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Emergency Contact Number
Location and Address of Work
If other, please explain
Description of Work
NOTE: Utilities Division must be notified at 813-749.1226, forty-eight (48) hours prior to excavation for utility line locations.
Signature of Applicant or Authorized Agent
Size of Culvert if Required
Length of Culvert if Required
Material of Culvert if Required
Special Conditions to be Approved by Senior Engineering Tech
2. CONTRACTOR now occupies and desires to occupy and utilize a portion of the
public right-of-way and easements. CONTRACTOR shall attach hereto the utility plan
sheets on which shall be shown the proposed system facilities to be constructed.
Compliance with the locations and conditions shown on said plans shall be a
requirement for active validity status of the Authorization. Construction of facilities not in
compliance with the terms and conditions of the Authorization shall render the
Authorization null and void.
4. CONTRACTOR shall determine and demonstrate to the CITY OF OLDSMAR
that right-of-way and easements are available to install the CONTRACTOR facilities.
CONTRACTOR shall obtain a legally sufficient easement or license from the present
owner (s) of the fee simple title as required where public right-of-way and easements
are insufficient for CONTRACTOR installation. CONTRACTOR shall furnish to the
CITY OF OLDSMAR a copy of each such easement or license prior to CONTRACTOR
commencing initial activities within the easement.
6. CONTRACTOR shall first obtain property authority, approval and/or authorization
from all other appropriate governmental body or public agency having jurisdiction over
any such installations at these locations. Contractor shall provide 48 hour advance
notice to CITY OF OLDSMAR Public Works Department/Utilities Division at (813) 855-
4612 before starting construction. Contractor shall utilize Florida underground utility
notification system “Sunshine State One-Call” (1-800-432-4770).
8. THE CITY OF OLDSMAR shall not be liable for any damages to CONTRACTOR
utilization howsoever resulting from the CITY OF OLDSMAR’S continued use and
occupancy of the public right-of-way and easements; the CITY OF OLDSMAR,
however, shall not willfully cause undue damage to CONTRACTOR’S utilization.
10. CONTRACTOR shall remove all above ground abandoned equipment and
restore areas to original grade and condition as the work progresses.
12. CONTRACTOR shall furnish the CITY OF OLDSMAR with a set of as-built
drawings within thirty days of final construction.
14. CONTRACTOR hereby expressly understands, covenants and agrees (a) that
nothing contained in this Authorization or contemplated is intended to or shall increase
the CITY OF OLDSMAR’S liability for personal injury or death or for any property
Revised 6/23/09 Page 4 of 4
damage, (b) that the CITY OF OLDSMAR does not assume any such additional liability,
(c) that liability arising out of the utilization and occupancy of the CITY OF OLDSMAR’S
public right-of-way and easements by CONTRACTOR and CONTRACTOR employees,
agents, contractors, invitees or any representative, is hereby assumed by
CONTRACTOR and shall be at the sole and exclusive risk of CONTRACTOR, (d) that
CONTRACTOR shall answer and satisfy to the CITY OF OLDSMAR’S satisfaction any
and all complaints relative to CONTRACTOR’S utilization of the CITY OF OLDSMAR
public right-of-way and easements, (e) that CONTRACTOR shall protect, defend, hold
harmless and indemnify the CITY OF OLDSMAR from and against any and all actions,
claims, damages, and/or loss, including costs and attorney’s fees, occasioned by or
growing out of any actual or claimed usage of condition of the CITY OF OLDSMAR’S
public right-of-way an easements arising in any manner whatsoever, directly or
indirectly, by reason of this Authorization for CONTRACTOR’S utilization thereof, and (f)
that CONTRACTOR covenants not to interfere with the CITY OF OLDSMAR’S existing
and future facilities in any manner whatsoever and shall fully indemnify the CITY OF
OLDSMAR from any and all losses resulting from such interference.
* indicates a required field