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BOX FOR OFFICE USE ONLY EXCAVATION / ENCROACHMENT PERMIT & AGREEMENT Murray City Public Services Department 4646 South 500 West Murray, UT 84123 Application Date: Issued: Work Location: Purpose of Excavation: Name of Applicant: Billing Address: City/State: Zip: Phone: ( ) Name of Contractor: State License Number: Responsible Party: ( ) Office Phone: ( ) Phone: ( ) Pavement Type: Approx. Size: Length Width Depth Construction Start Date: proposed Comp. Date: Time: Applicant agrees to meet all Murray City Public Works Road Cut Standards & Specification as published by Murray City Engineering Department. Authorized Signature: N O T E PERMITS MUST BE TAKEN OUT 48 HOURS IN ADVANCE OF ANY CUTS AND PRESENT AT THE WORK LOCATION AT ALL TIMES. CONTRACTOR SHALL NOTIFY INSPECTOR 24 HOURS IN ADVANCE BEFORE ANY WORK CAN PROCEED. FAILURE TO ACTIVATE PERMIT MAY RESULT IN A CITATION. To activate permit contact Lynn Potter, (801)270-2402 or [EMAIL REDACTED]. Special Conditions: BOND □ INSURANCE □ TRAFFIC CONTROL PLAN □ Permit Fees: - $200.00 asphalt, curb & gutter, sidewalk Permit Fee: - $100.00 park strip, unpaved right-a-way, Encroachment (NON-REFUNDABLE) ---PAGE BREAK--- MURRAY CITY EXCAVATION / ROAD CUT Requirements 1. Excavation Permit & Agreement. The applicant must complete the Excavation Permit & Agreement form, and be familiar with Murray City Standards and Specifications. 2. Bond. The applicant, in conjunction with their surety company, is required to complete a MurrayCity Corporation Excavation Bond form. Murray City requires the use of their bond form and the bond needs to be continuous until cancelled in the amount of $10,000.00. The bond guarantees that the excavated street or public right-of-way is restored or repaired by the applicant in accordance with city specifications, or, if the repair work is done by the city, to guarantee reimbursement to the cityfor that work. The amount of the bond may be increased or decreased at the discretion of the City Engineer whenever it appears that the amount and cost of the work to be performed may vary from the amount of the bond. The bond shall be conditioned that the applicant shall guarantee the materials and workmanship for a period of three years from completion of such work, reasonable wear and tear excepted. 3. Insurance. The applicant must furnish a certificate of insurance in a company authorized to issue insurance by the state showing that the applicant has a comprehensive general liability and property damage policy that includes contractual liability coverage with minimum limits of $1,000,000.00 for injuries, including accidental death to any one person; in an amount not less than $2,000,000.00 on account of injuries sustained in any one accident; and propertydamage insurance in an amount not less than $1,000,000.00 for each accident. The city shall be named as a named insured on the policy. 4. Permit Fees. The applicant shall pay the public services department the following fee deposit before a permit will be issued, these fees are nonrefundable. A. For excavations within asphalt or concrete, $200.00 minimum. B. For excavations within park strip or unpaved right-a-way, $100.00 minimum. 5. Activation/Inspection. Activation of permit must be scheduled with the Inspector 24 hours prior to commencing work, 48 hours if work is scheduled on weekends or holidays. Failure to activate may result in a citation. 6. Non compliance in work zone. If permit holder fails to comply with Murray City requirements, specifications or instructions pertinent to the permit, subsequent permits may not be issued. 7. Traffic Control Plan. The applicant shall also submit a formal traffic control plan which must meet the department's approval as a condition for the issuance of the permit (must meet MUTCD standards). Failure to comply with Murray City Code 12.16.060 (Traffic Control Devices Required Around Excavations) may result in a citation. 8. Trench Backfill. All trench backfill material shall be imported granular backfill meeting AASHTO M 145 classification A-1 and shall be compacted to 95% of the modified proctor densityas determined by ASTM 1557. Compaction testing may be required and shall be conducted by a certified materials testing lab at the contractors / permit holders expense. 9. Asphalt Saw Cut. All excavations in roadways shall be saw cut at least 1 foot beyond the excavation in all directions to form a AT@ patch. 10. Asphalt Patchwork. All Asphalt patchwork shall be done byan approved asphalt paving companyor by Murray City Street Department. Asphalt patch material for residential roads shall be AC-10 DM Asphalt patch material for all other roadways shall be AC-20 DM A Performance Grade asphalt mix may be required on high traffic roadways as determined by the City Engineer. Patch thickness shall be existing thickness + 1” min. residential, 6” min. arterials and collectors). Compaction testing may be required and shall be conducted by a certified materials testing lab at the contractors / permit holders expense 11. Temporary Asphalt Patching. Asphalt patching between November 15 and March 15 will be considered temporary and will need to be replace when weather conditions are suitable (46 degrees F and rising). Emergency permits may be issued on a case by case basis. Do not patch if surface is wet or weather is unsuitable (no frost in ground). Do not patch if wind or ground cools mix material before compaction. Paving standards are as outlined in Section 32 12 16 of APWA 2007 Standard Specifications. 12. No Cut Roads. Murray City has a NO CUT policy on roads newer than 3 years. If a road cut is absolutely necessary, extreme measures must be met to ensure that the road cut is placed back in the same or better condition, which may include mill and overlaying the proposed road cut area. 13. Concrete Placement. Before any concrete is placed the contractor must call for an inspection 24 hours prior to placement. It is the contractor=s responsibility to adhere to Murray City Standards and Specifications regarding concrete placement. If Murray City Standards are not followed, the concrete done will be removed and replaced at the expense of the applicant. 