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Home My WebLink About20192044EXHIBIT INVENTORY CONTROL SHEET Case USR18-0077 — CHEYENNE CONNECTOR, LLC Tyler Exhibit Page # Submitted By Description CDOT Utility Special Use Permits 1) Hwy 392 mm 120.48 or 6601' west of CR 49 2) Hwy 34 mm 118.43 or 1062' east of CR 51 3) 5138' east of CR 43 mm 158.33 BB. 2-141 Applicant 4) Hwy 85 mm 292 2019-2044 EXHIBIT N L COLORADO DEPARTMENT OF TRANSPORTATION v 0 te UTILITY PERMIT PERMITTEE Name: Cheyenne Connector Pipeline, Inc APPLICANT Name: Summit Resources C/O Rebecca Lieders DEPARTMENT Date Issued: USE ONLY 03/19/2019 REP: Rebecca Ueders Permit II 4190089 Milepost(s) Slde(s) j REP: Shawn Bates Address: S.H.4 392 120.480 Address: 370 Lakewood, Van Gordon Colorado St 80226 800 8th Greeley, Ave. Colorado Suite 204 80631 Region: 4 • Email: shawn.bates@tallgrassenergylp.com Email: S.H. Section : B I Telephone: (303) 763-2981 Telephone: 479-306-8807 Patrol 25 J NOTICE TO PERMITTEE: For underground facility location information, contact the Utility Notification Center of Colorado (UNCC). Pursuant to 9-1.5-103 C.R.S. you shall not make or begin excavation without first notifying the UNCC and if necessary, then notifying the tier two members having underground facilities in the area of such excavation. Notification shall also be given to the CDOT regional permitting office, or as otherwise directed by this Permit's Special Provisions. Notice of the commencement, extent and duration of the excavation work shall be given at least two business days prior thereto, not including the day of actual notice. The UNCC maav be c.ail.��1 at -L 0O -9z2-]9$1. ACTIVITY DESCRIPTION (Furnished b) Permittee) PURPOSE r Installation al Adjustment , Removal II Relocation ❑ SUE/Other ■ Maintenance of Existing Facility FACILITY (Type, size, class of transmittant, design pressure or etc. ) 36" Natural Gas Pipeline DESCRIPTION OF WORK: Bore under Hwy 392 to install a 36" natural gas pipeline NATURE OF INSTALLATION: ❑ Longitudinal Transverse (Crossing) &4 Buried Aerial/Ground-mounted LOCATION: Hwy 392 mm 120.48 or 6601' West of Cr 49 County: Weld County City/Town: ADDITIONAL REMARKS: NO TRAFFIC CONTROL APPROVED WITH THIS PERMIT SPECIAL PROVISIONS (completed In the Department) The Special Provisions are terms and conditions of this permit. • Any work shall only be in accordance with the approved plans and special provisions as set forth in this permit and its attachments. The COOT inspector is Chip Hopkinson Telephone: (970) S90-5745 Inspector Email: Work is to be completed on or before: 07/17/2019 or within 120 days, (as applicable) Work time restrictions: Daylight Hours. Designated minimum cover is 4 feet Designated overhead clearance is 24 feet (ALSO SEE ATTACHED STANDARD PROVISIONS,ANDADDITIONALSPECIALPROVISIONS), (TRAFFIC CONTROL MUST CONFORM TO THE MUTCO) Other: NO TRAFFIC CONTROL APPROVED WITH THIS PERMIT Permittee is prohibited from commencing any work within highway ROW prior to issuance of a fully endorsed and validated permit. Permit, plan exhibit, insurance certificate(s), and traffic control plan must be available on site during work. High visibility vests are required at all times during working hours. 1. Your request to use and/or occupy state highway system rights of way as described above is granted subject to the terms and conditions of this permit, including the Standard and Special Provisions as shown on the permit and all attachments hereto. 2. To the extent authorized by law, Permittee hereby assumes, releases and agrees to indemnify, defend, protect, and save the State of Colorado harmless from and against any loss and/or damages to the property of the State of Colorado, third parties or the Permittee's facilities, and all loss and/or damage on account of injury to or death of any person whomsoever, arising at any time, caused by or growing out of the occupation of Colorado State Highway rights of way by Permittee's facilities or any part thereof, including but not limited to installation, adjustment, relocation, maintenance or operation, or removal of existing facilities, unless such loss and/or damage arises from the sole negligence or willful conduct of the State of Colorado or its employees or agents. 3. Failure by the Permlttee to comply with any of the included terms or conditions may subject this permit to suspension or cancellation, at the discretion of the Department of Transportation. 4. THIS PERMIT 5 NOT VALID UNTIL FULLY ENDORSED BY ALL PARTIES, WITH DATE OF ISSUE AFFIXED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPARTMENT. A FULLY EXECUTED COPY OF THIS PERMIT MUST BE ON FILE AT THE TRANSPORTATION REGION OFFICE. S. In accepting this permit the undersigned, representing the Permittee, verifies that he or she has the authority to sign for and bind the Permittee, and that he or she has read, understands and accepts all the included conditions. CDOT Signature: Date A.A.Act_ et..cv.o.Mi COLORADO DEPARTMENT OF TRANSPORTATION Chief Engineer, Regional Transportation Director or Designee Permittee Signature Print Name/Title Date 03/22/19 Shawn Bates, Sr. Agent Land & ROW Distribution: Region File (Original) Permittee/Applicant Mtce Patrol Supvr. Mtce Landscaping Supvr Inspector CDOT Form # 0333 01/09 Previous versions are obsolete and should not be used. The following Standard Provisions are terms and conditions of this permit Effective March 1, 2006 Utility work authorized under this permit shall comply with the requirements of the State Highway Utility Accommodation Code, and applicable federal, state, local, and industry codes and regulations Construction of any portion of the highway facility, including the pavement structure, subsurface support, drainage, landscaping elements and all appurtenant features, shall comply with the provisions of the CDOT Standard Specifications for Road and Bridge Construction, and with the Colorado Standard Plans (M & S Standards) 1 COMMENCEMENT AND COMPLETION Work on highway Right of Way (ROW) shall not commence pnor to issuance of a fully endorsed and validated permit Permittee shall notify the CDOT inspector a At least 2 working days prior to commencing work, or resuming operations which have been suspended for five or more consecutive working days b When suspending operations for 5 or more working days c Upon completion of work Work shall not proceed beyond a completion date specified in the Special Provisions without written approval of the Department 2 PLANS, PLAN REVISIONS, ALTERED WORK Plans or work sketch (EXHIBIT A) are subject to CDOT approval A copy of the approved plans or sketch must be available on site during work Plan revisions or altered work differing in scope or nature from that authorized under this permit, are subject to CDOT prior approval Permittee shall promptly notify the CDOT inspector of changed or unforeseen conditions, which may occur on the job 3 INSURANCE Insurance Requirements for Utility and Special -Use Permits (Revised 7-05 per State Requirements) A The Pemuttee shall obtain, and maintain at all times during the performance of work authorized by this Permit, insurance in the following kinds and amounts The Permittee shall require any Contractor working for them within the State Highway Right of Way to obtain like coverage The Permittee shall also require any Contractor or Consultant perfuming work described in sub- paragraph 4) below, to obtain Professional Liability insurance 1) Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all employees acting within the course and scope of their employment and work on the activities authorized by this Permit 2) Commercial General Liability Insurance written on ISO occurrence form CO 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Consultants, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows a $1,000,000 each occurrence, b $2,000,000 general aggregate, t. $2,000,000 products and completed operations aggregate, and d $50,000 any one fire e For any permanent Permittee-owned installations located within the State Highway Right of Way, highway repairs, or site restoration, Completed Operations coverage shall be provided for a muumuu period of one year following final acceptance of work If any aggregate limit is reduced below 1,000,000 because of claims made or paid, the Permittee, or as applicable - their Contractor, shall immediately obtain additional insurance to restore the full aggregate limit and furnish to CDOT a certificate or other document satisfactory to CDOT showing compliance with this provision 3) Automobile Liability Insurance covering any auto (including owned, hired and non -owned autos) with a minimum limit as follows S1,000,000 each accident combined single hunt 4) For any a) engineering design, b) construction inspection, or, c) traffic control plans approved by a Traffic Control Supervisor, done in association with the operations or installations authonzed by this permit, Professional Liability Insurance with minimum limits of liability of not less than $1,000,000 Each Clain and $1,000,000 Annual Aggregate If the policy is written on a Claims Made form, the Penmttee, or, as applicable— their Consultant or Contractor, shall renew and maintain Professional Liability Insurance for a minimum of two years following final acceptance of the work, or provide a project specific Policy with a two year extended reporting provision 5) Pollution Legal Liability Insurance with minimum limits of liability of $1,000,000 Each Claim and $1,000,000 Annual Aggregate CDOT shall be named as an additional insured to the Pollution Legal Liability policy If the Policy is a component of the Professional Liability Policy, the Additional Insured requirement is waived, and the Policy shall be written on a Claims Made form, with an extended reporting period of at least two year following final acceptance of the work 6) Umbrella or Excess Liability Insurance with minimum limits of $1,000,000 This policy shall become primary (drop down) in the event the pnmary Liability Policy limits are impaired or exhausted The Policy shall be written on an Occurrence form and shall be following form of the prunary The following form Excess Liability shall include CDOT as an additional insured B CDOT shall be named as additional msured on the Commercial General Liability and Automobile Liability Insurance policies Completed operations additional insured coverage shall be on endorsements CG 2010 11/85, CG 2037, or equivalent Coverage required by the Permit will be primary over any insurance of self- insurance program earned by the State of Colorado C The Insurance shall include provisions preventing cancellation or non -renewal without at least 30 days prior notice to CDOT by certified mail D The Permittee, or, as applicable — their Contractor or Consultant, will require all insurance policies in any way related to the Permit and secured and maintained by the Pennittee, Contractor or Consultant, to include clauses stating that each earner will waive all rights of recovery, under subrogation or otherwise, against CDOT, its agencies, institutions, organiritions, officers, agents, employees and volunteers E All policies evidencing the msurance coverages required hereunder shall be issued by insurance companies satisfactory to CDOT F The Permittee, or as applicable - their Contractor or Consultant, shall provide certificates showing insurance coverage required by this Permit to CDOT prior to commencing work No later than 15 days prior to the expiration date of any such coverage, the Permittee, Contractor or Consultant, shall deliver CDOT certificates of insurance es idencmg renewals thereof At any time during the term of this contract, CDOT may request in writing, and the Permittee, Contractor or Consultant, shall thereupon within 10 days supply to CDOT, evidence satisfactory to CDOT of compliance with the provisions of this section G Notwithstanding subsection A of this section, if the Permittee is a "public entity" within the meaning of the Colorado Governmental Immunity Act CRS 24-10-101, et seq, as amended ("Act'), the Permittee shall at all times during the term of this permit maintain only such liability insurance, by commercial policy or self- msurance, as is necessary to meet its liabilities under the Act Upon request by CDOT, the Permittee shall show proof of such insurance satisfactory to CDOT Public. entity Permittees are not required to name CDOT as an Additional Insured H If the Permittee engages a Contractor and/or Consultant to act mripmenrlrntly frnm the Permttme nn the• nermitterl wnrir that CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS Contractor and/or Consultant shall be required to provide an endorsement naming CDOT as an Additional Insured on their Commercial General Liability, Auto Liability, Pollution Legal Liability and Umbrella or Excess Liability policies. 4. WORK WHERE DEPARTMENT LACKS AUTHORITY Utility work within municipal boundaries (pursuant to 43-2-135 CRS), on certain public lands, or on private property, may require separate approval of the appropriate jurisdictional agency or property owner. 5. INSTALLATIONS ON FREEWAYS CDOT may permit utility accommodations on freeways, including but not limited to the Interstate System, only in accordance with Utility Accommodation Code provisions. Special case exceptions as defined therein may be permitted only in accordance with FHWA-approved Departmental policy. 6. JOINT USE ALTERNATIVES As directed or approved by CDOT, if necessary for the safe and efficient use of the ROW, Permittee shall utilize joint use facilities such as the placement of two or more separate lines in a common trench, or attachment to the same overhead support. The Permittee will be responsible for proper coordination with other affected utilities. 7. ATTACHMENT TO HIGHWAY STRUCTURES Permittee is responsible for designing structure attachments, subject to the approval of the CDOT Staff Bridge Design Engineer. 8. DRAINAGEWAYS AND WATERCOURSES The flow of water shall not ever be impaired or interrupted. Where possible, ossings of ditches, canals or water -carrying structures shall be bored or eked beneath. Irrigation ditch or canal crossings require approval of the ditch ..ompany or owner. Permittee shall repair damage to any drainage facility to the satisfaction of the owner. 9. TRAFFIC CONTROL PLAN a. Prior to commencing work, the Permittee shall develop and submit to the Department for acceptance, a Traffic Control Plan (TCP) for any accommodation work that will affect traffic movement or safety. The Permittee shall implement the TCP and utilize traffic control devices as necessary to ensure the safe and expeditious movement of traffic around and through the work site. b. The Permittee shall develop the TCP, and Methods of Handling Traffic (MHT's) included therein, in conformance with the Manual on Uniform Traffic Control Devices (MUTCD), the Colorado Supplement thereto adopted by the Commission pursuant to sections 42-4-104 and 42-4-105 CRS, the Department's standard specifications for temporary traffic control and the Department's standard plans for signing - Standard Plans S 630-1 and S 630-2. The TCP shall include provisions for the passage of emergency vehicles through the work zone, and shall conform to the requirements of the Americans with Disabilities Act. The TCP and MI-IT's shall contain sufficient detail to demonstrate conformity with all applicable requirements. c. The Permittee shall have a competent person at the work site at all times in responsible charge of temporary traffic control. In situations where the TCP goes beyond any Typical Application shown in the MUTCD, or particularly dangerous roadway or traffic conditions exist, the Department may require the Permittee to have a Traffic Control Supervisor (TCS) develop or approve the TCP or to have a TCS on -site during work_ The TCS shall be certified as a worksite traffic supervisor by either the American Traffic Safety Services Association (ATSSA) or the Colorado Contractors Association (CCA), and shall have a current CDOT flaggers' certification card. The TCS shall be responsible for the planning, preparation, coordination, implementation, and inspection of the TCP. d. The Permittee shall not start the permitted work before the Department accepts the TCP. e. The Department may review and order changes to the TCP and MHT's during performance of the work, as required. f. The Permttee shall comply with the TCP at all times during performance of the work. g. The Permittee shall keep a copy of the TCP at the work site at all times during performance of the work for inspection. h. The TCP shall ensure that closure of intersecting streets, road approaches and other access points is minimized. On heavily traveled highways, the Department will not permit operations that interfere with traffic during periods of peak traffic flow. j� When Permittee operations coincide with highway construction or maintenance operations, the Permittee shall develop and implement the TCP in cooperation and coordination with the highway agency and/or its contractors and as otherwise directed by the Department in the permit. All flaggcrs shall have a current CDOT flagger certification card and shall be capable of communicating with the traveling public and others at the work site. 10. NCHRP 350 CRASHWORTHINESS REQUIREMENTS FOR WORK ZONE TRAFFIC CONTROL DEVICES Work zone devices designated by FHWA as: Category I, including but not limited to single -piece drums, tubes, cones and delineators; Category II, including but not limited to barricades, vertical panels with light, drums or cones with light, portable sign supports, intrusion detectors and type III barricades; or as Category III, including but not limited to concrete barriers, fixed sign supports, crash cushions, and other work zone devices not meeting the definitions of Category I or 11; shall meet NCI-IRP 350 crash test requirements. The Permittee, or their contractor shall obtain and make available upon request, the manufacturer's written NCHRP 350 certification, or as applicable, the FHWA Acceptance Letter, for each type of device. FHWA Acceptance Letters for Category II or Category III Work Zone Devices may be accessed through the FHWA websitc at httrvaafetliliwa,doLgaviroadwaas 4.anfroad hardware/wzdJtnt 11. WORKER SAFETY AND HEALTH a. All workers within the State Highway right of way shall comply with their employer's safety and health policies/procedures and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. b. Personal protective equipment (PPE) (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers in the SH ROW, except when in their vehicles, shall wear the following personal protective equipment: 1) Head protection that complies with the ANSI 289.1 standard; 2) At all construction sites or whenever there is danger of injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI Z4l ; 3) High visibility apparel, which shall, at a minimum comply with the Class 2 specifications of the ANSI/ISEA 107standard. 02/06 CDOT Permit Form 333 and Standard Provisions Page 3 of 9 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS Class 3 apparel shall be considered for use at night or in particularly hazardous situations 4) The most recent version of the ANSI standards listed above shall apply 12 ADA REQUIREMENTS The Permittee shall comply with the applicable provisions of the Americans With Disabilities Act, with respect to both permanent facilities installations and temporary work zones 13 CLEAR ROADSIDE CONSIDERATIONS a CDOT is committed to provide a roadside area that is as free as practical from nontraverseable hazards and fixed objects ("clear zone") New above ground installations may be permitted within the clear zone only upon a showing that no feasible alternate locations exist Pernuttee must utilize appropriate countermeasures to minimize hazards b Permittee shall remove materials and equipment from the highway ROW at the close of daily operations The traffic control plan must include protective measures where materials and equipment may be stored on ROW Protection of open trenches and other excavations within highway ROW shall be addressed in the Permittee's traffic control plan All excavations shall be closed at the end of daily operations, and no open excavation will be allowed in the clear zone after dark The Permittee agrees to promptly undertake mitigating or corrective actions acceptable to the Department upon notification by CDOT that the installation permitted herein has resulted in a hazardous situation for highway users 14 GENERAL CONSTRUCTION REQUIREMENTS a Work shall not be performed at night or on Saturdays, Sundays, or holidays without pnor authorization or unless otherwise specified in this permit CDOT may restrict work on ROW during adverse weather conditions or during periods of high traffic volume b Those areas within ROW, which must be disturbed by permit operations, shall be kept to a practical minimum Permittee shall not spray, cut, or trim trees or other landscaping elements within highway ROW, unless such work is otherwise specified in this permit, or clearly indicated on the approved plans Cleated or tracked equipment shall not work on or move over paved surfaces without mats, or pads on tracks c Material removed from any portion of the roadway prism must be replaced in like kind with equal or better compaction Segregation of material is not permitted The permitted facility shall be of durable materials in conformity with accepted practice or industry standards, designed for long service life, and relatively free from routine servicing or maintenance d Construction or compaction by means of jetting, puddling, or water flooding is prohibited within all highway ROW e Thrust blocks are required on all vertical and horizontal bends m pressure pipes f Meters shall not be placed on highway ROW except within corporate limits where municipal regulations allow such use 15 ALIGNMENT, COVER, CLEARANCE a Location and alignment of Permrttee's facilities shall only be as specified in this permit or as otherwise indicated in the approved plans or work sketch (EXHIBIT A) b Parallel installations will not be permitted within roadways (including curbing and/or shoulders) or median areas, except within corporate boundanes, subject to municipal regulations c d Parallel installations should be located as near as practicable to the ROW line Crossings shall be as nearly perpendicular to the highway as feasible Where no feasible alternate locations exist, the Department may permit parallel installations along roadside areas within 15 feet from edge of shoulder or back of curb In these cases, the facility must be so located and safeguarded as to avoid potential conflict with necessary highway appurtenances (signs, guard rail, delineators, etc ) Specific safeguards such as increasing depth of cover to 60 inches, capping, or encasement, shall be specified in this permit's Special Provisions e Parallel installations shall follow a uniform alignment, wherever practical Due consideration must be given to conserving space available for future utility accommodations The standard allowable deviation from the approved horizontal alignment is ± 18 inches f Minimum cover shall conform to the Special Provisions Normal specified cover will be 48 niches or greater, reduced cover may be approved where site conditions warrant, subject to other safeguards as may be specified or approved in the permit Minimum overhead clearance shall conform to the Special Provisions, consistent with Utility Accommodation Code criteria 16 PAVEMENT CUTS AND REPAIRS Paved surfaces shall not be cut unless otherwise specified in this permit No more than one half the width of the roadbed may be opened at a time, when otherwise permitted Pavement shall be sawed or wheel -cut to a neat line Pavement shall be replaced to a design equal to or greater than that of the surrounding undisturbed pavement structure Pavement repair shall conform to the Special Provisions or the approved plans 17 BORING, JACKING, ENCASEMENT Unless otherwise specified, burled crossings shall be bored or jacked beneath the roadway, at least from toe of slope to toe of opposite slope Portals for untrenched crossings more than 5 feet in depth shall be bulk headed in conformance with OSHA construction and safety standards Portal limits of untrenched crossings shall be established safely beyond the highway surface and clear zone and m no case shall the lateral distance from the surfaced area of the highway to the boring or jacking pit be less than the vertical difference in elevation between such surface and the bottom of the pit Water jetting or tunneling cs not permitted Water assisted boring may be permitted as determined by the CDOT Inspector Boring hole shall be oversized to the minimum amount required to allow pull -through of the conduit being installed Resultant voids shall be grouted or otherwise backfilled, subject to CDOT approval Ends of bored sections shall not be covered before being inspected Encasement shall be consistent with Utility Accommodation Code provisions CDOT may require protective casing for shallow installations or certain conduit materials Encased crossings shall extend at least from toe of slope to toe of slope, or the full width between access -control lines on freeways, including the Interstate System 18 INSPECTION AND ACCEPTANCE a CDOT will determine the extent of inspection services necessary for a given installation Pernuttee shall attend final inspection as may be required If the initial performance of permitted work was unacceptable, as determined by the Department, the Permnttee shall perform any reconstruction or improvement of that work as ordered by the Department, in a timely manner and prior to any further construction If permitted operations are not being carried out in compliance with the terms and conditions of this permit, the Department may order the Permittee to perform whatever corrective measures are necessary to attain compliance with the permit If there is an immediate danger to the public's health, safety or welfare, the Department may order the Pernuttee to cease all operations and if necessary, to remove all equipment and facilities from the SHROW b Final acceptance does not relieve Permittee of maintenance obligations toward those elements of the highway facility 02/06 CDOT Permit Form 333 and Standard Provisions Page 4 of 9 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS constricted under this permit. Final acceptance begins the two-year warranty period (see requirement under "Operation and Maintenance" below). 19. ENVIRONMENTAL CLEARANCESIPERMITS L V. a. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to their activities and to obtain any clearances that are required directly from the appropriate regulatory agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from CDOT Permitting Offices or may be accessed via the CDOT webpage at hup.,. w ww.riot.site.co.us/UtilityProgram/Forms.cfm. Failure to comply with regulatory requirements may result in suspension or revocation of your CDOT permit, or enforcement actions by other agencies. b. The Special Provisions of this permit shall list any specific environmental clearances or permits that the Department has been notified by the Permittee or by the administering regulatory agency apply to the operations authorized by this permit. The Special Provisions shall require the Permittee obtain the listed environmental clearances/permits prior to beginning work. c. The Permittee shall comply with all requirements described in the CDOT Environmental Clearances Information Summary, including those pertaining to: 1) Ecological Resources 2) Cultural Resources 3) Discharges of Stormwater or Process Water 4) Hazardous Materials 5) Discharges of Dredged or Fill Material 6) Erosion and Sediment Control 7) Disposal of Drilling Fluids 8) Concrete Washout 9) Spill Reporting 10) Transportation of Hazardous Materials d. Disturbance of any wildlife shall be avoided to the maximum extent practicable. If threatened or endangered species or archeological or historical artifacts are encountered during the progress of a project, work in the subject area shall be halted and the CDOT regional permitting office shall be contacted immediately for direction as to how to proceed. e. All discharges of stormwater or process water are subject to the applicable provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. f. There shall be no disposal of hazardous materials in the state highway right of way. Solid waste shall be removed from the state highway right of way and disposal of at a permitted facility or designated collection point (such as the Permittee's own dumpster). Drilling fluids must be disposed of as described in the ECIS. g. If pre-existing solid waste or hazardous materials contamination (including oil or gasoline contaminated soil, asbestos, chemicals, mine tailings, etc.) are encountered during the performance of work, the Penmittee shall halt work in the affected area and immediately contact the CDOT regional permitting office for direction as to how to proceed. h. Spills shall be reported immediately using the CDOT Illicit Discharge Hotline (303) 512-4446. Spills on the highway, into waterways, or that may otherwise present an immediate danger to the public, shall be reported by calling 911 or the Colorado State Patrol at (303) 239-4501, and the Colorado Department of Public Health and Environment at 1-(877) 518-5608. RESTORATION OF RIGHT OF WAY Prior to final acceptance, all disturbed portions of highway right of way shall be cleaned up and restored to their original condition, subject to CDOT approval. Seeding, sodding, and planting shall be as specified, or otherwise approved by CDOT. Construction, maintenance and watering requirements shall conform to the CDOT Standard Specifications. Where landscape restoration must be delayed due to seasonal requirements, such work may be authorized by separate permit. Permittee shall use only certified weed -free seed and mulch. Permittee shall clean equipment before transporting it into or out of the state to prevent the migration of noxious weeds. 21. OPERATION AND MAINTENANCE a. Permittee agrees to own and maintain the installation permitted herein. The facility shall be kept in an adequate state of repair and maintained in such a manner as to cause the least interference with the normal operation and maintenance of the highway. b. If any element of the transportation facility, constructed or replaced as a condition of this permit, fails within 24 months due to improper construction or materials, Permittee shall make all repairs immediately as notified in writing by CDOT. c. Routine, periodic maintenance and emergency repairs may be performed under the general terms and conditions of this permit. CDOT shall be given proper advance notice whenever maintenance work will affect the movement or safety of traffic. In an emergency, the CDOT Region office and the State Patrol shall immediately be notified of possible traffic hazards. Emergency procedures shall be coordinated beforehand, where possible. d. Maintenance activities requiring new excavation or other disturbance within highway ROW may require separate permit. Where highway construction or maintenance operations so require, Permittee will shut off lines, remove all combustible materials from the highway right of way, or provide other temporary safeguards. 