(12/2016)TA-W4106-9 (11/2015) StateNew Thruway York State Authority Canal •Corporation New York State Canal Corporation Page 1 of 2 REQUESTREQUEST TO ACCESS TO ACCESS AUTHORITY/CORPORATION CORPORATION PROPERTY PROPERTY

Purpose: This Request is used to obtain authorization from the appropriate Division prior to accessing ThruwayCanal Corporation(Corporation) Authority/Canal Corporation property.(Authority/Corporation) The Request is property. required when The Requestaccess/work is required is regulated when byaccess/work an existing is contract regulated or byagreement an existing and contract the access/work or agreement will not and be the monitoredaccess/work and/or will not supervised be monitored by Corporation and/or supervised staff. The by Request Authority/Corporation is not required: staff.(i) for existingThe Request construction is not required: contracts (i) or for construction existing constructioninspection agreements, contracts or or construction (ii) for existing inspection contracts agreements, or agreement or (ii)where for existingaccess/work contracts will be or supervised agreements by where Corporation access/work staff, or will be supervised(iii) when it by is moreAuthority/Corporation appropriate to obtain staff, a or work (iii) permit.when it is more appropriate to obtain a Work Permit. INSTRUCTIONS: • Applicant: Complete and sign Section I and send to appropriate Division Permit Office listed on page 2 of this Request. Submit this Request two (2) weeks in advance of any scheduled access if Division assistance is required (e.g., traffic control) or one (1) week in advance of any scheduled access if Division assistance is not required. Once approved, the Request must be available at the work site and provided upon request to confirm the applicant's authorization to access the specified property. • Division: Review Request, complete Section II and send Request back to the applicant. Send copies of approved Request to: ο Division Traffic Operations (for notification to State Police, and when necessary, for coordination of traffic control) ο Appropriate Division Program Manager ο Office of Real Property Management Section I Applicant Information Contract No. Project Description

Firm Name E-mail Address

Street Address City State Zip Code - Representative Name Phone No. Fax No. Cell Phone No. ( ) - ( ) - ( ) - HQ/Division Contact Phone No. ( ) - Names of persons entering Authority/CorporationCorporation Property Property Phone No. Cell Phone/Pager No. (attach additional sheets if necessary) ( ) - ( ) -

( ) - ( ) -

( ) - ( ) -

( ) - ( ) -

Location (e.g., milepost(s), GPS coordinates, tax map parcel numbers, etc.): Duration of scheduled access: From: To: What is the purpose of the access? (attach additional sheets if necessary):

What consultant equipment will be used?

Will traffic control be required? Yes No What support from CorporationAuthority/Corporation Division staff Division is being staff requested? is being requested?

Applicant Affirmation: The undersigned certifies that the above information is correct.

Signed by: Date: Firm Representative Section II Division Approval Authorization for the firm named above to access CorporationAuthority/Corporation property as property defined asin definedthis Request in this is: Request is:

Approved Disapproved If Approved, is Work Permit required? Yes No

Reviewed by (print name) Signature Date Division Comments/Conditions (attach additional sheets if necessary): TA-W4106-9(12/2016) (11/2015) REQUEST TO ACCESS CORPORATION PROPERTY Page 2 of 2 REQUEST TO ACCESS AUTHORITY/CORPORATION PROPERTY DIVISION PERMIT OFFICES

CANALTHRUWAY DIVISION DIVISION LIMITS LIMITS

New York Eastern Divisions Syracuse Western Divisions • New York (Mainline) - Mileposts: 0.00 - 76.50 • Syracuse (Mainline) - Mileposts: 197.90 - 350.60 • AlbanyGarden Office: StateErie Parkway Canal RiverConnection: from the GS Hudson 0.00 -River GS 2.40to Syracuse Office: ErieErie canalCanal from from Oneida Lake • New England Section: NE 0.17 - NE 15.01 the• Montgomery/Herkimer County line; Champlain Canal; (excluding Sylvan (excludiand Verona Beaches) to the GlensI-287 Falls Cross Feeder Westchester: Canal; Port HenryCWE 0.00 Terminal; - CWE and 10.90 Wilcox Monroe/Wayne County line; Oswega Canal; Dock (City of Plattsburgh). Cayuga-Seneca Canal; Jamesville and DeRuyter Albany Buffalo Reservoirs; and Cazenovia Lake. Utica• Albany Office: (Mainline) - Mileposts: from the Herkimer/Montgomery 76.50 - 197.90 • Buffalo (Mainline) - Mileposts: 350.60 - 496.00 County• Berkshire line to Section: the east endB 0.00 of Oneida - B 24.28 Lake (including • NiagaraBuffaloBuffalo Section: Office: Office: N 0.00 ErieErie Canal- Canal N 21.50 from from the the Monroe/Wayne Monroe/Wayne Sylvan and Versona Beaches); Adirondack Canal Lands and County line to theWayne . all other Reservoirs and Feeder Canals in Oneida, Madison and Herkimer Counties with the exception of DeRuyter Reservoir and Cazenovia Lake. Addresses and Phone Numbers Addresses and Phone Numbers NYS Thruway Authority NYS Thruway Authority NYS Thruway Authority NYS Thruway Authority New York DivisionEastern DivisionAlbany Division Syracuse Division WesternBuffalo Division Division DivisionNYS Canal Permit Corporation Coordinator Division NYS Canal Permit Corporation Coordinator Division NYS PermitN Canal CoordinatorCorporation DivisionNYS Canal Permit Corporation Coordinator 4Albany Executive Office Blvd. P.O. Utica Box Office 861 290 ElwoodSyracuse Davis Office Rd., Suite 250 455Buffalo Cayuga Office Rd., Suite 800 Suffern,Canal Permit NY 10901 Engineer Albany, Canal PermitNY 12201-0861 Engineer Liverpool,Canal NY Permit 13088-2103 Engineer Cheektowaga,Canal Permit Engineer NY 14225 Phone:P.O Box (845) 22058 918-2510 Phone: Phone: (518) (315) 436-2710 733-9530 Phone:149 (315) Northern 438-2420 Concourse Phone:4950 Genesee (716) 635-6253Street Fax:Albany, (845) NY 12201-2058 918-2596 Fax: Ext. (518) 36 436-2932 Fax: North (315) Syracuse, 461-0765 NY 13212 Fax:Cheektowaga, (716) 626-5362NY 14225 (mailing address same as Phone: (315) 423-2080 Phone: (315) 423-2080 Albany Office) Overnight mail address: Overnight mail address: Route 9W, 23 30 South Pearl Street Bldg. 1 Albany, NY 12207 Albany, NY 12209

CANAL DIVISION LIMITS

Eastern Division Western Division Albany Office: Erie Canal River from the to Syracuse Office: Erie Canal from Oneida Lake the Montgomery/Herkimer County line; Champlain Canal; (excluding Sylvan and Verona Beaches) to the Monroe/ Glens Falls Feeder Canal; Port Henry Terminal; and Wilcox Wayne County line; Oswego Canal; Cayuga-Seneca Dock (City of Plattsburgh). Canal; Jamesville and DeRuyter Reservoirs; and Cazenovia Lake. Utica Office: Erie Canal from the Herkimer/Montgomery County line to the east end of Oneida Lake (including Buffalo Office: Erie Canal from the Monroe/Wayne Sylvan and Verona Beaches); Adirondack Canal Lands and County line to the Niagara River. all other Reservoirs and Feeder Canals in Oneida, Madison and Herkimer Counties with the exception of DeRuyter Reservoir and Cazenovia Lake.

Addresses and Phone Numbers

Eastern Division Western Division NYS Canal Corporation NYS Canal Corporation NYS Canal Corporation NYS Canal Corporation Albany Office Utica Office Syracuse Office Buffalo Office Canal Permit Engineer Canal Permit Engineer Canal Permit Engineer Canal Permit Engineer P.O. Box 833 Phone: (315) 733-9530 290 Elwood Davis Rd., Suite 250 455 Cayuga Rd., Suite 800 Albany, NY 12201-0833 Ext. 36 Liverpool, NY 13088-2103 Cheektowaga, NY 14225 Phone: (518) 471-5033 Phone: (315) 438-2303 Phone: (716) 635-6250 Fax: (518) 436-3011 (mailing address is the Fax: (315) 461-0765 Fax: (716) 626-5362 same as Albany Office) Overnight mail address: 337 Southern Blvd. Albany, NY 12209