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Adopt-A-Street 1. Interested group is mailed an Adopt-A-Street Packet, which includes the Adopt-A-Street Agree- ment and application. 2. Agreement and application are returned and organization is informed of street assignments. 3. Organization calls Street Department at (360) 363-8100 48 hours in advance of cleanup day to reserve hardhats, bags, signs, etc. 4. Material is picked up from Public Works Department, 80 Columbia Ave. At this time, the group is given one Adopt-A-Street registration form for each person participating in the cleanup and one Adopt-A-Street participant’s roster. 5. After cleanup, materials are returned to Public Works Department. Adopt-A-Street registration forms and participant’s roster is turned in at this time. 6. Participant’s roster is sent to Paul Kinney in Public Works. Registration forms are filed with the organization’s Adopt-A-Street agreement. 80 Columbia Ave. ❖ Marysville, Washington 98270 ❖ (360) 363-8100 ❖http://marysvillewa.gov Public Works Department Street Division General procedures ---PAGE BREAK--- Adopt-A-Street Thank you for inquiring about the Adopt-A-Street program. This program was established by the Marysville City Council to create a better environment by encouraging citizen participation and reducing litter. Participating groups agree to remove litter from assigned sections of streets at least four times a year over a two-year period. Participating groups are asked to remove litter from at least six street blocks. In return, the Marysville Street Department erects permanent signs identifying the adopting group, provides safety vests, hard hats, trash bags and collects filled trash bags. The state Department of Labor & Industries insures volunteers for hours worked. We hope this program will remind everyone to dispose of trash properly and generate pride in this care of our City streets and the environment. We hope your group will become part of the solution. Enclosed are the basic rules for the program and an application form. Please complete the Adopt-A- Street Agreement and Adopt-A-Street Application form and return to Paul Kinney, Adopt-A-Street Coordinator, 80 Columbia Ave., Marysville, WA 98270. If you have any questions, please contact Mr. Kinney at (360) 363-8100. 80 Columbia Ave. ❖ Marysville, Washington 98270 ❖ (360) 363-8100 ❖http://marysvillewa.gov Public Works Department Street Division ---PAGE BREAK--- Adopt-A-Street Registration Form Name of organization Name of participant (print or type) Social Security Number Address City Zip Telephone Number Person to notify in case of emergency Relationship Address City Zip Telephone Number The City of Marysville’s Adopt-A-Street Litter Control Program is for volunteers who donate their time to help keep Marysville’s streets clean. Participants are advised that working adjacent to a Citiy street can be hazardous. Partici- pants shall exercise proper care in performing litter collection activities. Participants must wear the safety hat and vest furnished by the City of Marysville and appropriate protective clothing during cleanup activities. Participants are entitled to receive full coverage for medical treatment required for an injury incurred during partici- pation in the Adopt-A-Street Litter Control Program under the medical aid provisions of the Worker’s Compensation Act, which is administered by the state Department of Labor and Industries, but not for loss of time because of injury or illness, or for lasting disability or death. By signing below I certify that I am a volunteer and am at least 15 years old. I also understand the rights, responsibili- ties and privileges of participating in the Adopt-A-Street Litter Control Program and agree to hold harmless the City of Marysville and its employees from liability for damages or injury resulting from my participation in this program. Signature of participant Date Signature of parent or guardian if participant is less than 18 years old ---PAGE BREAK--- Date received (coordinator will fill in) Name of organization (type or print exactly as you would like it to appear on the permanent Adopt-A-Street sign). Street sections are assigned on a safety and first come, first-served. If the sections your group has identified are not available, the Adopt-A-Street Coordinator will suggest other alternatives. Adopt-A-Street Application Mailing address City, zip code Approximate number of people participating in each cleanup Please list the street and section you are interested in cleaning in order of preference: 1. Street name Section (from what block to what block). 2. Street name Section (from what block to what block). 3. Street name Section (from what block to what block). Signature of organization contact Name of organization contact Mailing address City, zip code Date Day telephone number Evening telephone number E-mail address (optional) Return this application to: Paul Kinney, Adopt-A-Street Coordinator Marysville Street Department 80 Columbia Ave. Marysville, WA 98270 80 Columbia Ave. ❖ Marysville, Washington 98270 ❖ (360) 363-8100 ❖ http://marysvillewa.gov ---PAGE BREAK--- Adopt-A-Street Application This agreement is made and entered into and between the City of Marysville, hereinafter call the "City" and hereinafter called the "Grantee". Whereas City of Marysville resolution 1563 authorizes the City to establish a Citywide Adopt-A- Street Litter Control Program; and whereas the Grantee wishes to contribute toward the effort to reduced roadside litter. The City does hereby authorize the Grantee permission to participate in the Adopt-A-Street Litter Control Program by picking up litter within the assigned sections of streets designated below, in accordance with the following terms and conditions: The Grantee does hereby agree: 1. To conduct cleanup activities in a safe manner and comply with any conditions as may be required by the City for safety of the participants. Safety of the participants is the number one priority of the program. 2. To assign a leader to each cleanup crew. The crew leader shall have a copy of this agreement with him/her during the cleanup. 3. To pick up litter no less than four times per year. Additional cleanups should be done as necessary maintain a neat appearance. Recommended cleanup interval is: Once every three months. One cleanup shall take place during the month of May. 4. To have all participants wear the hat and vest furnished by the City during cleanup activities. No more than 10 people shall participate in the cleanup activity at one time. 5. To have no more than 4 vehicles parked on the street shoulder within the assigned area during a cleanup. A minimum number of vehicles shall be used to transport participants to the assigned area. 6. Participants shall be at least 15 years old. The Grantee shall furnish supervision by one or more adults for every eight minors (under 18 years old) participating in the cleanup activity. 7. To obtain supplies and materials from the City during regular business hours and to reserve supplies by call the Marysville Street Department at (360) 363-8100 at least two days in advance of cleanup day. 8. To place filled trash bags and materials on the street shoulder for disposal by the City. 9. To call the 911 immediately in the event of any emergency during the cleanup. Participants who find anything that is hazardous or suspected to be hazardous will not touch it, but will flag the item for disposal by the proper authorities. ---PAGE BREAK--- 10. Participants will not pick up syringes, hypodermic needles, exceptionally large, heavy or unyielding objects. These kinds of materials should be flagged and the City notified as soon as possible to arrange for proper disposal. 11. Cleanups shall not be scheduled during the Marysville Strawberry Festival. 12. To provide the City a roster of individual participants in the cleanup within three working days after the cleanup. 13. The crew leader will report any injuries incurred by participants during cleanup activities to the City within two working days of the injury. Notification will include: • Name of injured person • Nature of injury • Date, time and place of injury • How the injury occurred 14. To return to the City within three working days the materials furnished by the City. 15. See Exhibit A for additional conditions that also apply to Grantee. Exhibit A included no additional conditions required. The City agrees to: 1. Furnish and install an Adopt-A-Street sign with the Grantee name or acronym. The sign will be installed at one end of the section of street the Grantee is responsible for. 2. Furnish the Grantee trash bags, safety hats and vests and a "Volunteer Litter Crew Ahead" advanced warning sign and stand for the participants to post during the cleanup activity. 3. Remove the filled trash bags from the street shoulder. 4. Assist the Grantee in cleaning up the litter if necessary (i.e. when large, heavy or dangerous items are found). 5. Maintain necessary records required to secure medical aid benefits for participants under RCW 51.36. The City recommends the Grantee have a first aid kit available at the cleanup site and at least one person with a valid first aid card be present during cleanup activities. Recycling is an accepted and encouraged activity. Recyclable items collected by participants may be removed from the site at the option of the Grantee. Profits from the sale of recyclable items shall belong to the Grantee. The City may suspend this agreement temporarily because of construction in the assigned area. After the construction is complete the Grantee will be notified and the agreement restored. The terms of this agreement shall begin on the date of execution indicated below and shall end on the date of termination unless terminated by the City or the Grantee on 30-day notice. Upon ---PAGE BREAK--- termination of this agreement the Adopt-A-Street sign will be removed and remain the property of the City. ---PAGE BREAK--- Street From To City of Marysville Please complete only this column. The Adopt-A-Street Coordinator will complete the remainder of this page Address Phone number Date of execution Date of termination Adopt-A-Street Coordinator Name of organization Address City, state, zip code Name of organization contact Home address City, state, zip code Day telephone Evening telephone E-mail (optional) Signature of organization contact Title 80 Columbia Ave. ❖ Marysville, Washington 98270 ❖ (360) 363-8100 ❖ http://marysvillewa.gov ASSIGNED STREET SECTION: