SUPER OVERSIZE / OVERWEIGHT SINGLE TRIP

CITY OF BAYTOWN City Clerk s Office 2401 Market Street Baytown, Texas 77520 Phone: (281) 420-6504 Fax: (281) 420-5891 Web: www.baytown.org FOR OFFICE USE ONLY Date Received: Date Processed: SUPER OVERSIZE / OVERWEIGHT SINGLE TRIP PERMIT APPLICATION PERMIT FEE: Applicant Information 1) Company Name: 2) Company Address: City: State: Zip: 3) Primary Contact for Permit: 4) Primary Contact s Title: 5) Primary Contact s Phone Number: Oversize / Overweight Trip Information 1) Date of scheduled move: Time of scheduled move: 2) Route description (include a map of the route): 3) Starting city: Ending city: 4) Description of materials being transported: 5) Gross Weight: 6) Max Width: Max Height: Max Length: 7) Rear Overhang: Front Overhang: 8) Description of matting to distribute the weight of the equipment and materials: * Note at any time, the Police Chief or Fire Chief may require additional matting if he in his sole discretion deems the same necessary in order to protect the underlying road or other facilities. 9) Permits (list and attach all federal, state and/or county permits for the transport): 10) Transport Equipment Information: Make: Year: Model: Registration: City of Baytown Super Oversize / Overweight Single Trip Permit Application Page 1 of 6

Axle Distance Weights Number of Tires Tire Sizes 1 2 3 4 5 6 7 8 9 10 Special Conditions Permittee shall use the equipment as described hereinabove or equipment of a comparable or higher quality for the transport of the materials detailed herein, which the Permittee warrants is adequate for its designated use. Permittee shall have immediate access to adequate backup equipment in order to sustain continuous operations in the event of equipment failure. Permittee shall employ well-trained individuals to perform the transport of materials under this Permit and that throughout all transports. Permittee will provide the necessary supervision of all such personnel. Permittee shall have a designated representative along the transport route at all times, who has the authority to respond on behalf of the Permittee and who is immediately available to the City during the transport. Permittee shall provide written documentation to the Chief of Police or his designee, as to who the representative is, where he/she will be located, and how he/she may be contacted. If the City, for any reason is unable to contact the representative, the Permittee agrees that any person employed by the Permitee shall have the authority to respond and act on behalf of the Permittee. Permittee shall appoint a transport safety officer, who shall be responsible for ensuring the public s health, safety, and welfare in relation to and throughout the activities of the Permittee, its agents, and its subcontractors. Permittee in the presence of a City representative shall inspect the property of the City prior to the scheduled move to inform itself regarding local conditions and shall note any existing damages of City property. Permittee shall submit a list of any such damages found to the City prior to the transport. If no written list of damages is submitted, it shall be presumed that no damages were found. After the move, the City shall inspect the route and any damages found, which were not documented and submitted to the City prior to the transport, shall be the sole responsibility of the Permittee. Permittee shall be liable to the City for damages for (i) the failure to restore the property in a timely manner, (ii) any injury to a facility, any portion of the transport route or the underlying facilities, (iii) the use of insufficient and/or inadequate machinery or equipment, (iv) the use of machinery or equipment in derogation of its intended use, or (v) the breach of any term or condition of its permit. City of Baytown Oversize / Overweight Single Trip Permit Application Page 2 of 6

Within 30 days of the transport, Permittee shall compensate all owners of property along the route and other persons whose property, either real or personal is damaged, whether caused in whole or in part by the transport. Permittee shall provide MSDS information if hazardous materials are being transported. Permittee shall adhere to the described route and no changes thereto will be allowed without the express written approval of the City. Permittee shall use caution at all railroad crossings. Railroad crossing hotline: 1-888-877-7267. Permittee shall not hinder or inconvenience travel on streets or intersecting alleys which are not located on the transport route. To this end, Permittee authorizes the Chief of Police to employee such force of men as is necessary, as determined in the sole discretion of the Chief of Police, to control the pedestrian and/or vehicle traffic and to endeavor to ensure the safety of the transport. The materials are to be transported with the equipment on the transport route during the times specified by the City in the resulting permit. Transports authorized shall, nonetheless, be cancelled by the City when the road surface is hazardous due to rain, ice, sleet, snow, wind or roadway maintenance/construction work, when visibility is less than 2/10 of one mile or when the public health, safety and welfare commands such result as determined in the sole discretion of the City. Permittee releases the City from all liability which may result from such cancellation. All street closures and barricades proposed by Permittee and/or necessary due to Permittee s transport must be secured from the City prior to the transport. If a permit is granted, Permittee must provide notice to property owners adjacent to a right-of-way which will be traversed by the Permittee s equipment and of any foreseeable loss of utilities. Such notice must include the dates and times of the transport as approved by the City. It is the responsibility of the Permittee to contact all utility companies whose facilities may be affected by the transport and shall make arrangements with each such company to temporarily move its facilities with minimal interruption of service to the citizens of Baytown. No transport shall be undertaken by Permittee until Permittee provides evidence that it has obtained all the necessary consent of the utility companies as well as other persons and entities potentially affected by the transport. All transport activities shall be subject to the operational approval and supervision of the Fire Chief. The Fire Chief at his sole discretion shall determine the type and number of personnel necessary to perform the services for the transport and shall have the authority to obtain the additional personnel at any time during the transport in order to protect public health, safety and welfare, including damage to City property. Permittee understands that the City cannot and does not guarantee a safe, secure transport or a transport without incident; therefore, Permittee agrees to and shall assume all liability with respect to the security of persons and property at all times, including, but not limited to, during the staging, operation and completion of the transport, and releases and fully discharges the City from any and all actions, causes of action, claims, demands, costs, controversies, damages, and all other liability whatsoever for any and all personal injuries, deaths or property damages arising out of or in connection with the operation, control, and security of the transport. Loads must use designated truck routes to the extent required in the Code of Ordinances, Baytown, Texas. It is expressly understood that the City of Baytown shall not be responsible in any way for any damage of whatever nature that may result from the movement of the described vehicle and load over the City streets, and that all such responsibility is hereby accepted on behalf of the applicant. The super oversized and/or overweight permit, if issued, is issued on the condition that the applicant will comply with all laws and rules. Violations of any laws or rules formally adopted by Texas Department of Transportation or any other applicable governmental entity regarding the movement of oversized and/or overweight vehicles and/or equipment may subject the Permittee to being cited for violation of City of Baytown Oversize / Overweight Single Trip Permit Application Page 3 of 6

