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HomeMy WebLinkAboutIowa DOT-9/21/20154top,, IOWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN Five Star Snow Trails Attn. Tony French 2202 Minnetonka Dr. Cedar Falls, IA 50613 1875 W. Ridgeway Ave. P.O. Box 1888 Waterloo, Iowa 50704-1888 Office 319-235-1832 david.ramirez@dot.iowa.gov October 22, 2015 RE: Permit # 9A-2015-012, Black Hawk County, Ref. # 604.2 Dear Mr. French, Please find the approved Application to Perform Work Within State Highway Right of Way for the grooming and signage for snowmobile trails in Black Hawk County. The work is to be accomplished in accordance with the agreements on page 2 of the permit to include the special requirements and attachments. Please review the agreement section of the permit. Please provide a copy of this to your contractors for their project files. If you have any questions please call me at 319- 235-1832. ncerely, ave Ramirez E.O.T. District 2 1 c.c. Dave Little, Assistant District Engineer, District 2 Jeff McCollough, Design Tech Specialist, Traffic and Safety Barry Thede, Waterloo Area Supervisor Ernest Clark, Mayor, City of Waterloo Edward Jessen, Mayor, City of Dunkerton Iowa Department of Transportation j 800 Lincoln Way l Ames, Iowa 500101515-239-1101i www.iadot.gov �IOWADOT Form 810028 (01-14) FOR DEPARTMENT USE ONLY Permit Number DOT Project Number N/A DG.te $(kr , ge APPLICATION TO PERFORM WORK WITHIN STATE HIGHWAY RIGHT-OF-WAY Highway Number (SEE ATTACHED LISTING) APPLICANT (INDIVIDUAL OR COMPANY) First Name Tony County Black Hawk Expiration/Completion Date 04/15/16 Company Name Five Star Snow Trails, Inc Street Address Middle D Last Name French (ASSISTANCE FROM DEPARTMENT AVAILABLE UPON REQUEST) 2202 Minnetonka Drive WORK TO BE ACCOMPLISHED City/Town Cedar Falls Phone Number 319-6104171 Phone Number 319-610-1171 State IA Ext. Ext. ZIP Code 50613 Approval is hereby requested to enter within the state right-of-way and to complete the proposed work as detailed on the attachments and further described as follows: Snowmobile Trail and Trail Crossing Locations as indicated on the attached listing. Trail is located partially within the city limits of Dunkerton and Waterloo. All crossings shall go into effect after all signs along the highway have been installed by IDOT forces. All signs placed on the ROW by the applicant shall be removed by the applicant. and shall be located as shown on the detailed plan attached hereto. (See current Iowa Department of Transportation Utility Accommodation Policy for submittal of detailed plan requirements.) WORK SITE LOCATION The proposed work as described above is located in Section Twp. (SEE ATTACHED LISTING) on Highway No. Range (SEE ATTACHED LISTING) (direction) from generally located (miles) (city, county line, or other land line). Work proposed is more specifically located as being from (Milepost #) and to (Highway Station) (Milepost #) and (Highway Station) on the side of highway. Applicant Signature and Agreement The undersigned have read the stipulations of this permit agreement as stated as well as attachments which may be included and by signing this application agree to abide by all stipulations and to complete the work as proposed in compliance with the stipulations and attachments within one year from the date Department approval is received for said request. Failure on the part of the applicant to abide by the stipulations or to construct the work desired as stipulated and within the time frame stated shall render this agreement and request null and void. The undersigned also agrees to save harmless the State of Iowa and the Iowa Department of Transportation from any damage or losses that may be sustained by any person or persons on account of the conditions and requirements of this agreement. Applicant Name (First, M.I., Last - Print or Type) Tony D. French N.a%.4� e n nrren) Date #1116ACTIititl IF PRtYl*Ep WQRK IB 1t1t1TH N AN I ' ORPORATED CITY CiTY ACTION 15' RlrQUifRED 'The undersigned city joins in the grants embodied in the above permit executed by the lowa Department of Transportation on 'condition that all of the covenants and undertakings therein running to the lowa Department of Transportation shall inure to the benefit of the undersigned city and recommends action on said permit application as noted below by the delegated city official". Recommend Approval fl Do Not Recommend Approval El None Required Date Handwritten Signature Type or Print Name (SEE ATTACHED CITY ACTION SHEETS) Title ,FEDERAL.. HIGHWAY ADMINISTRATION ACTION ID PARTMENT, REPRESENTATIVE WILL REVIEW THE REQUEST AND Recommend Approval E] Do Not Recommend Approval Authorized FHWA Representative Signature Authorized Official for the City of (SEE ATTACHED CITY ACTION. SHEETS) OBTAIN FHWA ACTION, WHEN NECESSAR' E None Required Date (DOT Final Action and Agreements on next page) Page 1 of 2 I pAY E T -40 TRANSPORTATION jg Application Approved ❑ Application Denied Authorized Highway District Representative Dave Ramirez Barry Thede Waterloo Area Supervisor Street Address 1875 West Ridgeway Avenue Sign City/I-own Waterloo Permit Nurri{ber• • Date WellocOlifen i to commove aft_tleeante NAAibneatl We* as herein. grentetby hlt monad applh�fon: I�ICIt gi#at be t the ._ appli a en Local DOT Contact Person (Type or Print Name) 2''a <Aen ai * rmagniellY teaunerating the s viilsnation Torateritstiveit1 Phone Number 319-233-3055 State IA ZIP Code 50704 AGREEMENTS The applicant agrees that if granted a permit to do said work the following stipulations shall govem. 