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R-08-02-28-11D1 - 2/28/2008 RESOLUTION NO. R-08-02-28-11D1 WHEREAS, the State of Texas, through the Texas Department of Transportation ( "TxDOT" ) owns and operates a system of highways for public use, including US 79 in Round Rock, and WHEREAS, the City of Round Rock Parks and Recreation Department has made a request to TxDOT that the right lane of US 79, westbound from Red Bud Lane to Harrell Parkway be closed on Sunday, April 6, 2008 from 5 : 30 o' clock a.m. to 1 : 00 o' clock p.m. for the Texas Road Rash Inline Skating Marathon ( "Event") , and WHEREAS, the City Council has determined that the Event will serve a legitimate public purpose, and WHEREAS, City Council wishes to enter into an Agreement for the Temporary Closure of State Right-of-Way with TxDOT authorizing the closure of US 79 as set forth above, Now Therefore BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK, TEXAS, That the Texas Road Rash Inline Skating Marathon will serve a legitimate public purpose, and BE IT FURTHER RESOLVED That the Mayor is hereby authorized and directed to execute on behalf of the City an Agreement for the Temporary Closure of State Right-of-Way with the Texas Department of Transportation, a copy of same being attached hereto as Exhibit "A" and incorporated herein for all purposes . The City Council hereby finds and declares that written notice of the date, hour, place and subject of the meeting at which this Resolution was adopted was posted and that such meeting was open to R80228D 1 the public as required by law at all times during which this Resolution and the subject matter hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act, Chapter 551, Texas Government Code, as amended. RESOLVED this 28th day of February 2008 . L, May Ci y of Round Rock, Texas ATTEST: L. SARA WHITE, City Secretary 2 Agreement No. EXHIBIT STATE OF TEXAS § g D � COUNTY OF TRAVIS § "All AGREEMENT FOR THE TEMPORARY CLOSURE OF STATE RIGHT OF WAY THIS AGREEMENT is made by and between the State of Texas, acting by and through the Texas Department of Transportation, hereinafter called the "State," and the City of Round Rock, a municipal corporation, acting by and through its duly authorized officers, hereinafter called the "local government.' WITNESSETH WHEREAS, the State owns and operates a system of highways for public use and benefit, including US 79, in Williamson, County; and WHEREAS, the local government has requested the temporary closure of US 79, right lane, westbound, between CR 122 and Harrell Parkway for the purpose of the Texas Road Rash Inline Marathon, from April 6, 2008 to April 6, 2008 as described in the attached "Exhibit A," hereinafter identified as the "Event;" and WHEREAS, the Event will be located within the local government's incorporated area; and WHEREAS, the State, in recognition of the public purpose of the Event, wishes to cooperate with the City so long as the safety and convenience of the traveling public is ensured and that the closure of the State's right of way will be performed within the State's requirements; and WHEREAS, on the day of -, 20 , the City Council passed Resolution / Ordinance No. / Street Use Permit , attached hereto and identified as "Exhibit B," establishing that the Event serves a public purpose and authorizing the local government to enter into this agreement with the State; and WHEREAS, 43 TAC, Section 22.12 establishes the rules and procedures for the temporary closure of a segment of the State highway system; and WHEREAS, this agreement has been developed in accordance with the rules and procedures of 43 TAC, Section 22.12; NOW, THEREFORE, in consideration of the premises and of the mutual covenants and agreements of the parties hereto, to be by them respectively kept and performed as hereinafter set forth, it is agreed as follows: AGREEMENT Article 1. CONTRACT PERIOD This agreement becomes effective upon final execution by the State and shall terminate upon completion of the Event or unless terminated or modified as hereinafter provided. Traffic—Traffic-Closure Incorporated (TEA30A) Page 1 of 8 Rev. 09/29/2006 Article 2. EVENT DESCRIPTION Agreement No. The physical description of the limits of the Event, including county names and highway numbers, the number of lanes the highway has and the number of lanes to be used, the proposed schedule of start and stop times and dates at each location, a brief description of the proposed activities involved, approximate number of people attending the Event, the number and types of animals and equipment, planned physical modifications of any man- made or natural features in or adjacent to the right of way involved shall be attached hereto along with a location map and identified as "Exhibit C." Article 3. OPERATIONS OF THE EVENT A. The local government shall assume all costs for the operations associated with the Event, to include but not limited to, plan development, materials, labor, public notification, providing protective barriers and barricades, protection of highway traffic and highway facilities, and all traffic control and temporary signing. B. The local government shall submit to the State for review and approval the construction plans, if construction or modifications to the State's right of way is required, the traffic control and signing plans, traffic enforcement plans, and all other plans deemed necessary by the State. The State may require that any traffic control plans of sufficient complexity be signed, sealed and dated by a registered professional engineer. The traffic control plan shall be in accordance with the latest edition of the Texas Manual on Uniform Traffic Control Devices. All temporary traffic control devices used on state highway right of way must be included in the State's Compliant Work Zone Traffic Control Devices List. The State reserves the right to inspect the implementation of the traffic control plan and if it is found to be inadequate, the local government will bring the traffic control into compliance with the originally submitted plan, upon written notice from the State noting the required changes, prior to the event. The State may request changes to the traffic control plan in order to ensure public safety due to changing or unforeseen circumstances regarding the closure. C. The local government will ensure that the appropriate law enforcement agency has reviewed the traffic control for the closures and that the agency has deemed them to be adequate. If the law enforcement agency is unsure as to the adequacy of the traffic control, it will contact the State for consultation no less than 10 workdays prior to the closure. D. The local government will complete all revisions to the traffic control plan as requested by the State within the required timeframe or that the agreement will be terminated upon written notice from the State to the local government. The local government hereby agrees that any failure to cooperate with the State may constitute reckless endangerment of the public and that the Texas Department of Public Safety may be notified of the situation as soon as possible for the appropriate action, and failing to follow the traffic control plan or State instructions may result in a denial of future use of the right of way for three years. E. The local government will not initiate closure prior to 24 hours before the scheduled Event and all barriers and barricades will be removed and the highway reopened to traffic within 24 hours after the completion of the Event. F. The local government will provide adequate enforcement personnel to prevent vehicles from stopping and parking along the main lanes of highway right of way and otherwise prevent interference with the main lane traffic by both vehicles and pedestrians. The local government will prepare a traffic enforcement plan, to be approved by the State in writing at least 48 hours prior to the scheduled Event. Additionally, the local government shall provide to the State a letter of certification from the law enforcement agency that will be providing traffic control for the Event, certifying that they agree with the enforcement plan and will be able to meet its requirements. G. The local government hereby assures the State that there will be appropriate passageeTraffc—Traffic—Closure Incorporated (TEA30A) Page 2 of 8 Rev. 09/29/200 6 Agreement No. allowance for emergency vehicle travel and adequate access for abutting property owners during construction and closure of the highway facility. These allowances and accesses will be included in the local government's traffic control plan. H. The local government will avoid or minimize damage, and will, at its own expense, restore or repair damage occurring outside the State's right of way and restore or repair