22. MARKERS, LOCATION AIDS, LOCATION ASSISTANCE a. The utility shall take all practical measures to ensure that buried utility facilities are surface -detectable by standard geophysical methods. Where the utility facilities, by the nature of their material properties, burial depth or other factors, may by themselves not be surface -detectable, the utility shall, where feasible, incorporate detection wire or other detection aids in the installation of those facilities. In instances where detection aids are not feasible or would be ineffective and surface -detestability cannot be ensured, surface markers shall be installed as directed by the Department and as -constructed plans and showing the accurate horizontal and vertical location of the buried facilities shall be provided to the Department. b. All plowed or trenched installations must include color -coded (using the American Public Works Association color coding system) warning tape placed not less than 12 inches vertically above the top of the line. The warning tape shall be surface -detectable if needed to facilitate detection of the line. c. The utility shall place readily identifiable markers at the right of way line where it is crossed by pipelines carrying transmittants which are flammable, corrosive, expansive, energized, or unstable, particularly if carried at high pressure or potential, except where a vent will serve as a marker. d. The utility shall place markers for longitudinal underground facilities vertically above the facilities or at a known horizontal offset, unless otherwise approved in writing by the Department. Each marker shall provide a fore- and backsight to succeeding and preceding markers. Markers shall be installed at suitable intervals along tangent sections, at angle points or points of curvature and at reasonable intervals along curves. e. The utility shall maintain any markers required by this Code for the life of the installation. CDOT Permit Form 333 and Standard Provisions Page 5 of 9 02/06 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS f The Department may require the utility to submit "as -constructed" plans The Department may enter into an agreement with the utility whereby the Department can rely on those plans for the exact location of the utility for any future excavations, and need not give notice to the utility under Article 1 5 of Title 9, C R S g The utility will comply with the applicable requirements of Article 1 5 of Title 9 CRS, Including any requirement to participate in the State's Notification Association pursuant to 9-1 5-105 C R S All owners of underground utilities within the SHROW, with the exception of the Department itself, must become members of the UNCC Notification Association h In addition to complying with the provisions of Article 1 5 of Title 9 C R S (One -Call Statute) in response to the Department's notification of planned excavations, utility owners shall surface - mark their buried utihty facilities that are located within the SHROW in order to facilitate Departmental engineering and design activities, upon reasonable request from the Department, and at no cost to the Department The Permittee shall respond to such request within a reasonable timeframe acceptable to the Department, but no longer than 14 calendar days from the date of request, and the accuracy of the surface marking shall be witlun 18 inches of either side of the actual location of the buried facility 23 ADJUSTMENTS DUE TO HIGHWAY CONSTRUCTION If for any transportation purpose it becomes necessary to remove, adjust, or relocate this facility, Pennittee will do so promptly, at no cost to the CDOT except as provided by law, upon written notice from CDOT and in accordance with the utility relocation permit issued to cover the necessary work The utility shall perform the relocation at or within a time convenient to and in proper coordination with the project or transportation -related activity, to mmnnize public inconvenience and cost, as directed by the Department in the permit authorizing the relocation The utility company shall pay for damages caused by the company's delay in the performance of utility relocation work or interference with the performance of transportation project work done by others Such damages include, but are not limited to, payments made by the Department to any third party based on a claim that performance of the transportation project work was delayed or interfered with as a direct result of the utility company's failure to timely perform the utility relocation work Damages resulting from delays in the performance of the utility relocation work or interference with the transportation project work that are caused by events beyond the utility company's ability to reasonably foresee or control (a force majeure) shall not be charged to the utility company 24 ABANDONMENT, RETIREMENT, CHANGE IN OWNERSHIP a The Pernuttee shall notify the Department in writing of the planned retirement or abandonment of its facility or any portion thereof The Department will notify the Permittee in writing if it determines that the facilities may be retired or abandoned in place, along with any special conditions that may apply b Retired facilities shall remain the Permittee's sole responsibility, subject to all provisions of the Utility Accommodation Code and all of the terms and conditions of the permit issued for that facility, including maintenance and relocation requirements c The Permittee shall promptly remove all abandoned facilities from the SH ROW and promptly restore the SH ROW to pre-existing or other conditions prescribed by the Department unless the Department in wntmg expressly allows the facility to remain in place Written notice from the Department, allowing an abandoned facility to remain in place, may include special conditions d If utility facilities are retired or abandoned in place, the utility shall comply with that decision if directed by the Department 1) cap, plug or fill lines, 2) furnish suitable location records for any such buried facilities, 3) maintain its own records of such facilities and respond to locate notices/requests from the UNCC and/or excavators, In providing such locates, the utility will indicate to the requesting entity whether or not the subject facilities are retired or abandoned 4) perform any other actions as deemed necessary by the Department to protect the transportation facility and/or the traveling public e lithe ownership of utility facilities is transferred, both the original Permittee and the new owner shall notify the Department in writing prior to the change in ownership, and such notice shall state the planned date of change in ownership The notice from the new owner shall include a written statement accepting all terms and conditions of the existing permit, effective upon the planned date of the change in ownership f Utility facilities containing asbestos may not be abandoned in -place Ordmanly, such facilities must be removed from the SHROW when take out of service On a case -by -case basis, the Department may allow such facilities to be retired in -place, with the owner retaining full legal ownership and responsibility for the facilities 25 SUSPENSION AND CANCELLATION a The CDOT inspector may suspend operation due to 1) Non compliance with the provisions of this permit 2) Adverse weather or traffic conditions 3) Concurrent transportation construction or maintenance operations in conflict with the permitted work 4) Any condition deemed unsafe for workers or for the general public b Work may resume when grounds for suspension no longer exist This permit is subject to cancellation due to I) Persistent noncompliance with pernut provisions 2) Abandonment or transfer of ownership 3) Superseded by new permit covering the same installation 4) Conflict with necessary planned transportation construction c Permittee must promptly terminate occupancy upon notice of cancellation of pernut, unless a new permit is applied for and granted d Where Permittee does not fulfill an obligation to repair or maintain any portion of the highway facility, or control and safely mamtam the flow of traffic thereon, CDOT reserves the nght, in lieu of canceling this permit, to accomplish the required work by any other appropriate means, and Permittee shall be liable for the actual costs thereof 02/06 CDOT Permit Form 333 and Standard Provisions Page 6 of 9 1 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances information Summary i PURPOSE - This summary is intended to inform entities external to CDOT that may be entering the state highway right-of-way to perform encountered work related environmental to their own permits/clearances facilities (such that as Utility, may apply Special to their Use or activities. Access This Permittees), listing is not about all-inclusive some of the - additional more commonly environmental agencies should or cultural be contacted resource for permits/clearances additional information may if there be required is any in uncertainty certain instances. about what Appropriate permits/clearances local, state are and required federal for a specific Requirements activity. IMPORTANT May Result In - Please Suspension Review or Revocation The Following of Information Your CDOT Carefully Permit, Or - Enforcement Failure to Comply Actions With By Regulatory Other Agencies. CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agencies may • be Colorado contacted Water Environmental Department Quality for additional Control Permitting of Public information: Division Health Website (WQCD): and ii ups Environment (303) iwww.ouioraao.govlpacific/cdphe/all-permits 692-3500 (CDPHE): General Information — (303) 692-2035 D CDOT Water Quality Program Manager: (303) 757-9343 tittps:lRwww.codot.gov/programs/environmental/water-quality o LI U CDOT Colorado U.S. Omaha Army Asbestos Office District Corps Project of (NE of Archaeology Engineers, CO), Manager: Denver District and Phil Office Historic Kangas, Regulatory (303) Preservation: (303) 979-4120 Offices: 512-5519 (303)866-5216 nttp:iiwww.nwo.usace.army_.mrliivlissionsi Regulatory_Program/Coloradosaspx Sacramento http://www.spk.usace.army.mil/Missions'Regr'atory.aspx Dist. (Western CO), Grand Junction Office (970) 243-1199 Albuquerque District (SE CO), Pueblo Office (719)-543-9459 http://www.spa.usace.army.mil/MissionsiRegulatoryProgramandPermits.aspx E CDOT Utilities, Special Use and Access Permitting: (3031757-9654 talps://www.codot.00v/business/permits ps://www.codot.00v/business/permits Wildlife Resources - Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or suspected threatened and the CDOT threatened or endangered Regional or endangered Permitting species are Office species encountered and habitat Region during wi Planning I require the progress and special Environmental authorization of the permitted Manager from work, the shall CDOT work be in contacted permitting the subject immediately. office. area If shall any be halted Authorization be obtained from must the be CDOT provided website, by CDOT http://www.codot.gov/programs/environmentalivvcldlife/guidelines, prior to the continuation of work. Information about threatened or or endangered the Colorado species Parks and may Wildlife (CPW) website, ntuyeiwww.cpw.state.co.us/learn/Pages/SOC-ThreatenedEndangeredList.aspx. Additional guidance may be provided by the ac?propriate Region Planning and Environmental Manager 1 RPEM). Cultural Resources - The applicant must request a file search of the permit area through the Colorado Office of Archaeology and (ittp://www.historycolorado.org/oahp/file-search). Historic Preservation (OAHP), Denver, to ascertain Inventory if historic of or the archaeological permit area by resources a qualified have cultural previously resources been identified specialist may be initiation necessary, of per the the permitted recommendation work or are of encountered CDOT. if archaeological as the project sites/artifacts progresses, all or historic work in the resources subject are area known shall to be exist halted prior and to the the CDOT Regional Permitting Office Region Planning Environmental and and Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact information: Contact the OAHP for file searches at (303) 866-5216. Paleontological Resources - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder (https://cumuseum.colorado.edu/research/paleontology/vertebrates/policies), and the Denver Museum of Nature and Science (ittp://www.dmns.org/science/collections/earth-science-collections/) to ascertain if paleontological resources have been previously in identified recommendation CDOT must the be Permit Regional provided in or Special near Permitting of by the CDOT. CDOT Provisions. permit If Office prior fossils area. to Contact and the inventory are Region continuation encountered information: of Planning the permit of during and work. See area the Environmental the Additional by permitted museum a qualified guidance work, websites Manager paleontologist all may listed work shall be in above be provided the may subject contacted for be necessary, by Paleontological area the immediately. Regional shall per be Permitting Collections the halted Authorization and Office the Manager contact information. Contact the CDOT Paleontologist for further information at nicole.peavey≥state.co.us or (303) 757- 9632. The CDOT Paleontologist will not conduct a com3rehensive file search independently of the museums. Hazardous Materials. Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved Certificate of Regulations are generated permitted solid Designation no is waste permitted facility (6 by or the (a CCR hazardous landfills landfill activities or designated 1007-3) during permit). or of materials TSD prohibit entities collection The sites contamination the Colorado entering within transfer, point the the (e.g., Hazardous State storage State (including for Highway Highway solid or Waste disposal waste, oil Right or Act Right petroleum a C.R.S. (TSD) of of utility Way. Way 25-15-301 of or contaminated hazardous Therefore, must construction be removed et all al, waste soil, solid company's and asbestos, except or from the hazardous Colorado the at own permitted ROW chemicals, dumpster). wastes Hazardous and disposed TSD mine that If sites. pre-existing tailings, Waste might of There at be a etc.) CDOT Hazardous encountered Regional Materials Permitting Management the Office performance for Supervisor: direction of as , work, 303 to the how ) 512-5524. permittee to proceed. shall Contact halt work Information: in the affected Theresa area and Santangelo-Dreiling, immediately contact CDOT the Asbestos Containing Materials, Asbestos Contaminated Soil - All work on asbestos containing materials (ACM) must comply with the asbestos applicable -contaminated requirements soil of must the CDPHE comply Air with Pollution the CDPHE Control Hazardous Division's Materials (APCD) and Regulation Waste Management 8. Disposal of Division's ACM, and ¶HMWMD, work done in Solid Environmental Clearances Information Page 1 of 3 Colorado Department of August Waste Regulations. is The being application for any CDOT permit must specifically identify any ACM involved in the work for which authorization Info: CDPHE APCD requested. HMWMD Additional Regulations guidance or requirements may be specified in the permit special provisions. Contact and can be accessed via the CDPHE Environmental Permitting Website listed above, Additional information concerning clearance on CDOT projects is available from the CDOT Asbestos Project Manager (303) 512- 5519, or Theresa Santangelo-Dreiling Hazardous Materials Management Supervisor: (303) 512-5524. Transportation of Hazardous Materials - No person may offer or accept a hazardous material for transportation in commerce unless that hazardous authorized person material by is registered applicable must in be requirements, conformance properly classed, or with an the exemption, described, United States packaged, approval Department or marked, registration of labeled, Transportation has and been in issued. condition regulations Vehicles for at shipment requiring 49 CFR, as Part a required placard, 171. The or must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission, Contact Information: For authorization and more info call the Federal Motor Safety Carrier Administration, US