Permit Number (Provided by Public Works) Project
WHEREAS, the County believes it is in the interest of the citizens of Montgomery County, Kansas to permit certain work or projects to be performed upon County rights of way, and WHEREAS, the Owner and/or Agent requests permission and authority from the County to perform certain work described as follows:
Description of Project Right of Way Location
involving County Highway rights of way in, upon or along:
County Road / Mile Number / Sec / Twp / Range Agreement Information
This Agreement, made and entered into the date below, by and between the Board of County Commissioners of Montgomery County, Kansas (referred to as "COUNTY") and the person listed below (referred to as "OWNER") and/or the person listed below as the Agent, Lessee, or Contractor of the Owner (referred to as "AGENT").
Owner Phone Agent Phone Petitioner
The Owner and Agent are hereinafter referred to collectively as the "Petitioner", where both are applicable, otherwise Petitioner shall refer to Owner.
Terms and Conditions
NOW THEREFORE, in consideration of the permission granted hereunder by the County to utilize County rights of way in the manner described above, the Petitioner agrees to the following terms and conditions.
Petitioner shall furnish 1 set of comprehensive plans or sketches, 8 1/2” x 11” or larger, of the proposed work. Plans for utility installation must include a description of the size, type and method of installation for the proposed facilities to be located within the highway rights of way, and adequate sketches to indicate the location of the proposed installation with respect to the traveled way of the highway.
Materials and Method
The Petitioner shall furnish all materials, do all work and pay all costs for the work described on this Permit. All utility installations shall comply with the conditions and requirements of the attached "Standards for Installation of Underground Utilities Upon Public Rights Of Way of Montgomery County".
Obstruction of Traffic
Petitioner agrees that highway traffic will be free of interference unless specifically provided for as a part of this permit. Traffic protection and signing shall be in accordance with the Manual on Uniform traffic Control Devices, current edition.
Right of Way
Petitioner agrees to restore said right of way to the condition existing prior to approval of the work described on the permit.
All utility installations shall be maintained or caused to be maintained by the Owner.
Fees for Inspection of Construction
The Petitioner agrees to deposit with the Montgomery County Public Works Department, the inspection fees shown on the Schedule For Fees and Deposits, attached hereto and made a part thereof, prior to approval of the Permit by the COUNTY.
Bond (select one of the two options) Bond Information
Petitioner agrees, that when a check or bond is filed pursuant to the option selected above, said check or bond will be forfeited or called if Petitioner fails or refuses to perform work required under this Permit to the satisfaction of the County.
Completion of Work
All work, including right of way restoration shall be completed within stated number of calendar days of Approval Date, otherwise this Permit is null and void. The County or it’s duly authorized representative may grant an extension of time provided the request is submitted in writing and states the reason for delay in completing the work.
Initiation of Work
Petitioner agrees to notify the Montgomery County Public Works Department or it’s duly authorized representative before work is initiated and again when the work is completed.
Completion of Work
All work, including right of way restoration shall be completed within the specified number calendar days (below) of Approval Date, otherwise this Permit is null and void. The County or it’s duly authorized representative may grant an extension of time provided the request is submitted in writing and states the reason for delay in completing the work.
Completion of Work Number of Calendar Days Liability
The Petitioner, his successor, or assigns shall assume all risk and liability for accidents and damages that may occur to persons or property on account of this work, and shall indemnify and hold the COUNTY harmless from any and all costs, liabilities, expenses, suits, judgments or damages to persons or property or claims of any nature whatsoever arising out of or in connection with this permit or the operation and performance thereunder by the Petitioner, his agents, employees or sub contractors. In this regard, it is further understood and agreed that the Petitioner shall obtain insurance coverage as is required by the COUNTY.
The Petitioner shall carry liability insurance to protect the public from injuries by reason of the carrying on of the work to which this Permit applies and to protect the COUNTY from all liability on account of injuries to workmen, as provided by law, and to protect the COUNTY from all liabilities to any person for damages sustained by reason of carrying on of this work to which this Permit applies.
Certificate of Insurance
The Petitioner agrees, that liability insurance is required pursuant to Liability Insurance paragraph above, to file with the Montgomery County Public Works Department prior to the granting of this Permit, "Certificate of Insurance" or other evidence to show that he carries Workman’s Compensation Insurance, Employer's Liability insurance, Standard Form Public Liability and Property Damage Insurance Comprehensive Automobile Owned, Nonowned and Hired insurance as recognized by the Commissioner of Insurance of the State Of Kansas. The Standard Form Comprehensive Public Liability and Property Damage Insurance shall carry the following coverage’s: Minimum Coverage A "Bodily Injury" each person $250,000; each accident $500,000; Coverage B "Property Damage" each accident $250,000; policy aggregate $500,000. The Comprehensive Automobile Owned, Nonowned and Hired Insurance shall carry the following coverage’s; Minimum Coverage A "Bodily Injury" each person $250,000; each accident $500,000; Coverage B "Property Damage" $250,000.
Cancellation of Insurance
Certificate of Insurance shall include a clause requiring the insurer to notify the Montgomery County Public Works Department thirty (30) days in advance of any cancellation or change in insurance contracts.
Maintained In Force
Insurance as herein required shall be maintained in force until final release of the Petitioner by the County from all obligations under the terms of this Permit. Said insurance shall cover claims for such length of time as said claims are permitted by law.
In the event the COUNTY deems it necessary or proper to make any alteration or improvement along or upon the County Road right of way which is subject to this Permit, the Petitioner agrees to hold the COUNTY harmless for any and all damage or injury to said Petitioner’s construction, whether finished or unfinished, as well as damage or injury to the Petitioner’s equipment, materials, employees, agents or contractees, and Petitioner further agrees that within a reasonable time after written notice from the County and without cost or expense to the County, that he will alter, change the location of, or move his construction or work.
Construction or Other Work
Petitioner agrees that the work approved on this Permit will be conducted in such a manner as not to interfere with construction or other work being performed by the COUNTY or its' contractors in the vicinity of the Petitioner’s work or project.
Standards of Installation of Underground Utilities upon Public Right of Way of Montgomery County
All cable, pipeline, or tile lines placed parallel to the roadway shall be placed as close to the rights-of-way line as possible (i.e., in the ditch bottom, blackslope of the ditch, or outside the ditch area) and shall be placed a minimum of 24 inches below the surface of any road ditch bottom, slope or ungraded portion of the rights-of-way, unless prior approval is granted by the county engineer.
All lines crossing the rights-of-way, are to be installed perpendicular to the roadway alignment to the extent feasible and practicable, shall be placed a minimum of 24 inches below the surface of any road ditch bottom, slope or ungraded portion of the rights-of-way. Crossings on bituminous or concrete road surfaces shall be by boring and/or jacking through the subgrade. Open trenching will be allowed on unpaved roads with the approval of the Montgomery County Public Works Department. All trenches shall be back filled, compacted, and surfacing materials shall be placed as specified by Montgomery County. Pipeline crossings having an inside diameter of more than 2 inches shall be placed in casings. The casing shall extend 2 feet beyond each edge of the surfaced roadway and be of sufficient strength to accommodate traffic loading.
Vents, Risers, and Markers
All vents, risers, and markers shall be placed on the rights-of-way line and marked with reflective coating, unless written approval for an alternate location is granted by the Montgomery County Public Department or it's designee.
Before any line is attached to a bridge, a detailed drawing must be submitted to the Montgomery County Public Works Department for review and approval.
Traffic is to be carried through construction unless prior approval is granted by the Montgomery County Public Works Department.
Traffic Control Devices
Maintenance of traffic control devices and safety devices shall be the responsibility of the contractor and owner at all times during which construction is in progress.
All construction shall be accomplished to minimize damage to roadways.
All Lines on the public rights-of-way shall be buried, except at approved structure locations and except public utility overhead lines.
Schedule of Fees and Deposits for Users of County Right-of-Way
The payment for Fees and Deposits must be made in two separate checks.
Fees $125 / $125 for Each Mile of Right-of-Way
$125 for Boring, Tunneling, or Jacking through roadbed and then an additional $125 PER MILE for each mile of right-of-way.
Deposits - Based on Size and Additional Deposit for Each Mile of Right-of-Way
$250 Deposit - Direct burial - Boring, plowing, or trenching each mile of right-of-way
Trenching, Boring, Tunneling, or Jacking through roadbed Bridge Attachments
Amount determined by Public Works for each foot of installation on bridge.
Deposits for Special or Unusual activities will be established by the County.
A deposit will not be required from non-profit Governmental Units doing work with their own forces.
The total amount of bond will be determined by the county based on proposed work.
Acceptance of Bond
Parties to sign and date below.
Owner Signature & Date Agent/Lessee/Contractor Signature & Date Permit Approval Date Montgomery County Public Works Signature Montgomery County Board of Commissioners Signature