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Application “Adopt-a-Roadside”

  1. Organization, Group, or Individual
  2. Name of Road
  3. Located from this road....
  4. this road.
  5. Approval is hereby requested to enter within the County Road right-of-way to perform the following described work (check all that apply):*
  6. *A sketch noting the quantity, location, and species must be attached to this application prior to Department granting approval.
    The Sponsor(s) agrees that if granted a permit to do said work the following stipulations shall govern:
    1. This application shall have been approved prior to Sponsor(s) beginning any operations as requested herein.

    2. Sponsor(s) agree to indemnify and hold harmless Hardin County, its Board of Supervisors, officers and employees from all liability, judgment, costs, expenses and claims growing out of damages, or alleged damages of any nature whatsoever to any person, property or third party arising out of the performance or nonperformance of said work.

    3. No vehicles, equipment or materials are to be stored within the right of way. A vehicle may be allowed to be parked on the shoulder during times of litter pick up.

    4. Right of way markers, signs and land monuments shall not be removed, altered or damaged.

    5. This permit shall be subject to any laws now in effect or any laws which may be hereafter enacted and all applicable rules and regulations of local, state and federal agencies.

    6. The Sponsor(s) agrees to give Hardin County forty-eight hours notice of intention to start operations. Notification shall be given to:
    IRVM Department
    708 16th Street
    Eldora, IA 50627

    Phone notification may be made at 641-939-8263, Monday through Thursday 7 a.m. - 5 p.m.

    7. Access to the work site will, where possible, be obtained from private property or other roadways and not from the traveled portion of the hard surfaced roadway.

    8. The Sponsor(s) shall carry on the work as required and authorized by this agreement with serious regard to the safety of the traveling public, adjacent property owners and volunteers or employees of the Sponsor(s).

    9. The Sponsor(s) acknowledges that all personnel involved in this project are initiators and volunteers directed by the Sponsor(s) and that the Sponsor(s) accept full responsibility for any injuries or damages sustained by or caused by such personnel. The Sponsor(s) acknowledges that they or their volunteers are in no way considered to be employees of Hardin County or the Hardin County Secondary Road Department.

    The Sponsor(s) and the Department further agree to the following terms and conditions of this agreement.

    Sponsor’s Additional Responsibility:
    To perform the work specified in a satisfactory, safe and professional manner. To provide adult supervision at the work site when volunteers or employees are 15 years of age or younger.

    To obtain required supplies and materials as may be needed from the Department to carry out this agreement, during regular business hours, Monday through Thursday 7 a.m. - 5 p.m. To put in place traffic control signs at all times when the Sponsor(s) is doing work near the roadway and remove only when the work has been completed.

    To place all trash bags used during collection of litter, adjacent to the Adopt-A-Roadway signs (if applicable), or at the ends of adopted sections, for pickup and disposal by the Department.

    To plant all right of way harvested seed on either County road rights of way or other public grounds as approved.

    To return all unused materials and supplies furnished by the Department, to the IRVM shop within one week after the activity is completed.

    Department’s Responsibilities:
    To erect a sign at each end of the adopted section with the Sponsor(s) name or acronym displayed (if requested).

    To provide reflective vests, trash bags, safety literature, and other related materials, to the Sponsor(s).

    To remove trash bags used for litter pickup by Sponsor(s).

    To assist in removal of litter under unusual circumstances such as when large, heavy or hazardous items are found.

    To assist in location and selection of enhancement plantings (if applicable).

    Please Note:
    The Department reserves the right to terminate this agreement and remove Adopt-A-Roadway signs when in the sole judgment of the Department, it is found that the Sponsor(s) has not met the terms and conditions of this agreement.
  8. Sponsor Electronic Signature*
  9. Leave This Blank:

  10. This field is not part of the form submission.