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HomeMy WebLinkAboutIowa Department of Transportation-10/17/2011Iowa Department of Transportation 1875 W. Ridgeway Ave. P.O. Box 1888 Waterloo, Iowa 50704-1888 Office 319-235-1832 david.ramirez@dot.iowa.gov November 7, 2011 Five Star Snow Trails Association Attn: Richard Melick 1314 Washington Street Cedar Falls, IA 50643 RE: Permit # 7A-2011-028, 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 Iowa Department of Transportation Form 810028 (02-11) FOR DEPARTMENT USE ONLY Application to perform Work Within St Ight-of-Way to Highway Permit Number r(1— Zo/` Z 8 Highway Number (SEE All ACHED LISTING) County Black Hawk DOT Project Number N/A Expiration/Completion Date APPLICANT (INDIVIDUAL OR COMPANY ASSISTANCE FROM DEP First Name Richard Middle Initial C Last Name Melick Phone Number (319) 231-0819 Company Name Five Star Snow Trails Association Phone Number (319) 231-0819 Street Address 1314 Washington St 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: 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 crossisngs shall go into effect after all sig is along the highway have been installed by DOT Forces. All signs placed on Row by applicant shall be removed by applicant. WORK SITE LOCATION (SEE ATTACHE The proposed work as described above is Range (direction) from on Highway No. specifically located as being from to (Milepost#) and LASTING) generally located (city, county line or other I (Milepost#) and (Highway Station) on the (miles) and line). Work proposed is more (Highway Station) 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.1., Last -Print or Type) Applifant Signature (Handwritten) i Date Richard C. Melick LI,] f ., 10/7/2011 CITY ACTION (IF PROPOSED WORK IS WITHIN AN INCORPORATED CITY, CITY ACTION 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". Recommend Approval a T f .:. (Handwritten) Do Not Recommend Approval None Required Title (See attached city action sheets) Date Name of Authorized City Official (Print or Type) (SEE ATTACHED CITY ACTION SHEETS) Authorized City Official for the City of (SEE ATTACHED CITY ACTION SHEETS) FEDERAL HIGHWAY ADMINISTRATION ACTION (DEPARTMENT REPRESENTATIVES WILL REVIEW THE REQUEST AND OBTAIN FHWA ACTION, WHEN NECESSARY) Recommend Approval Do Not Recommend Approval I 1 None Required Authorized FHWA Representative Signature Date (DOT Final Action & Agreements on next page) Page 1 of 2 DEPARTMENT OF TRANSPORTATION FINAL ACTION © Application Approved Application Denied Permit Number 7/4-2'erri- 038 Authorized High District R esentat�e�� (Type or Print): � eZ4Vited. Signatur Notice of intention to commence activities on the highway rights-of-way shall 48 hours prior to actually commencing the activities as herein granted by this the following Iowa Department of Transportation representative: Date if/1/// b ubmitted by the appl'cant a minimum of approved application. Notice is to be given to Local DOT Contact Person (Type or Print Name) DOUG LICILTEIG, GARAGE SUPERVISOR Phone Number (319) 233-3055 Street Address 1875 EAST RIDGEWAY AVE. PO BOX 1888 C ity/Town WATERLOO State IA ZIP Code 50704 AGREEMENTS The applicant agrees that if granted a permit to do said work the following stipulations shall govern. 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 lowa 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 lowa 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. 5. 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 lowa 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 applicant's expense. The applicant shall reimburse th lowa Department of Transportation for any materials removed from the highway right-of-way described as follows: e 16. The following special requirements shall apply to this permit: PLEASE NOTE: The sponsor agrees tohold 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 snow nopbile route, including, but not limited to. its establishment. construction, use, maintenance. signing. cofiguration 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 furnished 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". ecemenend "rproval Not e©ommen Approval 0 None «°equiresl (Hath. ityncial Signature Title 1) 9. or- a a of Aat o zed City Official (Print or type) %Vk cIme I . 