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Application Date
Applicant
Address
Number
Emergency Contact
Emergency Contact Number
Name
License No.
Location and Address of Work
If other, please explain
Description of Work
NOTE: Utilities Division must be notified at 813-749.1226, forty-eight (48) hours prior to excavation for utility line locations.
Starting Date
Completion Date
Signature of Applicant or Authorized Agent
Date
Size of Culvert if Required
Length of Culvert if Required
Material of Culvert if Required
Special Conditions to be Approved by Senior Engineering Tech
Date Approved
2. CONTRACTOR now occupies and desires to occupy and utilize a portion of the public right-of-way and easements. CONTRACTOR shall attach hereto the utility plan sheets on which shall be shown the proposed system facilities to be constructed. Compliance with the locations and conditions shown on said plans shall be a requirement for active validity status of the Authorization. Construction of facilities not in compliance with the terms and conditions of the Authorization shall render the Authorization null and void.
4. CONTRACTOR shall determine and demonstrate to the CITY OF OLDSMAR that right-of-way and easements are available to install the CONTRACTOR facilities. CONTRACTOR shall obtain a legally sufficient easement or license from the present owner (s) of the fee simple title as required where public right-of-way and easements are insufficient for CONTRACTOR installation. CONTRACTOR shall furnish to the CITY OF OLDSMAR a copy of each such easement or license prior to CONTRACTOR commencing initial activities within the easement.
6. CONTRACTOR shall first obtain property authority, approval and/or authorization from all other appropriate governmental body or public agency having jurisdiction over any such installations at these locations. Contractor shall provide 48 hour advance notice to CITY OF OLDSMAR Public Works Department/Utilities Division at (813) 855- 4612 before starting construction. Contractor shall utilize Florida underground utility notification system “Sunshine State One-Call” (1-800-432-4770).
8. THE CITY OF OLDSMAR shall not be liable for any damages to CONTRACTOR utilization howsoever resulting from the CITY OF OLDSMAR’S continued use and occupancy of the public right-of-way and easements; the CITY OF OLDSMAR, however, shall not willfully cause undue damage to CONTRACTOR’S utilization.
10. CONTRACTOR shall remove all above ground abandoned equipment and restore areas to original grade and condition as the work progresses.
12. CONTRACTOR shall furnish the CITY OF OLDSMAR with a set of as-built drawings within thirty days of final construction.
14. CONTRACTOR hereby expressly understands, covenants and agrees (a) that nothing contained in this Authorization or contemplated is intended to or shall increase the CITY OF OLDSMAR’S liability for personal injury or death or for any property Revised 6/23/09 Page 4 of 4 damage, (b) that the CITY OF OLDSMAR does not assume any such additional liability, (c) that liability arising out of the utilization and occupancy of the CITY OF OLDSMAR’S public right-of-way and easements by CONTRACTOR and CONTRACTOR employees, agents, contractors, invitees or any representative, is hereby assumed by CONTRACTOR and shall be at the sole and exclusive risk of CONTRACTOR, (d) that CONTRACTOR shall answer and satisfy to the CITY OF OLDSMAR’S satisfaction any and all complaints relative to CONTRACTOR’S utilization of the CITY OF OLDSMAR public right-of-way and easements, (e) that CONTRACTOR shall protect, defend, hold harmless and indemnify the CITY OF OLDSMAR from and against any and all actions, claims, damages, and/or loss, including costs and attorney’s fees, occasioned by or growing out of any actual or claimed usage of condition of the CITY OF OLDSMAR’S public right-of-way an easements arising in any manner whatsoever, directly or indirectly, by reason of this Authorization for CONTRACTOR’S utilization thereof, and (f) that CONTRACTOR covenants not to interfere with the CITY OF OLDSMAR’S existing and future facilities in any manner whatsoever and shall fully indemnify the CITY OF OLDSMAR from any and all losses resulting from such interference.
Signature
Title
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