RFB 3163 Scope & Plans.pdf

Subject: Approval of Utility Permit

This letter is notification that your request to establish Utility Accommodation along primary Highway US 30 E has been approved by the department.

As the applicant of record, you are responsible for compliance with the terms and conditions set forth in this permit. In particular, the prescribed traffic control measures must be installed prior to construction activities, ANSI 107 Class 2 high visibility apparel must be worn by all personnel within the highway rights-of-way and unless otherwise specified, work hours shall be between 30 minutes after sunrise and 30 minutes before sunset. Finally, a copy of the entire approved permit shall be available at the job site at all times for examination by department personnel.

Prior to commencing work, a 48-hour advance notice to the department representative is required.

Please contact the department representative listed below a minimum of 48-hours before work is to begin:

Upon completion of your installation, final field inspection shall be completed by the department.

Please call me to schedule this final inspection at your earliest convenience. If you should have any questions, please do not hesitate to contact me.

Dear , Best regards, 10/13/2026

Expiration Date:

County:

Primary Highway:

Permit Number:

10/13/2027

Story (85)

US 30 E

U2026-85-2-14

Enclosures

Form 810025(12-25)

PERMIT AND AGREEMENT FOR USE OF HIGHWAY

RIGHT-OF-WAY FOR UTILITIES ACCOMMODATION

(Permit to construct or modify a Utility)

FOR DEPARTMENT USE ONLY

APPLICANT (INDIVIDUAL OR COMPANY)

INSTALLATION TO BE ACCOMODATED

U2026-85-2-14 US 30 E Story

N/A 10/13/2027

First Name Middle Initial Last Name Phone Number Ext.

Company Name

Iowa Department of Transportation

Street Address State

IA

ZIP Code

50010

City/Town

Ames

Email Address Secondary Email Address

Approval is hereby requested to enter within the state highway right-of-way for the accommodation of a utility installation as detailed on the attachments and further described as follows.

Install new 12" steel pipe underground for surface and sub surface drainage. Existing pipe has failed and will be abandoned. Upstream and downstream connections to existing pipe at field verified locations.

and shall be located as shown on the detailed plan attached hereto. (See current Iowa Department of Transportation Utility Accommodation Policy for submittal of detailed plan requirements. See Section 115.7 (3).)

Work Site Location

US 30 E

160 2234+00

160 2235+0

Both

DOT Project Number

Permit Number Highway Number County

The work described above will be located as follows:

Highway: County: District:Story 1

Begin Reference Post: Offset: Begin Station:

End Reference Post: Offset: End Station: Side of Road:

0.369

0.39

Expiration Date

WITH THE FOLLOWING CROSSING LOCATION(S)

1 160Reference Post : Offset : 0.3798 Station : Encasing : Yes2234+00

SteelEncase Material : Encase Diameter :

Section : Township : Range : R22WT83N10

Section : Township : Range : R22WT83N15

Application Signature and Agreement

I __ ______________have read the stipulations for this permit agreement as stated, as well as attachments which may be included, and by signing this application agree to abide by all stipulations and to complete the work as proposed in compliance with the stipulations and attachments within one year from the date Department approval is granted for said request.

Failure on the part of the applicant to abide by the stipulations or to construct the work desired as stipulated and within the time frame stated shall render this agreement and request null and void. The undersigned also agrees to save harmless the State of Iowa and the Iowa Department of Transportation from any damage or losses that may be sustained by any person or persons on account of the conditions and requirements of this agreement.

Iowa Department of Transportation

Name of Utility Company (Print or Type) Date

FOR DEPARTMENT USE ONLY

Special Requirements - in addition to the stipulations above, the following special requirements shall apply to this permit.

CITY ACTION

City approval not required on this permit.

COUNTY ACTION

County approval not required on this permit.

FEDERAL HIGHWAY ADMINISTRATION ACTION

Federal Highway Administration approval not required on this permit.

The utility company, corporation, applicant, permit holder or licensee, (hereinafter referred to as the Permit Holder) agrees with the Iowa Department (herafter referred to as Department) that the following stipulations and those special requirements as listed on this page shall govern under this permit.