5chc xe ate /0/10/2b1 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". D Recommend Approval 0 Do Not e© mmend Approval 0 None Required Anthe Cityy_ C alai Signature (Handwritten) Title Dante 16(0/g01) dame ®t rh j ®rued C ©lel nt or type) hit yet ©rued City O 9;eat for the City e WATERLOO 3B 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') 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. 7. Marked, "groomed" trail along both ditches of US 218 from East Schrock Road, milepost 173.74 to LaPorte City north city limits. 8. 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. 12. This item is completely removed. Black llawk County-2011.wpd 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 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 13 B. 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 15A. Crossing IA 281 (independence Ave) east of Waterloo, approximately .90 of a mile east of intersection with County V43 (Elk Run Road) & approximately .10 of a 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 of US 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. 131a 6 11 i h County-3(11 I. %pd 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 171.0 3. * Item 10 is revised to show trail signing to be placed at this location. * * Item 11 is completely revised and Items 1 1 A 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 I. 131ack 1 Iawk County -201 1.wpd 6 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 11/09/2010 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(les) 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 - INSURED SNO HAWKS INC. 1314 WASHINGTON ST CEDAR FALLS CONTACT NAME: (A/C,PHONE No, Ext): (563) 547-2161 FAX (AIC, No): (563) 547-2046 E-MAIL ADDRESS: insurance@vandvins . com PRODUCER CUSTOMER ID 0: INSURER(S) AFFORDING COVERAGE IA 50613 - INSURER A Dakota Fire Insurance Co NAIC # INSURER B INSURER C : INSURER D : INSURER E : INSURER F : • REVISION NUMBER: I.V V CIVAUCJ THIS IS TO CERTIFY THAT INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE ISSUED EXCLUSIONS AND CONDITIONS vim..., THE POLICIES ANY REQUIREMENT, OR MAY OF SUCH .. ...r.. OF INSURANCE PERTAIN, POLICIES. ADDL INSR .. SUBR )'ND .. �...--. .. LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN REDUCED POUCY NUMBER ISSUED TO CONTRACT THE POLICIES BY POLICY EFF (MMIDDIYYYY) THE INSURED OR OTHER DOCUMENT DESCRIBED PAID CLAIMS. POUCY EXP (MMIDDIYYYY) NAMED ABOVE FOR THE POLICY PERIOD WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, UMITS INSR TYPE OF INSURANCE 1 ; GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY OCCUR 3031117 / / 12/01/2010 / / / / / / / / / / / / 12/01/2011 / / / / / / / / / / EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ X XI CLAIMS -MADE I I MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO JFCT LOC $ AUTOMOBILE UABIUTY ANY AUTO/ ALL OWNED AUTOS/ SCHEDULED AUTOSPROPERTY HIRED AUTOS NON -OWNED AUTOS / / / / / / / / / / / / / / / / / / / / / / / / / / COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ DAMAGE (Per accident) $ $ $ UMBRELLA UAB EXCESS LIAB — OCCUR CLAIMS -MADE / / / / / / / / / / / / / / / / EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS AND ANY OFFICERMIEMBER (Mandatory If yes, DESCRIPTION COMPENSATION EMPLOYERS' UABIUTY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED, In NH) describe under OF OPERATIONS Y / N N / A / / / / / / / / / / / / / / / / WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ / / / / / / / / DESCRIPTION Snowmobile trail this OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Club and Trail liability