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HomeMy WebLinkAboutLovelocks Locksmith Services - ContractAPPENDIX 1 ADOPT A -ROAD. APPLICATION Love Loc 5 Lock3ws i }Lt 5_elt/ i Ge- Name of Volunteer Organization Date Application ItcceWed S2 Mailing Address, City, State, Zip Code List the sections of road youare interested in cleaning in order of preference: fh 1. ‘5 A Road Name Vicinity 2. • Road Name 1(& 5 `vv c5 Road Name cw Vicinity �trG.cts w►d- le0-4 4.3 E 0ii nth*'v o • Vicinity Sections of County road are assigned on a safety and.first-come, first -serve basis. If the sections your group has identified above are not available the Mason County Public Works Department. will suggest other alternatives. Volunteer Organiza)on Representatives: Signature: Resentative li1 Name. of Representative (Print or Type) I a V Ci(CeIA lol tet.Q ` c4- `(,11./(,-. (443.C--g Mailing Address, City, State, Zip Code 53a-L 7al Day phone number R0 , L°VU- Signature: Representative 1/2 3-525..q 5Hq Day phone number. Return this application to: Adopt -A -Road Coordinator. 100 W Pubik Works Drive Shelton; WA 98584 Sao-1.1gct .m1 Evening phone number .008 Name of Representative (Print or.Type) 3.4_ 515.-4 541 Evening phone number ADOPT-A=ROAD AGREEMENT .. Page.1 of 4 ., ADOPT, A -ROAD AGREEMENT made and entered into this date and between Mason County a munldpal'subdnnsion of This agreement is the State of Washington herein known as the "Count"' and organization :'a volunteer Lac herein known as the "Grantee". toestablish a County -wide Adopt -A -Road Litter Control Program Whereas,;the Gountyhas the authority. (Adopt -A -Road Program) pursuant to RCW 47.40; and Whereas the Grantee wishes to contribute toward the effort to reduce roadside litter by volunteering to assist in picking up litter on the section of road specified herein; pow;therefore,does herbyauthorize the Grantee to participate in the Adopt -A -Road Program by the County pickinggup litter within the assigned section of County road designated below, in accordaflce with the following terms and conditions: MASON COUNtY PUBIC WORKS A. The Grantee does hereby agree: fired by the 1. To conduct cleanup activities in a safe manner and under any conditions as may be repaired the County for the safety vol of theteer participants. organization agrees to take full responsibility foripants is the rone priority the safety of each of its,' program and the volunteer participants. 2 To assign a leader to each cleanup crew, and that crew leader shall have a copy of this agreement with him/her during the cleanup activity. 3 To pick up litter no less than four times per year. tAdditional cleanup is once every three months. necessary interval to maintain a neat appearance_ Recommend 4 To furnish and require all participants wear a hard hat andsafety vest during cleanup activities. vi G e5 5, To allow no more than ten people to participate in the cleanup activity at one time over a one -mile section: • 6 To have no more than two vehides per one -mile section of assigned road parked on Countyroad shoulder within the assigned area,during cleanup activity, (A minimum number of vehicles shall be used to transport theparticipants to the assigned are.) All parking of vehicles shall be, in compliance. `with State Law; 7, To require that all participants shall be 15 years of age or older. The Grantee shall furnish supervision by one more'adults for every eight„(8):minorS (between ages of 15 to 18 years of age) participatingin the cleanup acdVity, ADOPT -A -ROAD AGREEMENT Page 2 of 4 APPENDIX 2 8. To conduct a yearly safety training session for volunteers utilizing materials and training aids provided by the County prior to participating in a roadside cleanup. 9. Provide supplies and materials from Mason County Building I during regular business hours at the address shown on page 4 of this agreement. 10. To place filled trash bags at the County road shoulder for pickup and disposal by the County and notify the County at the time of cleanup to'coordinate the pickup time and locations. 11. To notify the County immediately in the event of any emergency on County road right-of-way. Participants who find anything that is hazardous or suspected to be hazardous shall not touch, but take appropriate precautions flag it and leave it for disposal by the proper authorities. Participants shall also not pick up syringes, hypodermic needles, or exceptionally large, heavy or unyielding objects. These kinds of materials should be flagged and the County notified as soon as possible to arrange for proper disposal_ 12. Cleanups shall not be scheduled during a legal holiday, during the aftemoon on the day before a legal holiday, or during holiday weekends. 13. To provide the County a roster (Medical Aid Coverage Record) of individual participants in the cleanup within seven(7) calendar days following the cleanup activity. 14. To report any injuries, incurred by participants during cleanup activities, to the County, within two (2) working days of the injury. Notification shall include: o Name of injured person o Nature of injury o Date and time of injury o How the injury occurred 15. Furnish to the County an "Adopt -A -Road Registration Form" for each of the participants taking part in litter pickup activities. 16. It is recommended that 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. B. The County does hereby agree to: 1. To designate a program administrator to act as a contact person for this agreement. 2_ To furnish and install a maximum of two (2) Adopt -A -Road signs with the Grantee name and/or acronym displayed within the assigned area. 3. Furnish the Grantee with trash bags. 4. Remove the filled trash bags from County road shoulder upon notification by Grantee. 7 ADOPT -A -ROAD AGREEMENT Page 3 of 4 APPENDIX 2 Assist the Grantee, in cleaning up titter if necessary (i.e., when large, heavy, or hazardous items are found). 6. Provide safety materials and training aids to the Grantee's representative for use by the Grantee in training participants. 7. To fumish a portable "Volunteer Utter Crew Ahead" advanced warning sign and stand, and make available hard hats, safety vests for all participants, and other equipment as deemed necessary (a deposit may be necessary). C. General Conditions: 1. 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. 2. The County may suspend this agreement temporarily because of future construction that will take place within the limits of the assigned area. Once these have been completed, the Grantee will be notified and the agreement restored. 3. The terms of this agreement shall commence on the date of execution indicated below, and shall end on the date of termination unless terminated by the County, or the Grantee on 30 days notice. Upon termination of this agreement the Adopt -A -Road sign shall be removed and remain the property of the Department. 8 ADOPT -ABROAD AGREEMENT Page 4 :of,4 D: ;ASSIGNED ROAD SECTI O N : Road Name VA. 1 .S From Side of roadway North South East West (Circle assigned side/s) Date of Execution Date of Termination : Janua 31 l7 to Sv►ek'a-i► ` 56(Inc Name Of Volunteer. Organization PT RAailirig Address,; City, State,ZipCode L' Signature,; Representative f«. Name of Representative (Print or Type). Mailing Address City, State, Zip Code of Representative #1. 3_6a;rSZS� 5Z-5'469 • Day phone number Evening phone number � •. .. , APPENDIX Z . Office Use Only Signature RepfE{sentative #2 Name of Represe%tative (Print or Type) Nailing Addre$S, City, State, Tip Code of Representative'p2 Day phone: number • Chairman of the Board, MasonCounty 5 Eveningphone number Return To: Mason Col ntyPublic Works ] OO. W Public World Drfve Shelton, WA 9R584: :' `.