DOT for inter- and intra-state HAZMAT Registration t 3031 969-6748. Colorado Public Utilities Commission: ( 303) 894-2868. Discharge of Dredged or Fill Material — 404 Permits Administered By the U.S. Army Corps of Engineers, and Section 401 Water Quality Certifications Issued by the CDPHE WQCD - Corps of Engineers 404 permits are required for the discharge of dredged or fill materials into waters of the United States, including wetlands. There are various types of 404 permits, including line ,contact nationwide would required. activities be information required. Contact permits, (nwp the #12). if which above). an appropriate individual Depending 1 are Contact issued 404 Corps upon the for permit activities District CDPHE the specific is required, Regulatory Water with circumstances, relatively Quality section Office Control minor 401 for it information impacts. water is Division possible quality For at about that certification (303 example, either 1i what 692-3500. there a type "general" from of is the 404 a nationwide CDPHE or permit "individual" may WQCD permit be 404 is required for also permit utility Working on or in any stream or its bank - In order to protect and preserve the state's fish and wildlife resources from actions that may obtain solid 3) streams segments obstruct, blue a Senate having line of diminish, on streams wetlands Bill USGS 40 certification destroy, supporting 7.5' present quadrangle change, within from 25% 200 the maps; or modify, more by Colorado yards CDOT and/or or cover upstream vary Department 2) within a intermittent CPW, natural or 100 downstream existing of yards be Natural streams upstream stream of Resources. providing the or or project its downstream banks live A measured stream water or tributaries, beneficial of is the by defined project; valley it to as may 1) fish length. and/or be represented and necessary The wildlife; 4) segments CPW by and/or to a of application, as per guidelines agreed upon and can accessed at https://www.codot.gov/programs/environmental/ avildlife uidelines. Stormwater Construction Permit {SCP) and Stormwater Discharge From Industrial Facilities - Discharges of stormwater runoff from CDPS https://www.colorado.gov/pacific/cdeheiwq-construction-general-permits construction Stormwater sites Permit. disturbing Contact one Information: acre or more Contact - or certain the types CDPHE of Water industrial and Quality ittps://colorado.gov/pacific/cdphe/wo-commerce-and- facilities, Control such Division as concrete at (303) batch 692-3500. plants - Website: require a industry-permits. Construction Dewatering (Discharge or Infiltration) and Remediation Activities - Discharges of water encountered during excavation information: 3500. For Applications or work For Construction in wet and areas Instructions Dewatering may require ( CDPHE and a Construction Remediation website): httc Dewatering Activities Discharge or Remediation io.govipac, Permits, Activities contact sicdpherwq-constructionweenerai-permits Discharge the CDPHE Permit. WQCD Contact at (303) 692- Municipal Separate Storm Sewer System (MS4) Discharge Permit - Discharges from the storm sewer systems of larger municipalities, by the CDPHE and WQCD. from the For facilities CDOT highway that lie drainage within the system boundaries that lies of a within municipality those that municipalities, is subject are to an subject MS4 to permit, MS4 Permits the owner issued of such facility should contact the municipality regarding stormwater related clearances that may have been established under that the municipality's applicable MS4 provisions permit. of All the discharges Colorado to Water the CDOT Quality highway Control drainage Act, the Water system Quality or within Control the Right Commission of Way (ROW) (WQCC) must Regulations comply with (https:iiwww.coloracio.govipacificicdpneiwecc-requiations-and-policies-and-water-quality-statute) and the CDOT MS4 Permit # COS - 000005 (https://wvw rodot.gov/programs'environmental/water-quality/documents). Discharges are subject to inspection by CDOT and MS4 CDPHE. Permits, Contact or go to the nttes://www.colorado.gov/pacific/capneiwq-municipal-ms4-permits. CDPHE Water Quality Control Division at (303) 692-3500 for a listing For CDOT-related of municipalities MS4 required regulations, to obtain go to: htt•s://www.codot.goviprocramsfenvironmental/water-c ualitvlstnrmwater-nrocrarns.html. General Prohibition - Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but are not limited to, substances such as wash water, paint, automotive (303) 692-3500. fluids, solvents, oils or soaps and sediment. Contact Information: Contact the CDPHE Water Quality Control Division at General Authorization - Allowable Non-Stormwater Discharges - Unless otherwise identified by C DOT or the WQCD as significant sources of pollutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm uncontaminated activities. sewers, Allowable discharges springs, non-stormwater footing from potable drains, discharges water water sources, line can flushing, be foundation found flows under drains, from Illicit riparian air Discharge conditioning habitats PDD condensation, and at: wetlands, 'tttps://www and irrigation "odot.gov/programs/ flow from water, firefighting environmental/water-quality/stormwater-programs.html. Contact Information: The CDPHE Water Quality Control Division (telephone #'s listed above). Erosion and Sediment Control Practices - For activities requiring a Stormwater Construction Permit, erosion control requirements will minimize be specified erosion in that and sedimentation permit. In situations according where a to CDOT stormwater Standard permit Specifications is not required, 107.25, all reasonable 208, 213 measures and 216 (https://www.codot.gov. should be taken to business/desinnsupporti2011-construction-specificationsf2011-Specs/2011-specs-boc ). All disturbances require a stabilization plan, native seeding or landscape design plan according to applicable CDOT Standard Specifications 212-217 and 623. The CDOT Erosion Control erosion controls and and Stormwater restore disturbed Quality Guide vegetation. (available from the Bid Plans Office at (303) 757-9313) should be used to design Environmental Clearances Information Page 1 of 3 Colorado Department of August • Disposal of Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as "discharges" or "solid wastes," and in general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of soiids) may be left on -site after either being separated from fluids or after infiltration of the water, provided: 1) the drilling fluid consists of only water and bentonite clay, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, 3) the solids are covered and the area restored as required by CDOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: Contact CDPHE (telephone #'s listed above). Noxious Weeds and Invasive Species Management Plan — Noxious Weeds and Invasive Species guidance can be found by contacting the Colorado Department of Agriculture (https://www.colorado.gov/pacific/agconservation/noxiousweed ) and the Colorado Division of Parks and Wildlife (http://cpw.state.co us/aboutus/Pages/RS-NoxiousWeeds.aspx). In either case, management plans involving the control of noxious weeds associated with the permitted activity and cleaning of equipment will be required. Concrete Washout - Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, inlets, receiving waters, or in the CDOT ROW. Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, drainageways, and inlets. Concrete washout shall only be performed as specified by the CDOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact Information: Contact CDPHE or find additional information on the CDOT website: laps://www codot.gov/business; designcupport/2011-construction- soecifications/2011-Spe and refer to the specifications and their revisions for sections 101, 107 and 208. Spill Reporting - Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain or buried. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4446 (4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, into waterways, any spill in the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1-877-518-5608. More information car be found at https://www.colorado.gov/pacific. cdphe/emergency- reporting-line. Environmental Clearances Information Page 1 of 3 Colorado Department of August CO' ORS` , j Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowmen flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking into the ground Why is stormwater runoff a problem? Stormwater can pick up debris, chemicals, dirt and other pollutants and flow into CDOT's storm drain system or directly into a stream, river, lake, wetland or reservoir. Anything that enters CDOT's storm drain system is discharged untreated into the waterways we use for fishing, swimming, and providing dnnking water. Diect€eel `. 1►I, d►lt, r'y 6 (� S L'/•,_ , •a 1. sewaFt? ourfce, grr'b'1 tri •raj') a id 12 r_ Or, !J. ►1 i -�_ '(r. f,. • .lutrre;12 .1t_•L..� l ' boat. phi 1.v?ec?tN ;1 cr I ►fit, land. (.,ny stia if f - ill it $ ;31 lS'J:iir_ Tips for Reporting an Illicit Discharge Call the :liter discharge hotline at (303) 512-4426 From a safe distance try to estimate the amount of the discharge. Identify characteristics of the discharge (color, odor, algae; etc.). Obtain information on the vehicle dumping the waste (if applicable). Do not approach! Call '`C3P for illicit dumping. If possible, take a photo, record a license plate. For more information on CDOT Utility Permits: https.uwww.codot�. ovLtwsinesslpermitsJut,litre sspeualuse For more information on CDOT Access Permits: hrtpsitwww.cod- t-poyibusin ssiperMtWa CPs5 permits For more information on CDOT Water Quality Program: Water Quality Program Manager 4201 E. Arkansas Ave Shumate Building Denver, Colorado 80222 303-757-9343 C0°1 RA ot C Department of Transportation It filet • / . uality 1 I•Girran) Industrial f acilities trt arum CDOT has a Municipal Separate Storm Sewer System permit, otherwise known as (MS4) from the Colorado Department of Public Health and Environment.. The permit states that only stormwater can be discharged from CDOT's storm drain system THE WASTEWAllit TREATMENT PLANT TOM LOCAL %MINICOY As part of the permit, COOT has several different programs to prevent pollutants from entering into the storm drain system: • Construction Site Program • New Development Redevelopment Program Illicit Discharge Program • Industrial Facilities Program • Public Education and Outreach Program • Pollution Prevention and Good Housekeeping Program Wet Weather Monitoring Program CO _OR ADO Department of Transportation Control Measures for Industrial Facilities Industrial facilities can use control measures (CM} otherwise known as Best Management Practices (BMP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering into CDOT's storm drain system. Control Measures also include treatment, operating procedures, and practices to control site run off which can include structural and non-structural controls. THE 6AUNTLf ME nal 6TfULAMN • aw" INV Y 15The nE rto'er IMP PM NE'aunn tSTHE NAP PROPERLY timaiTAIMP7 In compliance!! COOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following: ✓ Communications ✓ Cable television 1 Power ✓ Electricity 1 Light ✓ Heat Gas ✓ OH • Crude Products Water • Stream I Waste ✓ Stormwater not connected with highway drainage • Similar Commodity _O AUO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work in the state highway right-of-way will require some type of environmental permit or clearance for that work. CDOT has put together an Environmental Clearances Information Summary for those applying for a COOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: hops:ljwww.codoLgovjprozra,msjenviro nmental/resourcesjguidance- standardslEnvironmentaP42xClearance s9 6 2olnfo%20Sumnnary.pdf Seed Mix 4 - Brown Elevation: Low Temperature: Warm Humidity: Average Grasses 1. Big Bluestem — 15% (3 6 lbs/acre) 2. Fringed Brome — 13% (1.9 lbs/acre) 3. Sand Lovegrass — 12% (0.3 lbs/acre) 4 Green Sprangletop —10% (0 6 lbs/acre) 5 Western Wheatgrass — 10% (3 1 lbs/acre) 6. Buffalograss — 10% (6 2 lbs/acre) 7 Sand Dropseed — 8% (0 1 lbs/acre) Forbs/Shrubs/Flowering 1 Gaillardia — 7% (1 6 lbs/acre) 2 California Poppy — 5% (0.6 lbs/acre) 3 Desert Verbena — 4% (0.3 lbs/acre) 4 Palmer Penstemon — 4% (0 2 lbs/acre) 5 Indian Blanket — 2% (0 3 lbs/acre) Seeding Application: Drill seed 0 25" to 0 50" into the topsoil In areas that are not accessible to drill, hand broadcast at triple the above rate and rake 0 25" to 0 50" into the topsoil Mulching Application: 15 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre Note: Hydroseeding and/or Hydromulching will not be allowed CDOT State Highwat Utility Accommodation Code 2009 ( 3 4 4 3 5 the utility shall replace excavated portions of the base and subgrade with flowable backfill, or as otherwise directed by the Department, and 3 4.4.3 6 the utility shall trim all overbreaks or incidental damage of existing pavement back to a neat line before patching, and 34437 the utility shall repair all surface gouges or other minor damage in a manner acceptable to the Department, and 34438 the utility shall restore all pre-existmg pavement markings in and adjacent to resurfaced areas 345 Trenched Construction and Backfill 3 4 5 1 The utility shall construct vertical -sided trenches, of uniform width, and no wider than the lme diameter plus three feet, unless the utility demonstrates to the Department's satisfaction that such construction is impracticable 3452 Shoring or bulkheadmg shall conform with all applicable Federal, State and local jurisdiction construction and safety standards O3 4.5 3 The utility shall provide drainage from excavation areas 3454 The utility shall not perform construction or compaction by means of jetting, puddling, or water flooding within SH ROW, however, a limited amount of puddling may be allowed up to the spnngline of the pipe when free -flowing granular backfill materials are used, when necessary to obtain proper compaction of pipeline bedding. 