Guidelines for Obtaining a LIRR Entry Permit

Step 1: LIRR Project: YES ______No______

If no, Proceed to Step 2.

If Yes, 1) Provide LIRR Project Number & Project Title, 2) Provide LIRR Project Manager’s Name and Telephone Number, 3) Contact LIRR Project Manager to manage and coordinate all property access requirements and support.

Step 2: Request for Entry Permit:

Contact: Mr. Edward Maines Tele: (718) 558-3536 Manager - Contracts & Agreements, Engineering Department Email: [email protected] Long Island Rail Road, Hillside Maintenance Complex 93-59 183rd Street, Dept. 3146 Hollis, NY 11423

Provide: 1) Company Name, Address, Principal of Company (President or VP), Contact Person’s Name, Title, & Telephone #’s, 2) Authority for whom the work is being performed, i.e., NYC or NYS DOT, County, Utility Company, etc. (if applicable), 3) Contract Number assigned by the above Authority, for the work to be performed, 4) Full Description of work to be performed (detailed scope of work), 5) Additional information that may clarify the working limits and any interference to LIRR operation (i.e. drawings, surveys, crane calculations, etc.) 6) Amount of time necessary to complete the work and anticipated period of performance.

After reviewing the Entry Permit request submittal package for completeness, two (2) original copies of the LIRR/MTA Entry Permit will be prepared and forwarded to the requestor for signature. Upon receipt, the requestor must sign the permit, return one (1) signed original to Mr. Maines, and proceed to Step 3.

Step 3: Insurance Submittal: (Acord certificates are unacceptable)

Contact: Ms. Carol Berlingieri Tele: (646) 252-1429 Standards Enforcement & Claims Analyst Fax: (646) 252-1434 MTA Risk & Insurance Management Email: [email protected] 2 Broadway, New York, NY 10004

Provide: 1) A copy of the executed Entry Permit (signed by LIRR and requestor), 2) Evidence of insurance, in accordance with the requirements identified in the executed Entry Permit

Upon receipt and approval of appropriate evidence of insurance, the requestor must proceed to Step 4.

Step 4: ************ If this is an LIRR Project, Contact the LIRR Project Manager ***********

If not: Contact: Ms. Donna Dill Tele: (718) 558-3218 LIRR Civil Design & Inspection Fax: (718) 558-3298 Managing Engineer- Civil Inspection, Engineering Department Email: [email protected] Long Island Rail Road, Hillside Maintenance Complex 93-59 183rd Street, Dept. 3146, Hollis, NY 11423

Provide: 1) A copy of the executed Entry Permit (signed by LIRR and requestor) 2) Original signed copies of Evidence of Insurance - submitted in the proper format 3) Items 1 through 6 from Step 2

Upon review of all documents, and obtaining appropriate confirmation from MTARIM that all insurances have been reviewed and approved, a Field Inspector will be assigned to coordinate activities associated with the project, such as arranging for appropriate flag protection, RWP Training and request for mark-out of LIRR assets.

* It should be noted that the requestor must not alter the documents or take exception to the LIRR Entry Permit Terms and Conditions. Failure to follow the Guidelines described herein may result in the cancellation of the Entry Permit Agreement. Long Island Rail Road

MINIMUM JACKING REQUIREMENTS FOR UNDERGROUND UTILITIES

All work must be in accordance with current American railway Engineering Association (A.R.E.A.) specifications Part 5, Pipelines and as referenced below.

1. All parties are notified that pipe jacking or directional boring under LIRR tracks without LIRR flagman present is a violation of Federal Law.

2. Jacking and Receiving pits located on LIRR property – Details and calculations of the jacking and receiving pits, sheathing and bracing to be submitted to the LIRR for review. All details and calculations must include original seal and signature of a Licensed Professional Engineer, Licensed in the State of New York.

Jacking and receiving pits located off LIRR Property – Details of jacking and receiving pits, sheathing and bracing to the LIRR for review. The utility and/or the contractor is responsible to assure the design of all sheathing and bracing complies with the New York State Building codes and New York State Engineering Law.

