HomeMy WebLinkAboutRESOLUTION NO. 2022-104RESOLUTION NO. 2022-104
A RESOLUTION APPROVING AN APPLICATION AND AGREEMENT TO
PERFORM WORK WITHIN STATE HIGHWAY RIGHT-OF-WAY FROM LINN
COUNTY FROZEN FEW SNOWMOBILE CLUB
WHEREAS, the Linn County Frozen Few Snowmobile Club has submitted an
Application and Agreement to Perform Work within State Highway Right-of-Way to sign
and groom snowmobile trails along sections of highways during daylight hours only; and
WHEREAS, since some of this work will be within the City of Fairfax, the Iowa
Department of Transportation is requiring the City of Fairfax sign off on this Application
and Agreement; and
WHEREAS, Lynn Miller has reviewed the information and is recommending
approval.
NOW, THEREFORE, BE IT RESOLVED, the City of Fairfax approves the
proposed work and this Application and Agreement between the IDOT and the Linn
County Frozen Few Snowmobile Club.
BE IT FURTHER RESOLVED, by the Fairfax City Council that the Mayor Pro
Tempore is hereby authorized to sign the attached Application and Agreement
BE IT FURTHER RESOLVED, by the Fairfax City Council of the City of
Fairfax, Iowa, that the Mayor Pro Tempore and City Clerk/Treasurer are hereby authorized
and directed to execute said Resolution.
Passed and approved this 15t" day of November, 2022.
AYES: Nurre, Daly, Pacha, Volk, and Wainwright
NAYS: None ` ..
,,'� �
�e
Marianne Wain
ATTEST:
,� � `
' ` � �-�
C` hia Stimsori; City Clerk/Treasurer
_,
�''��
Mayor Pro Tempore
,N: a
Pr�
a, ,
�
_�
.
.� I Uf,� illi r
�fORGEPhRi'h4ETlTIISEt#J4'Y ;:'s`.
�•
AYP! IX:At� P�11lfpMlkltL;OH;CCi}.f
Nimc
Unn County 5T
- - _.�..._ � _. .. _ _
Exp�naicn�CamF:r.ticn patQ
4 i�r2023
Phone Number Fxt �'�
319•2�0•9628
Phone Numba E�. .
lA � i 52406
CompanyName
Unn Cou�ty Frozen Few Snowmn611e Club
�rc.Mt AQdiet
PO Box Sf 2
�r,taa r•.aarazs
markbutachil�gmail.aam
sign and groom enowmobile traits atong aecNons of highways during daytight hours only.
a attached map for locations of traits.
are not permitted to crosa under stete highways through h(ghway cuiveris.
ana shau be IowtM as shaxn onlhe dda�fed plan anached herelo �5ea curcard lawa Depertme� ol7raraportenon utlnry
Accommadat(on Pdlay tw wbmlttel of dmelled Plen requlrcmnr�s.) fy�'�,�.r,,�-��,l��'���s..�.c'�°h'��dEf`u�z�t�s52�$:'�.4�.�.,e�t�.�9
WORK Si7fi LOCATION
The proposed a+ork as describcd abwe is located in Seel�on V9fIoU9 Twp VBdoUS __` _
---- ------ � ----'-
Ranqe Va1iaU4 p�Higt�wayNo ��P pene�aMylowfed Ne fmaesl Ne
�......r ..._.. ._,.__�....
(direcUoN iran Na. .... ..... _.__ _. __. ...... laty. cow2y Ime. «othd land 6no) Wak proposed �s more
spce�6sallylocateAasDc4nglran ?Ue.._ __ . ..,... .._ ... _ IMilepostqland Ne ._.__ M�ghway5tation)
.... ._._...
totVB _,,,„,�.A„w._,_....lMliepostpt�d N0 .......---._....__(Hlphv�aySlitlonloelhe j�pth s�deoYMphwaY
All ptoposed wmk coverod by thls permit shell be at [he appltamt's eMpenw. The eppticant shsll ydmbiase tho lowa
depattment of Transporrotfon tof any materlds ramorodhom Ihe Mghw�y rigta•oi•way daseri0�d as fallows:
Thc tollowing specid requrcmonts shtl{ apply to 11'ds pmoit:
Tha sponsor agrees to hold harmless tha State oi lowa and the lowa Department of Transponatlon
and to indemniiy ihem from any claim, demand or action 6y or on behaH oi eny person or enlity adaing
out of or in astahiishment, construdion, use, meintenance, signing, configuratlon, or exlalence.
