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Desired Hours of Traffic Control: (circle all days that apply) Day of Week: Mo Tu We Th Fr (from): : AM PM Sa Su (from): : (to): : AM PM (to): : Day of Week: Mo Tu We Th Fr (from): : Sa Su (from): : (to): : AM PM (to): : If additional days and times are desired, please list on a separate sheet. Insurance Company: Policy Private Traffic Control intersections @ $200 each = $ Check or Money Order Total Permit Fee = $ Applicant’s Name Applicant’s Internal Control # Applicant’s Status (Must mark one) Mailing Address Individual City State Zip Code Partnership Contact Person Phone# Fax # E-mail Address Corporation Owner’s Name (If different from applicant) Phone # Owner’s Address (If different from applicant) Fax # City State Zip Code E-mail Address Location of Traffic Control: Details of Traffic Control (Law Enforcement, Signs, etc.): I hereby certify that I have the authority to bind the above named applicant and the owner for the private traffic control under this permit to the terms, conditions and requirements of this permit. I have received a copy of the code, read and fully understand all requirements of Hamilton County Code Title 8, Article 20, Chapter 8, Section 1 and ordinance 4- 27-09-B concerning permit requirements. I also certify that I, the applicant and all persons performing the traffic control authorized by this permit understand all requirements of the above referenced code and permit and will abide by all of their requirements and conditions. I further certify that I, the owner and any persons performing traffic control authorized by this permit will not make any changes in the traffic control from the approved permit without receiving written permission from the Hamilton County Highway Department. The applicant agrees and understands that Hamilton County’s approval is limited to conveying its approval to perform traffic control only within legal road right of ways. If the traffic control as shown on this permit are not within legal road right of ways, it shall be the applicants duty to obtain the proper legal access to the property to perform said traffic control as shown on the permit.The applicant and I agree to pay all attorney's fees, court costs and other damages or costs incurred by Hamilton County in enforcing the terms of this permit, enforcing the County Code or which are a result of litigation incurred by the County as a result of this permit. The applicant, the owner under this permit and I understand that Hamilton County may revoke this permit at any time, at no cost to Hamilton County. The applicant, the owner and I agree that the commencement of work covered by this permit will serve as our acceptance of all terms, conditions and requirements of the approved permit. The applicant, owner, and I agree to hold harmless the county for any damage, accidents or other liabilities incurred as a result of this traffic control and to pay all judgments and legal costs incurred by the County as a result of this traffic control. Signature Date Printed Name Title Do Not Write In this Section - Highway Department Use Only Inspector: Date: County Engineer: Date: Approved by Hamilton County Board of Commissioners Attest: Hamilton County Auditor Date: Instructions: 1. Form must be completely filled out using a typewriter or printed using black ink. Any non-applicable blanks must be marked N/A. 2. Contact a Permit Inspector, the County Website or consult the Hamilton County “Permit Manual for County Roads” for questions concerning this application. 3. All applicants shall provide the following information: The average daily traffic (ADT) of the business/facility, peak hours and peak hour volumes for the desired hours of traffic control, turn counts for all affected approaches during peak hours, and the average vehicle delay for peak hours, both current and proposed. 4. Prior to the issuance of a permit, the applicant shall provide a certificate of coverage of general liability insurance, which shall name Hamilton County and the Board of Commissioners of Hamilton County as additional named insureds on that policy. The insurance must be maintained continuously throughout the year that the permit is valid, in an amount not less than $300,000 per person and $1,000,000 per occurrence. 5. When complete, mail or hand deliver this signed application, along with the permit bond and detailed plan to the above address, Attention: “Permit Application”. Hamilton County Highway Department 1700 S. 10th Street Noblesville, IN. 46060 Ph: (317) 773-7770 Fax: (317) 776-9814 www.hamilton.in.us APPLICATION TO FOR PRIVATE TRAFFIC CONTROL HCHD Form 1024 Revised 4/28/09 Permit AM PM AM PM AM PM AM PM AM PM 0 0 0 IN IN ---PAGE BREAK--- Hamilton County Highway Department Permit # TRFCON CONDITIONS TO PERMIT ⇒ All persons hired to direct traffic shall comply with the Indiana Manual on Uniform Traffic Control Devices: Chapter 5G, Chapter 6D and Chapter 6E. ⇒ Persons hired to direct traffic shall not do so in a manner that adversely affects any traffic signal or causes unnecessary delays to traffic on the County roadway, makes access to other areas more difficult or endangers the public, at or near the permitted location. ⇒ No persons hired to direct traffic shall stop traffic on a County roadway to facilitate a vehicle executing a right turn. ⇒ The permit will be valid for one year from application date. Any approved permit can be reviewed and subsequently revoked during the year in which it is valid. If there is a change of circumstances or information contained on the application substantially changes, a new permit application must be filed within seven days of that change. NOTICE! You must call in 24 to 72 hours prior to beginning work for Permit Activation # F:\users\dl2\condition: traffic control ---PAGE BREAK--- ORDINANCE 4-27-09-B An Ordinance Regulating the Use of Private Traffic Control on to Roads Maintained by the Hamilton County Highway Department WHEREAS, from time to time the owners of a property along certain roads maintained by Hamilton County desire to regulate traffic from private land onto, or off of, County roads, by temporarily obstructing said traffic; and, WHEREAS, Indiana Code 8-1-23-2 prohibits private parties from obstructing traffic on roads without permission of the Board of Commissioners of the County. IT IS THEREBY ORDAINED as follows: 1) The following definitions apply to this Ordinance: a) public emergency: a situation that requires an immediate response and where the failure to respond would result in immediate danger to life or property. b) private traffic control: a person who directs traffic on a public roadway that is not responding to an emergency. c) . average daily traffic: the total volume during a given time period, in whole days, greater than one day and less than one year, divided by the number of days in that time period . d) peak .hours: the hours of heaviest traffic at the intersection to be . controlled. Corresponding to the. desired hours of private traffic control. ---PAGE BREAK--- e) turn counts: number of vehicles at each turn or through movement, shown in fifteen (15) and sixty (60) minute intervals. 2) This Code does not apply to: a) The construction, repair or maintenance of a public street, a public Right-of-Way or a public utility, or b) The direction of a funeral procession, or c) An annual event such as a parade or festival d) A public emergency 3) Any person who desires to utilize private traffic control to direct traffic on, onto, from or in any County maintained roadway shall first apply for and receive approval from the Board of Commissioners or their designee. A permit application, supplied by the Highway Department, and related exhibits shall be submitted to the Highway Department to be reviewed and approved by the appropriate agencies as specified by the Board of Commissioners. 4) Fees for the permit shall be paid by check or money order made payable to the Hamilton County Treasurer and shall be submitted with . the permit. No permit will be reviewed or approved until the fee has been received by the Hamilton County Highway Department. The fee for private traffic control shall be $200 per location, per year. 5) Prior to the issuance of a permit, the applicant shall provide to the Hamilton County Highway Department a certificate of coverage of general liability insurance, which shall name Hamilton County and the ---PAGE BREAK--- Board of Commissioners of Hamilton County as additional named insureds on that policy. The insurance must be maintained continuously throughout the year that the permit is valid, in an amount not less than $300,000 per person, and $1,000,000 per occurrence. 6) All applicants shall provide the following information. No permit will be reviewed or approved until all required information has been received. Additional information may be required at the discretion of the County Engineer. a) The average daily traffic (ADT) of the business/facility. b) Peak hours and peak hour volumes for the desired hours of traffic control. c) Turn counts for all affected approaches during peak hours. d) Average vehicle delay for peak hours, both current and proposed. 7) The recipient of a permit shall comply with the following terms. a) All persons hired to direct traffic on a County roadway shall be an off-duty law enforcement officer. b) All persons hired to direct traffic must comply with the Indiana Manual on Uniform Traffic Control Devices (IMUTCD). All persons hired to direct· traffic shall do-so only duringthehours cc approved on the permit. d) All persons hired to direct traffic shall not do so in a manner that adversely affects any traffic signal or causes unnecessary delays to traffic on the County roadway, makes access to other areas ---PAGE BREAK--- more difficult or endangers the public, at or near the permitted location. 8) After an application is approved, the permit will be valid for one year from application date. All approved permits are subject to review during the time in which the permit is valid. If it is determined at any time that the permit holder is causing adverse affects on a traffic signal, unnecessary delays to traffic, making access to other areas more difficult or heightened danger to the public, at or near the permitted location, the permit may be immediately revoked by the County. If there is a change of circumstances or the information contained in the application substantially changes, a new permit application must be filed within seven days of that change in circumstances. 9) Any person who violates this section of the Hamilton County Code commits an ordinance violation. Each subsection violated and each day for which the violation remains shall be a separate violation. A judgment of up to $2,500 may be entered against a person who violates this Code section perviolation, per day. :10) Sectipns ,1 ~8 of this.Ordinanceshall be effective thirty (30) days after' passage and· no .person shall obstruct traffic upon a county road without a permit after May 27; 2009. .1.1) Section 9 imposing a penalty for violation of this Ordinance shall be effective on June 2,2009. ---PAGE BREAK--- 'J'II \ 12) The Hamilton County Auditor shall codify this Ordinance in the Hamilton County Code of Ordinances at 8-1-23-2. ALL OF WHICH IS ORDAINED by the Board of Commissioners of Hamilton County this 27th day of April, 2009. BOARD OFCOMMISSIONERS OF HAMILTON COUNTY _~(JetJ14 Steven A. Holt, President St~r Christine Altman ATTEST: Id1um Co Xl) c!aJ< Dawn Coverdale, Auditor