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HomeMy WebLinkAboutIowa Department of Transportation-10/8/2012RECEIVED OCT 24 2012 11, Iowa Department of Transporta "° • 1875 W. Ridgeway Ave. P.O. Box 1888 Waterloo, Iowa 50704-1888 Office 319-235-1832 david.ramirez@dot.iowa.gov Five Star Snow Trails Association Attn: Richard Melick 1314 Washington Street Cedar Falls, IA 50643 Cit i I ENGWE ' October 18, 2012 RE: Permit # 7A-2012-020, Black Hawk County, Ref. # 604.2 Dear Mr. Melick, Please find enclosed an approved "Application to Perform Work Within the State Right of Way" for the operation and maintenance of a seasonal trail. 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 maintain a copy for the association's records. If you have any questions please call me at 319-238-1832. Sincerely, Dave Ramirez E.O.T. District 2 c.c. Dave Little, Assistant District Engineer, District 2 Jeff McCollough, Design Tech Specialist, Traffic and Safety Doug Lickteig, Waterloo Area Supervisor Michael Schares, Mayor, City of Dunkerton Ernest Clark, Mayor, City of Waterloo alowa Department of Transportation 4+ Form 810028 (02-11) APPLICATION TO PERFORM WORK WITHIN STATE HIGHWAY RIGHT-OF-WAY FOR DEPARTMENT USE ONLY Permit Number 74 —7Q/Z — O ac) DOT Project Number N/A Highway Number Varies County Black Hawk Expiration/Completion Date 4/15/13 APPLICANT (INDIVIDUAL OR COMPANY) (ASSISTANCE FROM DEPARTMENT AVAILABLE UPON REQUEST) First Name Richard Middle Initial C Last Name Melick Phone Number 319-231-0819 Company Name Five Star Snow Trails Phone Number 319-231-0819 Street Address 1314 Washington Street City/Town Cedar Falls State Ia ZIP Code 50613-4153 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: Snow mobile 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 in 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. Range 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.l., Last - Print or Type) Applicant Signature (Handwritten) Dale. Richard C. M;,Iick 1�(.�i4nj ize/2e, tz 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". ❑ Recomrnend Approval ❑ Do Not Recommend Approval El None Required Handwritten Signature Title Date Type or Print :dame (SEE ATTACHED CITY ACTION SHEETS) 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) E Recommend Approval Do Not Recommend Approval Authorized FHWA Representative Signature Page 1 of 2 None Required Date (DOT Final Action and Agreements on next page) DEPARTMENT OF TRANSPORTATION FINAL ACTION - 1111 Application Approved Application Denied Permit Number. Authorized Highway District Representative Dave Ramirez Signature Date Notice of intention to commence activities on the highway rights-of-way shall be submitted by the applicant a minimum of 48 hours prior to actually commencing the activities as herein granted by this approved application, Notice is to be given to the following lows Department of Transportation representatives Local DOT Contact Person (Type or Print Name) Doug Lickteig Waterloo Area Supervisor Phone Number 319-233-3055 Street Address 1875 W Ridgeway Ave City/Town Waterloo 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 public and 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 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 losses, damages, claims, or demands, and from any and all liability 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 cover until it becomes well established. Any surfaced areas such as driveways or shoulders and sodded waterways and plantings which are disturbed shall be restored to their original condition. 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 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 after sunrise to 30 minutes before sunset. 14. After November 24, 2008, all personnel in the highway right-of-way shall wear ANSI 107 Class 2 apparel at all times when exposed to traffic or construction equipment. 15. All proposed work covered by this permit shall be at the applicants 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 harmless the State of Iowa and the Iowa Department of Transportation and to indemnify them from any claim, demand or action by or on behalf of any person or entity arising out of or in connection with anything having to do with the snowmobile route, including, but not limited to, its establishment,construction use, maintenance, signing, 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 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". ja-Recommend Approval 0 Do Not Recommend Approval 0 None Required Auth. Citty OfRcial Signature v-9-;4(t4(Handwri en) Title ).4011-fr Date A/8A,, 2_ game of Authori d City Official (Print or type) MIChae( J . S. e5 Authorized City Official for the City of DUNKERTON 3 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". LY Recommend Approval 0 Do Not Recommend Approval 0 None Required Au City Official i ature (H dwri en) Title }6361( Date % 70 q________ i O 13 lame of Aut armed �Official (Print or type) r�City foul 9 • L X*— U Authorized City Official for the City of WATERLOO 3A - /_,..,,,,I ® A►� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/26/2012 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 policy(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 (563) 547-2161 FAX IAlC. No. Extl: No). (563) 547-2046 E-MAIL ADDRESs: insurance@vandvins . com INSURER(S)AFFORDINGCOVERAGE NAIC# INsuRERA:Dakota Fire Insurance Company INSURED SNO HAWKS INC . 1314 WASHINGTON ST CEDAR FALLS IA 50613- INSURER B : / / INSURER C : EACH OCCURRENCE INSURER D : INSURER E : UABIUTY INSURERF: • COVERAGES t.cm 1 /rias+ 1 .w.r.o....... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL NCR SUER WVD POLICY NUMBER POLICY EFF JMM/DDJYYYYJ_IMM/DD/YYYY)- POLICY EXP LIMITS LTR / / / / EACH OCCURRENCE $ 1,000,000 GENERAL UABIUTY 4D78753 10/01/2012 10/01/2013 DAMAGE TO RENTEDPREMISES (Ea occurrence) $ X COMMERCIAL GENERAL LIABILITY / / / / MED EXP (Any one person) $ X CLAIMS -MADE OCCUR / / / / PERSONAL A. ADV INJURY $ / / / / GENERAL AGGREGATE $ 1,000,000 / / / / PRODUCTS - COMP/OPAGG $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LOC / / / / $ POLICYn / / / / COMBINED SINGLE LIMIT (Ea accident) $ AUTOMOBILE LIABILIUTYTY / / / / BODILY INJURY (Per person) $ ANY AUTO ALL OWNED _SCHEDULED / / / / BODILY INJURY (Per accident) $ AUTOS NAUTOS ON -OWNED / / / / PROPERTY DAMAGE (Per accident) $ HIRED AUTOS _ AUTOS / 1 / / $ / / / / EACH OCCURRENCE $ UMBRELLA LIAB_ OCCUR / / / / AGGREGATE $ EXCESS LIAB CLAIMS -MADE RETENTION $ / / / / $ WORKERS DED COMPENSATION / / / / WC STATU-OTH- TORY LIMITS T ER AND EMPLOYERS' LIABILITY Y / N / / / / E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A / / / / E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under OF OPERATIONS below / / / / E.L. DISEASE -POLICY LIMIT $ DESCRIPTION / / / / / / / / DESCRIPTION Snowmobile Maintenance attached OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) Club and Trail liability insurance, including liability coverage for (1) Groomer and (1) Equipment (Polaris ATV for trail maintenance). Additional insureds for Trail Usage - See (4) sheets. Premise liability coverage is Excluded on this policy. CERTIFICATE HOLDER ( ) 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 ACORD 25 (2010/05) INS025 (201005).01 / Pa I f © 1988-2010 ACORD CORPORATION. A rights reserved. The ACORD name and logo are registered marks of ACORD CLUB NAME; SNO HAWKS, INC. LANDOWNERS AS ADDITIONAL INSURED FOR , CLUB CONTRACTED TRAIL USAGE ONLY 61. Mary D. Shining Trust 5311 Hyacinth Drive Unit 64 Cedar Falls, IA 50613-6415 62. William A. Shining Trust 5311 Hyacinth Drive Unit 64 Cedar Falls, IA 50613-6415 71. Charles Wilmot 2596 Joplin Avenue Denver, IA 50622 72. Raymond & Pauline Youngblut 6732 LaPorte Road Waterloo, IA 50706 63. Ronald Steege 9321 Logan Avenue Waterloo, IA 50703 73. The State of Iowa & All of its political Subdivisions Wallace State Office Building Des Moines, IA 50319 64. Eugene E. & Jean M. Stokes 6225 Ford Road Cedar Falls, IA 50613 74. Five Star Snow Trails Association 5912 Aster Lane Waterloo, IA 50701 65. Tall Pine Farms, Inc. 7411 North Raymond Road Dunkerton, IA 50626 66. Michael & Kathy Tellinghuisen 7611 North Union Road Janesville, IA 50647 67: Clifford R. & L. Marcella Trent 8339 Leversee Road Cedar Falls, IA 50613 68. Alan & Marilyn Walker 1303 East Bennington Road Waterloo, IA 50703 69. Washburn BP Store 7305 LaPorte Road Washburn, IA 50702 70. City of Janesville Iowa 227 Main Street Janesville, IA 50647 Page 4 of 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) 21. Marked, "ungroomed" trail along the east ditch only of US 63 from Ridgeway Ave in Waterloo, milepost 159.58, south approx 500 feet to the parking lot of Heartland Inn Motel. Trail will end at that point. 