This pertnit is lo be in eHect during the period of October 15, 2022 through April 15, 2023. All sig�s
within the Righbof-Way ahall be uniform signs approved by the lowa Depertment of Natural Resources.
Aii signing within the Right•of-Way shall be instafted on or after Odo6er 15, 2022, and be removed by
April 15, 2623. Absolutely no sign can be ettached to hlghway related signs. This permit must be
renewed annually.
APPLICATION AN� AGREEMENT TO PERFOItM WORK
WITNIN STATE HIGHWAY RIGHT-OF-WAY
Wgfnvay
vadaus
R��¢�`nrseo 5i Wenwnt: The e�kx+nmwn hniv��l ari rtas 6�m �n1i ly� u�d 6y Ihe C1c0a�4nves3 of irem6�Paten ts� tledaems�o �pcuval a d�niai c9lhe
appluada� Fra�iae fa pra•mfe aH �nfmnrN�wg wdi rcaus in den,n4 rri uca sispAcaSon u�&s,N��an aeirvMhed �a ryvedu- iMarm�twn ar� ecPres may k�
pto�n(7� d 6o the pubte i�n rn t�u.st
Paqes 9 c(�
1L ..Y.•,, c�inrarl: cc=p:�at �R ,:� ���I I r� P;,�c° � n�.;v. n �;�n„ilcr ieleri�ii In as 1fln Per�;t a����carVi c��"Ces wu��h Ih4 I�a
Uq a..i-�r,f �1 T� 1,>{«fats+n h ��� a° rs?tr c� k s� t;,v G 0.'�t �r:�n!i A�I u,•. Ytyraw,� at.�.+�a�cns ard iPa�e :���z raryu�r�rrre�� as:;u�ti va
;1-C+C ..�'fd�1 (1-��'nSarK} ����M:M`�13! ; T�Fti.-�4\eT,1[eIT:4L1ti' .�=:�t�
{h. tvCCkqP�1
9. 7"h :nsr.ia7-:n slau na�� 1r rx.ry,.qri:5ru: ��ca� r�un-{��. r,c�rdy. ��Ic, astd 9e�era� frarrh�ae �v'�: at�d re�rataa5.. �gu�dCrms z�ntl
rirectnrc-5 dl n:e lavtt Sfalo C,-0mt^;�rcil Cc+rftlss 7n: �h(? Ib,va IJiP:'U",:'It u1 N�hr�! Rcsrvires'S. a� ru'.e5 tlntS rcglAatJdrS (!i �tt£ i#?(�lr0ncsst antl
miy nmM'�a�s, c+ n;�u'al ��r+s ag� caJ��.
2. 'fhu Pareni t�i`�:.r �tr�i, P.ta lu��+ respvns t�e tC+ ��p tvfur� ae3nis�rrc�rNs 41 ihe f�;�:165 w��7 n ihe e�3k� <h�;� h i$Iwfsy ra�hGOf�t�aY rea�d b(
�����1n5}c�n:qri i'n0�i�.7r?rn,�r T..s;�4.n
: k �:�gc.icnitS6;8tedSI.U� a..:�c�rr�ed�lxtPs�r.As�k?s;Fansa.ert-r��rinn��aa��.,a:,e ec,ps!t�netcc;;€mvf�,�s.t�aut�47
z��c it Li�ilull+ d:t�tS ts rae- �� G�,:�� n
,f Tha �� d,°� '� 7 n Il: � nn 1 h . L•5 c, v f 75 pm� d�n [��sF nce �^r�i� tn :�lar � C�;�.��.,5� � �^ ct� v 1 n ar�r y�,
t°c�7 �� d'� C Fs� �<m :nx.e � s ec3:a � � -�� u� r F�: c ac lr+ E a�t ci R P�i H t. � u t� I� et �u ��r e+ ��
rrist r:,�il;: �,s C��c.ta13ss11r�.:tAa�.,]i hn!i� firy' n.,+sl�t.}�� ���r� tr �.�e I.�d.�y_�tri �in�°. 17ft#�+,:".