3 4 5 5 Unless otherwise directed or approved by the Department, the utility shall backfill trenches as follows 3 4 5 5 l replace excavated matenal with flowable backfill as specified by the Department within toes of slopes, and/or 34552 place backfill in 6 inch layers, each consolidated by mechanical tamping and controlled addition of moisture to a density equal to or greater than that of the surrounding undisturbed soil outside toes of slopes 3 4 6 Trenchless Installations 346 1 Portal limits of untrenched crossings shall be established safely beyond the highway surface and clear zone, and in no case shall the lateral distance from the surfaced area of the highway to the boring or jacking pit be less than the vertical difference in elevation between such surface and the bottom of the pit O 55 CDOT State Highxay Utility Accommodation Cade 2009 3462 Shoring or bulkheadmg shall conform with applicable Federal, State and local jurisdiction construction and safety standards 3463 The utility shall not use water jetting or tunneling, but water -assisted or wet boring may be permitted if determined by the Department to not result in excessive erosion or unacceptable moisture conditions in the roadway subgrade 3464 The boring hole shall be oversized to the minimum amount required to allow pull - through of the conduit being installed, based upon equipment and product manufacturer's specifications If the oversize excavation is not already filled by the drilling slurry after product pull through, the void shall be grouted to the satisfaction of the Department Grout or other approved backfill material shall be used for pipe of 12 inches or more in diameter, and for overbreaks, unused holes or abandoned pipe The composition of the grout shall be a cement mortar, a slurry of fine sand or fine granular materials, subject to Department approval 3465 The utility shall follow manufacturer's guidelines and industry standards for equipment set-up and operation The utility shall assess soil conditions to determine the most appropriate installation technique Underground borepaths or tunnels shall be tracked and recorded by the utility Failed bores shall be appropriately abandoned by the utility 3466 Drilling fluids shall be prepared and used according to fluid and drilling equipment manufacturer guidelines The utility shall use fluid containment pits at both bore entry and exit points, and shall use appropriate operational controls in order to avoid heaving or loss of drilling fluids from the bore 3 4 6 6 1 Antifreeze additives shall be non-toxic and biodegradable products 34662 Depending upon chemical composition or the specific method of disposal, improperly disposed drilling fluids may be classified as solid wastes or illicit discharges per Section 3 1 7, and in general, shall be pumped or vacuumed from the construction area, removed from the SH ROW and disposed of at permitted facilities that specifically accept such wastes 34663 Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is expressly prohibited 34664 Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being separated from fluids or after infiltration of the water, provided - 346641 the drilling fluid consists of only water and bentonite clay, or 346642 if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling, and 56 rJ �J COOT State Highway Utility Accommodation Code 2009 3 4 6 6 4 3 the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, and 3 4 6 6 4 4 the solids are covered and the area restored as required by permit requirements 3 4 7 Utility Installations Near Drainage Ways and Watercourses 3 4.7.1 The utility shall not install any facility along or across the ROW of an imgatzon ditch or canal company without first obtaining the written approval of such company 3 4 7 2 The utility shall install facilities that cross a stream or other drainage only at a point beneath the bed of that watercourse and only at a depth that adequately allows for scour or ditch maintenance requirements The utility shall also take the added measures to protect such lines that the Department deems necessary in areas subject to erosion or other disturbance 3 4 7 3 In establishing the depth of cover below an unpaved channel, the Department will consider potential scour, ditch maintenance operations and/or future needs to increase the channel capacity The utility line shall be installed a minimum of three feet below the lowest expected level of scour or degradation 3 4 7 4 Utility construction operations within or near live streams, ditches, wetlands or other bodies of water shall include adequate provision to protect or maintain surface and/or ground water quality, and may require appropriate clearances as described in Section 317 3 4 7 5 The utility shall not install utility lines within culverts where the primary purpose of that culvert is to carry drainage For culverts or culvert -like structures where the primary purpose of the culvert is something other than dramage, such as providing passage for stock, wildlife, pedestnans or vehicles, utility installations shall be addressed through Section 3 3.10 3 4 7 6 In order to avoid any interference with the operations or maintenance of either utility lines or of drainage structures, the utility shall not install utility lines inside any such drainage structure or inside the trench that surrounds any drainage structure, and shall maintain a horizontal and vertical clearance from any such drainage structure or surrounding trench if further directed to do so by the Department in the utility permit 3 4 8 Protection, Construction and Restoration of Highway Property 3 4 8 1 The utility shall avoid disturbing or damaging all highway property, and shall be responsible for the prompt reconstruction, alteration, repair or maintenance of highway property, to repair any damage caused by the utility work, and to restore the SH ROW to pre-existing or better conditions as may be specified in the permit 57 State Highway Utility Permit 1 Attachment to Permit No 4190089 - Additional Terms and Conditions Version 5 1 GENERAL 2 This permit is issued in accordance with the State Highway Utility Code and is based in part upon the information submitted by the Permittee This permit is only for the use and purpose stated in the Application and Permit A copy of the State Highway Utility Code can be downloaded at http //www coloradodot info/business/permits/utihtiesspecialuse/2CCR 601_18 pdf/view 3 Please refer to this permit number in all communications and correspondence 4 The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required to proceed with permitted work Approval of this utility/special use permit does not constitute verification of this action by the Permittee 5 The Pernttee, his or her heirs, successors -in -interest, assigns, and occupants of the Utility/Construction/ Landscape/Special Use permitted by this permit shall be responsible for meeting the terms and conditions of this permit 6 Before work begins, a certificate of insurance naming the Colorado Department of Transportation (CDOT) as an additional insured is required to be submitted to CDOT Region 4 Utilities Permits 1420 2nd Street Greeley, CO 80631 Description should include this permit number Insurance should be in effect through 2 -year warranty penod from permit issue date and as long as installation exists m CDOT nght-of-way See attached Standard Terms 3 A through 3 H , inclusive 7 READ ALL ADDITIONAL STANDARD REQUIREMENTS OF THIS PERMIT AND OTHER TERMS AND CONDITIONS ON THESE ATTACHED SHEETS A COPY OF THIS PERMIT, INCLUDING ALL TERMS AND CONDITIONS, MUST BE ON THE JOB SITE WITH THE CONTRACTOR Call for an inspection of forms at least one working day prior to placing any concrete The Colorado Department of Transportation inspection is not an approval of the grade or alignment of the work The contractor and/or engineer is responsible for the proper grade and alignment Minor changes or additions may be ordered by the field inspector to meet field conditions Any survey monuments or markers disturbed during the execution of this permit shall be repaired immediately at the expense of the Permittee 8 NOTIFY THE DEPARTMENT OF TRANSPORTATION INSPECTOR CHIP HOPKINSON at [970] 590-5745 TWO WORKING DAYS BEFORE STARTING THE WORK OR RESUMING SUSPENDED WORK 9 On -premise and off -premise signing not in CDOT nght-of-way shall comply with the current Colorado Outdoor Advertising Act CRS 43-1-401, Rules and Regulations Pertaining to Outdoor Advertising For questions, please contact Outdoor Advertising Inspector Ally Mattson at 970-350-2148 n State Highway Utility Permit 2 Attachment to Permit No 4190089 - Additional Terms and Conditions Version 5 10 All work is to conform to the plans on file with the Colorado Department of Transportation or as modified by this Permit (IF DISCREPANCIES ARISE, THIS PERMIT SHALL TAKE PRECEDENCE OVER THE PLANS) The Colorado Department of Transportation plan review is only for the general conformance with the Colorado Department of Transportation design and code requirements The Colorado Department of Transportation is not responsible of the accuracy and adequacy of the design, of dimensions, and elevations which shall be confirmed and correlated at the job site The Colorado Department of Transportation, through the approval of this document, assumes no responsibility other than stated above for the completeness and/or accuracy of the plans. 11. The contractor shall follow the applicable construction specifications set forth by the Department of Transportation in the latest manual, Standard Specifications for Road and Bridge Construction, the M & S Standards, and the M U T C D 12 Any damage to any present highway facilities shall be repaired immediately and prior to continuing other work Any mud or other material tracked or otherwise deposited on the roadway shall be removed daily or as ordered by the Inspector. 13 CDOT will determine the extent of inspection services for the work. A daily inspection may be done by the Colorado Department of Transportation from the time work begins inside the highway right-of-way until the job is completed and right-of-way restored to its original condition 14 Water, storm sewer, sanitary sewer, gas, electrical, landscaping, telephone, traffic signal installations and fiber optic installations will require individual additional permits 15 Any surveying required as a result of this permit is the responsibility of the Permittee 16 It is the responsibility of the Penmttee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details The ECIS may be obtamed CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction-Environmental Guidance webpage at http //www.dot state co us/environmental/Forms/asp FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations Prohibited discharges include substance such as: wash water, paint, automotive fluids, solvents, oils or soaps Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit. landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, State Highway Utility Permit 3 Attachment to Permit No 4190089 - Additional Terms and Conditions Version 5 flows from npanan habitats and wetlands, and flow from fire fighting activities ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins For additional information and forms, go to the CDPHE website at http //cdphe state co us/wq/PermitsUnit/wqu 17 By accepting the permit, the permittee stipulates and agrees to fully protect, defend, indemnify, and hold harmless, to the extent allowed by law, the Issuing Authority and each of the Authority's directors, officers, employees, agents, and representatives, from and against any and all claims, costs (including but not limited to all reasonable fees and charges of engineers, architects, attorneys, and other professionals or expert witnesses and all court or other dispute resolution costs directly incurred by reason of claims directly brought against the Issuing Authonty), losses, damages, pre- or post judgment mterest, causes of action, permittee's failure to obtain, or disregard of, any applicable federal, state, or local environmental permits, approvals, authorizations, or clearances, or in meeting or complying with any applicable federal, state, or local environmental law, regulation, condition, or requirements in connection with any activities authorized by this Utility Permit 18 The permittee shall assume full responsibility for installation of and the resolution of any unforeseen problems regarding the installation of this facility 19. The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required to proceed with permitted work Approval of this utility/special use permit does not constitute verification of this action by the Permittee 20 DRAINAGE, WATER QUALITY CONTROL, ENVIRONMENTAL 21 All disturbed landscaping is to be restored to original or better condition 22. Areas of roadway and right-of-way disturbed during this installation or work shall be restored to insure proper drainage and erosion control 23. The Permittee is responsible for compliance with all Federal, State, and local environmental regulations The Permittee should have a qualified environmental consultant on staff or hire a qualified environmental consulting firm to assess the proposed project area for potential environmental impacts and obtain any necessary permits prior to disturbance Environmental impacts include, but are not limited to, wetlands, water quality, threatened or endangered flora and fauna, cultural resources including both archaeological and paleontological resources, and hazardous waste that can affect both human health and the natural environment Should enforcement action(s) be taken by any agency with jurisdiction, liability for noncompliance with any environmental regulation is the sole responsibility of the Permittee 24 TRAFFIC 25 No storage of materials or equipment will be allowed within CDOT right-of-way or 30 feet off the edge of the raveled way, whichever is greater. 26 TRAFFIC CONTROL State Highway Utility Permit 4 Attachment to Permit No 4190089 - Additional Terms and Conditions Version 5 27 No work will be allowed at night, or on Saturdays, Sundays, and legal holidays without pnor authorization from the Department The Department may also restrict work within the State Highway right-of-way during adverse weather conditions. 28 No equipment will be allowed in the main lanes of the roadway during construction 29 All work will be conducted from outside of CDOT right-of-way to outside of CDOT right-of-way Therefore, no traffic control is required for this installation. 30 MAINTENANCE OF UTILITY 31 Maintenance work may be done anytime within daylight hours as long as no interference to traffic is caused 32. MATERIALS 33 Disturbed right-of-way area, where applicable, must be top soiled, fertilized, mulched, and reseeded with Department of Transportation Specification grass seed mix, which meets specifications tJ 34 Please refer to attached sheet for CDOT seeding specifications for site revegetation 35 EARTHWORK 36 Conduit/casing shall be a minimum depth of 4 feet for all utilities except "wet" utilities, which must be placed to a minimum depth of 4.5 feet 37 All cable/conduit shall be installed by directional bore No trenchmg shall be permitted 38 MISCELLANEOUS 39 The Utility shall design and construct all buried facilities, including pipelines, conduits and casings, to withstand the full range of exptected internal and external pressures and loads, including internal pressures ranging from maximum expected pressure to zero pressure, and external loads from the highway and superimposed vehicle loads Pipelines shall also be designed and constructed to resist internal and external corrosion 40 All construction vehicles operating in CDOT right-of-way to have mounted flashers 41 The utility shall avoid disturbing or damaging all highway property, and shall be responsible for the prompt reconstruction, alteration, repair, or maintenance of highway property, as necessary, to repair any damage caused by the accommodation of the utility, and to restore the highway to pre-existing or other conditions as may be specified in a permit or agreement authorizing the accommodation 42 Utility Code, Section 3 4 6, requirements shall apply Copy of section attached 2/19/2019 REF -150219-168304 - Salesforce - Performance Edition REF -150219.168304 • Close Window • Print This Page • Expand All I Collapse All Permit Information Record Type Permit Number Permittee Permittee Street Permittee City/State/Zip Permittee Phone Permittee Email Permittee Select Permittee Rep Permittee Company Utility Permit 4190089 Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 Permittee Company Shawn Bates Cheyenne Connector Pipeline, Inc Permit Author Web Portal User Received By CDOT Project Number Project Engineer Utility Project Number Current Signatory Issuing Authority Activity Description Section Installation? 1 Adjustment? https://socgov.my.salesforce.comla0rl J0000061RaE/p?retURL=/a0r1 J000006IRaE 1/4 Reference Number Complexity Level Annual Permit? Applicant Applicant Street Applicant City/State/Zip Applicant Phone Applicant Email Applicant Select Applicant Rep Applicant Company Inspector Name Inspector Telephone Patrol Name REF -150219-168304 I Summit Resources C/O Rebecca Lieders 800 8th Ave. Suite 204 Greeley, Colorado 80631 Applicant Company Rebecca Lieders Summit Resources C/O Rebecca Lieders Chip Hopkinson (970) 590-5745 Patrol # 25 Maintenance 1 Section Water Quality Program Manager Regional Environmental Manager Facility & Type of Work (Other) 2/19/2019 REF -150219-168304 - Salesforce - Performance Edition %i Removal? Maintenance of Existing Facility? SUE/Other Relocation? Description of Work Location Additional Remarks Location Property Address Additional Information Intersecting Feature(s) GeoLocation ON SH 392 E/O CR 43 City County Weld County Local Jurisdiction UGcontact Utility Notification Center of Colorado UGphone (800) 922-1987 Special Provisions Time Restrictions Other Provisions Inspection Services jl Required? Permit Dates https //socgov my salesforce coin/a0r1J0000061RaE/p?retURL=/a0r1J0000061RaE 2/4 Longitudinal? Transverse? Buried? Aerial? Structure Number I Route Number 392 Mile Post 120 500 Side Route Number 2 Mile Post 2 Side 2 Route Number 3 Mile Post 3 Side 3 Route Number 4 Mlle Post 4 Side 4 State Highway B Section Category R -B Days to Complete Minimum Cover Overhead Clearance 2/19/2019 REF -150219-166304 - Salesforce - Performance Edition Receive Date Start Date Application Accepted as Complete Date Date Transmitted Issue Date Work Start Work Completion Date Expiration Insurance Expiration Extension Date Comments Web Status Comments Office Use Notes Comments for Reviewers Misc Permit Status 2/15/2019 4/1/2019 INITIAL REVIEW System information Created By Last Modified By Notified Inspector of Application Submission Notification Sent Previous Expiration Utility Permit Application Site Guest User, 2/15/2019 1 49 PM Utility Permit Application Site Guest User, 2/15/2019 4 35 PM I Notes & Attachments State Highway 392_WCR 68_Plan and Profile 21519 pdf Requesting Info Application Accepted? Withdrawn? Amendment/Extension Requested Reason for Request Type Attachment Last Modified Utility Permit Application Site Guest User Description Plan View file Date Withdrawn 2 -Year Warranty End Date 12/31/2019 Project Duration 274 Days Owner Region 4 Utility Permit Applications Region 4 MSA ID Applicant Contact Permittee Contact Visible In portal? Special Use Permit Narrative 1.23.19.docx Type Last Modified Descnption Attachment Utility Permit Application Site Guest User Cover Letter (Letter of Request) View file fl ', 1 https //socgov my salesforce com/a0r1J000006IRaE/p?retURL=/a0r1J0000061RaE 3/4 2/19/2019 REF -150219-168304 - Salesforce - Performance Edition CST -P -1000 -A145 -Model CDOT typical pdf Type Attachment Last Modified Utility Permit Application Site Guest User Description Traffic Control Plan View file Colorado Department of Transportation COI 10.24 18.pdf Type Attachment Last Modified Utility Permit Application Site Guest User Descnption Insurance View file Permit History 2/15/2019 4:35 PM CST-P-1000-A145_REV 11-27-18 CDOT Typical 11.27.18.pdf Type Attachment Last Modified Utility Permit Application Site Guest User Description Traffic Control Plan View file User Utility Permit Application Site Guest User Action Changed Submission Notification Sent from false to true. Changed Record Type from Application - Utility/Special Use Permit to Utility Permit 2/15/2019 4:33 PM User Utility Permit Application Site Guest User Action Changed End Date from 10/31/2019 to 12/31/2019. 2/15/2019 1:49 PM User Utility Permit Application Site Guest User Action Created. Copynght © 2000-2019 salesforce corn, inc All nghts reserved o https //socgov my salesforce com/a0r1J0000061RaE/p"retURL=/a0r1J000006IRaE 4/4 Ae®RbB CERTIFICATE OF LIA any INSURANCE DATE(MMI,DDIYYYY) 03/05/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer nghts to the certificate holder In lieu of such endorsement(s) PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P O Box 10265 Birmingham, AL 35202 NNAME. T PHONE 800-476-2211 I FAX /A/C. Na FAO. INC, No) ADDRESS PISURER(S) AFFORDING COVERAGE NAM* INSURER A .AIG Specialty Insurance Company 26883 INSURED BNN Water Solutions, LLC 370 Van Gordon Street Lakewood, CO 80228 INSURER a Commerce and Industry Insurance Company 19410 INSURER C INSURER 0 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 4U2CB6SF REV THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL SUER rrisq, wvo POLICY NUMBER POLICY EFF POLICY EXP ALINUDINTYYYLISIMID LIMITS A X COMMERCIAL GENERAL LIABILnY 12335226 03/01/2019 03/01/2D O 0 EACH OCCURRENCE - I $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE 1C) RENTED PREMISES (En occurrence) $ 300 000 MED EXP (My one person) $ 25,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEM_ AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO I $ 2 000,000 $ B AVTOMoBILE — X _ LIABILITY ANYAUTO OWNED v _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY CA 3962402 03/01/2019 03/01/2020 COMBINED SINGLE uMIT (Ee accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LlAB EXCESS ma X OCCUR CLAIMS -MADE 12335228 03/0112019 03/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTION $ WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY / N ANY PROPRJETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Ryes describe under DESCRIPTION OF OPERATIONS below N / A I I PER I IOTH- STATUTE E& E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE' $ E L DISEASE - POLICY LIMIT I s A Pollution Legal Liability (Claims Made Basis) 12335226 03/01/2019 03/01/2020 Each Loss Limit 5 1,000,000 $ s $ $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re State Highway Right of Way permit CDOT and Concessionaire are included as Additional Insured (Excluding Workers' Compensation) if required by written contract, subject to policy terms, conditions and exclusions In the event of cancellation by the Insurance companies the policies have been endorsed to provide 30 days Notice of Cancellation (except for non-payment) to the certificate holder shown below CERTIFICATE HOLDER CANCELLATION Colorado Department of Transportation 10601 West 10th Street Greeley, CO 80634 SHOULD ANY OFTHE ABOVE DESCRIBED POLJCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHOR ZED REPRESENTATIVE 1-44) Page 1 of 1 © 1988.2015 ACORD CORPORATION All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD A WR®® CERTIFICI`"TE OF LIABILITY INSURANCE DATE(MMI)DIYYY'q O3/05/2019 f THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS ' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the pollcy(res) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER MCGRIFF, SEIBELS & WILLIAMS INC P O Box 10265 Birmingham, AL 35202 NAME CT PHONE No. Ext), 800.476-2211 (FA/ , No) L ADDRESS SS INSURERS) AFFORDING COVERAGE NAIC 0 INSURER A Starr Indemnity & Liability Company 38318 INSURED Tallgrass Energy GP, LLC 4200 W 115th Street, Suite 350 Leawood KS 66211 INSURER B INSURER C INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER YK7TSVSC REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ILISR TYPE OF INSURANCE jj) SUBR WVT1 POLICY NUMBER (NIMI/DDrEFF IYYYY) (MM POLICYEXP UMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGEO RENTED PREMISES la occurrence) $ MED EXP (My one person) I $ PERSONAL & ADV INJURY I $ GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO S S AUTOMOBILE LIABILITY ANY AUTO OWNED _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY(Per accident 1 $ PROPERTY DAMAGE (Per accident) S $ UMBRELLALWB EXCESSLUIB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes descnbe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 x I STATPER I IOTH- UTE ER E L EACH ACCIDENT I $ 1,000,000 EL DISEASE - EAEMPLOYEEIS 1,000,000 E L DISEASE - POLICY LIMIT I $ 1,000,000 $ S $ $ $ DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES (ACORD 101, AddItonal Remarks Schedule, may be attached If more apace is required) Re State Highway Right of Way permit CERTIFICATE HOLDER CANCELLATION Colorado Department of Transportation 10601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE Page 1 of 1 © 1988-2015 ACORD CORPORATION All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AWR EP CERTIFICTE OF LIABILITY LITY INSU:`:'!,NCf DATE (MMIDDIYYYY) 03/05/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS ' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER MCGRIFF, SEIBELS & WILLIAMS INC P 0 Box 10265 Birmingham, AL 35202 CONTACT NAME PHONE 800-476-2211 FAX (Arc. No. ES)), (A/c, Nol E-MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAIC F INSURER A Aspen Insurance UK Limited INSURED Tellgrass Energy GP, LLC 4200 W 115th Street, Suite 350 Leawood KS 66211 INSURER B Starr Indemnity & Liability Company 38318 INSURER C Aegis Insurance Services Ltd INSURER D Ironshore Specialty Insurance Company 25445 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 9MM5LTNG REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR T TYPE OF INSURANCE MSC SUM EST POLICY NUMBER LIMILVLDDYnmY) (MMMIUDDK YYI OMITS A X COMMERCIAL GENERAL LIABILITY ME1902667 03101/2019 03/01/2020 EACH OCCURRENCE $ 4,000,000 PREMISES Ea occurrence $ X I CLAIMS -MADE OCCUR MED EXP (Any one person) S PERSONALE ADV INJURY $ GEN'L X AGGREGATE LIMIT APPLIES PER. POLICY JECT LOC OTHER GENERAL AGGREGATE S 4,000,000 PRODUCTS COMP/OP AGG $ $ B AUTOMOBILE X X LIABILITY ANY AUTO X SCHEDULED AUTOS NON -OWNED AUTOS ONLY SISIPCA08313219 03/01/2019 03/01/2020 M DSINGLE LIMIT EOaccident) $ 1,000 000 BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE (Per accident) $ $ C B X UMBRELLA LAB EXCESS LIAR X OCCUR CLAIMS -MADE L5236807P 03/01/2019 03/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1 000 000 OED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS LABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) Ryes descnbe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 v I PER I IOTH- STATUTE ER E L EACH ACCIDENT $ 1 000 000 E L DISEASE EA EMPLOYEE $ 1,000,000 E L DISEASE - POLICY LIMIT 5 1,000,000 D Pollution Legal Liability 002025904 03/01/2019 03/01/2020 Each Incident Aggregate s 1,000,000 $ 1,000 000 S S $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule may be attached If more apace Is required) The CDOT and Concessionaire are included as Add bona Insured (Excluding Workers' Compensation) if required by written contract subject to policy terms, conditions and exclusions For the General Liability, Automobile Liability, and Excess Liability policies Insurance is primary and non-contributory over any other collectable insurance if required by written contract subject to policy terms conditions and exclusions In the event of cancellation by the Insurance company the General Liability policy has been endorsed to provide 30 days Notice of Cancellation (except for non-payment) to the certificate holder shown below CERTIFICATE HOLDER CANCELLATION Colorado Department of Transportation 10601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE Om) ACORD 25 (2016/03) Page 1 of 1 © 1988-2015 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD A ®® CERTIFICATE OF LIABILITY INSURANCE DATE(MIMIDDNYYY) 03/05/2019 f THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED, the poiicy(Ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder m lieu of such endorsement(s) MCGRIFF, SEIBELS & WILLIAMS, INC P O Box 10265 Birmingham, AL 35202 ONTAPRODUCER Cue ACT JS/CJtNaF�ll 800-476-2211 . Nol ADDRESS INSURERS) AFFORDING COVERAGE RAC A INSURER A Aspen Insurance UK Limited INSURED Taligr ass Energy GP, LLC Including Cheyenne Connector Pipeline, Inc 4200 W 115th Street, Suite 350 Leawood, KS 66211 INSURER B Starr Indemnity & Lrabiliiy Company 38318 INSURER C Associated Elec. & Gas Ins Svcs Ltd (AEGIS) AA - INSURER D INSURER S INSURER F COVERAGES CERTIFICATE NUMBER AKNW9FUJ REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IL SCR �_ A TYPE OF INSURANCE J SO SUER POLICY NUMBER (M POLICY I YYY) EXP (pF �WDp _ LIMITS X COMMERCIAL GENERAL LIABILITY lutE1902687 03/01/2019 03/012020 EACH OCCURRENCE $ 4,000,000 X I CLAIMS -MADE OCCUR DAMAGE t 0 RENTED PREMISES (Ea occurrence) $ MED DIM (Any one person) $ PERSONAL & ADV INJURY $ GEN'L X AGGREGATE LIMIT APPLIES PER POLICY JET LOC OTHER. GENERAL AGGREGATE s 4 000,000 PRODUCTS - COMP/OP AGG $ $ f - AUTOMOBILE X X LULBIUTY ANY AUTO OWNED — X SCHEDULED AUTOS NON -OWNED AUTOS ONLY SISIPCA08313219 03/01/2019 03/01/2020 CEO aaBIBINdED SINGLE LIMIT S 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident' $ $ C X UMBRELLALIAB EXCESS LIAR X OCCUR CLAIMS -MADE XL5236807P 03/01/2019 03/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTION $ 5 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 2.c.1.117 I IOTH- U/JE ER E L EACH ACCIDENT $ 1,000,000 E L DISEASE- EA EMPLOYEE $ 1,000,000 E L DISEASE - POLICY MIT 5 1,000,000 S $ S $ $ DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required) Certificate Holder is included as Additional Insured (Excluding Workers' Compensation) and Waiver of Subrogation applies except where not permlss ble by law if required by wntten contract, subject to policy terms, conditions and exclusions The policies include sudden and accidental pollution coverage subject to policy terms, conditions and exclusions CERTIFICATE HOLDER CANCELLATION Colorado Department of Transportation Attn Utility Permit Office /10601 West 10th Street I Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE Oh) Page 1 of 1 © 1988-2015 ACORD CORPORATION AU rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 370 Van Gordon Street Lakewood, Colorado 80228 303 763 2981 Project Introduction Cheyenne Connector Pipeline, Inc. Cheyenne Connector, LLC ("Cheyenne") proposes to construct 70 miles of new thirty-six inch (36") natural gas pipeline from a point located within Section 14, Township 2 North, Range 66 West, north to a point located in Section 5, Township 11 North, Range 66 West, Weld County, Colorado This pipeline is anticipated to initially carry up to 600,000 Dth/d of natural gas per day accumulative activities in the surrounding area. The permanent easement width will vary based on the segment of the line, but generally will be fifty feet (50') m width. The five meter and regulating sites along the pipeline route — Lancaster, Latham, Mewbourn, O'Connor and Connector — will service the line with adequate pressure to move the product to existing Rockies Express Pipeline, LLC facilities north of Nunn, Colorado The O'Connor meter and regulating site requires a 0 7 - mile twenty-four inch (24") lateral to the thirty-six (36") pipeline ("Project"). After reviewing the lands to be crossed, Cheyenne Connector, LLC ("Cheyenne") selected a route from the point of origin at the Lancaster Meter Site located in Section 14, Township 2 North, Range 66 West northeast of the City of Fort Lupton, Colorado During negotiations with landowners along this route, Cheyenne made several alterations to the route both m response to landowner requests, topographical considerations, co -location with existing pipelines and Federal Energy Regulatory Commission ("FERC") Requirements The original route was largely retained as it continues to present the least intrusive path for construction and the most accessible location for service and maintenance during operation The lands concerned with the metering facilities includes the aboveground facilities — Lancaster, Latham, Mewbourn, O'Connor, and Connector — that will be constructed either within existing natural gas facilities or would be directly adjacent to existing natural gas processing and compression facilities The Lancaster and Connector Meter Stations would occur entirely within existing industrial sites Construction of the Mewbourn, Latham, and O'Connor metering facilities would represent a long-term conversion of agricultural and rangeland to industrial land uses. These aboveground facilities would affect land use and acreages Where possible, the new aboveground facilities would be located within existing facilities or adjacent to existing roads to minimize impacts and for convenience of access The lands located within the project area are primarily agricultural cropland and ranchland with rural residential and some industrial use along the proposed facilities In an effort to mitigate disturbance to the surface and to decrease as much as possible the impact to the lands post -construction, Cheyenne will bore all road crossings and all water bodies encountered on the route pursuant to all local, County, State and Federal rules and regulations Cheyenne would use different crossing techniques for