22. Crossing of US 63 at Airline Highway in Waterloo, milepost 166.71. 23. Crossing of US 63 approx .25 miles north of West Bennington Rd and approx 170 feet north of the small green highway milemarker 171. This location is a highway "turn -around) with farm field driveways coming directly from both the east and west farm fields, milepost 171.03. * Item 10 is revised to show trail signing to be placed at this location. ** Item 1 lis completely revised and Items 11A and 12 are completely removed due to extensive road construction near Janesville. With the changes being made, it appears at this time to be impossible to utilize last years route into Janesville. All other locations shown on this application are the same as listed on the 2010 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 listed as "THE STATE OF IOWA AND ALL OF ITS POLITICAL SUBDIVISIONS". Note: A copy of the Insurance for the Sno Hawks Snowmobile Club for the current year is enclosed. Insurance renewal for year 12-1-2011 to 12-1-2012 is in process. Policy has not yet been issued A copy of the approved policy will be provided to each entity involved upon receipt of the policy, which is expected to be sometime during the month of December 201 1. 131aek naw Cbunty-2011.wpd 6 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 1-380/US 20 at intersection with County V49. Club will install signs to direct Groomer and snowmobiles to cross over 1-380 & US 20 on the overpass bridge and not cross at grade. "No Snowmobiling" signs will be placed along the on and off ramps on both sides of the freeway. Trail marker signs will be installed along the bridge deck, milepost 66.52, 13 A. 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 Sycamore St in Dunkerton. Milepost 13.75 15. Crossing of IA 281 at the Kwik Star Convenience Store at the south edge of Dunkerton. Milepost 13 27 ISA. Crossing IA 281 (Independence Ave) east of Waterloo, approximately .90 ofa mile east of intersection with County V43 (Elk Run Road) & approximately .10 ofa 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. Marked, "ungroomed" trail along both ditches of US 63 from Hudson city limits north to milepost 158.04, south of US 20 interchange. 18 Crossing of US 63 south of interchange with US 20 at milepost 158.04 19. Marked, "ungroomed" trail along west ditch only ofUS 63 in Waterloo from milepost 158.04. crossing under US 20, and proceeding north to Ridgeway Ave. 20 Crossing of US 63 at Ridgeway Ave in Waterloo. milepost 159.58. 1lack 1 laick Crnmty-201 1.wpd 5 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 both ditches of US 218 from Marigold Dr in Waterloo, milepost 176.84, to bridge at the north Washburn city limits. 3. Crossing under US 218 by way of bridge at north Washburn city limits, milepost 175.58 (NO SIGNING REQUIRED ON ROADWAY) 4. Marked "ungroomed trail along east ditch only of' US 218 from bridge listed in item # 3 to farm driveway approx 300 ft north of Washburn city limits and immediately north of residence with street number 6605 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. Marked, "groomed" trail along both ditches of US 218 from East Schrock Road, milepost 173.74 to LaPorte City north city limits. Crossing under US 218 at Broadway St in Waterloo, mile post 185.8. (See item 9 below ) (NO SIGNS REQUIRED ON US 218) 9. Marked, "ungroomed" trail along south ditch of Broadway St from US 218 southbound "on ramp" to the US 218 northbound "off ramp". 10. *Crossing of US 218 at County C57 north ofCedar Falls. Stop signs will be placed along the trail on both sides ofthe 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 2 lanes. milepost 192.88. 11A. **Crossing US 218 at West Gresham Road. 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 2 lanes. This item is completely removed. 1 2. This item is completely removed. Black I lata County -201 1.u1)d 4