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State Highwav Utility Permit I <br /> Attachment to Permit No. 4190361- Additional Terms and Conditions Version 20 <br /> 1. GENERAL <br /> 2. This permit is issued in accordance with the State Highway Utility Code and is based in part upon the <br /> information submitted by the Permittee. This permit is only for the use and purpose stated in the <br /> Application and Permit. A copy of the State Highway Utility Code can be downloaded at: <br /> http://www,coloradodot.info/business/permits/utilitiesspecialuse/2CCR_601_18.pdf/view <br /> 3. Please refer to this permit number in all communications and correspondence. <br /> 4. The Penmittee is responsible for obtaining any necessary additional federal, state, and/or City/County <br /> permits or clearances required to proceed with permitted work . Approval of this utility/special use permit <br /> does not constitute verification of this action by the Permittee. <br /> 5. The Permittee, his or her heirs, successors-in-interest, assigns, and occupants of the Utility/Construction/ <br /> Landscape/Special Use permitted by this permit shall be responsible for meeting the terms and conditions <br /> of this permit. <br /> 6. Before work begins, a certificate of insurance naming the Colorado Department of Transportation <br /> (CDOT) as an additional insured is required to be submitted to: <br /> CDOT Region 4 <br /> Utilities Permits <br /> 10601 W. 10* Street <br /> Greeley, CO 80634 <br /> Description should include this permit number. Insurance should be in effect through 2-year warranty <br /> period from permit issue date and as long as installation exists in CDOT right-of-way. See attached <br /> Standard Terms 3.A through 3.H., inclusive. <br /> 7. READ ALL ADDITIONAL STANDARD REQUIREMENTS OF THIS PERMIT AND OTHER <br /> TERMS AND CONDITIONS ON THESE ATTACHED SHEETS. A COPY OF THIS PERMIT, <br /> INCLUDING ALL TERMS AND CONDITIONS, MUST BE ON THE JOB SITE WITH THE <br /> CONTRACTOR. Call for an inspection of forms at least one working day prior to placing any concrete. <br /> The Colorado Department of Transportation inspection is not an approval of the grade or alignment of the <br /> work. The contractor and/or engineer is responsible for the proper grade and alignment. Minor changes or <br /> additions may be ordered by the field inspector to meet field conditions. Any survey monuments or markers <br /> disturbed during the execution of this permit shall be repaired immediately at the expense of the Penmittee. <br /> 8. NOTIFY THE DEPARTMENT OF TRANSPORTATION INSPECTOR Kathy Peterson AT (970) 302- <br /> 7140 AND Kass Alkanani AT (303) 757-9079 TWO WORKING DAYS BEFORE STARTING THE <br /> WORK OR RESUMING SUSPENDED WORK. <br /> 9. On-premise and off-premise signing not in CDOT right-of-way shall comply with the current Colorado <br /> Outdoor Advertising Act CRS 43-1-401, Rules and Regulations Pertaining to Outdoor Advertising. For <br /> questions, please contact Outdoor Advertising Inspector Ally Mattson at 970-350-2148. <br />