the State's right of way, including, but not limited to, roadway and drainage structures, signs, overhead signs, pavement markings, traffic signals, power poles and pavement, etc. to a condition equal to that existing before the closure, and, to the extent practicable, restore the natural and cultural environment in accordance with federal and state law, including landscape and historical features. Article 4. OWNERSHIP OF DOCUMENTS Upon completion or termination of this agreement, all documents prepared by the local government will remain the property of the local government. All data prepared under this agreement shall be made available to the State without restriction or limitation on their further use. Article 5. TERMINATION A. This agreement may be terminated by any of the following conditions: (1) By mutual written agreement and consent of both parties. (2) By the State upon determination that use of the State's right of way is not feasible or is not in the best interest of the State and the traveling public. (3) By either party, upon the failure of the other party to fulfill the obligations as set forth herein. (4) By satisfactory completion of all services and obligations as set forth herein. B. The termination of this agreement shall extinguish all rights, duties, obligations, and liabilities of the State and local government under this agreement. If the potential termination of this agreement is due to the failure of the local government to fulfill its contractual obligations as set forth herein, the State will notify the local government that possible breach of contract has occurred. The local government must remedy the breach as outlined by the State within ten (10) days from receipt of the State's_notification. In the event the local government does not remedy the breach to the satisfaction of the State, the local government shall be liable to the State for the costs.of remedying the breach and any additional costs occasioned by the State. Article 6. DISPUTES Should disputes arise as to the parties' responsibilities or additional work under this agreement, the State's decision shall be final.and binding. Article 7. RESPONSIBILITIES OF THE PARTIES The State and the Local Government agree that neither party is an agent, servant, or employee of the other party and each party agrees:it-is responsible for its individual acts and deeds as well as the acts and deeds of its contractors; employees, representatives. and agents. Article 8. INSURANCE A. Prior to beginning any work upon the State',, right of way, the local government and/or its contractors shall furnish to the State a completed "Certificate of Insurance" (TxDOT Form 1560, latest edition) and shall maintain the insurance in full force and effect during the period that the local government and/or its contractors are encroaching upon the State right of way. Traffic—Traffic-Closure Incorporated (TEA30A) Page 3 of 8 y 9 Rev. 09/29/2006 B. In the event the local government is aself-insured entitAgreement No.the local government shall provide the State proof of its self-insurance. The local over claims and damages that may occur during the period of this closing lagrees to pay any and all accordance with the terms of this agreement. of the highway in Article 9. AMENDMENTS Any changes in the time frame, character, agreement provisions or obligations of the parties hereto shall be enacted by written amendment executed by both the local government and the State. Article 10. COMPLIANCE WITH LAWS . The local government shall comply with all applicable federal, state and local environmental laws, regulations, ordinances and any conditions or restrictions required by the State to protect the natural environment and cultural resources of the State's right of way. Article 11. LEGAL CONSTRUCTION In case one or more of the provisions contained in this agreement shall for any reason be held invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provisions hereof and this agreement shall be construed as if such invalid, illegal or unenforceable provision had never been contained herein. Article 12. NOTICES All notices to either party by the other required under this agreement shall be delivered personally or sent by certified U.S. mail, postage prepaid, addressed to such party at the following respective addresses: Local Government: —� State: I City of Round Rock Texas Department of Transportation Parks and Recreation Lowe.11.D. Choate, P.E. Attn: Rick Atkins Maintenance Operations 221 East Main P. O. Drawer 15426 Round Rock, Texas 78664 Austin, Texas 78761-5426 All notices shall be deemed given on the date so delivered or so deposited in the mail, unless otherwise provided herein. Either party hereto may change the above address by sending written notice of such change to the other in the manner provided herein. Article 13. SOLE AGREEMENT This agreement constitutes the sole and only agreement between the parties hereto and supersedes any prior understandings or written or oral agreements respecting the within subject matter. IN TESTIMONY WHEREOF, the parties hereto have caused these presents to be executed in duplicate counterparts. THE CITY OF ROUND ROCK Executed on behalf of the local government by: Traffic—Traffic-Closure Incorporated (TEA30A) Page 4 of 8 Rev. 09/29/2006 BCity Official Agreement No. y Date Typed or Printed Name and Title Nyle Maxwell Mavor THE STATE OF TEXAS Executed for the Executive Director and approved for the Texas Transportation Commission for the purpose and effect of activating and/or carrying out the orders, established policies or work programs heretofore approved and authorized by the Texas Transportation Commission. By Date District Engineer Traffic—Traffic-Closure Incorporated (TEA30A) Page 5 of 8 Rev. 09/29/2006 EXHIBIT January 11, 2008 Texas Department of Transportation, Austin District PO Drawer 15426 Austin, Texas 78761-5426 Dear Ms. Brown: The City of Round Rock Parks and Recreation will host the 5th Annual Texas Road Rash Inline Skate Marathon on Sunday, April 6, 2008. We will also be having some races within-the Dell Diamond on Saturday, April 5, 2008,but they will not require any road closures. This event attracts more than 200 inline skaters across the United States and some countries and helps Round Rock, the Sports Capital of Texas, provide an inline skating event for the community. Last year, the Texas Road Rash was very successful with the assistance of your agencies. The City of Round Rock Parks and Recreation requests the closure of one south-bound lane of CR 122 and the closure of the shoulder and the far right lane of west-bound HWY 79 from CR 122 to Harrell Parkway from 5:30 am— l:00pm on Sunday, April 6, 2008. This will insure the safety of our inline skaters as they complete our looped course. I understand that the following items must occur in order for your agency to grant us permission to close the lanes of traffic. (enclosed) 1) Round Rock Parks and Recreation must have a signed agreement from the City. 2)Barricade Plan 3) Engineering Plan from the Traffic Department 4)Number of participants 5) Certificate of Insurance 6) Letter from law enforcement stating their involvement T FA`A 7) Overall view of the race and layout. 8) City of Round Rock Resolution =. Q If you have any questions,please call 512-218-5540. 'IRO ' ROCK Rick Atkins ILI Round Rock Parks and Recreation 512.218-5540 EXHIBIT RESOLUTION NO. R-08-02-28- WHEREAS, the State of Texas, through the Texas Department of Transportation ( "TxDOT" ) owns and operates a system of highways for public use, including US 79 in Round Rock, and WHEREAS, the City of Round Rock Parks and Recreation Department has made a request to TxDOT that the right lane of US 79, westbound from Red Bud Lane to Harrell Parkway be closed on Sunday, April 6, 2008 from 5 : 30 o.'clock a.m. to 1 : 00 o' clock p.m. for the Texas Road Rash Inline Skating Marathon ( "Event" ) , and WHEREAS, the City Council has determined that the Event will serve a legitimate public purpose, and WHEREAS, City Counc i 1 wishes to enter into an Agreement for the Temporary Closure of State Right-of-Way with TxDOT authorizing the closure of US 79 as set forth above, Now Therefore BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK, TEXAS, That the Texas Road Rash Inline Skating Marathon will serve a legitimate public purpose, and BE IT FURTHER RESOLVED That the Mayor is hereby authorized and directed to execute on behalf of the City an Agreement for the Temporary Closure of State Right-of-Way with the Texas Department of Transportation, a copy of same being attached hereto as Exhibit "A" and incorporated herein for all purposes . The City Council hereby finds and declares that written notice of the date, hour, place and subject of the meeting at which this Resolution was adopted was posted and that such meeting was open to 00129946 the public as required by law at all times during which this Resolution and the subject matter hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act, Chapter 551, Texas Government Code, as amended. RESOLVED this 28th day of February, 2008 . NYLE MAXWELL, Mayor ATTEST: City of Round Rock, Texas SARA L. WHITE, City Secretary 2 EXHIBIT N d �pp VI C 11 a� ROUND ROCK.TEXAS FlitlYttil.N;SSION.Pr;f'ill'1:rift: eraEvents Permi" i cation Applications must be filed at least fifteen(15)days before the Special Event. There is a fifty dollars(550.00)application Cee for each event. If you are uncertain whether your event is considered a Special Event,please contact the City Manager's office for further information and clarification. Date Applicant Name J'� �. LAM 0 © 9411✓i A ko G k Address �p, YV s"]' Phone �14`1 ' 01 Organization U� �"! Auth.Rep. Please check one: a Vrl(� C e ❑Individual ❑D/B/A ❑Organization ❑Partnership El Corporation ❑Profit ❑Nonprofit Address Phone 0"00 V, Event title TQ t A.