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R-16-05 04 Authorizing Submission Apllication Permit Use Illinois Toll Highway Right-Of-WayRESOLUTION R (10 • O S RESOLUTION AUTHORIZING SUBMISSION OF THE APPLICATION FOR PERMIT TO USE ILLINOIS STATE TOLL HIGHWAY RIGHT -OF -WAY WHEREAS, the Village of Lemont desires to cross the Illinois State Toll Highway Authority (IHSTA) right -of -way for the purpose of constructing a 12 -inch water main at Tollway Station 603 +15; and WHEREAS, the IHSTA requires that the Village Board authorize the Village President to sign such Permit application; and NOW, THEREFORE, BE IT RESOLVED, by the President and Board of Trustees that the Resolution for submitting the Application for Permit to UseToll Highway Right -of -Way to the Illinois State Toll Highway Authority is hereby approved, and the Village President is authorized to sign and execute such documents as are necessary for this purpose. PASSED AND APPROVED BY THE PRESIDENT AND BOARD OF TRUSTEES OF THE VILLAGE OF LEMONT, COUNTIES OF COOK, WILL AND DuPAGE, ILLINOIS, on this 18th day of April, 2005. Debby Blatzer Peter Coules Brian Reaves Steven Rosendahl Ronald Stapleton Jeanette Virgilio AYES NAYS PASSED ABSENT v Approved by me this 18`h day of April, 2005. Attest: RLENE SMOLLEN, Village Clerk Approved as to form: Date: CHARLENE SMOLL N, Village Clerk F. PIAZ ' . Vill - """ esident JOHN ANTONOPOULOS, Village Attorney APPLICANT APPLICATION FOR PERMIT TO USE TOLL HIGHWAY RIGHT OF WAY THE ILLINOIS STATE TOLL HIGHWAY AUTHORITY (Submit Three Copies) VILLAGE OF LEMONT 418 MAIN STREET Street City LEMONT State ILLINOIS 60439 (1) The applicant hereby applies to The Illinois State Toll Highway Authority (hereinafter called "Authority" to grant a concession consisting of a permit to: (Briefly describe proposed use of Toll Highway Right of Way). Construction of a 12 -inch ductile iron water main in perpendicular crossing under a bridge structure, at STA 603 +15 of the I -355 South Extension. (2) Location of Toll Highway Right of Way to be used by Applicant: (a) Tollway Route 1 -355 South Extension (e) County Cook (b) Tollway Mile (f) Nearest Cross Road New Avenue (c) Tollway Station 603 + 15 (d) Sec. 30 Twp. 37 N , R 11 E. (g) (3) The Applicant attaches hereto and makes a part hereof its plans and specifications for the structure which shall occupy the Authority's Toll Highway Right -of -Way. Applicant shall furnish such additional plans and specifications of the structure as the Authority requests. In the event a permit is issued, applicant agrees to con- struct such structure and perform such work in accord with the plans and specifications approved by the Authority. (4) The Applicant further agrees and understands that the concession in the form of a permit herein request- ed, if issued, does not sell, lease, create an easement, or otherwise dispose of or encumber the Toll Highway Right of Way, or any part thereof, and does not create any charge or lien on the revenues of the toll Highway. (5) The applicant further agrees that, in the event a permit is granted, applicant will, before commencing work under the terms and conditions of the permit, comply with all applicable laws, rules and regu- lations of the State of Illinois, and with all the Utility Policy and Regulations, Traffic Regulations, Standard Specifications, bond and insurance requirements of the Authority. —1— 01100 (6) The applicant agrees to abide by and fully comply with all terms and conditions of the approved permit. (7) Applicant understands that issuance of the permit is expressly subject to approval by the Authority's Board of Directors. (8) Applicant warrants that he/she has full power of attorney to act on applicants behalf and the represen- tation in the information contained herein are true and accurate and may be relied upon by the Authority in exe- cuting applicants request. WITNESS the signature_ and seal_ of the applicant_ this 18th day of April ,A D 2005 STATE OF ILLINOIS COUNTY OF COOK } SS (SEAL) (See note below for signature instructions) Charlene Smollen a in and for and residing in said County in the State aforesaid, do hereby certify that John F. Piazza, Village President personally known to me to be the same person_ whose name_ subscribed to the foregoir.g instrument, appeared before me this day in person and acknowledged that _he_ signed, sealed and deli, ered the same instrument as free and voluntary act for the use and purposes set forth herein. Given under my hand and notarial seal this 18th day of April A D 2005 . Z- NtarrPttblicVillage Clerk NOTE FOR SIGNATURES If the applicant is a corporation, have the President or other authorized officer sign the Corporate name by him as President; also have the Secretary attest his signature as Secretary and affix the seal of the corporation. If the applicant is a partnership, have each partner sign. If the applicant is a county, city, or other municipal corporation, have the application signed by the Chairman of the County Board, Mayor, or other officer and have the proper clerk attest the same and affix the corporate seal. Also, a certified copy of the resolution or ordinance authorizing the application must be attached. All omens, attachments, documents or small plans which the applicant desires to have made a pan of this application, or otherwise necessary, shall be securely attached. EMU -11 —2— Illinois LTollwav The Illinois Stare Toll Highway Authority 2700 Ogden Avenue Downers Grove. Illinois 60515 -1703 630 241-6800 Fax: 630.141 -6100 T.D.D. 630 241-6898 Road Conditions: 1 -800- TOLL -FYI www. iiiinoisrollwar.eom CONTRACTOR'S INSURANCE REQUIREMENTS In order to comply with the statutes of the Illinois State Toll Highway Authority, the Contractor shall furnish insurance coverage of the kind and in amounts stated hereinafter: a. Worker's Compensation and Occupational Insurance for all prime and subcontractors employees, as required by law b. Employers' Liability Insurance for all prime and subcontractors employees: Each employee $ 500,000.00 c. Comprehensive General Liability Insurance Bodily Injury and Property Damage: Per Occurrence $ 1,000,000.00 Annual Aggregate $ 2,000,000.00 d. Comprehensive Automobile Liability Insurance Bodily Injury and Property Damage: Combined Single Limit .. $1,000,000.00 The Illinois State Toll Highway Authority and Consoer Townsend Envirodyne Engineers must be included as an additional named insured on the policy. The Permit Number is to be noted on the policy in the Description of Operation /Locations /Vehicles /Special Items area of the policy. The policy is to be sent to the following address: Mr. Dana Havranek Utility /Permit Engineer The Illinois State Toll Highway Authority 2700 Ogden Avenue Downers Grove, IL. 60515 07/19/01 rev Illinois j7bllway April 4, 2005 Village of Lemont 418 Main Street Lemont, IL 60439 ATTENTION: RE: Gentlemen: The Illinois State Toll Highway Authority 2700 Ogden Avenue Downers Grove, Illinois 60515 -1703 630/241 -6800 Fax: 630/241 -6100 T.T.Y. 630/241 -6898 Mr. James L. Cainkas, P.E. P.L.S. Acting Village Engineer Permit NS 05 -11 North -South Tollway Village of Lemont New Avenue Water Main Extension & Sanitary Sewer Connections Enclosed are three (3) Application forms for a Permit. Please sign the applications and return them to the Authority for further processing. We have assigned it Permit Number NS 05 -11. We require the Contractor to furnish a Certificate of Insurance providing the coverage as shown on the enclosed sheet entitled "Contractor's Insurance Requirements ". Policies should contain a ten (10) day notification to the Illinois State Toll Highway Authority in writing prior to cancellation. The Permit Number must be shown on the Certificate. A Notice to Proceed will be issued after approval by the Board of Directors, the receipt of the Certificate of Insurance documents and Tollway facilities have been located with a form A -36 (enclosed). The process usually takes about 45 days from approval of the application and plans. Should you have any questions, please call me at (630) 241 -6800 extension 3941. Sincerely, Dana B. Havranek Permit Utility Manager DBH:pm cc: Jeffrey S. Dailey, P.E. John Benda John Wagner Illinois State Toll HighwayAuthority A -36 Request to Locate TOLLWAY FACILITIES Rev O6 /09/04pm FOUR (4) BUSINESS DAYS ARE REQUIRED TO MARK THE LOCATION OF THE FIBER OPTIC SYSTEM, ROADWAY LIGHTING SYSTEM AND TOLLWAY COMMUNICATION LINES. THIS LOCATE IS VALID 14 BUSINESS DAYS AFTER THE REQUEST DATE. Today's Date: Company: Requested By: Telephone No.: Contact Person: Telephone /Cell No.: Tri- State /I -294 Northwest /I -90 East- West /I -88 North- South /I -355 Edens Spur Mile Post: Crossroad: Permit No.: Contract No.: AT LEAST 4 WORKING DAYS NOTICE BEFORE SCHEDULED WORKDATE MUST HAVE SCHEDULED WORKDATE: TYPE OF WORK: (PLEASE CIRCLE) BORING DIGGING HAND -HOE LANDSCAPING PLOWING PULLING OTHER Additional Information: Please note that J.U.L.I.E. location of buried utilities DOES NOT include ISTHA buried facilities. If you know J.U.L.I.E. dig number please list it. J.U.L.I.E. Dig No.: MUST ATTACH PLAN /SKETCH SHEET RETURN TO PATRICIA MATHEZ / UTILITY - PERMIT SECTION FAX 630/271 -7568 Questions ? Contact Ms. Mathez at 630/241.6800 extension 3306. VALID FROM to TOLLWAY LOCATING PROCEDURE Mark the location in the field. Prepare a sketch or plan sheet of the area showing the approximate location. Request a Tollway locate with a Form A -36 at 630/241 -6800 extension 3306. In order to do any underground work on Tollway property an A -36 form must be sent in. Follow the directions on the form. The forms can be faxed in. The marked area (the tolerance zone) is defined as a strip of land at least 3 feet wide, but not wider than the width of the underground facilities plus 24" on each side. The tolerance zone is the approximate location of the underground facilities. Excavation within the tolerance zone requires extra care and precaution. The contractor must hand dig and expose (pothole) Tollway facilities that are located within the tolerance zone. See Sketch: ■ -11tr coda ®coco LARGE PIPE OR MULTIPLE DUCTS OR MULTIPLE FACILITIES SMALL PIPE OR CABLE A SKETCH OR PLAN SHEET SHOWING LOCATION MUST BE INCLUDED WITH THE LOCATE REOUEST. Unless contacted within four (4) business days of the request date on the A -36, the contractor can proceed with the work. Tollway facilitieg are marked within four (4) business days and are valid for 14 business days. Tollway locates apply only to Tollway facilities. Contact J.U.L.I.E. to locate other utilities. Utility owners that do not participate in the J.U.L.I.E. system must be contacted directly. Contact Patricia Mathez 630 /241 -6800 Extension 3306 Locate fax number 630/271 -7568 (Revised 10/07/03)