Texas size and weight laws. The permit does not authorize the vehicles to exceed the manufacturer s tire load rating FMCSRT Section 393.75f. Insurance and Indemnity Agreement Prior to conducting any operations hereunder and throughout the term of this Permit, Permittee, at its own expense, shall purchase, maintain and keep in force and effect insurance against claims for injuries to or death of persons or damages to property which may arise out of or result from the Permittee s operations and/or performance of the work under this Permit, whether such operations and/or performance be by the Permittee, its agents, representatives, volunteers, employees or subcontractors or by anyone directly or indirectly employed by any of them, or by anyone for whose acts any of them may be liable. The Permittee s insurance coverage shall be primary insurance with respect to the City, its officers, agents and employees. Any insurance or selfinsurance maintained by the City, its officials, agents and employees shall be considered in excess of the Permittee s insurance and shall not contribute to it. Further, the Permittee shall include all subcontractors as additional insureds under its commercial general liability policies or shall furnish separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated herein. The following is a list of standard insurance policies along with their respective minimum coverage amounts required by this Permit: Commercial General Liability (CGL) General Aggregate: $5,000,000 Products & Completed Operations: $5,000,000 Personal & Advertising Injury: $5,000,000 Per Occurrence: $3,000,000 Fire Damage: $100,000 Coverage shall be at least as broad as ISO CG 00 02 12 07 No coverage shall be excluded from standard policy without notification of individual exclusions being attached for review and acceptance. Business Automobile Policy (BAP) Combined Single Limits: $1,000,000 Coverage for Any Auto. Workers Compensation: Statutory Limits Employer s Liability: $500,000 Waiver of Subrogation required. Prior to conducting any operations hereunder, Permittee shall file with the City valid Certificates of Insurance and endorsements acceptable to the City. Such Certificates shall contain a provision that coverage afforded under the policies will not be canceled, suspended, voided, or reduced until at least thirty (30) days' prior written notice has been given to the City via certified mail, return receipt requested. The Permittee shall also file with the City valid Certificates of Insurance covering all subcontractors. The following are general requirements applicable to all policies: AM Best Rating of A:VII or better. Insurance carriers must be licensed and admitted to do business in State of Texas. Liability policies will be on occurrence form. The City, its officials and employees are to be added as Additional Insured to liability policies but only to the extent of the liabilities of Permittee under this Permit. Upon request of and without cost to the City, certified copies of all insurance policies and/or certificates of insurance shall be furnished to City s representative. Upon request of and without cost to City of Baytown, loss runs (claims listing) of any and/or all insurance coverage shall be furnished to City s representative. City of Baytown Oversize / Overweight Single Trip Permit Application Page 4 of 6

Commercial General Liability policy should include endorsements for explosion and collapse. Should any insurance required herein lapse, Permittee shall immediately cease all operations as of the time and date of such lapse, and shall not resume any operations until authorized in writing by the City. If the lapse period extends fifteen (15) day, this Agreement shall automatically terminate with no notice to Permittee required and Permittee shall be in breach of its permit. PERMITTEE AGREES TO AND SHALL INDEMNIFY, HOLD HARMLESS, AND DEFEND THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS, LOSSES, DAMAGES, CAUSES OF ACTION, SUITS AND LIABILITY OF EVERY KIND, INCLUDING ALL EXPENSES OF LITIGATION, COURT COSTS, AND ATTORNEYS' FEES, FOR INJURY TO OR DEATH OF ANY PERSON, OR FOR ANY AND ALL DAMAGES ARISING OUT OF OR IN CONNECTION WITH THE WORK DONE BY PERMITTEE PURSUANT TO THIS AGREEMENT, THE CONDUCT OR MANAGEMENT OF PERMITTEE'S BUSINESS OR ACTIVITIES, OR FROM ANY ACT OR OMISSION BY PERMITTEE, ITS AGENTS, SERVANTS, EMPLOYEES, SUBCONTRACTORS, GUESTS, OR INVITEES, ON OR ABOUT THE PREMISES SUBJECT TO THIS AGREEMENT, WHERE SUCH INJURIES, DEATH OR DAMAGES ARE CAUSED (I) BY THE SOLE OR JOINT NEGLIGENCE OF THE CITY AND ANY OTHER PERSON OR ENTITY AND/OR (II) BY THE SOLE OR JOINT NEGLIGENCE OF PERMITTEE AND ANY OTHER PERSON OR ENTITY. IT IS THE EXPRESSED INTENTION OF THE PARTIES HERETO, BOTH PERMITTEE AND THE CITY, THAT THE INDEMNITY PROVIDED FOR IN THIS PARAGRAPH IS INDEMNITY BY PERMITTEE TO INDEMNIFY AND PROTECT THE CITY FROM THE CONSEQUENCES OF (I) THE CITY'S OWN NEGLIGENCE, WHETHER THAT NEGLIGENCE IS THE SOLE OR A CONCURRING CAUSE OF THE RESULTING INJURY, DEATH OR DAMAGE AND/OR (II) PERMITTEE'S OWN NEGLIGENCE, WHETHER THAT NEGLIGENCE IS THE SOLE OR A CONCURRING CAUSE OF THE RESULTING INJURY, DEATH OR DAMAGE. IN THE EVENT THAT ANY ACTION OR PROCEEDING IS BROUGHT AGAINST THE CITY BY REASON OF ANY OF THE ABOVE, PERMITTEE FURTHER AGREES AND COVENANTS TO DEFEND THE ACTION OR PROCEEDING BY LEGAL COUNSEL ACCEPTABLE TO THE CITY. THE INDEMNITY PROVIDED FOR HERIENABOVE SHALL SURVIVE THE TERMINATION OR EXPIRATION OF ANY PERMIT ISSUED PURSUANT TO THIS APPLICATION. Permit Fee Gross Weight in Pounds Road Maintenance Fee Permit Fee Total Fee Over 254,300 $200 $50 $250 City of Baytown Oversize / Overweight Single Trip Permit Application Page 5 of 6

Service Fee All payments to the City of Baytown shall be calculated based upon actual costs incurred. The following is an estimate of the hourly cost of the services, which could be performed by the City under this Agreement: DESCRIPTION OF SERVICE Police and Traffic Services Fire and Rescue Safety Services ESTIMATED COST OF SERVICE $100.00 per hour $175.00 per hour Permittee shall be responsible for the actual costs associated with the provision of police and traffic safety services, fire and rescue safety services, and emergency medical services by the City and the above-referenced figures are estimates and are provided to Permittee by the City for planning purposes only. Such amounts shall be due within fifteen (15) days after Permitee receives an invoice for the services rendered. Amounts not timely paid shall accrue interest at the rate of 1% per month. Bond Permittee shall provide a cash bond to the City in the amount specified in the permit, the purpose of which is to protect the City from any damages to traffic signs/markers, roads, bridges, drainage facilities, and rights-of-way owned by the City caused by Permittee s operations. In the event the City, at its sole and exclusive option, determines that any repairs to the roads, bridges, drainage facilities, and rights-of-way are required as a result of Permittee s operations, the City shall make such repairs and deduct the cost thereof from the cash bond amount without further notice to Permittee. The City shall provide Permittee a monthly accounting of all repairs and deductions made to the cash bond, which accounting shall be made only if a deduction has been made for which no prior accounting has been tendered. Upon expiration of one (1) year from the effective date of this Permit, the City shall refund any balance of the cash bond to Permittee, upon written application for same. Should the costs to repair or replace damaged property exceed the amount of the cash bond, Permittee shall reimburse the City for such costs within thirty (30) days of the receipt of invoice. Costs not timely paid shall accrue interest at the rate of 1% per month. Applicant Statement I (Name of Applicant) as the applicant herein, acting in my capacity for the above-referenced company, hereby state that the oversize/overweight transport complies with all applicable federal, state, and local laws and regulations. Permittee further agrees to all conditions and agreements contained herein. Signature of Applicant Other Information The City Clerk s office reserves the right to deny an incomplete application. Should you have any questions, feel free to contact the City Clerk s office, Phone: (281) 420-6504, Fax: (281) 420-5891 Web: www.baytown.org Submission Instructions: Mail or deliver original application to: City of Baytown, City Clerk, 2401 Market Street, Baytown, TX 77520. The City Clerk s office accepts only cash or checks for payment. City of Baytown Oversize / Overweight Single Trip Permit Application Page 6 of 6