A. General

1. The work shall meet the requirements of local municipal, county, state, and federal franchise rules and regulations, regulations and directives of the Iowa State Commerce Commission; the Iowa Department of Natural Resources, all rules and regulations of the Department and any other laws or regulations applicable.

This permit grants authority to perform work within the highway right-of-way and does not authorize work on private property or any other property such as railroad right-of-way.

2. The Permit Holder shall be fully responsible for any future adjustments of any installations within the established highway right-of-way caused by highway construction or maintenance operations.

3. As per Section 115.7(8) of the Utility Accommodation Policy, As-Built plans are due within 90 days after completion of construction, the applicant shall submit to the district representative an as-built plan in an electronic format in accordance with department specifications..

4. The work described in this permit shall be completed as proposed in compliance with the stipulations and special requirements within one year from the date Department approval is received for said request. Failure on the part of the Permit Holder to abide by the stipulations or in constructing the work described as stipulated and within the time frame stated shall render this agreement and request null and void. The Permit Holder also agrees to save the State of Iowa and the Department harmless of any damages or losses that may be sustained by any person, or persons, on account of the conditions and requirements of this agreement.

5. Non-compliance with any of the terms of the Department's policy, permit, or agreement, may be considered cause for shut-down of construction operations, revocation of the permit, or withholding of future application approvals until compliance is confirmed. The cost of any work deemed necessary to be performed by the State in removal of noncomplying construction will be assessed against the Permit Holder.

B. Construction and Maintenance

1. The location, construction and maintenance of the work covered by this application shall be in accordance with the current Department's Utility Accommodation Policy.

2. Before beginning any work in the highway right-of-way, it is the responsiblitiy of the Permit Holder to obtain an easement from the drainage district if necessary. The Department assumes no responsiblity for advising the Permit Holder of each location of a drainage district crossing. It is the Permit Holder's responsibility to locate these crossings and obtain any necessary easements or permission from the drainage district. See Code of Iowa, Chapter 468 for additional information.

3. A copy of the approved permit shall be available on the job site at all times for examination by Department officials.

4. Operations in the construction and maintenance of this work shall be carried on in such a manner as to cause minimum interference to or distraction of traffic on said highway.

5. Traffic protection shall minimally be in accordance with Part VI of the current Manual on Uniform Traffic Control Devices for Streets and Highways. The applicant shall be responsible for correctly using traffic control devices including signs, warning lights, and channelizing devices as needed while work is in progress or the clear zone is impacted. Flagging operations are the responsibility of the applicant. The Department's TC XXX Series Standards are the preferred traffic control specification plans.

6. The applicant shall seed and mulch all disturbed areas within the highway right-of-way and shall be responsible for the vegetative cover until it becomes well established. Any surfaced areas such as driveways or shoulders and sodded waterways and plantings which are disturbed shall be restored to their original condition. Any damage to any other underground facilities during installation shall be repaired at the permit holder's expense.

7. All personnel in the highway right-of-way shall wear ANSI 107 Class 2 apparel at all times when exposed to traffic or construction equipment.

8. As per Policy Section 115.3(9) parking or storage in the clear zone is prohibited. When not in actual use, vehicles, equipment and materials shall not be parked or stored within the clear zone or median.

TERMS AND CONDITIONS

9. Unless specifically noted in Special Requirements section, all work performed within the right-of-way shall be restricted to 30 minutes after sunrise to 30 minutes before sunset.

10. Pedestals shall be placed within 12 inches of the right-of-way line.

1. To the extent allowable by law, the Permit Holder agrees to indemnify, defend, and hold the Department harmless from any action or liability arising out of the design, construction, maintenance, placement of traffic control devices, inspection, or use of the Permit Holder's facilities. This agreement to indemnify, defend, and hold harmless applies to all aspects of the Department's application review and approval process, plan and construction reviews, and funding participation.

2. The Permit Holder shall indemnify and save harmless the State of Iowa, its agencies and employees, from any and all causes of action, suits at law or in equity, for losses, damages, claims or demands, and from any and all liability and expense of whatsoever nature, arising out of or in connection with the Permit Holder's use or occupancy of the public highway.

3. The State of Iowa and the Department assume no responsibility for damages to the Permit Holder's property occasioned by any construction or maintenance operations on said highway if the facilities are not located in accordance with this permit.

4. The State of Iowa, its agencies or employees, will be liable for expense incurred by the Permit Holder in its use and occupancy of the highway right-of-way only when negligence of the State, its agencies or employees, is the sole proximate cause of such expense. Whether in contract, tort or otherwise, the liability of the State, its agencies and employees, is limited to the reasonable, direct expense to repair damaged utilities, and in no event will such liability extend to loss of profits or business, indirect, special, consequential or incidental damages.

C. Liability

1. The Permit Holder is responsible for contacting Iowa One-Call (1-800-292-8989) and request the location of all underground utilities forty-eight (48) hours before excavation. Before beginning work in the highway right-of-way, the Permit Holder shall also contact any other known utility located in the area of the proposed work.

2. The Permit Holder agrees to give the Department forty-eight (48) hour notice of its intention to start construction or to perform routine maintenance on the highway right-of-way. Said notice shall be made to the local DOT contact person whose name is shown on Page 3.

3. 511 Notification-The Permit Holder may not obstruct or close primary highways or primary highway extensions (State highways within city limits) without prior consent of the Iowa DOT, except in emergency situations. Before setting up a lane closure or a vertical/horizontal restriction of any kind on a primary highway, call your local Iowa DOT Maintenance garage and call the Traffic Management Center per attached documents. Except in emergency situations, a 10 day advance notice is required.

D. Notification

E. Build America, Buy America (BABA)

1. Build America, Buy America (BABA) applies to relocations of utility facilities that must move due to highway projects under certain specific conditions that include reimbursable locations and relocations due to interstate projects.

2. Please contact the Department's District Permit Specialist for more information on BABA requirements or visit the following link:

Signature of received on 10/13/2026

160 0.369

Both

US 30 E Story

LOCATION DATA:

District:

Begin Reference Post: Begin Offset:

Side of road:

Highway: County:

160 0.39End Reference Post: End Offset:

2234+00Begin Station:

2235+00End Station:

Tile Crossing

October 13, 2026

Iowa Department of TransportationUtility Company

18228 Date:Request Number :

Utility Type :

Contact for Utility Company

UTILITY DETAILS

The Installation shall consist of : Install new 12" steel pipe underground for surface and sub surface drainage.

Existing pipe has failed and will be abandoned. Upstream and downstream connections to existing pipe at field verified locations.

Enclosures: Standard Terms and Conditions,Declaration Page, 4017794.pdf, Request Confirmation Email.pdf, TC-1, U.S 30 Tile.pdf

NoLane Restrictions:

WITH THE FOLLOWING CROSSING LOCATION(S)

12Largest Pipe Size (Closest size in inches):

SteelPipe Material:

Section : Township : Range : R22WT83N10

Section : Township : Range : R22WT83N15

1 160Reference Post : Offset : 0.3798 Station : Encasing : Yes2234+00

SteelEncase Material : Encase Diameter :

FINAL TERMS AND CONDITIONS REVIEW

The utility company, corporation, applicant, permit holder or licensee, (hereinafter referred to as the Permit Holder) agrees with the Iowa Department (herafter referred to as Department) that the following stipulations and those special requirements as listed on this page shall govern under this permit.

A. General

1. The work shall meet the requirements of local municipal, county, state, and federal franchise rules and regulations, regulations and directives of the Iowa State Commerce Commission; the Iowa Department of Natural Resources, all rules and regulations of the Department and any other laws or regulations applicable.

This permit grants authority to perform work within the highway right-of-way and does not authorize work on private property or any other property such as railroad right-of-way.

2. The Permit Holder shall be fully responsible for any future adjustments of any installations within the established highway right-of-way caused by highway construction or maintenance operations.

3. As per Section 115.7(8) of the Utility Accommodation Policy, As-Built plans are due within 90 days after completion of construction, the applicant shall submit to the district representative an as-built plan in an electronic format in accordance with department specifications..