� AA 5 Y i Event location: e4 0t ��� Irk A het( p1-Amp 4 PA V k C K ILZ Event Coordinator L u/� Phone �,a1� �"' ��'�' ($-A VI On-Site Contact On Event Day Phone Event Start Date 0*1*/n Event End Date: �� O V � Note:Event Cannot Exceed Three Days y Event set-upk�)time V Event teardown time (Not earlier t n 7:00 a.m.) (Completed not later than 10:00 p.m.) For each da o the week on which the event will be held,Indicate the start ands a times belmp: Event day Sunday Monday Tuesday Wednesday Thursday Friday Saturday Start time &00 Stop time Sop r3 D Number of persons expected a V ~4tv(� Number of animals Types of animals --�y Number of motorized vehicle 14 Number of inflatables f 1 ea In o-tOve r(-e (oad UJo svve S . . ._..... . Tents or Other Temporary Structures(Must meet City's Fire and Building Codes): If you are planning to erect tents,canopies,seating,awnings,booths,first aid stations,portable restrooms or other temporary structures,please describe: Quantity x,0izest o ,Types f Fire Retardant Letter �1ftt Yes No 149 0L_II GGl!/bt r5 Yes No X j Yes No Dom)D 5 d►'� Yes _ No Food or Beverages If you are planning on serving or selling food or beverages,please attach copies of any licenses or permits issued by the appropriate agencies for such vendors. Such vending shall be in compliance with all state and local laws. Amplified Sound If you are planning to utilize any loudspeakers or other form of amplified sound,please indicate on the attached sketch or map the location and orientation of those systems. Speakers should not be positioned so as to adversely affect any adjacent residential area between the hours of 7:00 a.m.and 10:00 p.m. Signage If you are planning to use or allow signs at such event,please provide details of any planned signage: vv-vs. xi 7X. Disposal of Wastewater Applicant shall submit a plan for disposal of any wastewater in connection with the Special Event and such plan must be approved by the Utilities Department. Events Layout,Equipment&Parking Plan Please attach a map or sketch of the Event indicating the following: Events Layout,Equipment ■ Entrance(s) • Exit(s) ■ Plan of evacuation and proposed fire lanes ■ Amplified Sounds/Loudspeakers Parking arrangements ■ Will parking spaces be utilized by this event?Yes X No ■ Number of parking spaces provided must accommodate projected attendees plus 10%surplus. Also,provide information concerning layout of parking, includin ,lisle widths and size of proposed parking spaces. • Parking attendants? Yes No If yes,how many? ■ Will there be any offsite parking? Yes No ■ If yes and parking is on private property,Applicant must submit a letter of permission from property owner. ■ How will attendees be transferred to the Special Event area and returned? 2 t y Place a check neat to the items tha will be utilized,and indicate location on map or sketch. Tent(s) Size bO 1 2-10 Portable Restrooms # Regular Handicap #Others Dumpster(s) Size Barricades Quantity f Size not Air Bar 10 w, (A I �VVlloons) Quantity Supplier Fire retardant letter(s) S Yes No Yes No Yes No Amusement Rides or similar equipment(insurance required) Quantity Type Insurance provided Yes No Yes No Yes No Alcoholic Beverages Giveaway Selling Type 1 ��,n �%g.beer,wine) N. FIrst Aid Stations Quantity___g_ Staffing Vy I r Other Permits&Fees Please attached copies of any required insurance,surety bonds,permits or other documents as described in Section 1.3400 of the City of Round Rock Code of Ordinances. Check all components that will be part of your event.Additional fees and other permits or reservations may be re wired. Animals Banners/Signs Park property Electricity Police Security /SX X -_-X Barricades/traffic cones Fireworks Alcohol Beverages(non-alcohol) Merchandise sales 1 X X Portable restrooms Special parking Food Liquidpropane k � 9 Street Cleaning by City Bleachers/Seating Street Closures Fencing Water hydrant-Temp.Meter Other X J_A X Security,Crowd Control and Traffic Control The Applicant may be required to provide police officers for security, crowd control, and traffic control at the Special Event. The total number of police officers working at the Special Event is determined by the Round Rock Police Department, and in some cases may use planning variables, including: (1) the estimated number of participants and spectators; (2) the availability of alcoholic beverages;(3)topography and size of the event location;(4)weather conditions;(S)the time of day during which the Special Event is conducted; (6)the need for street closures or rerouting of vehicular or pedestrian traffic; and,(7)the history of the particular Special Event. Public Notification If the City Manager requires it, the Applicant shall, at least thirty(30)days before the Special Event begins,deliver written notice to all owners or occupants of real property abutting the boundaries of the area in which the Special Event will be conducted. The notice must include the following information: (l)event date, time and location, and (2) statement that an Application for a Special Event Permit has been filed with the City of Round Rock. 3 Insurance and Bonds If a Special Event uses any portion of the City's rights-of-way,the Applicant shall provide a certificate of insurance to complies with the standards established by the City's risk manager. If a Special Event is on City property, a Ten Thousand Dollar ($10,000.00) surety bond shall be deposited with the Application to ensure that no damage is done to City property. if the City Manager certifies that all conditions set forth in Section 1.3425,Code of Ordinances, are complied with,the bond shall be returned. if the City Manager does not certify that all the conditions are complied with, any costs expended for policing and/or cleaning shall be deducted from the bond and the remainder returned. Additional conditions are spelled out in Section 1.3425 as to additional costs. If a Special Event is fully on private property,Applicant shall deposit Five Hundred Dollars($500.00)with the City as a condition that no paper, liter or other debris shall remain on the site after the Special Event is over. The deposit shall be returned to Applicant upon certification by the City Manager that all_conditions are met. If the conditions are not met,such costs for cleaning shall be deducted from the deposit and the remainder returned. INDEMNITY AGREEMENT 1) As a condition of a Special Event Permit being issued,the Applicant acknowledges that be/she has voluntarily applied for a Special Event permit that in consideration of the privileges associated therewith,Applicant agrees to PROTECT, INDEMNIFY and HOLD HARMLESS, the City, its officers, agents and employees, from and against suits, actions, claims, losses, liability or damage of any character, and from and against costs and expenses including attorney fees incidental to the defense of such suits, actions, claims, losses, damage or liability on account of injury, death or otherwise, to any person or damage to any property, arising from any negligent act, error or omission of the undersigned,Its officers,employees or agents,arising out of,resulting from,or caused by any act occurring as a result of the exercise of the privileges granted by this permit. 2) APPLICANT AGREES THAT THIS INDEMNITY AGREEMENT IS INTENDED TO BE AS BROAD AND INCLUSIVE AS IS PERMITTED BY THE LAWS OF THE STATE OF TEXAS, AND THAT IF ANY PORTION IS HELD INVALID, THEN IT IS AGREED THAT THE BALANCE SHALL, NOTWITHSTANDING, CONTINUE IN FULL LEGAL FORCE AND EFFECT. 