waterbodies, depending on the type of waterbody to be traversed Special care will be taken to minimize effects of construction on waterbodies. Cheyenne adopts the FERC's Wetland and Waterbody Construction and Mitigation O Procedures ("Procedures") without deviation and will follow mitigation requirements for waterbody and wetland crossings For stream and flowing waterbody crossings, Cheyenne would use HDD or bormg Cheyenne would open cut non -flowing and intermittent and ephemeral streams Cheyenne will comply with USACE Section 404 nationwide permit (NWP) 12 for construction in creeks and wetlands crossed by the Project To reduce potential impacts from construction on groundwater resources in the Project area, Cheyenne will implement the FERC's Procedures and the FERC's Upland Erosion Control, Revegetation, and Maintenance Plan (Plan) without deviation and will implement the following mitigation measures Wells withm 150 feet of construction activities will be staked, fenced, and/or flagged for visibility. Additionally, wells within 150 feet of construction activities where landowner permission is provided will be sampled both before and after construction to confirm that no impacts occurred as a result of the Project. If a known or unknown well is damaged by construction, Cheyenne will coordinate with the landowner to repair, replace, or remediate the well, if needed. Cheyenne will coordinate a temporary water source for domestic use during the repair and reclamation period if no other potable water is available Should the loss of water affect agricultural or livestock operations, Cheyenne will compensate the affected farmer(s) for any lost revenue from these operations during the reclamation and remediation period for the damaged well Cheyenne may choose to provide a temporary water source to support livestock operations while a new permanent water supply well is constructed or while the existing affected well is repaired The Project area is located in generally flat to rolling plains with few steep slopes. If construction occurs in areas exceeding slopes of 5 percent, Cheyenne will use trench breakers to limit the flow of water along the backfilled trench This will reduce the potential for the trench to act as a preferential pathway for groundwater migration If trench dewatenng is required in these areas, water will be discharged in a level upland area to allow for evaporation and infiltration back to the water table If the water must be discharged to a surface water body, appropriate filtration systems will be used to control any potential increase in total suspended solids (TSS) and all of the proper notifications and permits will be obtained Quality Control Erosion controls will be employed throughout construction in order to protect the easement property and the surrounding lands Cheyenne will employ tracking pads at all access points from roadways and all road crossings involving the ingress and egress of heavy equipment During construction, Cheyenne will double ditch the pipeline trench The pipe will be laid m the trench m such a manner as to leave the top of the pipe at least thirty-six inches (36") below the surface of the ground after restoration A Stormwater Management Plan will be secured from the appropnate State Agency and will be followed during construction and subsequently during operation of the pipeline and associated facilities Cheyenne will begin reclamation of the affected lands as soon as is practical after construction has finished on each parcel of land and will pursue re -grading and reseeding of the grounds until the property has been re-established to a condition comparable to its state prior to entry by Cheyenne. After construction, pipeline markers will be installed along the route that will contain a telephone number that will allow the public to contact Cheyenne It is Cheyenne's intention to fence -in all aboveground appurtenances in order to protect the equipment and the public from accidental contact Cheyenne will be operating this pipeline on a continuous basis, twenty-four hours a day, seven days a week A momtonng system, overseen by highly trained staff in the Lakewood, Colorado offices will allow Cheyenne to remain alert to all conditions affecting the operation of these assets In the unlikely event of an emergency, Cheyenne will be able to shut down the compromised segment of the pipeline by employing the system of remotely -controlled valves to be installed along the length of the pipeline Federal Permits Applications 1 Certificate of Public Convenience and Necessity Natural Gas Act Sec 7(c) applied to the Federal Energy and Regulatory Commission Submitted March 2018 Anticipated date of FERC Certificate award March 2019 2 Environmental Clearances Impacts on wildlife habitat Cumulative impacts on the environment may result when the environmental effects associated with a proposed project are added to other past, current, and reasonably foreseeable future actions The proposed Project locations are m agricultural, rangeland, and industrial/developed areas. The majority of development similar in nature and scope to the Project is associated with current or planned oil and gas exploration and development as well as midstream and upstream projects This information was obtained from Cheyenne Connector's consultation and coordination with other potential operators in the area during land acquisition and routing studies, as well as the FERC web site, state agency websites, and company -specific websites Information concerning other types of commercial and/or residential development within the Project area was obtained through consultations with the Weld County Planning Commission. The Cumulative Impact Assessment Area ("CIAA") for fish, wildlife, and vegetation impacts is the extent of HUC 12 watersheds crossed by the Project The Project would disturb approximately 598 2 acres of vegetation and topsoil within the CIAA, which would leave soils vulnerable to wind and water erosion during construction which could result m increased soil movement into surface waters as sediments Additionally, the open cut crossing of 23 streams would result m direct sedimentation into surface waters if construction were to occur during periods of flow This could incrementally reduce the quality of aquatic habitat downstream of construction when considered with existing sediment and runoff burdens from other past, present, and reasonably foreseeable oil and gas and agricultural development This potential incremental increase in sediment burdens from the Project would be temporary as Cheyenne would limit erosion and sedimentation through the development of a SWMP and would revegetated all pipeline ROW followmg installation The Project would utilize 4,000,000 gallons (12 27 acre-feet) of water to hydrostatically test the newly constructed pipeline This would not decrease the availability of aquatic habitat in the CIAA as this water would come from existing, permitted water rights The Project would disturb approximately 598.2 acres of ecological systems within the CIAA Reclamation would restore 427.6 acres of potential habitat within the CIAA. The remaining 170 6 acres of ecological systems would remain disturbed for operations This 170 6 acres would represent a long-term incremental increase in habitat loss within the CIAA Additionally, the presence and operation of these aboveground facilities could increase the amount of habitat lost due to displacement effects from noise, human presence, and fragmentation Cheyenne would have limited potential to incrementally impact federally and state listed species and their habitats within the CIAA. Pre -construction surveys for western burrowing owls and other protocol level clearance surveys, as requested by the USFWS, would limit the potential for direct loss of protected species or of occupied habitat Reclamation and revegetation of the ROW following pipelme installation would avoid any permanent loss of habitat for protected wildlife species As no new depletions from the South Platte River are needed and no direct disturbance would occur to the South Platte River, no incremental impact to species reliant on this habitat is anticipated Impacts on historical, archaeological and scenic resources The proposed pipeline route predominantly crosses through dry -land agricultural properties, thereby mimmizing any potential impacts to historical, archaeological and scemc resources Cheyenne has conducted archaeological surveys in accordance with guidance from the State Historical Preservation Office and has not encountered any historical or archaeological sites The CIAA for cultural resources is the overlapping impacts within the Area of Potential Effects (APE), since impacts to cultural resources are generally site -specific and not additive across a landscape As no past, present, or reasonably foreseeable future actions within the APE would overlap with potential Project impacts to cultural resources, no cumulative impacts are anticipated COUNTY ROAD CROSSING PERMIT WELD COUNTY, COLORADO T. 06 N., R. 65 W. . ,:•.; f •SEGTtC ;•°,11:` ;J-�'•*,:I•r,,; 1,111f.,:.f• ;,, r„ ,;. t',• /(.40 N. : • I I SECTION . - 13 ' , -7- . ., x• t .. 'f• f . /_...• s.•_;,.'-.r...�, '_.....I ---- s '___ � `,--1. ;, _.�'i,.._. __ 4- CROSSING LOCATION - - ___ ,_: -.::.. ___ 7i -A,0 it'. • lei-!., •. r..' f•. AA: • • -u .. , • • ,. . ' .• •,,, ,; •1 LAT N40.478712° ` -- $}-� 1 4• - t.--.-�--� �--- l 1�-�-----•-t !-•----.�.1 H-.i --=-�. ! 1,- ,-H,` „ ,',i .�- • ' 'r�%, 7. ,! I LON: W104.604342= 1418493 42 t"'t.--.'-• • ', • • E)&S`�.,Pip II',�I __ ....NORTHING: :.• •f:i�,.:' �� ... -_ -- .! ,' s.. ,.-.;..•....,t�.�,,..,_;L�.. _._. ' - -r- _... ..._. __._ .:,..immis . �. _...� -0^) FASTING: 3249156.21 ....: s:.....•.•... , ra'.. v.-":. 1. P. V1/.OIKSPA E - 11 . • ! ' ,�, rr ..•••;;: . • SI S i -+w �--; .c .:-. M:...•; -te r 173&+00 , .. 173&+00 a_ h....., .._ 17 .....� a 6.1 OD 75V001 BORE ENTRY i EXIT I ORE r t: rci+_A ._ - - 9O' -- .l. �• 1 -. . PRQPDSE�i. " PIPELINE•. bhKSPACE ` 50' PE.'NENx RA�' ' I . e � '�•.,. SAC► e , Cirri( • • • ' . I . i 1 . • • • • • ' • 0ir I 8 • • . \ • L',<t;11. s.;• .:�:.. • ' .,.... z d \ ',tom • . . N. • • ,-•� iT IN I• .. ,4owE:$99,000Y � r I I 1 (90-WE-90CT.:Q00) \ N . , COUNTY 1• ROAD 49 GENERAL NOTES: LEGEND:. 1. PIPELINE WARNING SIGNS SHALL BE INSTALLED AT EACH RIGHT-OF-WAY LINE. CL PROPOSED PIPELINE - s" n e ` PERMAN ENT EASEMENT 2. All. EXCAVATION AND BACCFILL SHALL BE IN -- PROPOSED BORE - . a TEMP WORK SPACE ACCORDANCE W R}i STATE DOT PIED U IRE U ENTS 3. ALL TRENCH EXCAVATIORS DEEPER THAN 5' FENCE PROPERTY UNE SHALL FOLLOW APPLICABLE STATE AND OSHA au ---I 1-• FOREIGN PIPELINE CENTERLINE OF ROAD SAFETY REGULATIONS 4. S N HEREON COORDINATES HOW ARE BASED ON -{ WG- - U NO ERG R O U ND ELECTRIC CENTERLINE OF DITCH COLORADO NORTH STATE PLANE, NA083 —0-0/1t -- —4/W DATUM, U.S. SURVEY FEET. OVERHEAD POWER UNE =RlV 3 ROAD RIGHT—OF—WAY QI O' ac I 1 s _ v� —jI CATHODIC PROTECTION TEST STATION WARNING SIGN ' rr C � o tl dt WARNING SIGN di lc`lo fir , �1 l I AS SPECIFIED BY , 10.0 10.0 --,j JURISDICTIONAL AUTHORITY o Z MIN. MIN. o BORE PIT BUT NOT LESS THAN 10.0' a BORE PIT • 1 t , 36' 0-4 . SMLS API 5Lj X70 PSL-2, 0.762' WT t _ _ 14-16 MILS MBE + 40 MILS AR0 1480 P. MAOP _ ' =--------------- •N.� 1N N-' ISSUED FOR PROFILE (TYP.) PERMIT NOT TO SCALE 11/14/18 AFE#: 70066 SM CHEYENNE CONNECTOR 7 PIPELINE, INC. °r"' DLM 37,1/2017 COUNTY ROAD 68 CROSSING OIL DID AA 36" CHEYENNE CONNECTOR PIPELINE Iota. � Jew �a WELD COUNTY, COLORADO 3 ISSUED FOR PERMIT DIN 1O/31/TQ1& DLIA JAA . PRa- . SUE: SIR. Ntt I REY: Nn RVor1-ten" Ff QMOn aeg 1" = 100' I CO -WE -899.900 3 ea—ea:rms.. f ------4f------41. SMALL CONTRACTOR S�� KA'FE7c l ALL I5T1NG Dg1Ekt51p+5. C1kvAT1QNMOS. O ��r,4 4 ...---.a 1..._.......---4 L * CONOmoN5 IN CAD PRIOR TO START or woAK — —1 • ��+ 41 1 p ..r. I . ----�- 1 TEAIRCOAR1 r � ITORKNCE} I I * SUES OF EXCAVATION Wit HIRE APPROf(MAT[- CONTRACTOR TO corm ANO - - :- UTILIZE OSHA APPROVED DC;AYATKTN. HEMMING, SLOPING OR CO SE t APPROVED SMORD4G OEYICES TO SAFELY aFRWDRu WORK yy • la ISf • 3. FCK A 36' O.O owt, MAX DECREE Of ALI° IS 1.5 DE1;ytFES PER 3 rc!r Or PIPE. -sellaaaalMISISIMMOS..._ a 4. CONTRACTOR TO O► TR1t .E FINAL U(At Mao METHODS TO MEET ALL a SI - - r as SO i as M 1A 4•i >r IIIII SI M a alma • MO 11. r A i r 1� wi 417)1 r /r .. .• - 1AN'tJl11A CIFMANGES COllT'RACTD9 y4A11 SUAK1E►FRY SUPPORT PIPE cunt DURING CONSTRUCTION AND mooch ACt 5. conceit u M-� LOr str FOR CALUNC STATE OAR[ Mm At1GM1fENT COITTPLAC :. -CAI) lOGTNG ., .� .-. _ - ..I AU. u I 4I NOEIiGROUN0 U1UJ1*S PftIoFR TO HECAi41N0 CONSTRUCION. PROPOSED 36' BORE TNT ,. L I. 0. TT Is THE CONTRACTOR'S RESPoNSIBIlm TO IDEIQFY MC PROTECT ANY `A FOREIGN Win THAT MAY Bt A.PtC11D of THE WRFC OPERATIONS ! at +•• �• " �' I W CMATE. Loa T101fs of UTILITIES ARE APPIEDJQ I7. H BEFORE POWER OR NWT PURPOSES ON S FOR 1.60 ON Mir D[ 11�E S _ - UTILITIEAPIIDIT I 9IQWN VHRS MAP, TEXACT LOCATION MO M OF , WIREIll 2 0 I B[tETaIB4e ENT rNF UTLns SlioULD HE FIRST QUERN MET) 8Y HAND E7(CJNATION OR In JROVAC •-- T av w0 aa1 St inn ■w NI■ a)•1 a1• a� a aF n a a — UM {a a a a a ass a a a AD0fflGN1` ilyPOItARY *OIbISF'AGE iTMP ) M CONTRACTOR SHALL M IRIADE A ISOM' 10 FEET OF COYER MILE &OEATM COOT RIGHT Of WAy. TO PROFEC7 THE r(TEORR V OF THE READ, TT 6 THE - a I CONTRACTOR'S RESPONSSUP/ TO ASSESS FIELD CONDITIONS MO SOIL 7es COPT RIC.HT-Of-ST `. COMPETENC`r PRIOR ID BORE OPEFNTI016. CONTRACTOR SHALL OMTE1lMNE I2* 10 FIST MWMUF UM COVER 15 SFTiaENT BMW ON nut CONDITIONS AND F REQUIRED. BE DEEPER 10 MMf(TNN 11•E WORM( OF THE ROADWAY. II .. '. It 10R PIDTtCE; a ■ a a •—•-t_ t - -...` 1. ALL UN°CRGROMIID UTILITIES OR STRUCTURES REPORTED BY Oft MOOT OR OTHERS ARO THOSE SHOP! ON THE RECORDS DAMNED ARE NDICAT[D MTH THEIR APPRDIOMATE LOCATION ANO EXTENT. THE CONTRACTOR IS REQUIRED TO TAKE DUE PRECAUTIONARY MEASURES 10 PROTECT INC UTILITIES OR Ira D/ (TN' ) - STRUCTURES MY" AND ANY a7THER UTWF ES OR STRUCTURES FOUND AT C N, ' r :It ac T+RTRl S KlYRA1EMT We MR) THE SITE. R SHALL BE THE CONTRACTOR'S RESPONSIBIU'TY TO N01':Y THE OWNERS Of THE UTILITIES OR STRUCT%RTS CONCERNED BEFORE STARTING /« i I.I WORK CONSTRUCTION OONTRALTOR ACC THAT N ACCORDANCE 14TH ' ♦ -► V ... CENEiTAtJ,Y AOCEF'►ED CONSTRUCT CS PRACTICES. C016TRUCTION CONTRACTOR IVLMOOD L 8t RTO ASSUr! COMPIiT[ RESYOfa64lL?T' ►QI JOB ATE 4 .. a aft. ' 4 / •- 0 E . A . a s �. r 4.All s - 3 I cocas COas DUPING TIC COURSE Of CONSTRUCTION Or TIE PROJECT LocumsLocumsTTY OF ALL PERSONS AND PROPERTY, THAT ITS RCDUREYEM surly U . T _ �HOURSWAX TO OR ANO SUBY el) Fa7T OE LAMM TO CONTRACTORS 4TTRACTORS PtRitakI1VC NORMU� _ ,.. M�ORl�flOFACC OTCMIATIGNS $140&L COIfPLY WITH ALL OSHA RLCUTK1fW►5 Oitl Q 1s_ of i smut N ?UT 4150 1 aO' 4750 4740 09 Od • • 4130 a; H WY a!2 TO OF DOCAvATEN EDGE 'I .- 31' f ION 302 Tv 01a Ut ar.AYATION 21 4740 47J0 4720 47.0 4 /00 1690 1 \• 1 ' T Cil 1 ( ,. . q 6.1' . + 4 ji t� 4720 "" 4710 4700 4610 - M91 CTMTT 4660 b J 4' YIN COYER Oa — b APPROX. TOP 0. 7rbf it . 40.10 4.)0 * t.i-.I.-�taT• 1 4670 I, . r1 --r- 3' SIN.f 4060 46SC 4640 BORE Pit CAFBl° PIPE 20"X HO* 41,1 51. 14- 70, SAM.. 70E ♦ ARO 20X12YiC PIT . 4600 20x12* . 1 4050 4640 `• 4430 - -• • 44Jp 92* _ t.ca r 1 40 O.00 tad0 ]♦OG 2+50 %` • � u.1 O I f (ere. HOW/OYTM PRO=Vomit. E 0 10' 20' • 0 10' 20' 40' �' � O' 03/04/2019 SCJLEIh FEt� i lFl RfT .-- _-- 7 - - 1NNELL TALLGRASS4 ENERGY COOT MMY 392 solve Caoaa>MO a1TE PWivaoFi�>r• IMP 33.4) - - - - �- a T e SIMD NN MI AML Vn n.^r. 1 0 RIMS 1M104607 - MR PDC WNW r 12* IMPS all wl Or .'