4. The work described in this permit shall be completed as proposed in compliance with the stipulations and special requirements within one year from the date Department approval is received for said request. Failure on the part of the Permit Holder to abide by the stipulations or in constructing the work described as stipulated and within the time frame stated shall render this agreement and request null and void. The Permit Holder also agrees to save the State of Iowa and the Department harmless of any damages or losses that may be sustained by any person, or persons, on account of the conditions and requirements of this agreement.

5. Non-compliance with any of the terms of the Department's policy, permit, or agreement, may be considered cause for shut-down of construction operations, revocation of the permit, or withholding of future application approvals until compliance is confirmed. The cost of any work deemed necessary to be performed by the State in removal of noncomplying construction will be assessed against the Permit Holder.

B. Construction and Maintenance

1. The location, construction and maintenance of the work covered by this application shall be in accordance with the current Department's Utility Accommodation Policy.

2. Before beginning any work in the highway right-of-way, it is the responsiblitiy of the Permit Holder to obtain an easement from the drainage district if necessary. The Department assumes no responsiblity for advising the Permit Holder of each location of a drainage district crossing. It is the Permit Holder's responsibility to locate these crossings and obtain any necessary easements or permission from the drainage district. See Code of Iowa, Chapter 468 for additional information.

3. A copy of the approved permit shall be available on the job site at all times for examination by Department officials.

4. Operations in the construction and maintenance of this work shall be carried on in such a manner as to cause minimum interference to or distraction of traffic on said highway.

5. Traffic protection shall minimally be in accordance with Part VI of the current Manual on Uniform Traffic Control Devices for Streets and Highways. The applicant shall be responsible for correctly using traffic control devices including signs, warning lights, and channelizing devices as needed while work is in progress or the clear zone is impacted. Flagging operations are the responsibility of the applicant. The Department's TC XXX Series Standards are the preferred traffic control specification plans.

6. The applicant shall seed and mulch all disturbed areas within the highway right-of-way and shall be responsible for the vegetative cover until it becomes well established. Any surfaced areas such as driveways or shoulders and sodded waterways and plantings which are disturbed shall be restored to their original condition. Any damage to any other underground facilities during installation shall be repaired at the permit holder's expense.

7. All personnel in the highway right-of-way shall wear ANSI 107 Class 2 apparel at all times when exposed to traffic or construction equipment.

8. As per Policy Section 115.3(9) parking or storage in the clear zone is prohibited. When not in actual use,

9. Unless specifically noted in Special Requirements section, all work performed within the right-of-way shall be restricted to 30 minutes after sunrise to 30 minutes before sunset.

10. Pedestals shall be placed within 12 inches of the right-of-way line.

1. To the extent allowable by law, the Permit Holder agrees to indemnify, defend, and hold the Department harmless from any action or liability arising out of the design, construction, maintenance, placement of traffic control devices, inspection, or use of the Permit Holder's facilities. This agreement to indemnify, defend, and hold harmless applies to all aspects of the Department's application review and approval process, plan and construction reviews, and funding participation.

2. The Permit Holder shall indemnify and save harmless the State of Iowa, its agencies and employees, from any and all causes of action, suits at law or in equity, for losses, damages, claims or demands, and from any and all liability and expense of whatsoever nature, arising out of or in connection with the Permit Holder's use or occupancy of the public highway.

3. The State of Iowa and the Department assume no responsibility for damages to the Permit Holder's property occasioned by any construction or maintenance operations on said highway if the facilities are not located in accordance with this permit.

4. The State of Iowa, its agencies or employees, will be liable for expense incurred by the Permit Holder in its use and occupancy of the highway right-of-way only when negligence of the State, its agencies or employees, is the sole proximate cause of such expense. Whether in contract, tort or otherwise, the liability of the State, its agencies and employees, is limited to the reasonable, direct expense to repair damaged utilities, and in no event will such liability extend to loss of profits or business, indirect, special, consequential or incidental damages.

C. Liability

1. The Permit Holder is responsible for contacting Iowa One-Call (1-800-292-8989) and request the location of all underground utilities forty-eight (48) hours before excavation. Before beginning work in the highway right-of-way, the Permit Holder shall also contact any other known utility located in the area of the proposed work.

2. The Permit Holder agrees to give the Department forty-eight (48) hour notice of its intention to start construction or to perform routine maintenance on the highway right-of-way. Said notice shall be made to the local DOT contact person whose name is shown on Page 3.

3. 511 Notification-The Permit Holder may not obstruct or close primary highways or primary highway extensions (State highways within city limits) without prior consent of the Iowa DOT, except in emergency situations. Before setting up a lane closure or a vertical/horizontal restriction of any kind on a primary highway, call your local Iowa DOT Maintenance garage and call the Traffic Management Center per attached documents. Except in emergency situations, a 10 day advance notice is required.

D. Notification

E. Build America, Buy America (BABA)

1. Build America, Buy America (BABA) applies to relocations of utility facilities that must move due to highway projects under certain specific conditions that include reimbursable locations and relocations due to interstate projects.

2. Please contact the Department's District Permit Specialist for more information on BABA requirements or visit the following link:

visit the following link: https://ia.iowadot.gov/erl/current/IM/content/107.htm

Signature: Date:

DECLARATION

Your signature acknowledging review of the final terms and conditions is required.DOT will issue your permit upon receipt.

I, Brian Whaley , under penalty of perjury, declare I am the owner of record or the legal and duly authorized representative of the owner of the Company requesting permission to perform work along the Primary Highway System. I acknowledge that I may not start my project until an official permit has been issued by the Iowa DOT.

I agree that I/we shall hold the State and the Iowa Department of Transportation (Iowa DOT) harmless of any damage or losses that may be sustained by any person, or persons, on account of the conditions and requirements of this agreement. If the Utility is not constructed within one year from date of issuance of the permit by the Iowa DOT, the Iowa DOT shall render this agreement and request null and void.

10/13/26

Special Requirements and Bidding Information: Story County, Nevada Township, T83N/ R22W Sections 10 & 15.

Project Location: Mile Marker 160.37 and Station 2234+90

Project Info: Existing underground drainage tile in DOT ROW has reached the end of its life expectancy and has failed at the location underground where the existing tile was coupled and extended from the project to widen U.S 30 to 4 lanes. Previous inspection work found the existing tile has separated at the jointed location and due to existing underground drainage pipe and pavement location prevent excavation to repair the existing pipe.

This project is to install a new 12” underground steel coated pipe via bore and jacking or other approved installation method. Length of installation is approx. 240’ from ROW-to-ROW boundary. Install inspection tubes or intakes on each side of Right of Way. Connection to existing tile on each side of ROW with approved materials.

Elevations and installation locations shall be field verified and confirmed.

Bidder Responsibility:

Install new steel underground drainage pipe crossing under U.S 30 per IDOT standards and special requirements. Connect new pipe to existing drainage connections on upstream and downstream sides of ROW.

Stabilize and restore all disturbed ROW. Bore pits shall be excavated on private property, Iowa DOT will work with landowners for agreement.

1. Steel pipe shall meet attached requirements- See steel pipe casing requirements.

2. Bid shall include all materials, installation, and restoration of all disturbed ROW.

3. Traffic control as required. No lane closures expected. TC-1 will be required for bidding purposes.

Contact if there are any additional questions or a field visit is needed- .

Untitled Map Write a description for your map.

Legend

500 ft

N

N Image © 2026 Airbus

Image © 2026 Airbus

Image © 2026 Airbus bwhaley Callout 12" tile between STA: 2234+00 & 2235+00 bwhaley Text Box Contractor responsible for connections of upstream & downstream connections. Located existing tile and verify location for new pipe. Elevations will be field verified.

bwhaley Text Box Existing Tile east of new proposed location bwhaley Line

IO W A DE P AR T ME NT O F T R AN S P O R T AT IO N

www.iowa d ot .gov

Steel pipe casing requirements:

- Steel pipe shall be new and meet the requirements of ASTM A139, Grade B; ASTM A 252, Grade 2; or ASTM A53, Grade B.

- Steel pipe shall have a coating to inhibit rust formation

- Steel pipe shall have a wall thickness of .281” or thicker

- Steel pipe shall meet the “Buy America” requirements