3) This indemnity agreement contains the entire agreement of the undersigned and the City of Round Rock,and may not be modified or altered without the express written consent of the City of Round Rock. 4) This indemnity agreement is interpreted by Texas law and is performable for all purposes in the County of WiWamson, State of Texas,or the County of Travis,State of Texas. I do solemnly swear(or affirm)that.all the answers given and statements made on this Application are full, true and correct to the best of my knowledge and beliefs: I have been given a copy of the ordinance and have read the provisions contained therein and agree to abide by them. Applicant: V v PP . Cyp I hereby grant the Applicant and any affiliated organization permission to use my property in connection with the Special Event and as described herein. Property Owner: 4 ***ttt* *tttt *** t** *,**tt *tttt• ttttOF]C'ICE USE ONLY******* * ** * *** ***** *** * Application # Check# Cash Credit Card Receipt# Comments: ADDITIONAL EQUIPMENT OR PERSONNEL: Equipment: Public Safety Personnel x — Public Works Personnel x = TOTAL ADDITIONAL CHARGES: APPLICATION REVIEWED AND APPROVED CITY MANAGER OFFICE: DATE: POLICE DEPARTMENT: DATE: PUBLIC WORKS: DATE: PARKS AND RECREATION: DATE: FIRE DEPARTMENT: DATE: 5 ROUND RUCK,TEXAS }+l.l+J't)�k Ix1�Sll�t•.!'lit.f.l�k�tllk. ---�----- PICNIC TABLES RAMI(m)_ AMU LONG TABLES TEXAS ROAD RASH SET-UP MAP OLD SETTLERS PARK AT PALM VALLEY ROUND ROCK, TEXAS Enclosures TxDJT Form�1560(Rev 04/2002)Previous editions of this form may not be used. Page 1 of 2 Texas Department of Transportation (TxDOT) CERTIFICATE OF INSURANCE Prior to the beginning of work,the Contractor shall obtain the minimum insurance and endorsements specified. Only the TxDOT eedffiirale of insurance form is acceptable as proof of insurance for department contracts.Agents should complete the form providing all requested Information then either fax or mail ft form directly to the address listed on the back of this form. Copies of endorsements fisted below are not required as attachments to this certificate_ Insured: Round Rock Street/Mailing Address: 221 E Main Ave City/StateMP: Round Rock,TX 78564 Phone Number:Area Code ( 512 )218-6643 WORKERS'COMPENSATION INSURANCE COVERAGE: Endorsed with a Waiver of Subrogation in favor of TxDOT. Carrier Name: Texas Municipal League-IRP Carrier Phone#: 800-537-6655 Address: 1821 Rutherford Ln.1sr Floor City,State,Zip: Austin,TX 78754 Type of Insurance Policy Number Effective Data EK iration Dste Limits of Lla..... Workers'Compensation 3127 10/1/2007 10/1/2008 I - - I ::NGI:Less�Trhan., Statutory—Texas COMPREHENSIVE GENERAL LIA131LITY INSURANCE: Endorsed with TxDOT as Additional Insured and with a Waiver of Subro anon in favor of TxDOT. Carrier Name: Texas Municipal League-IRP Carver Phone#: 800-537.6655 Address: 1821 Rutherford Ln.1st Floor I City,State,Zip: Austin,TX 78754 Type of Insurance: Policy Number: Effective Date: Expiration Date: Limits of Liability_ Comprehensive General 3127 10/1/2007 10/1/2008 Liability insurance Not Less Than: Bodily Injury Property Damage S 500,000 each occurrence S 100,000 each occurrence OR S 100,000 Jbr aggregate Commercial General Liability Insurance OR6 600,000 combined Single limit COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE: Endorsed with TxDOT as Additional Insured and with a Waiver of Subro anon in favor of TxDOT. Carrier Name:Texas MunIcipal Lea jue-IRP Carrier phone#• 800-537-6655 Address: 1821 Rutherford Ln. 1St Floor City,State,Zip:Austin,TX 78754 Type of insurance: Policy Number: Effective Date: Expiration Data: Limits of Liability. Comprehensive Automobile 312' 10/1/2007 10/1/2008 Liability Insurance OR Texas Business Automobile Policy Not Less Than: Bodily Injury S 250,000 each person Property Damage S 500,000 each occufrence $100,000 each occurrence UMBRELLA POLICY if applicable): Carrier Name: Carrier Phone#: Address: Type of Insurance: City,State,Zip: Umbrella Policy rancePolicy umber: Effective Date: Expiration bate: Limits of Liability: Agency Name Address City? St Texas Municl al Lea ue- IRP '1821 Rut rford Ln. .ISt Floor ode Austin,State e Zip 78?C Area Code (800) 537-6655 ext 397 Authorized Agent's Phone Number Authorized Agent Ori al Si nature 1j4120D7 9 Date This Certiflcate of insurance neither affirmatively nor negatively amends,extends,or alters the coverage afforded by,the above insurance licies issued po by the named Insurance company. Cancellation of the Insurance policies shall not be made until THIRTY DAYS AFTER the agent or the Insurance company has sent written notice by certified mail to the contractor and the Texas Department of Transportation. THIS IS TO CERTIFY to the Terms Department of Transportation acting on behalf of the State of Texas that the Insurance polities named meet all the requirements stipulated and such polidaS are in full force and effecL If this farm Is sent by facsfmft machl 9 (fax), the Sender adopts the document received by 7kDOT as a duplicate original and adapts the signature produced by the recelving fax machine as the sander's original signature. The Texas Department of Transportation maintains the Information collected throughthis x Informed about the information that we colleform_ With few eceptions,you are entitled on request to be collect about you. Under§§892.021 and 552,023 of the Texas Government Code,YOU are entied recelve and review the information. Under§559.004 of the Government Code,you are also entitled to have us correct Information2160 t abo you hthat is incorrecL TQOT Forth 1580 (Rev 04/2002) Page 2of2 Texas Department of Transportation NOTES TO AGENTS: Agents must provide all requested informetion then either fax or mail this form directly to the address listed below. Pre-printed limits are the minimum required, if higher limits are provided by the policy, enter the higher limit amount and strike-through or cross-out the pre-printed limit. To avoid work suspension, an updated Insurance form must reach the address listed below one business day prior to the expiration date. insurance must be in force In order to perform any work. Binder numbers are not acceptable for policy numbers. The certificate of Insurance, once on file with the department, Is adequate for subsequent department contracts provided adequate coverage is still In effect.Do not refer to specific projects/contracts on this form. The TxDOT certificate of insurance form is the only acceptable proof of insurance for department contracts. List the contractor's legal company name, including the DBA (doing business as) name as the insured or list both the contractor and staff:leasing service as insured when a staff leasing service is providing Insurance- Over-stamping and/or over-typing entries on the certificate of insurance are not acceptable if such entries change the provisions of the certificate in any manner. This form may be reproduced. The SIGNATURE of the agent is required. Stamped/typed/printed signatures are not acceptable. CERTIFICATE OF INSURANCE REQUIREMENTS: WORKERS'COMPENSATION INSURANCE: The contractor is required to have Workers`Compensation Insurance If the contractor has any employees including relatives. The word STATUTORY, under limits of liability, means that the insurer would pay benefits allowed under the Texas Workers'Compensation Law. GROUP HEALTH or ACCIDENT INSURANCE is not an acceptable substitute for Workers'Compensation. COMPREHENSIVE GENERAL LIABILITY INSURANCE or COMMERCIAL GENERAL LIABILITY INSURANCE: If coverages are specified separately,they must be at least these amounts: Bodily Injury $500,000 each occurrence Property Damage $100,000 each occurrence $100,000 for aggregate MANUFACTURERS'or CONTRACTOR LIABILITY INSURANCE is not an acceptable substitute fo General Liability Insurance or Commercial General Liability Insurance, r Comprehensive COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE or TEXAS BUSINESS AUTOMOBILE POLICY: The coverage amount for a Texas Business Automobile Policy or Comprehensive Automobile Liablli ma be shown as a minimum of$000,000 Combined Single Limit by a typed or printed entry and deletion of the specific amounts listed for Bodily Injury and Property Damage. P BASIC AUTOMOBILE LIABILITY INSURANCE is not an acceptable substitute for Comprehensive Automobile Liability Insurance or Texas Business Automobile Policy. MAIL ALL CERTIFICATES TO : Texas Department of Transportation CST--Contract Processing Unit(RA/200—1 st 1=1.) 125 E. 11 th Street Austin TX 78701-2483 5121416-2429 (V),512/416-2536(F) ROUND ROCK POLICE DEPARTMENT R 615 E. PALM VALLEY BLVD ROUND ROCK, TEXAS 78664 PHONE: (512) 218-5500 A FAX: (512) 218-7060 "TO PROTECT and SERVE" January 14, 2008 To: Susan Brown, TX DOT From: Lt. Bill Dixon Subject: Road closures Please allow this to act as notification that the City of Round Rock Police Department will be providing security and traffic control for the City of Round Rock's Parks and Recreation Department for the Texas Road Rash in the area of Old Settlers Park, CR 122, Harrell Pkwy. and Hwy 79 on Sunday, April 6t', 2008. Should you have any further questions please do not hesitate to contact me at 512-218-6659 PD-029-04 (Rev 12/07) DATE: February 21, 2008 SUBJECT: City Council Meeting - February 28, 2008 ITEM: 11D1. Consider a resolution authorizing the Mayor to execute an agreement for the temporary closure of the right westbound lane of US 79 with the Texas Department of Transportation for the 5th Annual Texas Road Rash Inline Skating Marathon. Department: Parks and Recreation Staff Person: Jenene Jeffries-Uhrig, Athletics &Aquatics Supervisor Rick Atkins, Director Justification: The Texas Road Rash Inline Marathon is the 1St ever Inline Marathon in the state of Texas. The first few years have been very successful and have doubled in size to more than 160 participants. This year we anticipate this number to increase into the 300's. The Texas Road Rash has the potential of being one of the key marathons in the Country. In fact, last year the Texas Road Rash was ranked the 5th best inline marathon in North America. Funding: Cost: N/A Source of funds: NA Background Information: Last year the City of Round Rock hosted the 4th annual marathon. The goal of this event is to be one of the key marathons in the United States and help with the City's tourism efforts. As part of the marathon we use Hwy 79 and CR 122 and will need to obtain the approval of the Texas Department of Transportation. As part of that agreement the City Council must give their approval for the event. EXECUTED DOCUMENT FOLLOWS STATE OF TEXAS § Agreement No. COUNTY OF TRAVIS § AGREEMENT FOR THE TEMPORARY CLOSURE OF STATE RIGHT OF WAY THIS AGREEMENT is made by and between the State of Texas, acting by and through the Texas Department of Transportation, hereinafter called the "State," and the City of Round Rock, a municipal corporation, acting by and through its duly authorized officers, hereinafter called the "local government." WITNESSETH WHEREAS, the State owns and operates a system of highways for public use and benefit, including US 79, in Williamson, County; and WHEREAS, the local government has requested the temporary closure of US 79, right lane, westbound, between CR 122 and Harrell Parkway for the purpose of the Texas Road Rash Inline Marathon, from April 6, 2008 to April 6, 2008 as described in the attached "Exhibit A," hereinafter identified as the "Event;" and WHEREAS, the Event will be located within the local government's incorporated area; and WHEREAS, the State, in recognition of the public purpose of the Event, wishes to cooperate with the City so long as the safety and convenience of the traveling public is ensured and that the closure of the State's right of way will be performed within the State's requirements; and WHEREAS, on the day of rP AA(,A/ M , 2000 . thj�m City Council passed Resolution / Ordinance No. / Street Use Permitt-M-02?$•ItU, attached hereto and identified as "Exhibit B," establishing that the Event serves a public purpose and authorizing the local government to enter into this agreement with the State; and WHEREAS, 43 TAC, Section 22.12 establishes the rules and procedures for the temporary closure of a segment of the State highway system; and WHEREAS, this agreement has been developed in ,3ccordance with the rules and procedures of 43 TAC, Section 22.12: NOW, THEREFORE, in consideration of the premises and of the mutual covenants and agreements of the parties hereto, to be by them respectively kept and performed as hereinafter set forth, it is agreed as follows: AGREEMENT Article 1. CONTRACT PERIOD This agreement becomes effective upon final execution by the State and shall terminate upon completion of the Event or unless terminate=d or modified as hereinafter provided. Traffic—Traffic Closure Incorporated (TEA30A) Page 1 of 8 Rev. 09/29/2006 � R~ob- -2`b�tlb� Article 2. EVENT DESCRIPTION Agreement No. The physical description of the limits of the Event, including county names and highway numbers, the number of lanes the highway has and the number of lanes to be used, the proposed schedule of start and stop times and dates at each location, a brief description of the proposed activities involved, approximate number of people attending the Event, the number and types of animals and equipment, planned physical modifications of any man- made or natural features in or adjacent to the right of way involved shall be attached hereto along with a location map and identified as "Exhibit C." Article 3. OPERATIONS OF THE EVENT A. The local government shall assume all costs for the operations associated with the Event, to include but not limited to, plan development, materials, labor, public notification, providing protective barriers and barricades, protection of highway traffic and highway facilities, and all traffic control and temporary signing. B. The local government shall submit to the State for review and approval the construction plans, if construction or modifications to the State's right of way is required, the traffic control and signing plans, traffic enforcement plans, and all other plans deemed necessary by the State. The State may require that any traffic control plans of sufficient complexity be signed, sealed and dated by a registered professional engineer. The traffic control plan shall be in accordance with the latest edition of the Texas Manual on Uniform Traffic Control Devices. All temporary traffic control devices used on state highway right of way must be included in the State's Compliant Work Zone Traffic Control Devices List. The State reserves the right to inspect the implementation of the traffic control plan and if it is found to be inadequate, the local government will bring the traffic control into compliance with the originally submitted plan, upon written notice from the State noting the required changes, prior to the event. The State may request changes to the traffic control plan in order to ensure public safety due to changing or unforeseen circumstances regarding the closure. C. The local government will ensure that the appropriate law enforcement agency has reviewed the traffic control for the closures and that the agency has deemed them to be adequate. If the law enforcement agency is unsure as to the adequacy of the traffic control, it will contact the State for consultation no less than 10 workdays prior to the closure. D. The local government will complete all revisions to the traffic control plan as requested by the State within the required timeframe or that the agreement will be terminated upon written notice from the State to the local government. The local government hereby agrees that any failure to cooperate with the State may constitute reckless endangerment of the public and that the Texas Department of Public Safety may be notified of the situation as soon as possible for the appropriate action, and failing to follow the traffic control plan or State instructions may result in a denial of future use of the right of way for three years. E. The local government will not initiate closure prior to 24 hours before the scheduled Event and all barriers and barricades will be removed and the highway reopened to traffic within 24 hours after the completion of the Event. F. The local government will provide adequate enforcement personnel to prevent vehicles from stopping and parking along the main lanes of highway right of way and otherwise prevent interference with the main lane traffic by both vehicles and pedestrians. The local government will prepare a traffic enforcement plan, to be approved by the State in writing at least 48 hours prior to the scheduled Event. Additionally, the local government shall provide to the State a letter of certification from the law enforcement agency that will be providing traffic control for the Event, certifying that they agree with the enforcement plan and will be able to meet its requirements. G. The local government hereby assures the State that there will be appropriate passage Traffic—Traffic—Closure Incorporated (TEA30A) Page 2 of 8 Rev. 09/29/2006 Agreement No. allowance for emergency vehicle travel and adequate access for abutting property owners during construction and closure of the highway facility. These allowances and accesses will be included in the local government's traffic control plan. H. The local government will avoid or minimize damage, and will, at its own expense, restore or repair damage occurring outside the State's right of way and restore or repair the State's right of way, including, but not limited to, roadway and drainage structures, signs, overhead signs, pavement markings, traffic signals, power poles and pavement, etc. to a condition equal to that existing before the closure, and, to the extent practicable, restore the natural and cultural environment in accordance with federal and state law, including landscape and historical features. Article 4. OWNERSHIP OF DOCUMENTS Upon completion or termination of this agreement, all documents prepared by the local government will remain the property of the local government. All data prepared under this agreement shall be made available to the State without restriction or limitation on their further use. Article 5. TERMINATION A. This agreement may be terminated by any of the following conditions: (1) By mutual written agreement and consent of both parties. (2) By the State upon determination that use of the State's right of way is not feasible or is not in the best interest of the State and the traveling public. (3) By either party, upon the failure of the other party to fulfill the obligations as set forth herein. (4) By satisfactory completion of all services and obligations as set forth herein. B. The termination of this agreement shall extinguish all rights, duties, obligations, and liabilities of the State and local government under this agreement. If the potential termination of this agreement is due to the failure of the, local government to fulfill its contractual obligations as set forth herein, the State vril! nt.)tify the local government that possible breach of contract has occurred. The local government must remedy the breach as outlined by the State within ten (10) days from receipt of the State's notification. In the event the local government does not remedy the breach to the satisfaction of the State, the local government shall be liable to the State for the costs of remedying the breach and any additional costs occasioned by the State. Article 6. DISPUTES Should disputes arise as to the parties' responsibilities or additional work under this agreement, the State's decision shall be final and binding. Article 7. RESPONSIBILITIES OF THE PARTIES The State and the Local Government agree that neither party is an agent, servant, or employee of the other party and each party agrees it is responsible for its individual acts and deeds as well as the acts and deeds of its contractors, employees, representatives, and agents. Article 8. INSURANCE A. Prior to beginning any work upon the State'�i, right of way, the local government and/or its contractors shall furnish to the State a completed "Certificate of Insurance" (TxDOT Form 1560, latest edition) and shall maintain the insurance in full force and effect during the period that the local government and/or its contractors are encroaching upon the State right of way. Traffic—Traffic—Closure Incorporated (TEA30A) Page 3 of 8 Rev. 09/29/2006 Agreement No. B. In the event the local government is a seif-insured entity, the local government shall provide the State proof of its self-insurance The local government agrees to pay any and all claims and damages that may occur during the period of this closing of the highway in accordance with the terms of this agreement. Article 9. AMENDMENTS Any changes in the time frame, character, agreement provisions or obligations of the parties hereto shall be enacted by written amendment executed by both the local government and the State. Article 10. COMPLIANCE WITH LAWS The local government shall comply with all applicable federal, state and local environmental laws, regulations, ordinances and any conditions or restrictions required by the State to protect the natural environment and cultural resources of the State's right of way. Article 11. LEGAL CONSTRUCTION In case one or more of the provisions contained in this agreement shall for any reason be held invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provisions hereof and this agreement shall be construed as if such invalid, illegal or unenforceable provision had never been contained herein. Article 12. NOTICES All notices to either party by the other required under this agreement shall be delivered personally or sent by certified U.S. mail, postage prepaid, addressed to such party at the following respective addresses: Local Government: —�-� State: City of Round Rock i Texas Department of Transportation ansportation Parks and Recreation Lowell D. Choate, P.E. Attn: Rick Atkins Maintenance Operations 221 East Main P. O. Drawer 15426 Round Rock. Texas 78664 Austin, Texas 78761-5426 All notices shall be deemed given on the date so delivered or so deposited in the mail, unless otherwise provided herein. tither party hereto may change the above address by sending written notice of such change to the other in the manner provided herein. Article 13. SOLE AGREEMENT This agreement constitutes the sole and only agreement between the parties hereto and supersedes any prior understandings or written or oral agreements respecting the within subject matter. IN TESTIMONY WHEREOF, the parties hereto have caused these presents to be executed in duplicate counterparts. THE CITY OF ROUND ROCK Executed on behalf of the local government by: Traffic-Traffic-Closure Incorporated (TEA30A) Page 4 of 8 Rev. 09/29/2006 Aqreement No. "10�W ��/V CityWcial � -- Typed or Printed Name and Title Nyle Maxwell Mayor THE STATE OF TEXAS Executed for the Executive Director and approved for the Texas Transportation Commission for the purpose and effect of activating and/or carrying out the orders, established policies or work programs heretofore approved and authorized by the Texas Transportation Commission. By Date_ District Engineer i Traffic—Traffic—Closure Incorporated (TEA30AI Page 5 of 8 Rev. 09/29/2006 EXHIBIT "An January 11, 2008 Texas Department of Transportation, Austin District PO Drawer 15426 Austin, Texas 78761-5426 Dear Ms. Brown: The City of Round Rock Parks and Recreation will host the 5 1 Annual Texas Road Rash Inline Skate Marathon on Sunday, April 6, 2008. We will also be having some races within the Dell Diamond on Saturday, April 5, 2008, but they will not require any road closures. This event attracts more than 200 inline skaters across the United States and some countries and helps Round Rock, the Sports Capital of Texas, provide an inline skating event for the community. Last year, the Texas Road Rash was very successful with the assistance of your agencies. The City of Round Rock Parks and Recreation requests the closure of one south-bound lane of CR 122 and the closure of the shoulder and the far right lane of west-bound HWY 79 from CR 122 to Harrell Parkway from 5:30 am— 1:OOpm on Sunday, April 6, 2008. This will insure the safety of our inline skaters as they complete our looped course. I understand that the following items must occur in order for your agency to grant us permission to close the lanes of traffic. (enclosed) 1) Round Rock Parks and Recreation must have a signed agreement from the City. 2) Barricade Plan 3) Engineering Plan from the Traffic Department 4)Number of participants 5) Certificate of Insurance 6) Letter from law enforcement stating their involvement 7) Overall view of the race and layout. 8) City of Round Rock Resolution Q If you have any questions, please call 512-218-5540. ROUND ROCK or Rick Atkins Round Rock Parks and Recreation 512.218-5540 EXHIBIT a D RESOLUTION NO. R-08-02-28- 11R11 WHEREAS, the State of Texas, through the Texas Department of Transportation ( "TxDOT" ) owns and operates a system of highways for public use, including US 79 in Round Rock, and WHEREAS, the City of Round Rock Parks and Recreation Department has made a request to TxDOT that the right lane of US 79, westbound from Red Bud Lane to Harrell Parkway be closed on Sunday, April 6, 2008 from 5 : 30 o'clock a.m. to 1 : 00 o' clock p.m. for the Texas Road Rash Inline Skating Marathon ( "Event" ) , and WHEREAS, the City Council has determined that the Event will serve a legitimate public purpose, and WHEREAS, City Council wishes to enter into an Agreement for the Temporary Closure of State Right-of-Way with TxDOT authorizing the closure of US 79 as set forth above, Now Therefore BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK, TEXAS, That the Texas Road Rash Inline Skating Marathon will serve a legitimate public purpose, and BE IT FURTHER RESOLVED That the Mayor is hereby authorized and directed to execute on behalf of the City an Agreement for the Temporary Closure of State Right-of-Way with the Texas Department of Transportation, a copy of same being attached hereto as Exhibit "A" and incorporated herein for all purposes . The City Council hereby finds and declares that written notice of the date, hour, place and subject of the meeting at which this Resolution was adopted was posted and that such meeting was open to 00129946 •theublic as required quired by law at all times during which this Resolution and the subject matter hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act, Chapter 551, Texas Government Code, as amended. RESOLVED this 28th day of February, 2008 . NYLE MAXWELL, Mayor ATTEST: City of Round Rock, Texas SARA L. WHITE, City Secretary 2 EEXHIBIT a D 11 C 11 E. 1 r irROUND ROCK.TEXAS F11_C 1.NA551C1:'�.1'Rli�.l'I ell i Special Events Permit Application Applications must be filed at least fifteen(15)days before the Special Event. There is a fifty dollars(550.00)application fee for each event. If you are uncertain whether your event is considered a Special Event,please contact the City Manager's office for further information and clarification. l/� Date V-12-0 J �/ Applicant Name J4VJ f J1 Vah r[ q — V 0 Im Address �� W Q ��Q"1 u Phone I o 14 q ' C1 Organization �� �'\ Auth.Rep. ' Please check one: Pa�Kt 12e c ve rn ❑Individual ❑DB/A ❑ Organization ❑Partnership ❑Corporation `�, p El Profit ❑Nonprofit Address_A� 90 V 6 }n Phone 01'00 k e Event title Te tA KO A� �O` 5 Y l Event location: Deft 0I #,WHO to A L �, ) Oct( pt-AMo O /Pn r k ICK IZz Event Coordinator f° Phone 516- On-Site Contact On Event Day L�APhone a,� o V-c Even[Start Dale 0''1o6PEvent End Date: 0 0 V � Note:Event Cannot Exceed Three Days Event set-up time_M k6 vl� A R y Event teardown time Sal[ f j I awo LA V?d 3 r (Not earlier thAn 7:00 a.m.) (Completed not later than 10:00 p.m.) ForeachdaVyo the week an which lite event will be held,indicate the start and stop times below. Event day Sunday Monday Tuesday Wednesday Thursday Friday Saturday Start time Stop time Sop 2 0 Number of persons expected 9VO ",*OD Number of animals - Types of animals Number of motorized vehicle !/I Number of inflatables l 1 ea W rn 0-He' c4-e o►%� Din road �/JO svure S ' Tents or Other Temporary Structures(Must meet City's Fire and Building Codes): If you are planning to erect tents,canopies,seating,awnings,booths,first aid stations,portable restrooms or other temporary structures,please describe: Quantity Sizes T pes Fire Retardant Letter �b Y40 20 )<� t7 'f Gly `(�� Yes -Y\ No �Gti t/kt�✓5 Yes No t j X Yes No fD�10 Vf S n t'Vlc' Yes _ No Food or Beverages If you are planning on serving or selling food or beverages,please attach copies of any licenses or permits issued by the appropriate agencies for such vendors. Such vending shall be in compliance with all state and local laws. Amplified Sound If you are planning to utilize any loudspeakers or other form of amplified sound,please indicate on the attached sketch or map the location and orientation of those systems. Speakers should not be positioned so as to adversely affect any adjacent residential area between the hours of 7:00 a.m.and 10:00 p.m. Signage If you are planning to use or allow signs at such event,please provide details of any planned signage: �I/r l0 y vL -TX- 0 Disposal of Wastewater Applicant shall submit a plan for disposal of any wastewater in connection with the Special Event and such plan must be approved by the Utilities Department. Events Layout.Equipment&Parking Plan Please attach a map or sketch of the Event indicating the following: Events Layout,Equipment ■ Entrance(s) ■ Exit(s) • Plan of evacuation and proposed fire lanes ■ Amplified Sounds/Loudspeakers Parking arrangements ■ Will parking spaces be utilized by this event?Yes x No ■ Number of parking spaces provided must accommodate projected attendees plus 10%surplus. Also,provide information concerning layout of parking, includin aisle widths and size of proposed parking spaces. ■ Parking attendants? Yes No If yes,how many? ■ Will there be any offsite parking? Yes No Ve(I A,VV4 �(� • If yes and parking is on private property,Applicant must submit a letter of permission from property owner. • How will attendees be transferred to the Special Event area and returned? 2 s-ee a-� �-�( C vnAlp Place a check next to the items tha will be utilized,and indicate location on map or sketch. Tent(s) Size bO 4(��4 Portable Restrooms # Regular _ Handicap #Others Dumpster(s) Size Barricades Quantity Size 11 k4/11 (A I Hot Air Balloon(s) ( ) Quantity Supplier Fire retardant letters t Yes No Yes No Yes No Amusement Rides or similar equipment(insurance required) Quantity Type Insurance provided Yes No Yes No Alcoholic Beverages Giveaway Selling Type Yes No Vy ��1� I D ,(e.g.Beene) First Aid Stations Quantity Staffing Other Permits&Fees Please attached copies of any required insurance,surety bonds,permits or other documents as described in Section 1.3400 of the City of Round Rock Code of Ordinances. Check all components that will be part of your event.Additional fees and other permits or reservations may be required. Animals Banners/Signs Park property Electricity Police Security ✓�(\ X Barricades/traffic cones Fireworks Alcohol Beverages(non-alcohol) Merchandise sales >1 X X . Portable restrooms Special parking Food Liquid propane Street Cleaning by City x Bleachers/S eating Street Closures Fencing Water hydrant-Temp.Meter Other X Security,Crowd Control and Traffic Control The Applicant may be required to provide police officers for security, crowd control, and traffic control at the Special Event. The total number of police officers working at the Special Event is determined by the Round Rock Police Department, and in some cases may use planning variables, including: (1) the estimated number of participants and spectators; (2) the availability of alcoholic beverages;(3)topography and size of the event location;(4)weather conditions;(5)the time of day during which the Special Event is conducted; (6)the need for street closures or rerouting of vehicular or pedestrian traffic; and,(7)the history of the particular Special Event. Public Notification if the City Manager requires it, the Applicant shall, at least thirty(30) days before the Special Event begins, deliver written notice to all owners or occupants of real property abutting the boundaries of the area in which the Special Event will be conducted. The notice must include the following information: (1)event date, time and location, and (2) statement that an Application for a Special Event Permit has been filed with the City of Round Rock. 3 Insurance and Bonds If a Special Event uses any portion of the City's rights-of-way, the Applicant shall provide a certificate of insurance to complies with the standards established by the City's risk manager. If a Special Event is on City property, a Ten Thousand Dollar($10,000.00) surety bond shall be deposited with the Application to ensure that no damage is done to City property. if the City Manager certifies that all conditions set forth in Section 1.3425, Code of Ordinances, are complied with,the bond shall be returned. If the City Manager does not certify that all the conditions are complied with, any costs expended for policing and/or cleaning shall be deducted from the bond and the remainder returned. Additional conditions are spelled out in Section 1.3425 as to additional costs. If a Special Event is fully on private property,Applicant shall deposit Five Hundred Dollars($500.00)with the City as a condition that no paper, liter or other debris shall remain on the site after the Special Event is over. The deposit shall be returned to Applicant upon certification by the City Manager that all conditions are met. If the conditions are not met,such costs for cleaning shall be deducted from the deposit and the remainder returned. INDEMNITY AGREEMENT l) As a condition of a Special Event Permit being issued, the Applicant acknowledges that he/she has voluntarily applied for a Special Event permit that in consideration of the privileges associated therewith,Applicant agrees to PROTECT, INDEMNIFY and HOLD HARMLESS, the City, its officers, agents and employees, from and against suits, actions, claims, losses, liability or damage of any character, and from and against costs and expenses including attorney fees incidental to the defense of such suits, actions, claims, losses, damage or liability on account of Injury, death or otherwise, to any person or damage to any property, arising from any negligent act, error or omission of the undersigned,its officers,employees or agents,arising out of,resulting from,or caused by any act occurring as a result of the exercise of the privileges granted by this permit. 2) APPLICANT AGREES THAT THIS INDEMNITY AGREEMENT IS INTENDED TO BE AS BROAD AND INCLUSIVE AS IS PERMITTED BY THE LAWS OF THE STATE OF TEXAS, AND THAT IF ANY PORTION IS HELD INVALID, THEN IT IS AGREED THAT THE BALANCE SHALL, NOTWITHSTANDING, CONTINUE IN FULL LEGAL FORCE AND EFFECT. 3) This indemnity agreement contains the entire agreement of the undersigned and the City of Round Rock,and may not be modified or altered without the express written consent of the City of Round Rock. 4) This indemnity agreement is interpreted by Texas law and is performable for all purposes in the County of Williamson, State of Texas,or the County of Travls,State of Texas. I do solemnly swear(or affirm)that all the answers given and statements made on this Application are full, true and correct to the best of my knowledge and beliefs. I have been given a copy of the ordinance and have read the provisions contained therein and agree to abide by them. Applicant: V v I hereby grant the Applicant and any affiliated organization permission to use my property in connection with the Special Event and as described herein. Property Owner: 4 ..........*................*..,...,.;......OFFICE USE Application # Check# Cash Credit Card Receipt# Comments: ADDITIONAL EQUIPMENT OR PERSONNEL: Equipment: Public Safety Personnel g — Public Works Personnel z = TOTAL ADDITIONAL CHARGES: APPLICATION REVIEWED AND APPROVED CITY MANAGER OFFICE: DATE: POLICE DEPARTMENT: DATE: PUBLIC WORKS: DATE: PARKS AND RECREATION: DATE: FIRE DEPARTMENT: DATE: 5 ROUND ROCK,TEXAS PlW'OSt 13LSRh.p1U.41'tigl! - PICNIC ABLES PALRTI LONG TABLES f TEXAS ROAD RASH SET-UP MAP OLD SETTLERS PARK AT PALM VALLEY ROUND ROCK, TEXAS r f Enclosures TxDJT Formig550(Rev 0412002)Previous editions of this form may not be used. Page 1 oft2 Texas Department of Transportation (TxDOT) CERTIFICATE OF INSURANCE Prior to the beginning of work,the Contractor shall obtain the minimum Insurance and endorsements specified. Only the TxDOT certificate of insurance form Is acceptable as proof of Insurance for department contracts.Agents should complete the form providing all requested Information then either fax or man this form directly to the address listed on the bads of this form. Copies or endorsements fisted below are not required as attachments to this cerfific ale. Insured; Round Rock Street/Mailing Address: 221 E Main Ave City/State/Zip: Round Rock,TX 78664 Phone Number:Area Code 512 218-0643 WORKERS'COMPENSATION INSURANCE COVERAGE: Endorsed with a Waiver of Subrogation in favor of TxDOT. Carrier Name: Texas Municipal League-IRP Carrier Phone#: 800-537-6655 Address: 1821 Rutherford Ln.1sr Floor City,State,Zip: Austin,TX 78754 Type of Insurance Policy Number Effective Date Ex Iration Oate Limits of Llablllt Workers'Compensation 3127 10!112007 10/1/2008 Not Less Than: Statutory—Texas COMPREHENSIVE GENERAL LIABILITY INSURANCE: Endorsed with TxDOT as Additional Insured and with a Waiver of Sub ro ation in favor of TxDOT. Carrier Name: Texas Municipal Lea ue-IRP Carver Phone#: 800-537.6655 Address: 1821 Rutherford Ln.1st Floor City,State,Zip_ Austin,TX 78754 Type of Insurance: Policy Number: Effective Date: Expiration bate: Limits of Liability: Comprehensive General 3127 10/1/2007 10/1/2008 Not Less Than; Liability Insurance Bodily Injury Property Damage 5 500,000 each occurrence 5 100,000 each occurrence OR S 100,000 for aggregate Commercial General OR Liability Insurance 5 600,000 combined single limit COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE": Endorsed with TxDOT as Additional Insured and with a Waiver of Subro at'on in favor of TxDOT. Carrier Name:Texas Municipal Lea ue-IRP Carrier Phone#. 800-537-6655 Address: 1821 Rutherford Ln. 1st Floor City,State,Zip:Austin,TX 78754 Type of Insurance: Policy Number: Effective Date: Expiration Date: Limits of Liability Comprehensive Automobile 3127 10/1/2007 10/1/2008 Liability Insurance OR Texas Business Automobile Policy Not Less Than: Bodily Injury 3 250,000 each person Property Damage 5 500,000 each occurrence 3 100,000 each occurrence UMBRELLA POLICY Iff a livable Carrier Name: Carrier Phone#: Address: City,State,Zip: Type o�Insuranvue: Policy umber: Effective Date: Expiration bate: Limits of Liability: Umbrella P Agency Name Address City, State Zip Code Texas Municipal League- IRP 1821 Rut Mord Ln. 1St Floor Austin, TX 78754 Area Code (800) 537-6655 ext 897 1/4/2007 Authorized Agent's Phone Number Authorized Agent Ori al Signature Date -This Certillcate of lnsurance neither affirmatively nor negatively amends,extends,or alters the coverage afforded by the above Insurance policies issued by the named insurance company. Cancellation of the insurance policies shall not be made until THIRTY DAYS AFTER the agent or the insurance company has sent written notice by certified mail to the contractor and the Texas Department of Transportation. THIS IS TO CERTIFY to the Texas Department of Transportation acting on behalf of the State of Texas that the Insurance policies named meet all the requirements stipulated and such policies are In full force and effect If this fwrn is sent by facsimile machine (fax), the sender adopts the document received by 7kDOT es a duplicate origtnal and adopts the signature produced by the receiving fax machine as the sender's original signature. The Texas Department of Transportation maintains the Information collected through this form_ With few exceptions,you are entitled on request to be informed about the information that we coiled about you. Under§§SSZ021 and 552.023 of the Texas Govemment Code,you also are entitled to receive and review the information. Under 6559.004 of the Government Code,you are also entitled to have us correct Information about you that is incorrecL Txl)OT Fomi,1580 (Rev 04/2002) Pape 2 of,,2 } Texas Department of Transportation NOTES TO AGENTS: Agents must provide all requested information then either fax or mail this form directly to the address listed below. Pre-printed limits are the minimum required. If higher limits are provided by the policy, enter the higher limit amount and strike-through or cross-out the pre-printed limit. To avoid work suspension, an updated Insurance form must reach the address listed below one business day prior to the expiration date_ Insurance must be in force In order to perform any work. Binder numbers are not acceptable for policy numbers. The certificate of Insurance, once on file with the department, Is adequate for subsequent department contracts provided adequate coverage is still In effect. Do not refer to specific projects/contracts on this form. The TxDOT certificate of insurance form is the only acceptable proof of Insurance for department contracts. List the contractor's legal company name, including the DBA (doing business as) name as the insured or list both the contractor and staff leasing service as insured when a staff leasing service is providing Insurance. Over-stamping and/or over-typing entries on the certificate of insurance are not acceptable if such entries change the provisions of the certificate in any manner. This form may be reproduced. The SIGNATURE of the agent is required. Stamped/typed/printed signatures are not acceptable. CERTIFICATE OF INSURANCE REQUIREMENTS: WORKERS'COMPENSATION INSURANCE: The contractor is required to have Workers' Compensation Insurance If the contractor has any employees Including relatives. The word STATUTORY, under limits of liability, means that the insurer would pay benefits allowed under the Texas Workers' Compensation Law. GROUP HEALTH or ACCIDENT INSURANCE is not an acceptable substitute for Workers'Compensation. COMPREHENSIVE GENERAL LIABILITY INSURANCE or COMMERCIAL GENERAL LIABILITY INSURANCE: If coverages are specified separately,they must be at least these amounts: Bodily Injury $500,000 each occurrence Property Damage $100.000 each occurrence $100,000 for aggregate MANUFACTURERS'or CONTRACTOR LIABILITY INSURANCE is not an acceptable substitute for Comprehensive General Liability Insurance or Commercial General Liability Insurance. COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE or TEXAS BUSINESS AUTOMOBILE POLICY: The coverage amount for a Texas Business Automobile Policy or Comprehensive Automobile Liability may be shown as a minimum of$600,000 Combined Single Limit by a typed or printed entry and deletion of the specific amounts listed for Bodily Injury and Property Damage. BASIC AUTOMOBILE LIABILITY INSURANCE Is not an acceptable substitute for Comprehensive Automobile Liability Insurance or Texas Business Automobile Policy. MAIL ALL CERTIFICATES TO : Texas Department of Transportation CST—Contract Processing Unit(RA/200—1 st 1=1.) 125 E. 11 th Street Austin TX 78701-2483 5121416-2429 (V), 512/416-2536(F) ROUND ROCK POLICE DEPARTMENT y 615 E. PALM VALLEY BLVD ROUND ROCK, TEXAS 78664 PHONE: (512) 218-5500 FAX: (512) 218-7060 "TO PROTECT and SERVE" January 14, 2008 To: Susan Brown, TX DOT From: Lt. Bill Dixon Subject: Road closures Please allow this to act as notification that the City of Round Rock Police Department will be providing security and traffic control for the City of Round Rock's Parks and Recreation Department for the Texas Road Rash in the area of Old Settlers Park, CR 122, Harrell Pkwy. and Hwy 79 on Sunday, April 6t', 2008. Should you have any further questions please do not hesitate to contact me at 512-218-6659 PD-029-04 (Rev 12/07)