3. The casing pipe shall not be less than 7’-0” from the base of the railroad tie to the top of the casing pipe at their closest point. Important note: All locations on the Port Jefferson branch require the casing pipe shall not be less than 10’-0” from the base of the railroad tie to the top of the casing pipe at their closest point.

4. When jacking operation is underway, the void from the soil material being removed shall not proceed in advance of the casing.

5. Once jacking operations has commenced, the jacking procedure shall be carried on continuously until it is completed.

6. Open excavation on/or adjacent to LIRR Right of Way (ROW) must be secured safely with fencing, barricades and flashing light or other methods as deemed necessary by the LIRR.

7. The contractor must comply with all applicable Maintenance and Protection of Traffic Control standards during construction.

8. The contractor must keep the LIRR ROW clean of all construction material, equipment and debris at all times.

9. The contractor shall satisfy LIRR Insurance requirements prior to commencement of work. Furthermore, the contractor shall satisfy the requirements of the Federal Law and LIRR requirements for Roadway Worker Protection training.

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10. An Entry Permit or Force Account Agreement will be necessary to ensure the reimbursement of railroad costs associated with design review and construction monitoring.

11. The LIRR must be given two (2) weeks notice prior to the commencement of work. No work shall be performed with a representative of the Long Island Rail Road Engineering Department and LIRR flagman being present. Contact Managing Engineer – Civil Inspection at 718-558-3218 with two (2) week notification.

12. A utility markouts must be performed by LIRR utility departments and other agencies prior to any excavation on or adjacent to the LIRR Right of Way.

13. The cost incurred by the LIRR to correct settlement or upheaval of the railroad tracks resulting from jacking will be reimbursed to the LIRR directly by the permittee.

14. The cost incurred by the LIRR resulting from damage to LIRR facilities (grade crossing, overhead wires, signal systems, underground utilities, structures, etc.) caused by jacking operations will be reimbursed to the LIRR directly by the permittee.

15. All references and notes to jacking operations shall also apply to directional boring operations. The directional boring pipe shall not be less than 12’-0” from the base of the railroad tie to the top of the pipe at their closest point.

ISO information removed. Note 3 revised for Port Jefferson Branch. Must be updated in ISO procedures for 3rd Party group.

Procedure Number: 3rd Party – 3 Title: Jacking Revision: 2 Date: 03/12/12 Saved Location: H:\Structures\3rd Party Contracting\Procedures\Minimum Jacking Requirements.doc

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Long Island Rail Road

GENERAL REQUIREMENTS FOR PROJECTS ADJACENT TO LIRR PROPERTY WITH POTENTIAL TO IMPACT LIRR SAFETY AND OPERATIONS

• Attached are “General Requirements for Outside Contractors Working on LIRR Property”. These requirements apply to this project. Entry Permit requires an outside agency or contractor to reimburse the LIRR for all project costs (i.e. Flag Protection, Project engineers, Inspectors, etc.) • Shop drawings and calculations detailing sheeting must be submitted prior to excavation, which may impact the stability of adjacent embankment supporting our tracks. Shop drawings and calculations to include the original seal and signature of a NYS Licensed Professional Engineer. Sheeting to be designed for Cooper E- 80 Axel Loading as per the American Railway Engineering Associates. • Fouling of LIRR Track includes work within 15 ft. of or along LIRR tracks. This also includes operation of equipment or any part of equipment (i.e. crane booms) which could fall onto or within six (6) feet of LIRR tracks. • All parties are notified that fouling LIRR track without LIRR flag protection being present is a violation of Federal Law. • CRANES o Crane operation must maintain at least fifteen (15) feet vertical and horizontal separation from overhead LIRR High Tension Lines. If overhead power lines from outside agencies are supported from LIRR High tension poles, a letter from that agency must be submitted to the LIRR stating their vertical and horizontal separation requirements. o The following conditions apply for operating cranes with booms of sufficient length to fall onto or within six (6) feet of LIRR tracks. ƒ Crane information must be submitted to the LIRR for review, including proposed location of crane, proposed boom angle and loading diagram indicating that the crane is capable of supporting 150% of load to be lifted. Loading diagram to include original seal and signature of NYS Licensed Professional engineer. ƒ LIRR flag protection must be on site. Crane operations will generally be restricted to 10:00 am to 3:00 pm daily. ƒ Crane operator or one (1) construction supervisor who will be on the site full time must be trained and verified in Roadway Worker Protection. ƒ Crane operations must follow the direction of LIRR flagmen and face boom parallel to our track when ordered to do so.

