.11.

17.†† A packer who includes a confidentiality provision in a contract with a livestock seller in violation of section 202A.4.

18.†† Manufactures, creates, reproduces, alters, possesses, uses, transfers, or otherwise knowingly contributes to the production or use of a fraudulent retail sales receipt or universal price code label with intent to defraud another person engaged in the business of retailing.

For purposes of this subsection:

a.†† Retail sales receipt" means a document intended to evidence payment for goods or services.

b.†† Universal price code label" means the unique ten-digit bar code placed on the packaging of an item that may be used for purposes including but not limited to tracking inventory, maintaining price information in a computerized database, and serving as proof of purchase of a particular item.

19.†† A contractor who enforces a provision in a production contract that provides that information contained in the production contract is confidential as provided in section 202.3.