|
|
|
|
Part 1: Adopt-a-County-Road Volunteer Application
|
|
Placard Message
|
Please use the boxes below to write
your message for the Group Name Placard.
No more than 10 characters (spaces included) are
allowed per line.
|
For a placard with 2.5" high text, use the following
|
|
For a placard with 3" high text, use the following
|
|
|
Terms & Conditions
1. Permittee shall on each work occasion notify the Pinal County Department of Public
Works at telephone number 520-866-6515 five (5) working days prior to start of any
work by this permit. County furnished litter bags and vests shall be obtained at
the Public Works Office located at 31 N. Pinal, Bldg. F, Florence, Arizona during
normal business hours.
2. Pinal County reserves the right to approve, disapprove and/or edit names or acronyms.
3. Work shall be conducted during daylight hours, and shall be done at such time
and in such a manner as is least inconvenient to the traveling public and as directed
by the County. Work shall not be conducted on holiday weekends, or within twenty-four
hours proceeding a holiday weekend unless specifically authorized in writing as
an amendment to this permit. All work done shall be done at no expense to Pinal
County.
4. Litter pickup shall not be performed within six feet of the traveled way, upon
bridges, culverts, or structures of any kind; pickup within medians is allowed only
when specifically authorized in this permit.
5. Volunteers shall not cross the traveled way to access median areas.
6. If weather or other adverse circumstances cause a public hazard, work shall be
immediately discontinued.
7. Volunteers performing work under this permit shall wear personal protective clothing,
including safety vests, while in the County highway right-of-way. Protective equipment
furnished by the County shall be returned within seven (7) days of completion of
the project. Volunteers are expected to provide their own gloves.
8. Work SHALL NOT be initiated PRIOR to briefing on safety procedures by County’s
representative and the Adopt-A-Highway Supervisor(s).
9. Permittee shall designate a coordinator who shall represent the group. In addition,
one adult supervisor shall be assigned by the volunteer organization for each ten
children between the ages of fourteen and eighteen years of age. No child less than
twelve years of age shall be allowed to participate or to remain in the right-of-way
assigned to the permittee.
10. Volunteers’ personal vehicles shall be legally located off the traveled ways
so as not to interfere with the free flow of traffic or pedestrians; expect, approved
vehicle(s) used to transport volunteers or materials to and from the work site may
be parked off the roadway on access controlled highways in an area approved by the
County. If permit is for access controlled highways, see map which indicates where
parking is allowed.
11. This permit is valid for two calendar years from date of issue and may be renewed
with the approval of the Director of the Department of Public Works. The County
may impose additional conditions as needed. This permit may be canceled by the County
at any time for nonconformance with permit provisions.
12. All Adopt-A-Highway supervisors must attend a safety orientation conducted by
the Pinal County Department of Public Works prior to entering the County Highway
right-of-way. The orientation shall include a discussion and explanation of the
attached safety requirements (Attachment A). Supervisors must participate in a safety
orientation at least once during each permit period.
13. Prior to entering the County highway right-of-way, each volunteer must attend
a brief orientation given by the Adopt-A-Highway supervisor explaining the safety
requirements in Attachment A.
14. Each volunteer (or parent or guardian of a minor volunteer) shall sign a waiver
form for each pickup event. The permittee has volunteered to pick up litter in the
right-of-way at its own risk. Pinal County and its officers and employees shall
not be liable for any death, injury or property damage claims and all the costs
associated therewith which arise. If any claim arises out of the foregoing, the
permittee shall indemnify, defend, save, and hold harmless Pinal County, its officers
and employees from same. Permittees’ obligation under this provision shall not extend
to any liability caused by the sole negligence of the County or its employees.
15. In the event the work to be done under the authority of the permit necessitates
the creation of any hazard or source of danger to any person or vehicle using said
highway, said Permittee shall and will provide and maintain at all times during
the existence of said hazard, sufficient barriers, danger signals, lanterns, detours,
and shall and will take such other measures of precaution as the County shall direct.
16. Each volunteer shall comply with the “Policies and Procedures for Adopt-A-Highway
Program”.County will provide safety training, litter bags and safety vests.
County will pick up filled litter bags. County will erect signs showing the participation
of the names organization/family in the Adopt-A-Highway Program. The work order
for the sign will be processed after the permit is approved and installed approximately
thirty (30) days after the FIRST scheduled pickup event.
|
I (We) have read and agree with the conditions as stated above
|
|
|
| | | | | | |