HomeMy WebLinkAboutFive Star Snow Trails-9/21/2015 (2)FIVE STAR SNOW TRAILS
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September 15, 2015
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Thank you for your assistance with this matter.
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POLICY # 4D78753-15
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TS: $1,000,000 OCC
DATE ISSUED: 10/10/14
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SPORTATION
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IOWA DEPA
Application to perform work within State Highway Right -of -Way
STAR SNOW TRAILS ASSOCIATION
Snowmobile Trail and Crossing Locations -Black Hawk County
Crossing of US 218 in Waterloo at Marigold Dr, milepost 176.84.
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Crossing of US 218 at East Schrock Road, milepost 173.74.
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Black Hawk County-2015.docx
SPORTATION
IOWA DEPART
Application to perform work within State Highway Right -of -Way
STAR SNOW TRAILS ASSOCIATION (Cont'd)
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Snowmobile Trail and Crossing Locations -Black Hawk County (Cont'd)
* Denotes changes from 2014 by moving the trail to the east ditch only.
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# Denotes change from 2014 by deleting the location due to
Balance of items are the same as shown on the 2014 application.
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Black Hawk County-2015.docx
0 None Required
0 Do Not Recommend Approval
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Authorized Official for the City of
WATERLOO
\
Type or Print Name 'J
£encs- G. C'oa-k
G
DATE (MM/DDW YYY)
09/30/2014
THIS CERTIFICATE 1S 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).
CONTACT
NAME:
---(563) 547-2161 FAx
imc. o,, XO: (AA/C, No)_ (563) 547-2046
A'DRADDRESS: insurance@vandvins.com
INSURER(S) AFFORDING COVERAGE NAICm
INSURERA:Dakota Fire Insurance Company , 10863
INSURERB: _
INSURER C:
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I COMBINED SINGLE LIMIT I $
a accident)
/ / BODILY INJURY (Per pro) $
/ / BODILY INJURY (Per accident) $
PROPERTY DAMAGE --y --- --- — —
/ / Per
accident) _.__ $ __..._
/ / I $
/ / EACH OCCURRENCE i$
/ / AGGREGATE I$
/ / i I$
INSURER D:.
INSURER E
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Ac R15® CERTIFICATE OF LIABILITY INSURANCE
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PRODUCER
V & V Insurance Agency, Inc
PO Box 159
103 Bth St E
Cresco IA 52136 -
INSURED SNO HAWKS INC.
1314 WASHINGTON ST
CEDAR FALLS IA 50613 -
REVISION NUMBER:
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COVERAGES
THIS I5 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATEQ,.., .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 TrIE TERMSH
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EXP 1 LIMITS
(MM)DD/YYYY)
Ig_ 1,000,000j
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a accident)
/ / BODILY INJURY (Per pro) $
/ / BODILY INJURY (Per accident) $
PROPERTY DAMAGE --y --- --- — —
/ / Per
accident) _.__ $ __..._
/ / I $
/ / EACH OCCURRENCE i$
/ / AGGREGATE I$
/ / i I$
/ / PER OTH-
_ STATUTE!. ER ._._._. ... __..—_..._
/ / 'ii, E.L EACH ACCIDENT I $
/ / E.L. DISEASE- EA EMPLOYE $ _____ ______
/ / E.L DISEASE - POLICY LIMIT j $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 707, 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.
/ / EACH OCCURRENCE
10/01/2015 PREMISES
RENTED �—
PREMISES (Ea occurrence)
/ / L MED EXP (Any one person)
/ / I PERSONAL 8 ADV INJURY
/ / GENERAL AGGREGATE
/ / I PRODUCTS - COMP/OP AGG 1i
/ /
INSR IADDLISUBRI T POLICY EFF
LTR. TYPE OF INSURANCE INSDJfND POLICY NUMBER I(MM/DD/YYYY)I
A i X i COMMERCIAL GENERAL LIABILITY 1 ,i / / I
_ X I CLAIMS -MADE i,J OCCUR i - 1 4D78753 10/01/2014
1•
/ /
i
I GEN'L AGGREGATE LIMIT APPLIES PER: / /
_� POLICY r__J JECT L LOC / /
I OTHER: : / /
: AUTOMOBILE LIABILITY / /
ANY AUTO / /
ALL OWNED i_ ' SCHEDULED i / /
L. AUTOS L_....! AUTOS
I _ I HIRED AUTOSI. : NON -OWNED ( / /
AUTOS
I I I / /
OCCUR
/ /
CLAIMS -MADE_ I / /
WORKERS COMPENSATION / /
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE / /
OFFICERJMEMBER EXCLUDED? I 1 N / A I _
I (Mandatory in NH) —' / /
III yes, describe under
DESCRIPTION OF OPERATIONS below ! 1 / /
S.,i",
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
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County
Black Hawk
Expiration/Completion Date
04/15/16
AVAILABLE UPON REQUEST)
Phone Number Ext.
319-610-1171
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Street Address City/Town State ZIP Code
2202 Minnetonka Drive Cedar Falls IA 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 !DOT forces.
All signs placed on the ROW by the applicant shall be removed by the applicant.
Phone Number
319-610-1171
Permit Number Highway Number
(SEE ATTACHED LISTING)
DOT Project Number
N/A
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Last Name
French
Company Name
Five Star Snow Trails, Inc
Middle
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First Name
Tony
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WORK SITE LOCATION
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The proposed work as described above is located in Section
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generally located
on Highway No.
Range (SEE ATTACHED LISTING)
(city, county line, or other land line). Work proposed is more
(direction) from
(Highway Station)
(Milepost #) and
specifically located as being from
side of highway.
(Highway Station) on the
(Milepost #) and
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(DOT Final Action and Agreements on next page)
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