N2 �t a��a ah� r, ,a .�.r �is Si .. i e! I,.r.r ,2a�f tl u U,Fx t� z M�rr�i _5 ei nrrF t�,ra �.. r�-<:;a .i st m�y 4R .�,.� =cJ Lt an� G- �..tt, C�
� n o� �etc i tcpl attr�l icr c��:�i.e<7 t+�' i..ptit �.cu�'ni
5 F7sicor��ht ir� 111:}•CIIt t�mi �t:f�U .9.�'n 5fr3CY t.-nAl C l�" �"�ri r�agl�'-r�7' 1C ��.fc"IC� Jr- .._s5fl€Ic�i� 1 Ct��e
c�^�,a,esi_ ::a.,!.v�ollim�_m�c ,..,?�d �c��r�s�cr.attn <�+bstcrrrl,v,.^`.c.,,��r�an�cCi_..iearp��_a! iF.,.F��tix�i'�+ mr �.�rc
; tc ;� •��,�- ii,_ �.E c� ��riy �.,�, �:�. �ca n��.ti�ss.7ry �A t� �u�fam� �,.t tt � S1;sn rr r, i+��s � t� ry°r ,;m,s>p ,n�� e, r;!ruc3 ,rs ti U_ as.. ��=,: a
aqn nst �e Pt�m t Ho'd3r.
F�. Co�yxtPuet�oa�.��d fl��ti�Y�rt�tcu
1 ti�_ :l':i:� eAW)tnle[rm 3r;j t_3�+r.n• ��e v1 diC ed, ip At�Gt.:• Pc:r� � dy lti t4i� v,�.,-I >hx �[A� r, i:C.,rJ�ndt �`iq �Ir; t;a+n^,�4
�'�-f�n�*_rSsl4�`fyhe�.,�;;-�e�Ja�:rt�f'a�i.t .- 4, .. ,�, �.��uC� a t�"�.�-,ra�1
'� C� �� G 4� � 3rp �s..r� n i7. irtia st t a�i I IR.-s ��+ r s�t th F r� N���.� 1 c�an an casc �rllrcri ir A�^,g�c
t£ t ri I n.�-s,i i TI I.FPtet^ N a �� � i^i � I I iX �a 4(iv F�t ^ri ° H rt .gtfi a1.ae t511 r"an� _ 6�trtt t c r J i! c.
tI.F� � dh�aue,�[.4.r-?b .,t�4.w_ti..1_va.. 7.:a,.lct7e��e.iyn�.e..se��v�s°nr.� t.Fa�m�.._.,nfrc.miY�76an��C..,..t $_.�CaJa
��� c � Ci7 Ic dC,lv .Sd��a� +rrrra ;n
3 A�4��GdU:�'sF�a dCcrm h C aa:3ab crtm.� �h 2a�ta...lr 1rax3m�n:�I�+t�U� :��: crip. .nnr
d Gi.`.1..s..nt��64en.�.��tstaria,lnLtnl�.r`Su.�E.�.«4 S; -.�t:3�iwf.l� tG'ca+t�. e.ln.,;,5o;�t9_�reFaStRCau59r*tttil_ t;dlQiciKf
StlC�(S�lt,.x16( 3��;:C+1S71lih'a.l`j.
� tra�f prvtc� �;n ..ir,� m�^ i � t� �n ac-c�dxr�e �9� PU�I VI o! Ilsa c.dr#�I Aiai,7 cn UrsE-�rer� irxF.-� Ctrlr tJr^.rt:+c Sf t=. ��d
Nia r,� °� ih e���wrilsiex� 6or� � r. �, t��.?ty� �ls+laasrrr 4 :° # 2 �'�-.wannq .�t:t^ nJchr.nn_' r�d t,a�
r dc! uli u;ir, �» p�c��+r , a Vi^ r;a., rcrn - mC. r.�.� E,��r �.� c�, ral,n,��sc r� . r� .{ sr,;,�9� P� of ��+, ap� s,s! 6hq U4Pa�r,i�.� 7C
xxx sc�ns s�.��l .�. .�t,ha C c�cr,�.} � a� c, rc= s;.�;.,+ at c n F-ar-:
Y34fQ:fr'�i'S?'Pr.�l.grS9`�?4?'.�Ad�'RL�'��k . 4�ltttt?
F, Tn ����.�7.t �� cUrrlmu ii��a. t d� .�� Itttfl�lt�iney I.tih�t� n�]_ha h� ��n��%'���. t�rtal v ar��nE'd
t„..,!rv_��.i�C.,���_h�].nrt�.,�t.v_J��c,.....h,fti�.��M1ty.r��`s(wld2 i.ntl:,�dl+�nit�n.y Jf�1P��tni�_,d�cttd�.�G.laimd.i�aiil�
��.Ftre�tl �a tict� crqns r,rn;dt :�i, nr:{ a.i =-t�7a !� xr.y cU � r.Jc�yound t;.; i�s �w r,g r.s1a'�8tcr rr.a= b� �r�paam! ,�! It��. e rtt 15�u�'s
oa{�nsc
7.1L• pC��r,e' :i� the hgRn�sy n�il�4va�y 9l�3 5� .. A'�!$� i0i C'ass 2 al�ra•� � sl a1 fane� vdr�n erpr s] 4n Ir�(f-c or c�nsiruc€an t 3 rm �I.
6. As por Po'1� Seci�pzs 1FSAl4} �nc�rs� ot s5a.a,,t' 't �+.t c'ewr zCn2 � P ahC,Hi Vdh� nol m acl:.y'....:^. vcdt��s. �.�qu{'�ricnl ��7rs.tli v�; ;�ra �
r�ir be p�ticei or st��d s�3hri �7e c�ear ta�e ot m24r�i.
9 Un�ss �,=�e'.4�.y ra�d �n 5pcta: R!v2vremcrit� �:�ts�m. �t� v�ra �:e.Pcumed va�hn tl� rgm�nl�ux� sle�n bc �esdnpeat va 3A ornuivs ali�s
s�rr�� fa ?fi r at �:'�,s t,.e�,^. q,.^.rn;
tU. Fedcsla's sfl5o bt� �acsaiNmn IF.neP�nolilm ng?a�aav�zy �rte
tt. !t� abo�.�a anJ pu�ow grrrJR1 3�r �:ra.� :x i�tl�ssa�, Uy�r&n�, ctr��.�s. �a�3ses. �1�.) €�ia` 6v n.�;Qet4 u,it� P�gh �.•_�-fy At�ar� 7mS s��t�.
iYiemnr�5umha5d��ro4useae�v9(r �K,a�.frr:CbS4,xiL=�L^snRaa��yam.t�Wr�zmaybanxem�ad5rfhdt�rartrnm�aEn,rcra�
C.. Llu61tL4Y
t To tt x:r i�ra�-s l�f i �l P^�r f H 1�;�� 1 crnr;a tS I t f trf B. j n 4�^^pa�l nl I��m� i,mi,l:��y e�9an c:�'v'P{
a. .oy tut di u� dr,an, C�,r, f us a� r�a � r�n.,� tr.sc, r�ri f t sU�. U,r ,�r: �s .t��tk*�. u�i cs!;,ss Pcan i HS�rs t�Q va� Y�s
�, �?az:,�t i9 r,1,+nr�y, dt entl. rai:� I�?'9 n.� ��,�y'is�[_ ta ..a[-3.�ti_ �� V�c [lcjst�3 en1 s�(.�-c,,t.¢ 4:irr �arJ aE;aa:,r prr�4�s. Ran sr]
Co t 't�t+t•:�.: 'rCJlu'v! 7f 1r{al:f
2 The Pesm-t M� i3 r sfu �r� .� s�.3 �.� t, � cm:,i,5 ['-° . St�� ut �c:�J 19 h)�nnG5 iU1tl f,Kiip�er{ees I•�.m ,y�r� 1n!1 3`. c�u5� at a�:l�;ali. su95 31
�tnv ar ri eqwty (c <�f. �! •nn�ci. c'�9m c< t�=�iraJs. ar� Ncm aTiy:�r;j g'ab71p ��t6 e#�ti2s(t a) �s3t7t5asset r.a'strE�. 3r�s�ng fNii nl cu :n
wnnctitr�nwth Itti> �mtNaJ r�;�0o!iyc ':€+�Ctctfh (wlY�h���rn3r
3 5�hrs S'�ate al Icnaa �n!i the l7eRaNm��l x�suvsw r� i�cl�n�' �b:.y 4or dr�n��2s m tlua F�rehi t�*s��rs g�a��ty cr�assi�cf by ariy c��t�ri�[aar c�
m7 e�lcsi�W r.parat��vi9 � a�J �zgi5}s�ay �{ tha Ix�iS��rs nea rrtrt ��qbti �n aanrd��c� wSh ih� flCrcn@.