insurance, including liability coverage for (1) Groomer and (1) ATV (used for maintenance only). Additional insured: See (4) attached sheets. Premise liability coverage is Excluded on 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 /--"ni ACORD 25 (2009/09) INS025 (200909) © 1988-2009 ACORD CORPORATION. Ali rights reserved. The ACORD name and logo are registered marks of ACORD CLU 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 71. Charles Wilmot 2596 Joplin Avenue Denver, IA 50622 62. William A. Shining Trust 5311 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 East Washburn Road Washburn, IA 50706 64. Eugene E. & Jean M. Stokes $225 Ford Road Cedar Falls, IA 50613 74. David M. & Nancy J. Zeien 4622 West Cedar Wapsi Road Cedar Falls, IA 50613 65. Tall Pine Farms, Inc. 7411 North Raymond Road Dunkerton, IA 50626 75. The State of Iowa & All of its political Subdivisions Wallace State Office Building Des Moines, IA 50319 66. Michael & Kathy Tellinghuisen 7611 North Union Road Janesville, IA 50647 67. Clifford R. & L. Marcella Trent 8339 Leversee Road Cedar Falls, IA 50613 76. Five Star Snow Trails Association 5912 Aster Lane Waterloo, IA 50701 77. City of Janesville Iowa 227 Main Street Janesville, IA 50647 68. Alan & Marilyn Walker 1303 East Bennington Road Waterloo, IA 50703 69. Washburn BP Store 7305 LaPorte Road Washburn, IA 50702 70. W4wrloo Industrial Development 10 West 4th Street Waterloo, IA 50701 Page 4 of 4 MASTER POLICY NAME: IOWA STATE SNOWMOBILE POLICY # 3D31117--11 ASSOCIATION * SNOWMOBILE CLUB CERTIFICATE * CARRIER: DAKOTA FIRE INSURANCE COMPANY EFFECTIVE DATE: 12-01-10 TO: 12-01-11 RETROACTIVE DATE: 11-30-04 CLUB #: 029 ENDORSEMENT#: 01 CLUB NAME: SNO HAWKS INC ADDRESS: 1314 WASHINGTON STREET CEDAR FALLS, IA 50613 COVERAGE : SNOWMOBILE CLUB ONLY SNOWMOBILE/ATV CLUB ❑ TRAIL LIABILITY EXPOSURE: PREMISES LIABILITY EXPOSURE PREMISES LOCATED AT: YES ❑ NO CLUB PREM $1040.00 MP ENDST FILING FEE +❑APPLIES ❑ YES ® NO SURPLUS LINES TAX +®APPLIES STAMPING FEE TAX +❑APPLIES SL SERVICE CHARGE +❑APPLIES #GROOMERS: 1 #/USE OTHER EQUIPMENT: 1 - 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 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: ADDITIONAL INSURED'S ❑NO EYES SEE ATTACHED ENDORSEMENT **OTHER THAN CLUB CONTRACTED LANDOWNERS FOR USE OF TRAILS ONLY CG7501 (1-06) 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 THE MASTER ASSOCIATION POLICY. IF YOU HAVE ANY QUESTIONS YOU SHOULD REFER TO THE ASSOCIATION FOR POLICY INFORMATION. DATE ISSUED: 12/13/10 HB INSURANCE AGENCY Highway u [aril F'll Hn, Fa. Nn 09_9 S:; ❑5urairtyrUPvarulyati. i ah DALE VAGTS SCHEDULE OF SPECIFICALLY COVERED ACTIVITIES CLUB NAME: 029 - SNO 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 TRAIL MAINTENANCE AND TRAIL GROOMING— TRAILS INCLUDE OWNED OR LEASED PROPERTY WITHIN DESIGNATED TRAILS ONLY CONCESSION STAND - JUNE 24, 25 & 26, 2011 AND AUGUST 5, 6 & 7, 2011 **IF RADAR RUNS ARE SCHEDULED ABOVE — THE FOLLOWING WARRANTY APPLIES TO THIS EVENT: **Coverage is hereby warranted for this event that no one under 18 is allowed to participate.** **COVERAGE APPLIES ONLY TO THOSE SPEFICALLY SCHEDULED ACTIVITIES LISTED ABOVE 11 9 n) eact L . \ 'S swum, bossy loos osuoalu dfsdloM f i�•. •suis ltopgl asual,l 'nnsuas Bowing aaap oul.tnp 113)110.0.1 .10 pasola ,cull) qua' amus 011041 ado0us mous /luno 4ape 9 Ill,' ILA; 7:11377r- �..., ulfa sdoou g mous Mono°1. j_1. Ll%ys/aPIN-ouSrrPseflol43 4. 40613 MUa 101 swan MOUq mem OAHU mmm»J Mol 8 na urvwo /R) I woo SQIJM1l1 MOTHS 3A1 j OOT :Irking, unloading Area's 'averly Cedar Falls rking lot at Hwy 218(27) & Sl. Nw. & C57 :c 218 Business Dewar 2643 E. Donald St. East of Buildings The Fite SInr Snow Trails Is a loial operation of (3) Three elutes. Dewar Snow' Chasm s Norm Kimball 319-233-363.1 S319-2.10-7009 Bremer County Sao -Knights Dare Barber - 319-279-3091 t 319.269-6096 Cedar Falls Sao Hawks Stanley \Calf 319-290-3604 0319-240-2153 Parts, Service, and Dealers Waterloo sA°sR`Q'dgr .: d 000.6clow r a. AWA ,`4,Z,R-c Business's may change hours, locations, or close without notice Denver ICWIK STAR Gas. Diesel. & Food Open 24 Hrs. 341 S. State St. Dewar KATHY'S ICORNOR Food & Bar Mon -Sat. 10am-2an. 1830 N. Raymond Rd. Frederika CO-OP Gas & Diesel (Pay inside Only) Mon -Fri. 7:30am-5pm. Sal. 7:30am-12:OOpm. 1 Sl. & 4th Ave. Janesville KWIK STAR Gas. Diesel. & Foud Open 24 Hrs. 811 Barrick Rd. Plainfield D J's Gas & Food Mon -Sal. Gam-9pm. Sun. 7am-9pm. 833 North Main Sl. • Tripoli PANTHER LANES Food & Drink. Mon -Fri. 4pm-9pm. Sat -Sun. I I am- l Opm. 502 7'h Ave SW. Washburn WASHBURN BP TRUCKSTOP Gas. Diesel. & Food Sun -Sat. 5am-11pnm. 7305 LaPorte Rd. Waverly THE PIZZA RANCH Restaurant Sun -Sal. lam-10pn. 2020 \V Bremer Ave Fairbanks exit!, •SCIO 11'1 Denver DL'KES Bar& Grille Mon-Thu.-1put-11pnm. Fri.4pm=and Sat 12p10-2mu. Sun. 12pnrl Opm. 113 S. State St. Dunkertou KWIK STAR Gas, Diesel. & Food Sun -Sat. 5am- I I pm 813 S. Canfield St. Frederika FREDERIKA STEIN & DINE Supper Club & Bar Bar. Thu -Sat. 4pat-2an Dining. Thu -Sal. 5pm- 1093`d St. Janesville JACK'N ARNES Restaurant Tue-Sat. 4pm-1 Opm. Sun -\Ion. Closed 319 'MIain St Plainfield D J's Gas & Diesel Open 24 Flrs. Credit Card Only (No receipt atpumps) Main St. & 2" ST. Tripoli SOMEWHERE ELSE Food & Drink Mon-Tue. 7am-2pnt. Wed -Thu. 7am-8pm. Fri -Sat. 7am-9pm. 206 7d' Ave S\V. Waterloo MOTEL 6 Motel Front desk open 24Hrs. 2343 Logan Ave. Denver RITE SPOT Bar & Restaurant Mon-Thru. 7aln-8:30pm. Fri. 7ant-1 Opm. Sat. 6:3Oan-1 Opm. 107 S. State Sl. Dunkertou CHUCKY'S TOLLGATE Bar Mon -Fri. 3pm-2aut. Sat. 12:00pm-2anm. 204 W. Main St. Gilbertville lei INNING Food & Bar. Mon-Fri.1 lam -tam. t. Sat. 11 am -tan. 9pm. Sun.4:30pm-Close. 110 25th Ave. Waverly McDONALDS RESTAURANT Sun -Thu. 5ant-12pm. Fri -Sat. Open 24 Hrs. 110 20th SL NW. Denver WHISKEY JUNCTION Bar Mon -Sat. 1l am -tan Sun. 2pm-12am. 101 S. Slate St Dunkertou DUNKERTON CO-OP Gas & Diesel Credit Card Only 509 W. Dunkerton St. Gilbertville GILBERTVILLE MINI MART Gas & Food Mon -Fri. 6aut- l Opm. Sat -Sun. 7am-9pm. 115 25th Ave. Janesville Jesup JANESVILLE TAP ICWIIC STAR Bar Gas, Diesel, & Foud Mon -Fri. 1 L:30ant-tam. Open 24 Hrs. Sat. 9:30am-2arn. 841 South St. 404 Main St. Raymond FAMILY INN Food & Drink Sun -Sat. I lam-lOpm. 309 South 35) St. Tripoli TONNE SERVICE Diesel & Gas (Pay inside) Full Service Mon -Sat. Sam -spin. 300 S. Main St. Waterloo HYVEE Food. Gas. & Diesel Sun -Sat. Sam-llpm. Main Store Sun -Sat. 5am-12:30am. 2181 Logan Ave. Waverly ABE DOWNING STEAK HOUSE Restaurant Wed -Sat. 5pnm-9pm. In Americas Best Value Inn Complex. 1901 Heritage Way (Hwy 3 West) independence Shl-doo & ARCTIC CAT 055-500, RTV'e Elbayyy-= Sol"" & Smv1"e GARY'S a f,. . 13rntY CHI,c' Readlyu K\VIIC STAR Gas & Food Sun -Sat. 5amu-11 pm. 410 East 6'h St. Denver PIZZA PALA Restaurant Tue-Thu. 4:30 Fri -Sat. 4:30p1 Sun. 4:30pnt-5 230 S. State Si Frederika COUNTRY Ci Tue-Fri. 7am-2 Fri. 5pm-8pm. Sat. 7am-Ipm ) Sat. 7am-9pm 1 Sun. 7am-1 put. 108 3r0 St. IIorton CLIFF'S PLAC Bar & Grill Mon -Thur. 6aur Fri -Sat. Gam -tat Hwy 188 & V 14 (On The Strip) Jesup CASEY'S Gns & Food Sun. Sam-11pm. Mon -Sat. 5:300111-1 1330 C,d'St. Readhrn THE CENTER INN Bar & Grille Mon -Sat. 4pm-I2am 209 Main St. Tripoli Tripoli KORTBEIN'S TRIPOLI GUPPY's MARKET. Diesel & Gas Gas & Food Deli Snacks & Beverages Moa -Fri. 5an-101 Mon -Sat. Sant-9pm. Sat -Sun. 6anr 101 Sun. 7am-9pm. 100 North Main 5 600 7th Ave SW. Waterloo McDONALD'S RESTAURANT Sun -Thu. Sam-11pm Fri -Sat. Sant-12am. 2222 Logan Ave Waverly FAMILY TABLE Restaurant Tue-Sun. Eau-2pm. Sun. 7:30am-2pm. In Americas Best Value Inn Complex 1901 Heritage Way (Hwy 3 West) Dunkerton FOOS Waver!, AMERICAS HES VALUE INNS & SUITES Front desk open 2 1900 Heritage Wa (Hwy 3 West) Waverly. PREGAME BAR Bar Sun -Sat. 4pnt-2aut In Americas Best Value Inn Comple 1901 Heritage Wa (Hay 3 West)