14. Painted Traffic Lines and Markings. Any Painted traffic lines and markings disturbed during the excavation shall be re-painted in the same location with materials meeting City Standards. 15. Storm Water Pollution Prevention. Catch basins and storm drain inlets within 300 feet of the excavation location must be protected from dewatering, sediment, excavated materials, and general construction debris. 16. Clean Up. Upon completion of the excavation and patchwork the area shall be swept and returned to original condition. ---PAGE BREAK--- 1 BOND EXCAVATION BOND To Cover Excavation on Property, Right-of-Ways and Highways Belonging to Murray City Corporation KNOW ALL MEN BY THESE PRESENTS: THAT, we, as Principal, and as Surety, are jointly and severally held firmly bound unto Murray City State of Utah, as Obligee, in the sum of lawful money of the United States for which payment well and duly to be made, we and each of us bind ourselves and each of our successors and assigns jointly and severally by these presents. Signed and Sealed this_____day IN WITNESS WHEREOF, Principal has signed this bond and said Surety has caused these presents to be signed by its duly authorized officer and its corporate seal to be affixed hereto. The conditions of this obligation are such that: WHEREAS, Principal has or is about to obtain from the Obligee, a permit(s) for making excavations in connection with underground utilities, waterways, or other improvements within the Public Way of Murray City; and WHEREAS, Principal is required by ordinance to file with the Murray City Public Services Department a bond acceptable to the City guaranteeing that all excavation work in Public Way of Murray City shall be restored in accordance with the standard specifications of Murray City; NOW, THEREFORE, the condition of this obligation is such that on or after the day Principal shall in all respects comply with all the applicable terms, conditions, provisions, requirements and specifications of the Murray City Development Code, Murray City Traffic Code, Murray City Design Standards and Murray City ---PAGE BREAK--- 2 Standard Specifications and the terms and conditions upon which the said permit(s) have been approved, and which terms and conditions will be incorporated by reference in said excavation permit(s) when issued, and shall fully perform his, their or its obligations in completing the work for which said permit is issued, and shall well and truly and in a manner satisfactory to the Murray City Public Services Department, complete the work described in said approved permit(s), and shall save harmless and indemnify Murray City, State of Utah from any loss, costs, expense or damage incurred through the failure of the Principal, its agents, and servants to complete the work as required by the any law, statute, ordinance, rules, regulations or requirements which pertain to such permits, included but not limited to the Murray City Design Standards and Murray City Standard Specifications and as may be further specified in his approved permit(s), or from any damages growing out of the negligence of the Principal or its agents, servants or employees and in particular shall restore all excavations made with the Public Way of Murray City in accordance with the specifications of Murray City and shall guarantee restoration of the work site, normal wear and tear excepted, for a period of three years from the date of restoration for all the excavations made by Principal under such permit(s). This obligation shall remain in full force and effect and this bond shall be deemed continuous in form and shall remain in force and effect for all excavations in the Public Way of Murray City made by Principal pursuant to all such permits approved by Murray City on or after the of unless terminated or canceled in the manner hereafter provided. The Surety herein reserves the right to withdraw as such surety except as to any liability already incurred hereunder or as to any future liability which may incur from work pursuant to a permit already issued at the time of withdrawal by the giving of thirty (30) days written notice of withdrawal sent by certified mail to the Principal and to the Murray City Engineer. ---PAGE BREAK--- 3 Regardless of the period this bond shall be in force, the aggregate liability of the Surety hereunder shall at no time exceed the penal sum of the bond. IN WITNESS WHEREOF, said Principal has signed these presents and said Surety has caused these presents to be signed by its duly authorized officers and its corporate seal to be affixed hereto the day and year first hereinabove set forth. Principal: Mailing Address: SURETY: Mailing Address: ---PAGE BREAK--- 4 STATE OF UTAH ) (Surety) : ss. County of Salt Lake ) being first duly sworn on oath, deposes and says: that s/he is the Attorney-in-Fact of a corporation organized under the laws of the State of that s/he is duly authorized to execute and deliver the foregoing obligation; that the said is authorized to execute the same, and has complied in all respects with the laws of the State of Utah, in reference to becoming the sole surety upon bonds, undertakings and obligations. Attorney-in-Fact Subscribed and Sworn to before me this NOTARY PUBLIC, Residing in My Commission Expires: (Attach Power of Attorney) STATE OF UTAH ) (Complete if Principal is an individual) : ss. County of Salt Lake ) On this presently appeared before the signer(s) of the foregoing instrument, who duly acknowledged to me he/she (they) executed the same. NOTARY PUBLIC, Residing in My Commission Expires: ---PAGE BREAK--- 5 STATE OF UTAH ) (Complete if Principal is Corporation) : ss. County of Salt Lake ) On personally appeared before who is being by me dully sworn, did say that s/he is said corporation by authority of its Board of its Directors, and s/he acknowledged to me that said corporation executed the same. NOTARY PUBLIC, Residing in My Commission Expires: STATE OF UTAH ) (Complete if Principal is an individual) : ss. County of Salt Lake ) On this presently appeared before who being by me duly sworn, did say that he is a partnership, and that the foregoing instrument was signed in behalf of said partnership and that said partnership executed the same. NOTARY PUBLIC, Residing in My Commission Expires: