Printed 2/1/2019 City of Decatur, Public Works Department
CITY OF CITY OF DECATUR
1 GARY K. ANDERSON PLAZA
DECATUR, ILLINOIS 62523
engineeringforms@decaturil.gov
Right of Way
Facility Permit
Public Im
p
rovemen
t
Yes No
Facilit
y
Owner Information
,
Name of Permittee Mailing Address
,
City State & Zip Telephone Fax
Permittee Information
Same as Above
Yes No
,
Name of Permittee Mailing Address
,
City State & Zip Telephone Fax
E-Mail Address
Consultant / Contractor Information
,
Name of Permittee Mailing Address
,
City State & Zip Telephone Fax
E-Mail Address
Describe the work in detail below. Attach drawings, plans and specifications for the proposed work.
This permit covers the operation and presence of specified equipment, material or facility on the right-of-way that may be related
to the authorized work. A copy of this permit must be present when crews or equipment occupy City right-of way. Failure to
comply may result in the cessation of all construction.
This permit is subject to conditions and restrictions of Chapter 41.1 of the City Code, Standards for the Construction of Facilities
in Public Rights-Of-Way. The Permittee agrees to comply with the requirements of the City Code and with all terms and
conditions established by this permit. This permit is subject to revocation by the City on violation of the terms and conditions
governing its use.
The Permittee is required to provide, or have on file with the City, the following:
Liability insurance policies insuring the facility as named insured and naming the City, and its elected and appointed
officers, officials, agents, and employees as additional insured on commercial and automobile liability insurance.
Insurance shall be required as follows:
a. Commercial general liability insurance shall be written on an occurrence basis by an insurer acceptable to the
City and, when applicable, including premises-operations, contractual liability, explosion, collapse, and underground
hazard (commonly referred to as “X” “C” and “U” coverage) and products-completed operations coverage with limits not
less than:
i. $5,000,000 for bodily injury or death to each person;
ii. $5,000,000 for property damage resulting from any one accident; and,
iii. $5,000,000 for all other types of liability;
iv. $10,000,000 for general aggregate and completed operations aggregate.
Printed 2/1/2019 City of Decatur, Public Works Department
b. Automobile liability for owned, non-owned and hired vehicles with combined single limit of $1,000,000 for
personal injury and property damage for each accident;
c. Worker’s compensation with statutory limits; and,
d. Employer’s liability insurance with limits of not less than $1,000,000 for (1) each accident, (2) Disease-policy
limit, and (3) disease-each employee.
Excess or Umbrella Policies. The coverage required may be in any combination of primary, excess, and umbrella
policies. Any excess or umbrella policy must provide excess coverage over underlying insurance on a following-form
basis such that when any loss covered by the primary policy exceeds the limits under the primary policy, the excess or
umbrella policy becomes effective to cover any such loss.
Copies Required. The Permittee shall provide copies of any of the policies required by the City within 10 days of
receiving a written request. Certificates of Insurance may be requested in lieu of policies and must evidence all of the
City’s requirements.
Maintenance and Renewal of Required Coverage. It shall be an affirmative obligation upon the insured to advise the
City Public Works Department within two days of the cancellation or substantive change of any insurance policy set out
above, and failure to do so shall be construed to be a revocation of the approval of such structures or signs. Certificates
evidencing insurance and additional insured shall be sent to the Certificate Holder at:
City of Decatur
Public Works Department
#1 Gary K. Anderson Plaza
Decatur Illinois 62523
Self-Insurance. A Permittee may self-insure all of a portion of the insurance coverage and limit requirement required
by the City. A Permittee that self-insures is not required, to the extent of such self-insurance, to comply with the
requirement for the naming additional insured. A Permittee that elects to self-insure shall provide to the City evidence
sufficient to demonstrate its financial ability to self-insure the insurance coverage and limit the requirements required
by the City, such as evidence that the Permittee is a “private self insurer” under the Workers Compensation Act.
Effect of Insurance and Self-Insurance on Permittee’s Liability. The legal liability of the Permittee to the City and any
person for any of the matters that are the subject of the insurance policies or self-insurance required by the City shall
not be limited by such insurance policies or self-insurance or by the recovery of any amounts there under.
Indemnification. By occupying or constructing facilities in the right-of-way, the permittee shall be deemed to agree to defend,
indemnify and hold the City and its elected and appointed officials and officers, employees, agents and representatives harmless
from and against any and all injuries, claims, demands, judgments, damages, losses and expenses, including reasonable
attorney’s fees and costs of suit or defense, arising out of, resulting from or alleged to arise out of or result from the negligent,
careless or wrongful acts, omissions, failures to act or misconduct of the utility or its affiliates, officers, employees, agents,
contractors or subcontractors in the construction of facilities or occupancy of the rights-of-way, and in providing or offering
service over the facilities, whether such acts or omissions are authorized, allowed or prohibited by City Code 41.1 or by a
franchise, license, or similar agreement; provided, however, that the utility's indemnity obligations hereunder shall not apply to
any injuries, claims, demands, judgments, damages, losses or expenses arising out of or resulting from the negligence,
misconduct or breach of City Code 41.1 by the City, its officials, officers, employees, agents or representatives.
The Permittee represents all parties in interest and shall furn
ish material, do all work, pay all costs and shall in a reasonable
length of time restore the damaged portions of the City right of way to a condition similar or equal to that existing before the
commencement of the described work, including any landscape restoration necessary.
The proposed work shall be located and constructed to the satisfaction of the Public Works Director or his duly authorized
representative. No revisions or additions shall be made to the proposed work on the right-of-way without the written
permission of the Public Works Director. In certain circumstances the City may require that the construction plans
and/or the as-built documents be sealed by an Illinois Registered Professional Engineer. Typical of such projects would
be petroleum or gas pipelines.
The Permittee shall at all times conduct the work in such a manner as to minimize hazards to vehicular and pedestrian traffic.
All signs, barricades, flaggers, etc., required for traffic control shall be furnished by the Permittee.
The Permittee shall not trim, cut or in any way disturb any trees or shrubbery on City right of way without the approval of the
City Forester.
Notification of Change. The Permittee shall notify the City no less than 30 days prior to the transfer of ownership of any facility
in the right-of-way or change in identity of the owner. The new owner of the facility shall have all the obligation and privileges
enjoyed by the former owner under the permit, if any, and all applicable laws, ordinances, rules and regulations, including City
Code 41.1, with respect to the work and facilities in the right-of-way. The new owner shall update the current permit along
with all required insurance or bonding.
Printed 2/1/2019 City of Decatur, Public Works Department
Removal, Relocation, or Modifications of Facilities.
Within 90 days following written notice from the City, a utility shall,
at its own expense, temporarily or permanently remove, relocate, change or alter the position of any utility facilities
within the rights-of-way whenever the corporate authorities have determined that such removal, relocation, change or
alteration, is reasonably necessary for the construction, repair, maintenance, or installation of any City improvement in
or upon, or the operations of the City in or upon, the rights-of-way.
Cleanup and Restoration. Upon completion of all construction, maintenance, or removal of facilities, the Permittee shall
remove all excess material and restore all turf and terrain in a timely manner and to the satisfaction of the City. This
includes restoration of entrances and side roads. Restoration of roadway surfaces shall be made using materials and
methods approved by the Public Works Director. Such cleanup and repair may be required to consist of backfilling, re-
grading, reseeding, re-sodding, or any other requirement to restore the right-of-way to a condition substantially equivalent
to that which existed prior to the construction of the facility.
All work within City right of way shall be completed by a contractor that is licensed and bonded with the City.
In no case shall this permit give or be construed to give an entity any easement, leasehold or other property interest of any
kind in, upon, under, above or along the City’s right-of-way.
Signature of Agent for Permittee Date
Name of Permittee (Print or Type)
Mailing Address
City State Zip
The work authorized by this permit shall be completed by or within days after the date of approval by
the Cit
y
, otherwise the
p
ermit will be considered null and void.
Utilit
y
Contact Person:
Phone
Work to be done by:
Contractor:
Da
time Phone:
Emer
g
enc
y
Phone:
This permit allowin
g
occupanc
y
and work on Cit
y
ri
g
h
t
-of-wa
y
is approved.
Information Technology Department Date
Public Works Department Date
click to sign
signature
click to edit