1. The applicant shall carry on the construction, repair, and maintenance with serious regard to the safety of the traveling adjacent property owners and shall save the State and the Iowa Department of Transportation harmless of any damage or losses that may be sustained by the traveling public and public on account of such construction, repair, or maintenance operations. 2. The applicant shall indemnify and save •harmless the State of Iowa, its agencies, and employees, from any and all causes or actions, suits at law or in equity, for kisses, damages, claims, or demands, and from any and all liabilitjy and expense of whatsoever nature, arising out of or in connection with the applicant's use or occupancy of the public highway. 3. The applicant shall hold the State and the Iowa Department of Transportation harmless of any damage that may result to said highway because of the construction or maintenance of the facility, and shall reimburse the State or the Iowa Department of Transportation for any expenditures that the State of Iowa or the Iowa Department of Transportation may have to make on said highway rights-of-way on account of said applicant's construction or maintenance activity or lack thereof. 4. Traffic protection shall be in accordance with Part VI of the current Manual on Uniform Traffic Control Devices for Streets and Highways. The applicant shall be responsible for correctly using signs as needed while work is in progress. Flagging operations are the responsibility of the applicant. 5. Before beginning any work within the highway rights-of-way, it is the responsibility of the applicant to contact utility companies whose installations may be affected or encountered. Contact should be made at 1-800-292-8989, a minimum of 48 hours in advance . of starting construction. If the work requested in this application should cause a need to relocate or modify an existing utility, any cost associated shall be as negotiated between the applicant and the utility owner. 6. A copy of the approved application shall be available on the job site at all times for examination by Department of Transportation officials. 7. The applicant shall seed and mulch all disturbed areas within the highway right-of-way and shall be responsible for the vegetative which are disturbed shall be restored to their original condition. cover until it becomes well established. Any surfaced areas such as driveways or shoulders and sodded waterways and plantings 8. If the proposed work results in a pool of water on the applicant's property, this pool of water will be exclusively owned, controlled, and maintained by the applicant. That part of the modification located on highway right-of-way will be maintained by the Iowa Department of Transportation for road purposes only. 9. The applicant shall maintain any drainage structure built within the right-of-way that is built for the benefit of the applicant and not necessary for highway use. 10. This permit is subject to any laws now in effect as well as any new laws which may be hereafter enacted and all applicable rules and regulations of local, state, and federal agencies. 11. This permit is subject to all the rules and regulations of the Iowa Department of Transportation, and to revocation by the Iowa Department of Transportation at any time and at no cost to the Department, when in the judgment of the Department it is necessary in the improvement or maintenance of the highway or for other reasonable cause. 12. The applicant agrees to give the Iowa Department of Transportation 48 hours notice of intention to start construction or perform maintenance on the highway right-of-way. Any modification to the proposed work shall be approved by the Department prior to making after sunrise to 30 minutes before sunset. the change. 13. Unless specifically noted in item #15, all work performed within the right-of-way shall be restricted to a time frame of 30 minutes exposed to traffic or construction equipment. 