Property Relocation Permit

PROPERTY RELOCATION PERMIT

Recitals

WHEREAS, Applicant Name: (hereinafter "Permittee") seeks authorization to relocate a structure or other property within the jurisdiction described below; and

WHEREAS, Issuing Authority: (hereinafter "Authority") is empowered to grant permits and to impose conditions to protect public health, safety and infrastructure.

NOW, THEREFORE, the Authority grants this Property Relocation Permit subject to the terms and conditions set forth in this document and attachments incorporated herein.

Permit Information

Scope of Work

Describe the work to be performed, including structure type, dimensions, relocation route, temporary staging areas, and any proposed road or sidewalk closures.

Schedule and Dates

Proposed Start Date:   Proposed End Date:

Payment Terms

Permit Fee Amount:

Late Fee:

Term and Termination

Permit Effective Date:   Permit Expiration Date:

Authority may suspend or revoke this permit for failure to comply with permit conditions, failure to maintain required insurance or bonds, or conduct that endangers public safety. Termination by either party requires written notice delivered at least days prior to the proposed effective termination date.

Insurance, Bonds and Security

Applicant shall maintain commercial general liability insurance with minimum limits of per occurrence and shall provide a certificate of insurance naming the Authority as additional insured where required.

Permit Conditions

Applicant must obtain separate permits for any street, sidewalk, or utility work; comply with traffic control and public notification requirements; protect existing utilities; and restore public and private property to pre-relocation condition to the satisfaction of the Authority.

Road closure required:    Utility disconnection required:

Inspections and Compliance

The Authority will schedule inspections at key milestones including pre-move inspection, route clearance, and final restoration. Applicant shall notify the Authority at least hours prior to each required inspection.

Indemnification and Liability

Applicant agrees to indemnify, defend and hold harmless the Authority, its officers, employees and agents from and against any and all claims, liabilities, losses, damages, costs and expenses, including reasonable attorneys' fees, arising out of or resulting from the relocation work, except to the extent caused by the negligent acts or willful misconduct of the Authority.

Confidentiality

To the extent Applicant furnishes plans or technical data marked confidential, the Authority will use reasonable efforts to maintain confidentiality as permitted by law. Applicant acknowledges that the Authority may be required by law to disclose certain information and that public disclosure requirements govern permit records.

Applicant hereby acknowledges this confidentiality provision:

Governing Law; Entire Agreement

This Permit shall be governed by and construed in accordance with the laws of the State of . This Permit, including any approved plans or conditions incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior negotiations and agreements.

Certifications and Attachments

The Applicant certifies under penalty of perjury that the information provided in this application and attachments is true and complete, that required insurance and bonds will be maintained, and that work will conform to all applicable laws and permit conditions.

Site Plan:    Traffic Control Plan:    Insurance Certificate:    Bond Documentation:

Administrative Use

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