s 71�e at�uu ol Icni ��c+� E� t"i c+ L�. :at fo c c�n� es u[p t PeR i Ha �+ � uzc ir � c C�n� v N n�hc�Jr
��t e" �1ta�l�r� n�F-�.�ao4t � �u�n �1 .c� �i (a �c, tnr t��aFnh�ca�;na oiu�ea t,tnc.iis�ren l.c�tcr
c r.e:w �;. 5�s atr ., r: t.;e 9.1t , s. aqca�r arn3 � mC�o�e.,. ��. isf e� i r�c°:<c�iat a u t-c9 r.a� r�e !� =�a ct�r �y�+�i u� i.. arJ a rti
ca��r� wv suri� dalai.r� er.�r� f� uass N �xoLts nr t�usness. �r�3r��i, sp�a�. sonset�+ea�ta� ar �nc�rScni�i tlam,:c�s
n. P1a¢t�c�9ipn
t Yho(�ermtko'�Sr�sres�s:l�ulnrt�u�tad�.rn�lovsa�nn�Ca11{9�8fMb•d�E•B3�j:aeuiee4a�siitwasS��Panota!�ur�€aq�ouneivfl��g�esksr4y.e+r��
i��if�..,,.,;L_fc.Ebriat:ficfl.l-r,fW.[_v�`nr� „„M�i,",Ic'lilt,�.,,r:�?tlnl mj.l�.vfe�.�.�iN�31;.'t:�3 ,xiJtGfl!.YtikryGl�t�*vIL"5�r.i ,j'._�i:i;:3
t t-rtacl't eo�osdti.w
« TI Ftlt,+! H tl 77�Ge ta t,t` l�Pa E�f �..,d�P-�1! t6AI h It �" ��� �� `!tt�t N�art �:r,i �'t� es G S� t�C7*� �:r1fl�
�a,.t�»,�r.ccanll�l�+�i:�ir�irl..sR•.Slt! � stt�kcros7at�lk ,aL`�'i7c;atl.e�F[��tts•�h� nann;ytinnrnFh�3
�. 511 t�01NIW0011 In ,s:„it,17� s mitt IGlra 1�93 at,t�'� ::1 ti r9, f'lf.,.+�7+�3 uf ;1�N31(Wq t101 (fi351fpG1 01 c103a p nt7'Y St4�i;isq, 9 �i'•";5'-y
I f S}�rl-i? rtSisrt�:p� a� �'�NC{t lsYv�+tb9ulpalptmnsCplo11h01mv�OQ7��ai�inmrr�ry-r;.•�+o�te�..l?..-ta ttr�,g;z
^r�r .:,.acayti act4�cr�crn� rt rr t�nN ���drnt{° �'�s.�r��e-�y 7���;a .�i ����ODT���ren=.nrn�urir�an4c� Uala!hs
"f5r�„ini;nlCen. C _alt;�,liv�p .,��:.�rs E st�Cl n�:ry,. .��m.xx..,Yit7d3ta.r„+.,br;.. , .2erEd.
�s�:`���wr�r�3tii�.�abC�t�i��b.,�.�tS v��5�9 s��'a����a�tsr� �4
�Eita�nall�cs
� t mra�ta �(y� as �o catr,n3 0! u4.o[y fso.l:rK tha! rnosi n`�Ors ticn to h�iar�y�uo�cis vnt$�rr.QrG3�n s4�s�t�uUi'e.i2'Gns dt3t ��:hdc6i
•rri. �9i,rlacato�is�r�Anr.:t�taisdueian�rs&aFoprcj�ls�
f����5a tAsii�lci ti10 C`r`ey>a�i�w�kTiis U;541�`t� �ngnf2e.17�j "�£HnF�i 16t'hrro3n (C`QT14N m6rE: 91tt�tr+L51t�'1 Cdt �,try Aarr�tr40 rE�.yu�rCHik tt15 0�'v.9Y Ift&
(a��r.vng 1 nt: hi�9'Ai�s�c�.",mr��.,l���`��""���a�`s'?2,FE�!
