CITY OF PATASKALA
KEEP PATASKALA BEAUTIFUL
ADOPT-A-STREET
Volunteer Agreement
This Agreement is entered into this _____ day of ___________________, 20_____ by and
between the City of Pataskala, hereinafter referred to as the Sponsor, and
___________________________________, hereinafter referred to as the Adopting Group.
WHEREAS, the Sponsor and the Adopting Group recognize the importance of clean and safe
roadways; and
WHEREAS, the Sponsor and the Adopting Group share the common goal of providing clean and
safe roadways;
NOW THREFORE, in consideration of the mutual benefits to be derived, the Sponsor and the
Adopting Group agree to the following terms and conditions:
A
. The Adopting Group:
1. S
hall be the volunteer caretaker of _____________________
for the purposes of
a roadway cleanup for a two-year period of time commencing on the date first
noted herein above.
2. Acknowledges that the Adopt-A-Street Program contemplated herein involves
activities which because of their close proximity to roadways and roadway traffic
are inherently dangerous and accepts the risks associated therewith. In addition,
agrees to conduct a minimum of six (6) cleanups per year.
3. Assumes all risks of accident or injury and release and forever discharge Sponsor
and its employees, officers and agents from any and all liability for personal injury
or property damage of any kind sustained in association with participation in the
Adopt-A-Street Program and agrees to indemnify and hold harmless the Sponsor,
its employees, offices and agents from all liability loss and expense, including but
not limited to damages, legal expenses, and cost of defense in any matter arising
from participation in the Adopt-A-Street Program.
4. Agrees to have all participants of legal age complete and sign the Release and
Waiver form, attached and incorporated into this Agreement by reference as if
fully set out herein as Attachment A.
5. Agrees to have all minors participating in the Adopt-A-Street Program and their
parents or legal guardians complete and sign the Release and Waiver for Minor
form attached and incorporated into this Agreement by reference as if fully set
out herein as Attachment B.
6. Agrees that any volunteer group containing personnel less than eighteen (18)
years of age shall have adequate adult supervision. A minimum ratio of one (1)
adult for each six (6) persons under 18 years of age is required and persons under
the age of 12 are prohibited from participation.
7. Agrees not to perform any of the volunteer work contemplated by this
Agreement under dangerous conditions including, but not limited to
thunderstorms, fog, extreme heat or cold, or darkness. Can only work 1 hour
after sunrise to 1 hour before sunset. No work shall be performed under
conditions of restricted visibility.
8. Agrees to the understanding that other dangerous conditions do exist such as
insect bites, snake bites, and animal bites.
9. Agrees to avoid contact with any dead animals, weapons, hypodermic needles,
hazardous chemicals and suspicious containers and will contact law enforcement
authorities immediately if any such items are found along the roadside.
10. Shall require all participants to wear a bright orange or green vest or garment for
high visibility while participating in a litter cleanup on the roadway.
11. Shall prohibit all participants from trespassing on private property while engaged
in cleanup activities contemplated by this Agreement.
12. Shall submit collection reports to the Sponsor after each cleanup.
13. Notify City of Pataskala at least 48 hours prior to schedule a pick-up and obtain
supplies and material from the City during regular business hours.
14. Return to the City of Pataskala within 2 days following clean up, safety equipment,
traffic control devices and unused supplies. The City of Pataskala may allow the
group to retain certain equipment for future use.
15. Be required to pick up litter when the appearance of the adopted section is
objectionable.
B. The Sponsor:
1. Shall provide safety vests for each participant to wear during litter collection
activities along the roadside as well as provide orange traffic control signs to be
posted during the activity.
2. Will provide trash and recycling bags or containers, trash grabbers, disposable
gloves and disposal of collected litter/debris.
3. Provide a sign installed on your adopted street identifying your group as a
participant in the Adopt-A-Street Program.
IN WITNESS WHEREOF, the parties hereto have set their hands as of the date first noted
hereinabove.
Adopting Group:
__________________________________________________
Group Name
__________________________________________________
Group Leader (Printed Name) (contact person)
__________________________________________________ __________________________
Group Leader (Signature) Date
__________________________________________________ _________________________
Address Phone Number
__________________________________________________
E-mail Address
__________________________________________________
City of Pataskala (Printed Name)
___________________________________________________ __________________________
City of Pataskala (Signature) Date
The Sign will read: (please print clearly):
This street/road is adopted by ______________________________________________________
______________________________________________________________________________
click to sign
signature
click to edit
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome