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Signed Contract_S&R Jackson, LLC Revocable License ROW at 1065 Jackson Street Copyrighted November4, 2019 City of Dubuque Consent Items # 17. ITEM TITLE: Signed Contract(s) SUMMARY: Tri-State Occupational Health, LLC Amendment to Agreement; K&L Leasing Revocable License for use of right-of-way at 778 W. 8th Street; S&R Jackson, LLC Revocable License for use of right-of-way at 1065 Jackson Street; Powers of Communication Vendor Service Agreement for Census 2020 Communication Consulting. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File ATTACHMENTS: Description Type Tri-State Occupational Heath AgreementAmendment Supporting Documentation K&L Leasing Revocable License Supporting Documentation S&R Jackson, LLC Revocable License Supporting Documentation Powers of Communication Census 2020 Consulting Supporting Documentation Services Agreement IlIIII IIIIII I II I III IIIII Ilill llll lllll l llll llll lllll lllll l ll J Doc ID: 010370310006 Type: GEN ' � Kind: MISCELLANEOUS I1 Recorded: 10/16/2019 at 12:48:15 PM ;� Fee Amt: $32.00 Paqe 1 of 6 ' Dubuque County Iowa John Murphy Recorder I Fi1e2019�0001L��V �r �i� �' i;� II I Prepared by: Gus Psihoyos,City Engineer,City of Dubuque,50 W. 13th Street, Dubuque, IA 52001 (563 589-4270) I,� Return to: Gus Psihoyos,City Engineer,City of Dubuque,50 W. 13th Street, Dubuque, IA 52001 (563 589-4270) I� II '�: REVOCABLE LICENSE ; AUTHORIZING S�`c�'- � J�'cer I'�.S'4�, L-( �-- � TO CONSTRUCT .��-`-��,� d�- �� _ ';; � �N PI��LiC RIGH1'-OF-iIVAIf �,� , p i . , (business) (�icensee), known as ,�° �` c., � in I Section 1. �",�- � ��.�. ��c��., �.C C. as the owner of the remises, , �f� � �" r� i Dubuque, lowa, and legally described as��-+��,� ��s�p�.�3�� -� °��Z (",��•,L�-`��fl� ',I be and is hereby granted a Revocable License and authority to construct and maintain ;; �`-�-��,5" d- ��c (� , (Encroachment) (see attachment for q location) under the terms and conditions set forth in this License. � rj Section 2. The permission herein granted is expressly conditioned on " Licensee's agreement to: � � Il a. Assume any and all liability for damages to persons or property which may �' result from the existence, location, installation, construction or � maintenance of said Encroachment; � b. Procure and maintain in force during the term of this License a policy of � liability insurance as set forth in the attached Insurance Schedule or private policy of liability insurance which covers your encroachment of the public right of way; as required by the City Manager c. Pay on behalf of the City of Dubuque, all sums which the City of Dubuque shall become obligated to pay by reason of the liability imposed upon the City of Dubuque for damages of any kind resulting from the location, � installation, existence, construction or maintenance of said Encroachment � sustained by any person or persons, caused by accident or otherwise to � defend at its own expense and on behalf of said City any claim against the ;� City of Dubuque arising out of the location, installation, , existence, r construction or maintenance of Encroachment and to pay reasonable � attorney fees therefor; and � - � R � �J�-�� .�.� �f,l�-�i�-�''� � ot II ' E, �� G� d. Indemnify, defend and hold the City of Dubuque free and harmless from ; any and all claims, including but not limited to damages, loss, liability and '' expense for death and/or injuries to third persons or damages to property � of third persons, or for damage to any property of the City of Dubuque %; which may occur as a result of or in connection with the location, li ,; installation, existence, construction, maintenance and repair of !� Encroachment. �� e. Any special conditions as set forth for this License as identified: � ;; ;; � i �I �, Section 3. The Encroachment shall be maintained in accordance with all � applicable state and federal laws and regulations, and the Ordinances of the City of � Dubuque. � r Section 4. The permission herein granted is expressly conditioned upon � Licensee's further agreement that should the right and privilege herein granted be h rescinded or revoked by the City Manager, with or without cause, Licensee, shall within I! ten (10) days after receipt of written notice from the City Manager, so to do, at its own � expense, remove said Encroachment at Licensee's expense and dispose of the same, "� and Licensee shall have no claim against the City or its officers, agents, or employees ��' for damages resulting from the removal of said Encroachment. I� � Section 5. Licensee covenants and agrees that the Revocable License herein ;; granted does not constitute an approval of the design, erection, location, construction, � repair or maintenance of said Encroachment and Licensee hereby covenants and � agrees not to assert such claim or defense against the City of Dubuque in the event of j claim asserted for death, personal injuries and/or property darnage against Licensee � arising out of or in any way connected with the location, installation, construction, �; design, repair and maintenance of the Encroachment. � Section 6. This Revocable License shall become effective and the rights � hereunder accrue to Licensee when this License has been approved by the City � Manager and the terms and conditions thereof accepted by Licensee by acceptance endorsed on this License. This Revocable License is not assignable or transferable to another location. This license is for this property only. Section 7. The City Clerk shall file a copy of this License at Licensee's expense in the Office of the Recorder in and for Dubuque County, lowa. � � � � 2 � �� `l { Section 8. lowa One-Call registration may be required by the Code of lowa. � When applicable Licensee shall submit documentation to the City Engineer of lowa One-Call registration membership. � ^ i Signed this day of /f��r , 2p�� , �� 1 __._ � Mich el� C. Van Milligen, City Manager � �, ��i 'I Attest: '� ,'I � � ��, � ,..� �! ''� � Ke n S. Firns ah , City Clerk I � I '!I i State of lowa ) '1 ) ss County of Dubuque ) � On this �� day of fF ✓�'� , c�d1 , before me, the � undersigned, a Notary Public in and for e State of lowa, personally appeared Michael C. Van Milligen and Kevin S. Firnstahl, to me personally known, who, being by me duly sworn, did say that they are the City Manager and City Clerk, respectively, of the City of ;� Dubuque, lowa, a municipal corporation, that the seal affixed to the foregoing instrument is the corporate seal of the corporation, and that the instrument was si ed ',� and seale on behalf of the corporation, ' , on the �� day of , �-�� , and Michael C. Van Milligen and Kevin S. Firnstahl �I acknowledg ,� the execution of the instrument to be their voluntary act and deed. � �.� {�, KERRY JO BRADl.EY � � p � Gommission Number 808090 � ��° My��y m' sion E pires NOfiat'�/ PU II �NrS and for said tate I . 3 � � � � � � i . I I � ACCEPTANCE OF TERMS AND CONDITIONS OF LICENSE � The undersigned, being duly authorized to execute this Acceptance on behalf of ' �"' GC.� , and having read and being familiar with the terms ;� J'd2 �GEc_taS"a,-�,. , and conditions of the Revocable License, accepts the same and agrees to be bound by ' the terms and conditions herein. ' 'i I LICENSEE: �� ;i Signature � , 1 By. �'i e�`' �� . �,� !1 r�tie: �� , .�� ,IDated: c�-- "2 c3 -- j � �i � ;�I Signature requires notary— Use "All Purpose Acknowledgement" on next page '�'�I �ii �I i I,I, I li I i �� 4 � � � � ALL PURPOSE ACKNOWLEDGMENT STATE OF IOWA ) COUNTY OF DUBUQUE ) �i �i On this � day of , 20� before me, the undersigned, a I;� Notary Public in and for said State, pe onally appeared �(>�y, �G�Ze �.- r; (NAME/S) to me personally known, OR proved to me on the basis of � satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within i instrument and acknowledged to me that he/she/they executed the same in his/her/their � authorized capacity(ies), and that by his/her/their signature(s) on the instrument the ; person(s) acted, executed the instrument. � (Notary Seal) i I, i pe�� <s KERRY JO BRADLEY (sign in ink) � � Commission Number 80$09U � ! 1 � °°' ': My m�nission Expires J �.,/ ? '°"'�' ` � v� (print/type name) � � Rotary Public in and f� State of lowa �' AP � � C ACITY CLAIMED BY SIGNER INDIVIDUAL �� '� CORPORATE OFFICER(S) (Title) I'';; � (CORP SEAL) � ,i; AFFIXED NO SEAL PROCURED l PARTNER(S) LIMITED GENERAL ; � ATTORN EY-I N-FACT G TRUSTEE(S) � Gua�DiAn�icon�sERVA-roR ij OTHER I ; SIGNER IS REPRESENTING: Name of Person(s) or Entity(ies): 5 I� � 4 � . �II { CITY OF DUBUQUE EN�aINEERIIWG DEp�4RTMEN7 '� APPLICA�'ION FQR LICEN56 dF ENCRAACHMENT-DETAtL SNEE1' � pWNER: �� ('�dl�_. ��Sf� s'\ �Date: d "r �(�'" �f:�„ �� QWNER MAILING: �=j(� l'7 C� m IJ Contac Name&f�hone Number: � CITY/5't'ATE/21P: � � � �Qf�y �� l2('�"` � �ari'"" �',�{2— 2.S��'i f' j �.ocaTiaN: �� 6.5� �l z�.c_('�S"c�.� t��Ac oE c��p-riorv: ;a :/-� c � ` � i fi� �—�'`�'" ��'� � PARCEL fp�: '� (;;+ b � � Items that need to be shawn to scale on drawins -Use Additional sheets as n�eded ,i 5treet Names � � Raght-af-way Widths ;i Pavement Widths I� 5idewalk Location&�ize j ObstaclesJimprovements in/or near erea-ie-trees,fences,drainage structures,vaults,signs,meters,etc. I, Horizontal and verticat location and physicai size i� Utility locations(One-ca61 required-1-800-292-8985 or#811) �'j Special Attention Areas-i.e.-railing size,dimensipn,height,material,c�lor � Encraachrnent construction material-i.e,cazncrete,stane,dirt,metal,coiors,etc. !i 1 Z 3 A S 6 7` 8 9'' 1p 11 - 12 13 14 15 'i& 17 18 19 20 21 22 Z3 34 35 26 27 2$ 29 30 31 32 33 34 �{ � � p 2 � ; '� 3 �`„�"�' i � l:� ' , 4 .. .....� � .. � . . , . .., ... ._. ... .. � . 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