14. After November 24, 2008, all personnel in the highway right-of-way shall wear ANSI 107 Class 2 apparel at all times when 15. All proposed work covered by this permit shall be at the applicant's expense. The applicant shall reimburse the Iowa Department of Transportation for any materials removed from the highway right-of-way described as follows: 16. The following special requirements shall apply to this permit. PLEASE NOTE: The sponsor agrees to hold any claim, demand or action by or on behalf off any per on oss the raentity te of larising out of or in connection wih owa and the Iowa Depariment of °mon and to incl route, including, but not limited to, its establishment, indemnify them from lishment, construction, use, maintenance, sig hoeing to do with the snowmobile fining, configuration or existence. Disclosure Statement: The information furnished on this form will be used by the Department of Transportation to determine approval or denial of the application. Failure to provide all information will result in denial of the application. Information fumished is public information and copies may be provided to the public upon request. Page 2 of 2 0co. R -14W CHICKArr. 0 0 --7'" iv.... Snoops Trails Sutler Coun4r of___IWIS ( P i Five Star Snow Trails c3 R. -11W 011Ocoot CO. two MO= aunt rti 5'. Sumner Trailblazers v•si Trails • Butler county Snow Snoo• s Trails Some trails may closed or rerouted during deer hunting season. Please follow signs. NAME ArAphoic.iiir Assoc ation 'Ws WapslpI'ninon &town bile • 1-1kAP4 CCL R -14W Tr -I -County 800wmObue Association Tra Is Bremer & Black Hawk Counties poor. •444. 211161.01EI RAW ORTON CO. • 7 t F "The undersigned city joins in the grants embodied in the above permit executed by the IowaDepartment of�Transportation on condition that all of the covenants and undertakings therein running to the Iowa Department of Transportation shall inure to the benefit of the undersigned city and recommends action on said permit application as noted below by the delegated city official". 1 Recommend Approval Type or Print Name Fomes G . Uo - -k 0 Do Not Recommend Approval 0 None Required Title Ml�©� Authorized Official for the City of WATERLOO Date 3A <fv „IPWL ���1�EQ1Jil�g1 "The undersigned city joins in the grants embodied in the above permit executed by the Iowa Department of Transportation on condition that all of the covenants and undertakings therein running to the Iowa Department of Transportation shall inure to the benefit of the undersigned city and recommends action on said permit application as noted below by the delegated city official". /Recommend Approval 0 Do Not Recommend Approval 0 None Required ten Signature Type or Print Name Title 111/1 -162,t, -- Date Authorized Official for the City of DUNKERTON 3 IOWA DEPARTMENT OF TRANSPORTATION Application to perform work within State Highway Right -of -Way FIVE STAR SNOW TRAILS ASSOCIATION Snowmobile Trail and Crossing Locations -Black Hawk County 1. Crossing of US 218 in Waterloo at Marigold Dr, milepost 176.84. * 2. Marked, "ungroomed" trail along east ditch of US 218 from Marigold Dr in Waterloo, milepost 176.84, to bridge at the north Washburn city limits. Install a temporary bridge in the east ditch of US 218 over the small creek at the north Washburn city limits. (NO SIGNING REQUIRED ON ROADWAY) 4. This item was completely removed and the number retained to avoid renumbering balance of items. ** 3. 5. Marked, "groomed" trail along east ditch only, of US 218 from the convenience store at 7112 LaPorte Road in Washburn to East Schrock Road, southeast of Washburn. 6. Crossing of US 218 at East Schrock Road, milepost 173.74. 7. Marked, "groomed" trail along both ditches of US 218 from East Schrock Road, milepost 173.74 to LaPorte City north city limits. 8. This item was completely removed and the number retained to avoid renumbering balance of items. 9. This item was completely removed and the number retained to avoid renumbering balance of items. 10. This item was completely removed and the number retained to avoid renumbering balance of items. # 11. Crossing US 218 at West Gresham Road north of Cedar Falls. Stop signs will be placed along the trail on both sides of the highway requiring snowmobiles to stop prior to crossing the first two lanes and also in the median to require snowmobiles to stop before crossing the next two lanes. 12. This item was completely removed and the number retained to avoid renumbering balance of items. Black Hawk County-2015.docx 4 IOWA DEPARTMENT OF TRANSPORTATION Application to perform work within State Highway Right -of -Way FIVE STAR SNOW TRAILS ASSOCIATION (Cont'd) Snowmobile Trail and Crossing Locations -Black Hawk County (Cont'd) 13. Crossing of I-380/US 20 at intersection with County V49. Club will install signs to direct Groomer and snowmobiles to cross over I-380/US 20 on the overpass bridge and not cross at grade. "No Snowmobiling" signs will be placed along the "on" and "ofP' ramps on both sides of the freeway. Trail marker signs will be installed along the bridge deck, milepost 66.52. 