Procedure Number: 3rd Party – 3 Title: Adjacent Revision: 2 Date: 03/13/12 Saved Location: H:\Structures\3rd Party Contracting\Procedures\Projects Adjacent to LIRR Property.doc

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GENERAL REQUIREMENTS FOR OUTSIDE CONTRACTORS WORKING ON LIRR PROPERTY

• Obtain Entry Permits. Call LIRR Manager – Engineering Contracts, Agreements and Materials at 718-558-3356. • Obtain required Railroad Protective Liability Insurance and submit original signed insurance documents to the MTA Risk and Insurance Management, call 646-252- 1429. • All contractor personnel whose duties include working on, within fifteen (15) feet of or above railroad tracks or operating equipment (i.e. cranes) on or near railroad tracks shall attend annual Roadway Worker Protection (RWP). Call LIRR Training Department at 718-558-3100 to schedule. • Two (2) weeks prior to start of construction call Managing Engineer – Civil Inspection at 718-558-3218.

Procedure Number: 3rd Party – 3 Title: General Revision: 2 Date: 03/13/12 Saved Location: H:\Structures\3rd Party Contracting\Procedures\Outside Contractors Working on LIRR Property.doc Page 1 of 1 Guidelines for Submission of Evidence of Insurance MTA LONG ISLAND RAIL ROAD (LlRR) AGREEMENTS These are basic acceptance guidelines-read your agreement for specific insurance requirements. Policies must be written by Carriers rated A-/VII or better to be acceptable to MTA &MTA's Operating Agencies

1. General Requirements:

• Use Long Island Rail Road (LlRR) Certificate if contract applies to only LlRR; • Use Joint Agency Certificate if contract applies to more than one MTA Agency; • ACORD Certificate may be used for operating-funded contracts under $250,000 unless otherwise noted in agreement. On the Certificate, you are required to: • Reference the Agreement or Contract #; • Disclose any deductible, self-insured retention, sub-limit or aggregate limit; • Provide insured's telephone number, contact person and e-mail address; • Must be signed by an Authorized Representative of the Insurance Carrier or Producer and notarized. • Insurance expiration dates may not be within 30 days of submission unless written assurance from the authorized broker that the policy (s) will be renewed with the same terms and conditions is submitted with the certificate. • Select / Check (,I) the appropriate boxes for Additional Insured / Additional Named Insureds and/or Loss Payees,

2. Minimum Coverages (Refer to Agreement for Specific Insurance Requirements):

a. Workers' Compensation • The New York State Insurance Fund form is acceptable. • If a company is located out of state, an flAil Stat~s" endorsement is required • Sole Proprietors may provide CE-200 form as documentation of exemption status. Others may provide a letter from their accountant or attorney as evidence of exemption.

b. General liability (Refers To Primary and Umbrella/Excess liability Policies) • Minimum limits of Commercial General Liability may be satisfied by a combination of primary and umbrella / excess policies and must follow form of the underlying policy and be extended to "drop down" to become primary in the event the primary policy is exhausted. • A physical copy of the Additional Insured Endorsement (I.S.0. Form CG 20 10 1185 version or equivalent) reflecting the policy number(s) and covering the required indemnitees in your agreement must accompany the certificate of insurance. c. Railroad Protective liability (RRPL) / Builder's Risk • A Certificate of Insurance is not acceptable proof of these coverages: an insurance binder must be provided pending issuance of actual policy. • RRPL binder must list all required Named Insured (indemnitees). • Actual policies must be submitted within 30 days from issuance of binder.

d. Environmental Coverages - Contractor or its sub-contractor may provide: • Contractor's Pollution Liability coverage must be endorsed to include the additional insureds per terms of contract and a copy of the physical endorsement must accompany the certificate of insurance. • Pollution Legal Liability coverage must be endorsed to include the additional insureds as required in your contract. Evidence of coverage can be satisfied by the following: • Stand alone Pollution Legal Liability policy listing the Non-Owned Disposal Site • A Non-Owned Disposal Site Endorsement to the Contractors Pollution Liability policy. • A certificate of insurance from the disposal facility adding the applicable Agency (s) as additional insured. • The Hauler must provide evidence of their Busi~ss Auto Liability policy with copies of the MCS90 &CA9948 endorsement,

e. Joint Venture • If the Contractor/Consultant is a joint venture, the jOint venture must be listed as the insured on page one of the MTA Long Island Rail Road Certificate of Insurance.

3. Provide Signed Certificate or a Certified Copy(s) of the actual Policy(s) to: Mailing Address: MTA Risk and Insurance Management Dept., Standards, Enforcements and Claims Unit, 2 Broadway, 21st floor, New York, NY 10004.

INS-PROCEDURE-GUIDELINES - MTARIM -02-18-11 Capital Contract Operating Contract Long Island Rail Road Entry Permits CERTIFICATE OF INSURANCE

AGREEMENT or CONTRACT NAME/DESCRIPTION: AGREEMENT or CONTRACT #:

INSURANCE PRODUCER: CERTIFICATE ISSUANCE DATE: DATE RECEIVED: REFERENCE #:

ADDRESS:

PHONE #:

CO COMPANIES AFFORDING COVERAGE INSURED: LTR

ADDRESS: A NAIC #

B NAIC # PHONE #: C NAIC #

D NAIC # CERTIFICATE Long Island Railroad/MTA HOLDER: Attention: Risk & Insurance Management E NAIC #

ADDRESS: 2 Broadway F NAIC # 21st Floor New York, NY 10004 G NAIC # PHONE #: (646) 252-1429 COVERAGES (See Notes 1 and 2) CO POLICY EFFECTIVE EXPIRATION TYPE OF INSURANCE LIMITS LTR NUMBER DATE DATE

GENERAL LIABILITY BI & PD COMBINED $ Commercial General Liability Form OCCURRENCE Underground Expl.& Collapse Hazard Products/Completed Operations GENERAL AGGREGATE $ Contractual Liability Independent Contractors PRODUCTS/COMPLETED $ Fifty Foot Exclusion Removed OPERATIONS AGGREGATE Personal & Advertising Injury SIR/Deductible $ OTHER $ BODILY INJURY $ (Per Occurrence) AUTOMOBILE LIABILITY Any Auto PROPERTY DAMAGE $ Owned Autos (Per Occurrence) Hired Autos Non-Owned Autos BODILY INJURY/PROPERTY DAMAGE COMBINED SINGLE $ LIMIT (Each Accident

AUTO ONLY EACH $ ACCIDENT GARAGE LIABILITY

Any Auto OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS LIABILITY EACH OCCURRENCE $ Umbrella Form

Other Than Umbrella Form AGGREGATE $ SIR/Deductible $ WORKER’S COMPENSATION STATUTORY LIMITS AND EMPLOYER’S LIABILITY

USLH Jones Act EMPLOYER’S LIABILITY $ “All States” Coverage PROFESSIONAL LIABILITY Includes Pollution Liability $ Deductible $ OTHER: $ OTHER: $ OTHER: $ EVIDENCE OF RAILROAD PROTECTIVE LIABILITY AND/OR BUILDER'S RISK INSURANCE, WHEN APPLICABLE, REQUIRES SUBMISSION OF THE ORIGINAL POLICY. THE ORIGINAL BINDER(S) WILL BE ACCEPTED, PENDING ISSUANCE OF THE ORIGINAL POLICY(S). Revised 8/09 CERTIFICATE OF INSURANCE LIRR (Continued) Page 2

LIABILITY COVERAGES: PROPERTY COVERAGES: (See Note 3) Check all that apply ADDITIONAL INSUREDS (See Note 3) Check all that apply Coverage: General Liability, Garage Liability, Excess/Umbrella Liability ADDITIONAL NAMED INSUREDS/LOSS PAYEE Contractor’s Pollution Liability, Pollution Legal Liability, etc. Property, Builder’s Risk, etc.

For All Long Island Rail Road Agreements: LOSS PAYEE Long Island Rail Road (LIRR), Metropolitan Transportation Authority Coverage: Crime Insurance, Valuable Papers (MTA), and its subsidiaries and affiliates and New York & Atlantic Railway Company (when applicable). For all Long Island Railroad Agreements Long Island Rail Road (LIRR), Metropolitan Transportation Authority (MTA), and its subsidiaries and affiliates and New York & Atlantic Railway Additional Indemnitees Required on Long Island Rail Road Agreements, Company (when applicable). depending on Location of Work: NJ Transit Corporation/NJ Transit Rail Operations, Inc. Additional Indemnitees Required on Long Island Rail Road Agreements, National Railroad Passenger Corp. (Amtrak) depending on Location of Work: Consolidated Rail Corporation NJ Transit Corporation/NJ Transit Rail Operations, Inc. CSX Transportation Inc. National Railroad Passenger Corp. (Amtrak) Triborough Bridge & Tunnel Authority (B&T) Consolidated Rail Corporation Port Authority of NY & NJ CSX Transportation Inc. Triborough Bridge & Tunnel Authority (B&T) Other Port Authority of NY & NJ

ADDITIONAL NAMED INSUREDS, when applicable Other

NOTE 1: The subscribing insurance company(s), authorized to do business in the State of New York, certifies that insurance of the kinds and types and for limits of liability herein stated, covering the Agreement/Contract herein designated, has been procured by and furnished on behalf of the Insured and is in full force and effect for the period listed on the front of this Certificate of Insurance. In addition, the subscribing insurance company(s) certifies that the insurance limits for General Liability Insurance are not amended by deductible clauses of any nature except as has been disclosed to and approved by the Long Island Rail Road; and that coverage is afforded for the Insured’s obligations under that provision of the contract providing for indemnification of the Indemnified Parties, including the Long Island Rail Road, named therein. When applicable, the subscribing insurance company(s) certifies that: any exclusion applying to construction or demolition operations on or within fifty (50) feet of a railroad (stations, yards, tracks, etc.) has been removed; and any employer liability exclusion which may otherwise operate to exclude claims for bodily injury asserted by an employee of an additional insured has been removed.

NOTE 2: The subscribing insurance company(s) shall endeavor that no policy referred to herein shall be changed or canceled until thirty (30) days written notice has been sent to the following address: Long Island Rail Road c/o MTA Risk and Insurance Management Department, 2 Broadway, 21st Floor, New York, NY 10004.

NOTE 3: All references to Additional Named Insureds and Additional Insureds include those entities’ directors, officers, employees, partners, agents, subsidiaries and affiliates.

NOTE 4: This certificate is issued to the Certificate Holder in consideration of the Agreement/Contract entered into with the named insured. It is understood and agreed that the certificate holder relies on the certificate as basis for continuing such Agreement/Contract with the name insured.

AUTHORIZED INSURER/PRODUCER ______

BY ______(signature of authorized Insurer/Producer)

TITLE ______

STATE OF ) ) s.s. COUNTY OF )

On this ______day of ______20___, before me personally came ______, to me known, who being duly sworn, did depose and say that he/she resides in ______, that he/she is the ______of the corporation and described in and which executed the foregoing Certificate of Insurance, that he/she is fully authorized to execute the foregoing Certificate of Insurance.

______(Notary Public)

CERTIFICATES OF INSURANCE MUST BE COMPLETED BY AUTHORIZED INSURANCE REPRESENTATIVES ONLY.

Revised 8/09