Event_34101-13747_Contractor_NG_FC_Std_Form_Permit.pdf

Approved by TDOT Legal 12/2019

TENNESSEE DEPARTMENT OF TRANSPORTATION

PERMIT TO STATE AGENCY OR LOCAL GOVERNMENT

FOR PROJECT WITHIN HIGHWAY RIGHT-OF-WAY

The State of Tennessee, Tennessee Department of Transportation (“TDOT”), hereby grants this special permit for the use of State property under the following terms and conditions:

PERMITTEE:

Tennessee Army National Guard 395 George Fraley Pkwy Winchester, TN 37398

Chuck Nance | Joint Force Headquarters Real Estate Management Director Charles.w.nance11.nfg@army.mil Office | 615-313-2608 Cell | 615-829-2753

AUTHORIZED USE:

Construct and install a new Force Protection Fence along the perimeter of the property. This development will encroach onto TDOT (State) ROW. The Fence will need to be installed at a minimum of 10 ft from the pavement.

LOCATION OF PREMISES:

SR 50 11.1 mm Rt. 395 George Fraley Pkwy in Franklin County

EFFECTIVE DATES OF PERMIT:

as designated at time of Issuance

STANDARD TERMS AND CONDITIONS

A. PERMITTEE shall assume all liability for claims arising out of conduct on the part of the PERMITTEE for which it would be liable under either the Tennessee Claims Commission Act, Tenn. Code Ann. §§ 9-8-301, et. seq., if a State of Tennessee entity, or the Tennessee Governmental Tort Liability Act, Tenn. Code Ann. § 29-20-101, if a local government entity, for up to the limits for which it can be held liable for such conduct under the applicable act, arising from its use of the Premises.

https://urldefense.com/v3/__http:/Charles.w.nance11.nfg@army.mil/__;!!PRtDf9A!qdjbw8HukP42MbQa-XjIHakYisLzhvJK9XA3b3hcGnie3ks-EbiHvT0phdrfnWpe-yipJQHkC5Fx54GPAKEWcz5D1Lvri_TVJb67pQ$

B. In addition, PERMITTEE shall require that any contractor of PERMITTEE that performs any work on the State’s property, including any installation, maintenance, or operation of the authorized use, shall indemnify and hold harmless the State and all of its officers, agents and employees from all suits, actions or claims of any character arising from the contractor’s acts or omissions in the prosecution of the work and shall provide proof of adequate and appropriate general liability insurance providing liability coverage in an amount not less than $1 million dollars per occurrence and

$300,000 per claimant, naming the State of Tennessee as an additional insured.

1. Prior to commencing the work authorized herein, PERMITTEE shall obtain any other permits or approvals required by federal, state or local laws, and shall notify any utility company affected by this project. PERMITTEE shall be financially responsible for any relocation or replacement of such utilities.

2. Prior to commencing the work authorized herein, PERMITTEE shall notify

Tennessee One Call regarding any excavation(s) and shall ensure that the provisions of TCA 65-31-101 et seq. are met.

3. Access to the Premises shall only be at those points that have been previously approved by TDOT. Equipment and vehicles shall be confined to unpaved portions of the Premises.

4. PERMITTEE shall not cut any tree or similar vegetation that has a trunk over four inches in diameter. OR

A. PERMITTEE may only cut trees or similar vegetation within the area designated as “To Be Cleared of Vegetation” on the plans that are Attachment A hereto [ If clear cutting of vegetation is to be allowed, use second option]

B. PERMITTEE shall not cut any flowering trees regardless of size [except in areas designated on the plans for clear cutting of vegetation].

5. All work on the premises shall be performed in compliance with current TDOT Standard Specifications for Road and Bridge Construction, TDOT Standard Drawings, TDOT Roadway Design Guidelines, and the Americans with Disabilities Act PROWAG 2011 standards, in addition to applicable federal, state and local law and regulations.

6. PERMITTEE must obtain prior, written approval from TDOT before deviating from the scope of the project or the manner of its construction as described in this permit, including Attachment A.

7. At no time will work authorized by this permit interfere with the normal flow of traffic on roadways adjoining the Premises. PERMITTEE is responsible for providing traffic control, including pedestrian access, for this work zone in accordance with the requirements of the current Manual on Uniform Traffic Control Devices. If proper traffic control is not in place, TDOT may order PERMITTEE to stop work until proper traffic control is put in place.

8. While the project is underway, TDOT may conduct inspections to insure compliance with this Permit. Upon completion of the project, PERMITTEE shall notify TDOT so that the project may be inspected and approved by

TDOT.

9. PERMITTEE shall be liable for any damage to state property resulting from the subject work, including but not limited to, the roadway, shoulders, guardrail, drainage, landscaping, signs and controlled-access fences. All repair or replacement of such damage shall be made in accordance with the current TDOT Standard Specifications for Road and Bridge Construction, TDOT Standard Drawings and any other applicable design and/or construction standards or guidelines.

10. PERMITTEE shall keep all debris, soil, refuse or waste of any kind associated with the project from accumulating within the highway right-of-way.

[PERMITTEE shall pay TDOT $ 0.00 per cubic yard for usable materials removed from the Premises.] Include this last sentence only if applicable.

11. PERMITTEE does hereby covenant and agree that in the event the Permit is for the construction or use of or access to space on, over, or under real property acquired, or improved under the Federal-Aid Highway Program, the PERMITTEE shall comply with all requirements imposed pursuant to Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally-assisted programs of the Department of Transportation – Effectuation of Title VI of the Civil Rights Act of 1964, and as said Regulations may be amended.

12. Nothing in this Permit shall be construed to limit TDOT’s right to enter the Premises at any time.

13. If the PERMITTEE fails to comply with any of the foregoing conditions, TDOT shall have the right to revoke this permit, and require the immediate vacation of the Premises by the PERMITTEE. In the event of revocation, PERMITTEE must restore the Premises to its original condition. If PERMITTEE fails to do so within a reasonable time after revocation, TDOT may restore the Premises at the expense of the PERMITTEE.

14. This permit is non-transferable.

15. This permit shall not be construed as a conveyance of any interest in real property.

16. All notices required to be given to TDOT under this Permit shall be sent to:

Cory Sells 1208 E Carrol St Tullahoma TN, 37388 cory.sells@tn.gov 931-434-8054

IN WITNESS WHEREOF, the parties, through their authorized representatives, have executed this agreement.

STATE OF TENNESSEE

TENNESSEE DEPARTMENT OF TRANSPORTATION

BY:____________________________________ _____________________

REGIONAL ENGINEERING DIRECTOR DATE

APPROVED AS TO FORM:

REGIONAL ATTORNEY DATE

PERMITTEE:

[INSERT NAME OF STATE AGENCY OR LOCAL GOVERNMENT PERMITTEE]

mailto:cory.sells@tn.gov

BY: ____________________________________ _____________________

DATE

TITLE: _________________________________

CONTRACTOR:

[INSERT NAME OF CONTRACTOR]

BY: ______________________________________ _____________________

(to be signed only when bond and/or certificate DATE of general liability insurance is furnished by Contractor) By signing this Permit, Contractor agrees to be bound by the terms and conditions herein.

TITLE:____________________________________