13A. Along IA 281, trail exits private property via farm field driveway approx 150 ft west of bridge over creek. Milepost 21.61 13B. The trail then proceeds east along shoulder to cross bridge, then along shoulder approx 150 ft east of bridge to farm field driveway where it enters private property again. This location is approx halfway between Goeller Road & Black Hawk Buchanan Road (County V62). Milepost 21.72 14. Crossing of IA 281 at the alley between Main St and the bridge over the creek in Dunkerton. 15. This item was completely removed and the number retained to avoid renumbering balance of items. 15A. Crossing IA 281 (Independence Ave) east of Waterloo, approximately .90 mile east of intersection with County V43 (Elk Run Road) & approximately .10 mile east of property address 4914, immediately east of the blue "Litter Removal" sign, where trail uses field driveways on either side of the highway. Milepost 4.63. 16. Crossing of IA 281 at County C57, milepost 16.64 17. Crossing of US 63 at Airline Highway in Waterloo. Milepost 166.71. 18. Crossing of US 63 approx .25 of a mile north of West Bennington Rd and approx 170 feet north of the small green highway milemarker 171. This location is a highway "tum -around°' with farm field driveways coming directly from both the east and west farm fields, milepost 171.03. Black Hawk County-2015.docx 5 IOWA DEPARTMENT OF TRANSPORTATION Application to perform work within State Highway Right -of -Way FIVE STAR SNOW TRAILS ASSOCIATION (Cont'd) Snowmobile Trail and Crossing Locations -Black Hawk County (Cont'd) * Denotes changes from 2014 by moving the trail to the east ditch only. ** Denotes change from 2014 by no longer crossing under the highway bridge and installing a temporary trail bridge in the east ditch of US 218. # Denotes change from 2014 by deleting the location due to construction of the new interchange. Balance of items are the same as shown on the 2014 application. Note: Marked, "groomed" trail indicates that a track driven motorized trail grooming tractor pulling a snow drag will be operating to prepare the trail for snowmobile use and special signs applicable to snowmobile trails will be installed. Note: Liability insurance for the Five Star Snow Trails Association is covered on page 4 of the "Land Owners as Additional Insureds" page on the enclosed Certificate of Insurance for the Sno Hawks Snowmobile Club. All towns involved and the Iowa Department of Transportation are covered by the additional insured that is listed as "THE STATE OF IOWA AND ALL OF ITS POLITICAL SUBDIVISIONS". Black Hawk County-2015.docx 6 1► 18886 'SNOtS Nd A31104 MU. HIM Ni )fia2i3A1-T3Q 38 -i1IM 30Ll.0N�Q032T3Eii Siva NO VaIdXSOSRRL 3210438 (ISli33NV3 3S S3io1104 13812I0sas 3A08V an AO ANV Cffl0Hs •.. x a arvva vv vvva easT a6ezassoa ? T'L?tEe7 i aszucaag -abesu 1 T ao3c szauatoprxst pyo v ?Tod s?sl. uo pepu'tos s -tOLOS a 00T i?jy,::,':? i Zt6S 'uoTle?aoselt s r S euLTa bu-rpxS la sOSL 3 urea p L ;:, ea?a30 s eaerieigE •'struTeT - pqus Zeal?tod el•T '€1e fi�erso/S o e 4S .elT4. 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NOdfl SJH9Ri ON S2134N0O t1NV AINO NOLLvwjOjNI 40 k13LLVW V SV QafSSi Sl 31V31311N30 SiHL S.10Z/10/01 Arnewlwl area 33NYWISNI 31V3IALL11219 GUIlriammirm RL tdr..tvr.impa. imlAgiILIT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED m DESIGNATED PERSON OR ORGANIZATION — VICARIOUS LIABILITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Additional' Insured Person(s) Or Organization(s). ALL STATE SNOWMOBILE ASSOCIATION AND SNOWMOBILE CLUB DESIGNATED TRAIL LANDOWNERS FOR USE OF LAND FOR SNOWMOBILE TRAIL USAGE ONLY. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A°:. Section 11 — Who is An Insured is amended to in- clude as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for °bodriy injury. `property dam- age or °personal and advertising injury caused, in whole, by your acts or omissions or the acts or omis- sions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection w€lth your premises owned by or rented to you. However, the insurance afforded to such additional insured only applies to the extent permitted by law. B. This insurance does not apply to any "bodily injury`, • property damage" or °personal and advertising in- jury" resulting from any act or omission by, or willful misconduct of the additional insured shown in the Schedule, whether the sole or a contributing cause of the•loss. The .coverage afforded to the addidonal insured is. limited solely to the additional insured's 'vicarious liability' that is a specific and direct result of your conduct °Vicarious liability'. as used in this endorsement= means liability that is imposed on the additional in- sured solely by virtue of its relationship with you, and not due to any act oromission of the additional in- sured. C. With respect to the insurance afforded to these ad- ditional insureds, the following Is added to Section Ill -- Limits Of Insurance. if coverage provided to the additional insured is re- quired by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreements or 2. Available under the applicable Limits of. Insur- ance shown in the Declarations; whichever is less. . This endorsement shall not increase the appICabre Limits of insurance shown in the Declarations. CG7501(90-13) includes copyrighted mafeeria! of ISO Properties, inc. with its permission. Page 1 of I IOLO5 VI 0°IlaAri lalsV Z165 no!MwssV sffel.L MOUS AVIS 61£05-V1 `572140TAU!pjflj�I kummunuisik stioytins reolModstIO rtV2.ff RA1°14° ar4S. L.-1790,5 Vrovisouer PaltS LZZ uMPI 11o40 Aram anvsa rum aa.tavituAtoa taro 10,ff 412MISISIUTWOLLURIV SV SIIA&Offisirl 'aNL %MAME ONS JAW KI SUM MASTER POLICY NAME: IOWA STATE SNOWMOBILE ASSOCIATION * SNOWMOBILE CLUB CERTIFICATE CARRIER: DAKOTA FIRE INSURANCE COMPANY EFFECTIVE DATE: 10-01-14 TO: 10-01-15 RETROACTIVE DA 1'h: 11-30-04 CLUB #: 050 ENDORSEMENT#: 01 1 COVERAGE : SNOWMOBILE CLUB ONLY TRAIL LIABILITY EXPOSURE: /.1 POLICY # 4 78753-15 CLUB NAME: SNO HAWKS, INC. ADDRESS: 1314 WASHINGTON ST CEDAR FALLS, IA 50613 SNOWMOBILE/ATV CLUB 0 YES 0 NO CLUB PREM ENDST FILING FEE NO SURPLUS LINES TAX --.STAMPING.FEE TAX SL SERVICE CHARGE PREMISES LIABILITY EXPOSURE 0 YES PREMISES LOCATED AT: #GROOMERS: 1 #/USE OTHER EQUIPMENT: 1 - POLARIS 4 WHEEL ATV USED FOR TRAIL MAINTENANCE ONLY #EMERGENCY SLEDS: 0 (EMERGENCY SLED) IS A SPECIFIC SLED ATTACHED TO A SNOWMOBILE TO CARRY INJURED PEOPLE TO AN EMERGENCY VEHICLE WHEN DUE TO WEATHER THE EMERGENCY VEHICLE CANNOT GET TO THE INJURED PARTY. ***WARRANTED THAT AN EMT OR PARAMEDIC MUST ACCOMPANY OUR SNOWMOBILE CLUB DRIVER (NO PROFESSIONAL LIABILITY COVERAGE IS PROVIDED) COVERED CLUB ACTIVITES: SEE ATTACHED SCHEDULE OF SPECIFICALLY COVERED $1040.00 MP +❑APPLIES +14APPLIES —''[]APPLIES- +[]APPLIES ACTIVITIES THIS CLUB IS MADE UP OF OTHER INDIVIDUAL CLUBS WHO EACH CARRY THEIR OWN CLUB LIABILITY POLICY FOR THEIR ACTIVITIES. ❑ YES /1 NO IF YES, THE FOLLOWING EXCLUSION APPLIES TO THE COVERAGE PROVIDED FOR THE CLUB LISTED ABOVE. EXCLUSION: IT IS HEREBY AGREED AND UNDERSTOOD THAT "NO COVERAGE" EXISTS FOR ANY ACTIVITIES OF THE INDIVIDUAL CLUBS WHICH MAKE UP THE CLUB: ir************ e**9:9enc*****3e*'cde**********oY*9eden4&9e9e9e****9e******3eFe*3e*9e*e' ****3e****a it J_ ADDITIONAL INSURED' S - . ENO OYES .. . ..... SEE ATTACHED ENDORSEMENT **o MAK THAN CLUB CG7501 (1013) CONTRACT ED LANDOWNERS FOR USE OF TRAILS ONLY LIMITS: $1,000,000 OCCURRENCE $1,000,000 GENERAL AGGREGATE **COVERAGE IS FOR SPECTATOR LIABILITY ONLY. COVERAGE FORMS APPLICABLE ARE THE SAME AS SCHEDULED ON nit MASTER ASSOCIATION POLICY. IF YOU HAVE ANY QUESTIONS YOU SHOULD REFER TO THE ASSOCIATION FOR POLICY INFORMATION. DATE ISSUED: 10/10/14 $ INSURANCE GENCY 1058thSI.E P.O. Box 159 Oresca, Iowa 52125 Phone (563) 547-2161 Fax No. (563)547.2848 insurance@yar dvhys wm DALE YAWS SCHEDULE OF SPECIFICALLY COWRIE ri ACTIVITIES CLUB NAME; 050 - SNCL HAWKS INC. GENERAL MEMBERSHIP/CLUB MEETINGS BOARD MEETINGS/CHAPTER MEETINGS ANNUAL CONVENTIONS/STATE CONVENTIONS — attending not sponsoring event SNOWMOBILE TRAIL/CLUB RIDES POKER RUNS/FUN RUNS SAFETY CLASSES • RADAR RUNS DISPLAYS/BOOTHS/RAFFLES BANQUETS/LANDOWNER DINNERS - DANCES - _...._..._.... __......... _ _ . SCAVENGER HUNTS SWAP MEET -attending not sponsoring entire event FLEA MARKET — attending not sponsoring entire event PARADES HAYRIDES CAMP -OUTS CHRISTMAS PARTY CLUB COOK OUTS/PICNICS/CHILI FEEDS/DINNERS PANCAKE BREAKFAST CHRISTMAS TREE SALES TAIL MAINTENANCE AND TRAIL GROOMING— TRAILS INCLUDE OWNED OR LEASED PROPERTY WITHIN DESIGNATED TRAILS ONLY CONCESSION STAND - JUNE 26-28, 2015 AND JULY 31 -AUGUST 1 & 2, 2015 **IF RADAR RUNS ARE SCHEDULED ABOVE — THE FOLLOWING WARRANTY APPLIES TO THIS EVENT: **Coverage is hereby warranted for this event that no one under 16 is allowed to participate.** **COVERAGE APPLIES ONLY TO THOSE SPECIFICALLY SCHEDULED ACTIVITIES LISTED ABOVE September 15, 2015 City of Waterloo Attn: City Clerk 715 Mulberry Street Waterloo, IA 50703 FIVE STAR SNOW TRAILS ASSOCIATION, INC. 2202 Minnetonka Drive, Cedar Falls, IA, 50613-1522 Ph: 319-266-2929(H) • 319-610-1171(C) ♦ Email: frenchtd1(& vahoo.com Enclosed for your consideration is the Application to the Iowa Department of Transportation (IDOT) for renewal of the permit to establish and sign a snowmobile trail within the right-of-way of State highways. A portion of that trail resides within the City limits of Waterloo. The IDOT requires that each affected City approve the application before being processed by the Department. -age 3A of the application has'a block for the signature of the, onsibl'e individual re a resentin e Waterloo.' PLEASE USE THIS'- PAGE FOR THE CITY SIGNATURE. Permits are issued for one season only and must be renewed each year. This application is the same as