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PUBLIC WORKS DEPARTMENT Streets Division 80 Columbia Ave, Marysville, WA 98270 (360) 363-8100 (360) 651-5099 Fax Revised 8/20/2021 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 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 the 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 application form and return to: Jesse Perrault Streets Division Supervisor (360) 363-8160 Phone 80 Columbia Avenue (360) 363-8284 Fax Marysville, WA 98270 [EMAIL REDACTED] If you have any questions, please contact Jesse Perrault. ---PAGE BREAK--- PUBLIC WORKS DEPARTMENT Streets Division 80 Columbia Ave, Marysville, WA 98270 (360) 363-8100 (360) 651-5099 Fax Revised 8/20/2021 Adopt-A-Street General Procedures 1. Interested group is an Adopt-A-Street Packet, which includes the Adopt-A-Street application, agreement and registration forms for group participants. 2. Agreement and application are returned to the Public Works Department and organization is informed of street assignments. 3. Organization calls Streets Division at (360) 363-8100 at least 48 hours in advance of clean-up day to reserve hardhats, bags, signs, etc. 4. Materials are picked up from Public Works Department, 80 Columbia Ave. At this time, registration forms should be turned in for each person participating in the clean-up event as well as one Adopt-A-Street roster. 5. After clean-up event, materials are returned to the Public Works Department. 6. Participant’s roster and individual registration forms are forwarded to Jesse Perrault, the Adopt-A-Street Coordinator, and filed with the organization’s agreement. ---PAGE BREAK--- PUBLIC WORKS DEPARTMENT Streets Division 80 Columbia Ave, Marysville, WA 98270 (360) 363-8100 (360) 651-5099 Fax Revised 8/20/2021 Adopt-A-Street Application Name of Organization (type or print exactly as you would like it to appear on the permanent Adopt-A- Street sign.) Mailing Address City, State, Zip Approximately number of people participating in each cleanup: 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) Street sections are assigned on a safety and a first-come, first-served basis. If the street sections your group has identified are not available, the Adopt-A-Street Coordinator will suggest other alternatives . Signature of organization contact Date Name of organization contact Day telephone number Mailing address Evening telephone number City, Zip Code E-mail address Please return this application to: Jesse Perrault, Adopt-A-Street Coordinator 80 Columbia Ave., Marysville, WA 98270 jperrault@marysville ---PAGE BREAK--- PUBLIC WORKS DEPARTMENT Streets Division 80 Columbia Ave, Marysville, WA 98270 (360) 363-8100 (360) 651-5099 Fax Revised 8/20/2021 Adopt-A-Street Agreement This agreement is made and entered into and between the City of Marysville, hereinafter called the “City” and hereinafter called the “Grantee”. Whereas City of Marysville resolution 1563 authorizes the City to establish a City-wide Adopt- A-Street Litter Control Program; and whereas the Grantee wishes to contribute toward the effort to reduce 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 to 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 clean up 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 activity. A minimum number of vehicles shall be used to transport the 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 (less than 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 calling the Marysville Street Department, 363-8100, at least two days in advance of clean up day. 8. To place filled trash bags and materials on the street shoulder for disposal by the City. 9. To call (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 items for disposal by the proper authorities. 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. ---PAGE BREAK--- Page 2 of 3 12. To provide the City a roster of individual participants during cleanup within three working days after 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 for additional conditions that also apply to Grantee. exhibit A included no additional conditions required. The City does hereby agree 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 sign and stand for the participants to use 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 term 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 termination of this agreement the Adopt-A-Street sign will be removed and remain the property of the City. ---PAGE BREAK--- Page 3 of 3 Please complete top portion of this page only. Name of Organization Address, City, State, Zip Code Name and Title of Contact for Organization Home Address, City State, Zip Code Day Phone Evening Phone E-mail Signature of Contact for Organization The Adopt-A-Street Coordinator will complete the remainder of this page. ASSIGNED STREET SECTIONS: to Date of Execution Date of Termination Adopt-A-Street Coordinator ---PAGE BREAK--- PUBLIC WORKS DEPARTMENT Streets Division 80 Columbia Ave, Marysville, WA 98270 (360) 363-8100 (360) 651-5099 Fax Revised 8/20/2021 Adopt-A-Street Release Form Name of participant (print or type) Name of Organization Address City Zip Telephone Number Person to notify in case of emergency Relationship Emergency Contact 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 City street can be hazardous. Participants 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 participation 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 and I am a volunteer and am at least 15 years old. I also understand the rights, responsibilities 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 guardian if participant is less than 18 years old Date