Papezar] PCrtnitNumbH:. ....._ .
_.__.__._.... __-
Appiicar¢ Sigretu�e ond Ageoement
ih� unJc•ssignest ha�r rrad tha :!:ps�lat:r,ns at thrs perm�t a;7rc��mrm a6 statcd �s vn41 n: a3iachmcntszrh�tih may be �m:luc{cU and by
c;gr-np �hi;,�pf lemi� ��toe ta aoidc dy a4 �z7�utstrr.n•. arcJ �a bamrytelett�e �x�+k ac prcgc:r� fn �ompranr.c �h Rh iha st.pulnt�cn: and
atf9cl+?nRn4�: w h:n cvte yexr hnm thc da�a �t�pa�imenl apptcn��f ir, reccr.cd fu- z�n;J teqwo:i Fai.:,.�re 4n fh� P�� o} 9ha �ryp'scant io
UStCC b/lYttr SSip11IA7i(,N15OI IP t4n'iII�Ci 1M� V.OtM QC5#�•fI d5 511f1{1`:31f,9 AiIO WiIHEn IMe i+mc hame »'at,rd sfiati r�drrlh�s a,ryrcement aid
reqao�' nuEl nnd sroid Thc uizdormyned ai� , gre�s la �.���s liamdcs, Ili4 Sla!v ut firar.a and !ha fvrra DeF�+lment ot iran�anatson
Sram sny d.rmapr a lossc•. 1hn1 may Cc wstmooU by .�nX t�ar^on ce pe�cAm crr atie:uunt ti! itic e5ntl.ueara .hnd reUwroti*enlz W Ih!a
agrcement
�.MBIkBUbChI^�FGsI.l.tl.4rst�AtartQrT�X�tAppltantS�gn�urc(N,1P{�vjl�rn)� , � IDa�o �al7�l�l1��
� �;�,�Gr U �►�� �- � �
'��. rMaA Address j
CITY ACTIOti (IF PftOPOSED VLC)RK IS WITriIN AN INCORPOHATEUCRV, CfTYACTtON 19 REQUIRED)
'The undervgned cdy )ans m lhe graNs emhodicd m thc ahove pdmd executed by Ihe laea Depatlment o} Tronspottallon vn
crondmon that ali otihc covenanis and undMa6ings Iheran runninp to Ihc 1nv� Depahmcnt of Yr+nspatatron shaN inu+e lo Ihe benefrt
ot lhe unticr9gned s�ly antl recommmds aeUon on said pamd apphcalron as nefcd 6elav by Ihe dNcqated aly o}fieial'
��� RocammenUAppoval �� n DoNo�FecommendAppovd �] NoiroRequvea
P:meNamc.} � �`��i. ... � . U �'RWnar�.edOMna1}orlheCilyM
'. cMatl Address �t � ,n �r_ �
' 7-Gc� i t'< � cs3 �'i�C�" r�C A l (�Cu � < e � ,_____n__,-------- .,_.__ __—
COUNTY ACTION pF PROPOSED WORK CROSSHS COUNTY RIGHT-OFWAY, COUNTY ACTION IS REOUIRED)
'ihe undervgned caumy �wn� m Ihe grants cmbod�ad in the a6we pertnrt ex�tr,te6 by the lor,m Oaputmont ot TranspatNion m
condmon �h�t all of ihe r.a«nanls an0 uadMs�nqs ihkran runrvng to Ihe lovn OG�snrnent ot TrxnxpcA��Unn 2��st+in�irt ta ihc tfrnet6
o11ho undersigned counly nnd recommcnds acoon on saW perm0 appl¢anon as nolad beiow 6ythe ddtgated cwnly eflSaal"
i�' Re[omtn��WAppro�ai U OoNalRaeortvnendApproval u ��orroH�Wuod
.. ___'__ �_._ ._.. . . w__ .,..._ _..� . ...._.. __....
'.fiandvmttrn S�gnalurc � Trtle Pa�e..
� �_ l
Typc a Pont Namc , Aulhonted OfKdal lar thc County of
FEOERAI HIGHWAY ADMtN16TRA710N hCTION
(DEPARTMENT REPRESENTATNE W1lL REVIEWTNE REDUESTAND OBTAIN FHWAACTION, NMEN NECESSARY�
��. Huca v ciRd /V 1 uval � Po tlm pcconw�ixaui Ar�prov:� [� Norw Nw{uual
.. ..�_�.. _ ....—__._.�.. _ .< ._.__, ��.��... -.a. —
��, Auu�or¢ed FHWA Repre.emauva Synmurc TQa�"� ��.
., - -- _ .. ___..------ -___.._ . ...--________—_____,.._ .. 1 _-_....----__..__..;
pEPARTMENT OF TRIW SPOR TASION FlNAL ACTION
-- � --- ' _._ ... __ , . ;
L� A7�phctlionApprowd r] Appllcmion0ened ',PCrmdNumber
AulhaiRed Highway Chs4nct Represenhhw ��&gnalurc v�— ��� C3atc
rMan Address
�Iw+adolus
C"i".� :sif:A !.'.p• %�
tvi=.J�flts4GL r'�^nt�� i!>M�d.v1
Lacal DOT CoMaH Per,on (Typc oe PnM Name)
Beau Weimar, Highway Matatenance Supervisor for UrbaneMdepandence
Slreet Address C�yRP"'�
54551Grkwood B1vd. Sw Cedar F
rAtau addres: � �
papc 3 oI7
Pttm4 NumCcr
�� CERTIFICATE OE LIABILITY INSURANCE °"�, �a°�"n
__
1`HI5 C@RTIFICATE 1$ {SSUEO AS A MATfER OF INFORIAATiON ONLY AND CONFBR3 NO WGNT8 UPOH THE CERTIFICATE NOLDER. THlS
CERTIFICATE DOEB NOT AFFIRMA7IVELY OR NEGA71VE6Y AMEND, EXTEND OR ALTER 7HE COVERAOE AFFOR�EO BY THE PO�ICIES
6ELOW. 7HIS CERT1FiCATE OK INSURANCE OOE3 NOT C�NSi1TUTE A CONTRACT BETWEEN TNE I$SUINO INSURER(S), AUTHORIZEO
REPRE9EtiTATNE OFt PROpUCE(i, AND 7HE CERTiFtCATE HOLDER.
IMPORTANT: if the ceA111cete holdar Is an AaDiTtONAL IN8URED, tho polky�los) must have ADD1710NAL INSUREI; provietone or 6e endorood.
H SUBROGA71oH IS WAIVED, aubJect W tha Wrms and condlUane ot the polley, csRaln polieles may requlre an endoroemen4 A atatemer�t on
ehis eactiticata doss not oontar riahts to ttre carNtiwte hotder In ileu of auah endorsemenqs)_._�
vnooucrn
V� V Insurance Agency Inc
Po Box 158
583-547-2448
Creeco IA 52138 ���; Weat Bend Mutual Ineurance Co. ; �6350
-- ------- ----- �- -- _ ..v, _� __— ___ __— .�
w'u`�a FR02EN FEVIISN01fUMOB1LE CLUB ""°�g$`------- - - -- ""�
PO BOX 612 ��nuaeaa: -- ------------ ��____
CEDAR RAPIDS IA 524U6 w°un�R.Q:��_� "�_
;
_--- .�roa � .._.
SNOULD AfiY OF THE A80VE DEBCRtB60 PC7LFCIES BE CANCEU.ED BEPQRE
TNE EXPIRAt10N DAT6 'iHEREOF, N0710E WILI 88 OELNEREtl iN
ACCORDANGE Wi1li THE POLICY PROYISION3.
� �
Q 1888-2d'18 ACORD CqRP4RATlON. All rlghts
ACORD 25 (20t5103) The ACORn name and logo are reglstered marks of ACORD
�r�zen �ew Sn�►wr�a��le Gi�tb
��'
GM
�
,r✓ �. _� N4� � &
7rsil t4�a iar Linn County,.1A
s
;
a
�
�
9
�' ��� � a : � ^ _ �.
i it€�
� � !'i�
� �i ;
i °1;
t
<
i �
i ��� t�'�
r �i(, (�j
�1
i i�� r (tc
� `�-- Ef ------__
fi' j
�
�
�
�"wz
I-Y.�•.i}r<n'.c:�:lirrt IJ:ti'.1Sit0'.:�;•�ith5 itiC(;����.y Sr»t�n�rNP•�� Ax•Xd+ •.��tt