the one which was approved last year for the City of Waterloo. Items 1, 2 on page 4 and item #17 on page 5 are the only items that currently affect Waterloo. If you have any questions concerning the application and related paperwork, you may contact me at: 319-610- 1171(Cell) or e-mail to: frenchtdl@Yahoo.com I would appreciate it very much if City action could be taken at the September 21' Council meeting, if Council action is required. It is imperative that we get the application in the hands of the IDOT as soon as possible, so as to beat the freezing temperatures and first snowfall with installation of the signs along the trail. Please return the signed copy to me in the enclosed, "postage applied" envelope as soon as possible after action has been taken by City Officials. Thank you for your assistance with this matter. Sincerely, Tony D French Five Star Snow Trails Assoc., Inc. Administrative Advisor MASTER POLICY NAME: IOWA STATE SNOWMOBILE POLICY # 4078753-15 ASSOCIATION SNOWMOBILE CLUB CERTIFICATE * CARRIER: DAKOTA FIRE INSURANCE COMPANY EFFECTIVE DA FE: 10-01-14 TO: 10-01-15 RETROACTIVE DA I'E: 11-30-04 CLUB #: 050 ENDORSEMENT#: CLUB NAME: 01 ADDRESS: SNO HAWKS, INC. 1314 WASHINGTON ST CEDAR FALLS, IA 50613 COVERAGE : SNOWMOBILE CLUB ONLY TRAIL LIABILITY EXPOSURE: 11 YES 0 PREMISES LIABILITY EXPOSURE 0 YES PREMISES LOCA IEDAT: #GROOMERS: 1 #/USE OTHER EQUIPMENT: 1 - POLARIS 4 WHEEL ATV USED FOR TRAIL MAINTENANCE ONLY #EMERGENCY SLEDS: 0 (EMERGENCY SLED) IS A SPECIFIC SLED ATTACHED TO A SNOWMOBILE TO CARRY INJURED PEOPLE TO AN EMERGENCY VEHICLE WHEN DUE TO WEATHER THE EMERGENCY VEHICLE CANNOT GET TO THE INJURED PARTY. ***WARRANTED THAT AN EMT OR PARAMEDIC MUST ACCOMPANY OUR SNOWMOBILE CLUB DRIVER. (NO PROFESSIONAL LIABILITY COVERAGE IS PROVIDED) SNOWMOBILE/ATV CLUB 0 NO CLUB PREM ENDST FILING FEE NO SURPLUS LINES TAX - - STAMPING -FEE TAX SL SERVICE CHARGE $1040.00 MP +❑APPLIES +/ 4 APPLIES +❑APPLIES:._ .. +❑APPLIES COVERED CLUB ACTIVITES: SEE ATTACHED SCHEDULE OF SPECIFICALLY COVERED ACTIVITIES ****************************************************************************** THIS CLUB IS MADE UP OF OTHER INDIVIDUAL CLUBS WHO EACH CARRY THEIR OWN CLUB LIABILITY POLICY FOR THEIR ACTIVITIES. 0 YES ►1 NO IF YES, THE FOLLOWING EXCLUSION APPLIES TO THE COVERAGE PROVIDED FOR THE CLUB LISTED ABOVE. EXCLUSION: IT IS HEREBY AGREED AND UNDERSTOOD THAT "NO COVERAGE" EXISTS FOR ANY ACTIVITIES OF THE INDIVIDUAL CLUBS WHICH MAKE UP HE CLUB: *********sex*nY9e**************ot***ase*nY*de*n1r9e****9eetexsY********sir******a2sF**de*eh9r*s'e*** ADDITIONAL INSURED' S ONO **OMLR THAN CLUB CONTRAC FED LANDOWNERS FOR USE OF TRAILS ONLY YES ' SEE ATTACHED ENDORSEMENT CG7501 (1013) LIMITS: $1,000,000 OCCURRENCE $1,000,000 GENERAL AGGREGAI'h **COVERAGE IS FOR SPECTATOR LIABILITY ONLY. COVERAGE FORMS APPLICABLE ARE 1`HE SAME AS SCHEDULED ON TILE MASTER ASSOCIATION POLICY. IF YOU HAVE ANY QUESTIONS YOU SHOULD REFER TO THE ASSOCIATION FOR POLICY INFORMATION. DATE ISSUED: 10/10/14 MANCE GENCY 103 8th St. E P.O. Sox 159 Cresco, lows 52136 Phone (563) 547.2161 Fax No. (563) 547.2846 fisuranca@vandvMs.com DALE VAGTS • CLUB NAME; SNO HAWKS, INC. LANDOWNERS AS ADDMONAL INSURED FOR CLUB CONTRACTED TRAIL USAGE ONLY 61. My D. Shining Trust 5311 Hyacinth Drive Unit 64 - Cedar Falls, IA 50613-6415 . 7L Charles Wilmot 2596 Joplin Avenue Denver; IA 50622 1 - 62. William A. Shining Trust 4311 Hyacinth Drive Unit 64 cedar Falls, IA 50613-6415 - 72. Raymond & Pauline Youngblut • 6732 LaPorte Road Waterloo, IA 50706 63. Ronald Steege • : *9321 Logan Avenue • Waterloo, IA 50703 . 73. Tim Youngblut .. 6905 LaPorte Road Washburn, IA 50706 Stoimi — - . 8225 Ford Road Cedar Falls, IA 50613 -74. David M. A -Nancy- J. Zeien 4622 West Cedar Wapsi Road Cedar Falls; IA 50613 65. Tall pine Farms, Inc. 7411 North Raymond Road Punkerton, IA 50626 75. The State of Iowa & All of its political Subdivisions Wallace State Office Building Des Moines, IA 50319 66. rchael & Kathy Tellinghuisen ' 7011 North. Union Road lanesville, IA 50647 76. Five Star Snow Trails Association 5912 Aster Lane Waterloo, IA 50701 67. piffmi R. & L. Marcella Trent ' 039 Leversee Road Cedar Falls, IA 50613 77. City ofJanesville Iowa 227 Main Street Janesville, IA 50647 • 68. Air 4 Marilyn Walker `..103 East Bennington Road " Waterloo, IA 50703 '•7105 LaPorte Road ., . ashburn, IA 50702 . 70. Watgloo Industrial Development AO West 4th Street Waterloo, IA 50701 Page 4 of 4 IOWA DEPARTMENT OF TRANSPORTATION Application to perform work within State Highway Right -of -Way FIVE STAR SNOW TRAILS ASSOCIATION Snowmobile Trail and Crossing Locations -Black Hawk County 1. Crossing of US 218 in Waterloo at Marigold Dr, milepost 176.84. * 2. Marked, "ungroomed" trail along east ditch of US 218 from Marigold Dr in Waterloo, milepost 176.84, to bridge at the north Washburn city limits. ** 3. Install a temporary bridge in the east ditch of US 218 over the small creek at the north Washburn city limits. (NO SIGNING REQUIRED ON ROADWAY) 4. This item was completely removed and the number retained to avoid renumbering balance of items. 