To Andy Mulder

City of Holland - Transportation Services 333 Wyngarden Way Holland, MI 49423 Request to work in the Public Right-of-Way All Contractors working within the Public Right-of-Way, must provide the following information to the City of Holland Transportation Department in order to obtain a permit before starting work. 1. Complete application information (below) and attach sketches or plans of the work. 2. Submit a traffic control plan for lane or full road closures for all major & some local streets. 3. Submit proof of liability insurance listing “The City of Holland, its officers, agents and employees are named as additional insured” and include a waiver of subrogation. The certificate holder must be the City of Holland, 270 River Avenue, Holland, MI 49423. All subcontractors must submit the same proof of liability insurance. 4. Indicate who is going to perform the restoration work. If the City is to perform some or all of the restoration, our rates shall apply and will be added to the cost of the permit. Winter rates do apply during certain times of the year, check our rate sheets for details. 5. All backfill materials shall be density tested according to MDOT specifications. The Contractor shall be responsible procuring and arranging the density testing and must submit acceptable density test results to Tami Glover at [email protected]. Failure to obtain density testing may result in fines and the ability to obtain permits for future work.

Application Date - ______Description of the work Contractor Name - ______(reference attachments) Person Requesting Permit - ______Phone - ______E-mail - ______Address of job site - ______Sketches or plans attached - yes no ______Start Date/Completion Date - ___/___ Road or Lane Closures - ______(Traffic control plans must be preapproved by City Engineer. Submit to [email protected]) Subcontractor Name or Names (list all) ______

Submit Application and Supporting Documents to the following by email (preferred), fax or drop off at the transportation office during regular business hours: Attention – Tami Glover Email – [email protected] and [email protected] (submit to both email addresses) Fax – 616-928-2408 Questions or comments? Call the main transportation office phone – 616-928-2400.

Comments Upon approval of your application, a permit will be e-mailed to the applicant, provided the applicant is in good standing with the City. An applicant in good standing is defined as one who promptly pays permit/restoration invoices, performs & submits density testing and has no history of working in the right-of-way without first obtaining the proper permit(s).

Working in the Right-of-Way permit without first obtaining proper permits is subject to a Civil Infraction Ticket in accordance with the Holland Municipal Code.

Local companies that provide density testing services. Driesenga & Associates: 616-396-0255 Materials Testing Consultants: 616-456-5469 Soil & Materials Engineering: 616-406-1756 Soils & Structures: 231-760-6841