5. Marked, "groomed" trail along east ditch only, of US 218 from the convenience store at 7112 LaPorte Road in Washburn to East Schrock Road, southeast of Washburn. 6. Crossing of US 218 at East Schrock Road, milepost 173.74. 7. Marked, "groomed" trail along both ditches of US 218 from East Schrock Road, milepost 173.74 to LaPorte City north city limits. 8. This item was completely removed and the number retained to avoid renumbering balance of items. 9. This item was completely removed and the number retained to avoid renumbering balance of items. 10. This item was completely removed and the number retained to avoid renumbering balance of items. # 11. Crossing US 218 at West Gresham Road north of Cedar Falls. Stop signs will be placed along the trail on both sides of the highway requiring snowmobiles to stop prior to crossing the first two lanes and also in the median to require snowmobiles to stop before crossing the next two lanes. 12. This item was completely removed and the number retained to avoid renumbering balance of items. 4 Black Hawk County-2015.docx IOWA DEPARTMENT OF TRANSPORTATION Application to perform work within State Highway Right -of -Way FIVE STAR SNOW TRAILS ASSOCIATION (Cont'd) Snowmobile Trail and Crossing Locations -Black Hawk County (Cont'd) * Denotes changes from 2014 by moving the trail to the east ditch only. ** Denotes change from 2014 by no longer crossing under the highway bridge and installing a temporary trail bridge in the east ditch of US 218. # Denotes change from 2014 by deleting the location due to construction of the new interchange. Balance of items are the same as shown on the 2014 application. Note: Marked, "groomed" trail indicates that a track driven motorized trail grooming tractor pulling a snow drag will be operating to prepare the trail for snowmobile use and special signs applicable to snowmobile trails will be installed. Note: Liability insurance for the Five Star Snow Trails Association is covered on page 4 of the "Land Owners as Additional Insureds" page on the enclosed Certificate of Insurance for the Sno Hawks Snowmobile Club. All towns involved and the Iowa Department of Transportation are covered by the additional insured that is listed as "THE STATE OF IOWA AND ALL OF ITS POLITICAL SUBDIVISIONS". 6 Black Hawk County-2015.docx ITYACT_ION (IF_3ROPOSED:WOR4C l iAiITHIN Alii INC RPORAT D ITY,CITY ACTIOIy ES REQUIRED' "The undersigned city joins in the grants embodied in the above permit executed by the Iowa Department of Transportation on condition that all of the covenants and undertakings therein running to the Iowa Department of Transportation shall inure to the benefit of the undersigned city and recommends action on said permit application as noted below by the delegated city official". ►71 Recommend Approval ❑ Do Not Recommend Approval 0 None Required H.���,�'ti tten Signature ti ,44/ Type or Print Name dynes A- G C. -\D vk Title Date Authorized Official for the City of WATERLOO 3A 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER V & V Insurance Agency, Inc PO Box 159 103 8th St E Cresco • IA 52136- CONTACT NAME: PHONE Ext): (563) 547-2161 1 FAX No): (563) 547-2046 E-MAIL insurance@vandvins.Com ADDgESS: INSURERS) AFFORDING COVERAGE ? NAIC # INSURERA:Dakota Fire Insurance Company 110863 INSURED SNO HAWKS INC. 1314 WASHINGTON ST CEDAR FALLS IA 50613- INSURER B : 1- INSURER C : } INSURER D : INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS INDICATEQ.. CERTIFICATE EXCLUSIONS INSR ; LTR , TO CERTIFY THAT NOT\MTHSTANDING THE POLICIES ANY REQUIREMENT, OR MAY OF SUCH OF INSURANCE PER'TA1N, POLICIES. INSD SUER WVD LISTED BELOW HAVE BEEN ISSUED TO TERM OR CONDITION OF ANY CONTRACT THE INSURANCE AFFORDED -BY THE:POLICIES-DESCRIBED-HERE(N:IS:•SUBJECT.TO.ALL LIMITS SHOWN MAY HAVE BEEN REDUCED BY 1 POLICY EFF POLICY NUMBER i (MM/DD/YYYY) THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE TERMS— PAID CLAIMS. POLICY EXP I (MM/DD/YYYY) 1 LIMITS MAY BE ISSUED AND CONDITIONS ~�A-OSL TYPE OF INSURANCE A i X I.-.• i�. Ii COMMERCIAL GENERAL _i X I CLAIMS -MADE LIABILITY OCCUR i I I j 1 4D78753 1 S j / / 10/01/2014 / / / / / / / / / / / / 10/01/2015I / / / / / / / / / / EACH OCCURRENCE $ 1,000,000 I j DAMAGE TO RENTED PREMISES (Ea occurrence) $ I MED EXP (Any one person) $ i I PERSONAL & ADV INJURY $ I GENII. . AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 1,000,000 j I PRO- POLICYi JECT LOC ' PRODUCTS - COMP/OP AGG i $ IOTHER: . $ AUTOMOBILE _ 'AUTOS f' J_ LIABILITY ANY AUTO -OWNED / / i / / • i / / iPROPERTY 1 / 1 1; t// / / / / / / / / // 1 (EOMaBBIIiNdsnt) ED SINGLE LIMIT 1} BODILY INJURY (Per person) i $ $ ALL OWNED 1 1 SCHEDULED AUTOS j NON HIRED AUTOS � ' AUTOS 1 1 BODILY INJURY (Per accident) $ DAMAGE $ j (Per accident) f $ UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE I 1 ( 1 I / / / / / / / / / / / / EACH OCCURRENCE $ AGGREGATE $ DED ? RETENTION $ $ ( WORKERS COMPENSATION I j / / :AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE Y • N; I / / OFFICER/MEMBER EXCLUDED? j N / A i i (Mandatory In NH) ' / / If yes, desTe under DESCRIPTION OF OPERATIONS below ` / / i I / / / / / / / / '• PER OTH- EL EACH ACCIDENT -------- — - — E.L. DISEASE - EA EMPLOYEE $ — — .__.-- $ E.L DISEASE - POUCY LIMB , $ i / / / / / / / / DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Snowmobile Club and Trail Liability Insurance, including Liability coverage for (1) Groomer and (1) ATV used for trail maintenance only. See attached form CG7501 regarding contracted landowners for Trail usage. Premise Liability coverage is Excluded on this policy. U1: -IN. I trIVl91 L. 11 %/1.1.. ,. ( ) - , ( ) - - -- ----------- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, •• NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS: AUTHORIZED REPRESENTATIVE /."1„,„,, I I 6 , 06-- ACORD 25 (2014101) INS025 (201401) -4U74 Ht..LJt U vrcrvrw uvw. s -u . The ACORD name and logo are registered marks of ACORD "4411 . DOT Form 810028 (01-14) APPLICATION TO PERFORM WORK WITHIN STATE HIGHWAY RIGHT-OF-WAY FOR DEPARTMENT USE ONLY Permit Number Highway Number (SEE ATTACHED LISTING) County Black Hawk DOT Project Number N/A Expiration/Completion Date 04/15/16 APPLICANT (INDIVIDUAL OR COMPANY) (ASSISTANCE FROM DEPARTMENT AVAILABLE UPON REQUEST) First Name Tony Middle D Last Name French Phone Number 319-610-1171 Ext. Company Name Five Star Snow Trails, Inc Phone Number 319-610-1171 Ext. Street Address 2202 Minnetonka Drive City/Town Cedar Falls State IA ZIP Code 50613 WORK TO BE ACCOMPLISHED Approval is hereby requested to enter within the state right-of-way and to complete the proposed work as detailed on the attachments and further described as follows: Snowmobile Trail and Trail Crossing Locations as indicated on the attached listing. Trail is located partially within the city limits of Dunkerton and Waterloo. All crossings shall go into effect after all signs along the highway have been installed by IDOT forces. All signs placed on the ROW by the applicant shall be removed by the applicant. and shall be located as shown on the detailed plan attached hereto. (See current Iowa Department of Transportation Utility Accommodation Policy for submittal of detailed plan requirements.) WORK SITE LOCATION The proposed work as described above is located in Section , Twp. (SEF ATTACHED LISTING) Range (SEE ATTACHED LISTING) on Highway No. generally located (miles) (direction) from (city, county line, or other land line). Work proposed is more specifically located as being from (Milepost #) and (Highway Station) to (Milepost #) and (Highway Station) on the side of highway. Applicant Signature and Agreement The undersigned have read the stipulations of this permit agreement as stated as well as attachments which may be included and by signing this application agree to abide by all stipulations and to complete the work as proposed in compliance with the stipulations and attachments within one year from the date Department approval is received for said request. Failure on the part of the applicant to abide by the stipulations or to construct the work desired as stipulated and within the time frame stated shall render this agreement and request null and void. The undersigned also agrees to save harmless the State of Iowa and the Iowa Department of Transportation from any damage or losses that may be sustained by any person or persons on account of the conditions and requirements of this agreement. Applicant Name (First, M.I., Last - Print or Type) Applicant Signature (Handwritten) Date Tony D. French CITY ACTION (IF PROPOSED WORK IS WITHIN AN INCORPORATED CITY, CITY ACTION IS REQUIRED) 'The undersigned city joins in the grants embodied in the above permit executed by the Iowa Department of Transportation on condition that all of the covenants and undertakings therein running to the Iowa Department of Transportation shall inure to the benefit of the undersigned city and recommends action on said permit application as noted below by the delegated city official". Rec • y end Approval El Do Not Recommend Approval Type or Print Name (SEE ATTACHED CITY ACTION SHEETS) Title VVILSA El None Required Date 9/ii Authorized Official for the City of (SEE ATTACHED CITY ACTION SHEETS) FEDERAL HIGHWAY ADMINISTRATION ACTION (DEPARTMENT REPRESENTATIVE WILL REVIEW THE REQUEST AND OBTAIN FHWA ACTION, WHEN NECESSARY) 0 Recommend Approval 0 Do Not Recommend Approval El None Required Authorized FHWA Representative Signature Date (DOT Final Action and Agreements on next page) Page 1 of 2