� • co aaliYy4M to items Mei N a MR Psr 4 J► M� t !4 at it �` ry' NOitl 6�1t Hirt 1IOL a �WN ' YAA ter___" : °R""'° 0 .. a14tooG•S00 �v i7� { k��NCE QRS 3/19/201 c Cheyenne Connector Pipelii /Y 392 Utility_Special Use Capture_3.18.19.PNG LGO 3 z u.,,i•. Fa v4 MM !to NS https://mail.google.com/mail/u/0/#inbox/QgrcJHsbhNtgmHZZfjjGmdvxGgxbmtnnHvG?projector=18tmessagePartld=0.1 1/2 02/22/2019 Quality Control Plan - Inadvertent Fluid Release Conventional Bore Cheyenne Connector — Pipeline Installation RE: CDOT Crossings — 36" Conventional Bore Hanging H is working with Tallgrass Energy to build the Cheyenne Connector Pipeline which crosses several Colorado state highways. As currently designed, these highways will be crossed by means of conventional bore, a method that does no: utilize drilling fluids. Being that this method requires no drilling fluids, the threat of an inadvertent fluid release is non-existent. Below is a step-by-step explanation of our proposed installation method. 1. Before any excavation takes place, all locates will be called in and all utilities within the work zone will be potholed and their depths verified. 2. All environmental BMPs will then be installed in accordance with the approved environmental drawings provided by Tallgrass. 3. Should groundwater be present at any of the CDOT crossing work sites, Hanging H would install dewatering wells prior to performing any excavations. Hanging H would activate the wells prior to performing any excavations so that the groundwater is drawn down by the time the bore pits are ready to be excavated. 4. Crew will then excavate the bore pits on each side of the crossing using an excavator (CAT 336 size or equivalent). Hanging H will use trench boxes for shoring the excavation. 5. Hanging H will use a tracked boring machine to complete the crossing. The entry pit will be dug to specific grade and the tracks will be set up at the bottom of the pit. Before lowering the boring machine into the pit, the plumbness of the track system is checked to ensure that the trajectory of the bore is correct. Once the designed trajectory is confirmed, the boring machine is lowered onto the track system. 6. The boring machine auger will then be inserted into a piece of 36" sacrificial pipe. The sacrificial pipe will then be lowered into the pit using a pipelayer (CAT 583 or equivalent) and the auger will be connected to the boring machine. The pipelayer will support the sacrificial pipe, further ensuring the crossing will be completed at the designed trajectory. 7 After activating the auger, the boring machine will track forward, pushing the sacrificial pipe into the headwall of the entry pit. The auger will cut into the headwall and convey the bore cuttings through the sacrificial pipe and into the bore pit. Hanging H Companies 11912 S. Burlington Blvd, Ste 100, Burlington, WA 98233 1 360.726.2334 info@hanginghco.com I www.hanginghco.com 8. On longer crossings, the boring machine will disconnect from the auger and track to the back of the entry pit. Another joint of sacrificial pipe with more auger will be lowered into the pit. The auger that was originally attached to the boring machine will be connected to the auger in the new piece of sacrificial pipe. The new piece of sacrificial pipe will be welded to the end of the sacrificial pipe that is sticking out of the headwall of the pit and then X-rayed to ensure a quality weld was made. Steps 7 & 8 would repeat until the crossing was completed. 9. Once the sacrificial pipe bores through the headwall of the exit pit, the auger is disconnected from the boring machine and removed from the sacrificial pipe. 10. The permanent pipe is then lowered into the entry pit and welded onto the sacrificial pipe. The boring machine then tracks ahead, pushing the permanent pipe into place while pushing the sacrificial pipe out into the exit pit. 11. The sacrificial pipe is then cut and removed from the exit pit. 12. On longer crossings, steps 10 and 11 may repeat. The welds made on the permanent pipe will be X-rayed and coated prior to being pushed into place. 13. After all permanent pipe is installed, the boring machine and track system is removed from the entry pit. 14. Prior to backfilling the bore pits, pipe that has engineered and bent to get the line from the depth of cover required for the crossing to the depth of cover required on each side of the crossing, is welded onto the crossing pipe in both the entry and exit pit. 15. The pits are then backfilled and compacted. As mentioned above, this method of installation does not require any drilling fluids. This method also does not leave any voids throughout the crossing like horizontal directional drills. The cutting head of the auger is sized to match the outside diameter of the pipe, leaving no voids or pockets that could result in future settlement issue. If at any time you require further information, please do not hesitate to contact me. Sincerely, Kasey Entrikin Project Manager Hanging H Companies 1912 S Burlington Blvd. Suite 100 Burlington, WA 98233 Cell: 360.661.0696 E-mail: kentrikin@hanginghco.com Website: http://hanginghco.com Hanging H Companies 11912 S. Burlington Blvd, Ste 100, Burlington, WA 98233 1360.726.2334 info@hanginghco.com www.hanginghco.com COLORADO DEPARTMENT OF TRANSPORTATION UTILITY PERMIT PERMITTEE Name: Cheyenne Connector Pipeline, Inc APPLICANT Name: Summit Resources C/O Rebecca Ueders DEPARTMENT USE ONLY Date Issued: 03/19/2019 REP: Shawn Bates ♦ REP: Rebecca Lieders t Permit g 4190090 Milepost(s) Side(s) Address: 370 Lakewood, Van Gordon Colorado St 80226 Address: 8OO Greeley, 8th Ave. Colorado 80631 S.N.# 034 118.430 Region: 4 . Email: shawn.bates@tallgrassenergylp.com Email: S.H. Section : A j Telephone: (303) 763-2981 Telephone: 479-306-8807 Patrol: 25 NOTICE TO PERMITTEE: For underground facility location information, contact the Utility Notification Center of Colorado (UNCC). Pursuant to 9-1.5-103 CRS. you shall not make or begin excavation without first notifying the UNCC and If necessary, then notifying the tier two members having underground facilities In the area of such excavation. Notification shall also be given to the COOT regional permitting office, or as otherwise directed by this Permit's Special Provisions. Notice of the commencement, extent and duration of the excavation work shall be given at least two business days prior thereto, not including the day of actual notice. The UNCC ACTIVITY DESCRIPTION (Furnished by Permittee) PURPOSE 1,/ Installation ■ Adjustment • Removal ■ Relocation [] SUE/Other ■ Maintenance of Existing Facility FACILITY (Type, size, class of transrnittant, design pressure or etc. ) 36" Natural Gas Pipeline DESCRIPTION OF WORK: Bore under Hwy 34 to install a 36" natural gas pipeline NATURE OF INSTALLATION: Longitudinal ►:1 Transverse (Crossing) 9 Buried ■ Aerial/Ground-mounted LOCATION: Hwy 34 MM 118.43 or 1062' East of CR 51 County: Weld County City/Town: ADDITIONAL REMARKS: No Traffic control will be allowed on Hw 34 for the Bore. Only approved TCP with 568 for equipment move SPECIAL PROVISIONS item tided b,‘ the Department) The Special Provisions are terms and conditions of this _ Distribution: Region File (Original) Permittee/Applicant Mtce Patrol Supw. Mtce Landscaping Supvr Inspector CDOT Form # 0333 01/09 Previous versions are obsolete and should not be used. The following Standard Provisions are terms and conditions of this pernut: Effective March 1, 2006 Utility work authorized under this permit shall comply with the requirements of the State Highway Utility Accommodation Code, and applicable federal, state, local, and industry codes and regulations Construction of any portion of the highway facility, including the pavement structure, subsurface support, drainage, landscaping elements and all appurtenant features, shall comply with the provisions of the CDOT Standard Specifications for Road and Bridge Construction, and with the Colorado Standard Plans (M & S Standards) 1 COMMENCEMENT AND COMPLETION Work on highway Right of Way (ROW) shall not commence prior to issuance of a fully endorsed and validated permit Permittee shall notify the CDOT inspector a At least 2 working days prior to commencing work, or resuming operations which have been suspended for five or more consecutive working days b When suspending operations for 5 or more working days c Upon completion of work Work shall not proceed beyond a completion date specified in the Special Provisions without written approval of the Department 2 PLANS, PLAN REVISIONS, ALTERED WORK Plans or work sketch (EXHIBIT A) are subject to CDOT approval A copy of the approved plans or sketch must be available on site during work Plan revisions or altered work differing in scope or nature from that authorized under this permit, are subject to CDOT prior approval Permittee shall promptly notify the CDOT inspector of changed or unforeseen conditions, which may occur on the job 3 INSURANCE Insurance Requirements for Utility and Special -Use Permits (Revised 7-05 per State Requirements) A The Permttee shall obtain, and mamtam at all times during the performance of work authonzed by this Permit, insurance in the following kinds and amounts The Permittee shall require any Contractor working for then[ within the State Highway Right of Way to obtain like coverage The Permittee shall also require any Contractor or Consultant performing work descnbed m sub- paragraph 4) below, to obtain Professional Liability Insurance I) Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all employees acting within the course and scope of their employment and work on the activities authorized by this Pemut 2) Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Consultants, products and completed operations, blanket contractual liability, personal injury, and advertising habihty with minimum limits as follows a $1,000,000 each occurrence, b $2,000,000 general aggregate, c $2,000,000 products and completed operations aggregate, and d $50,000 any one fire e For any permanent Permittee-owned installations located within the State Highway Right of Way, highway repairs, or site restoration, Completed Operations coverage shall be provided for a minimum period of one year following final acceptance of work If any aggregate limit is reduced below 1,000,000 because of claims made or paid, the Permittee, or as applicable - their Contractor, shall immediately obtain additional insurance to restore the full aggregate limit and furnish to CDOT a certificate or other document satisfactory to CDOT showing compliance with this provision 3) Automobile Liability Insurance covering any auto (including owned, hired and non -owned autos) with a minimum limit as follows $1 000,000 each accident combined single limit 4) For any a) engmeerntg design, b) construction inspection, or, c) traffic control plans approved by a Traffic Control Supervisor, done in association with the operations or installations authorized by this permit, Professional Liability Insurance with minimum limits of liability of not less than $1,000,000 Each Claim and $1,000,000 Annual Aggregate If the policy is written on a Claims Made form, the Penmttee, or, as applicable — their Consultant or Contractor, shall renew and maintain Professional Liability Insurance for a minimum of two years following final acceptance of the work, or provide a project specific Policy with a two year extended reporting provision 5) Pollution Legal Liability Insurance with minimum limits of liability of $1,000,000 Each Claim and $1,000,000 Annual Aggregate CDOT shall be named as an additional insured to the Pollution Legal Liability pohcy If the Policy is a component of the Professional Liability Policy, the Additional Insured requirement is waived, and the Policy shall be written on a Claims Made form, with an extended reporting period of at least two year following final acceptance of the work 6) Umbrella or Excess Liability Insurance with minimum limits of S 1,000,000 This policy shall become primary (drop down) in the event the pnmary Liability Policy limits are impaired or exhausted The Policy shall be written on an Occurrence form and shall be following form of the primary The following form Excess Liability shall include CDOT as an additional insured B CDOT shall be named as additional insured on the Commercial General Liability and Automobile Liability Insurance policies Completed operations additional insured coverage shall be on endorsements CG 2010 11/85, CG 2037, or equivalent Coverage required by the Pemut will be primary over any insurance or self- insurance program earned by the State of Colorado C The Insurance shall include provisions preventing cancellation or non -renewal without at least 30 days prior notice to CDOT by certified mail D The Permittee, or, as applicable — their Contractor or Consultant, will require all insurance policies in any way related to the Permit and secured and maintained by the Permittee, Contractor or Consultant, to include clauses stating that each earner will waive all nghts of recovery, under subrogation or otherwise, against CDOT, its agencies, institutions, organizations, of₹icers, agents, employees and volunteers E All policies evidencing the insurance coverages required hereunder shall be issued by insurance t,ompanres satisfactory to CDOT F The Permittee, or as applicable - their Contractor or Consultant, shall provide certificates showing insurance coverage required by this Permit to CDOT prior to commencing work No later than 15 days pnor to the expiration date of any such coverage, the Permittee, Contractor or Consultant, shall deliver CDOT certificates of insurance evidencing renewals thereof At any time during the term of this contract, CDOT may request in writing, and the Permittee, Contractor or Consultant, shall thereupon within 10 days supply to CDOT, evidence satisfactory to CDOT of compliance with the provisions of this section G Notwithstanding subsection A of this section, if the Permittee is a "public entity" within the meaning of the Colorado Governmental Immunity Act CRS 24-10-101, et seq , as amended ("Act'), the Permittee shall at all times during the term of this permit maintain only such liability insurance, by commercial policy or self- insurance, as is necessary to meet its liabilities under the Act Upon request by CDOT, the Permittee shall show proof of such insurance satisfactory to CDOT Public entity Permttees are not required to name CDOT as an Additional Insured H If the Pernttee engages a Contractor and/or Consultant to act inrlenenrlently from the Permitter on the nertmttevl work that CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS Contractor and/or Consultant shall be required to provide an endorsement naming CDOT as an Additional Insured on their Commercial General Liability, Auto Liability, Pollution Legal Liability and Umbrella or Excess Liability policies. 4. WORK WHERE DEPARTMENT LACKS AUTHORITY Utility work within municipal boundaries (pursuant to 43-2-135 CRS), on certain public lands, or on private property, may require separate approval of the appropriate jurisdictional agency or property owner. 5. INSTALLATIONS ON FREEWAYS CDOT may permit utility accommodations on freeways, including but not limited to the Interstate System, only in accordance with Utility Accommodation Code provisions. Special case exceptions as defined therein may be permitted only in accordance with FHWA-approved Departmental policy. 6. JOINT USE ALTERNATIVES As directed or approved by CDOT, if necessary for the safe and efficient use of the ROW, Permittee shall utilize joint use facilities such as the placement of two or more separate lines in a common trench, or attachment to the same overhead support. The Permittee will be responsible for proper coordination with other affected utilities. 7. ATTACHMENT TO HIGHWAY STRUCTURES Permittee is responsible for designing structure attachments, subject to the approval of the CDOT Staff Bridge Design Engineer. 8. DRAINAGEWAYS AND WATERCOURSES The flow of water shall not ever be impaired or interrupted. Where possible, "rossings of ditches, canals or water -carrying structures shall be bored or acked beneath. Irrigation ditch or canal crossings require approval of the ditch :ompany or owner. Permittee shall repair damage to any drainage facility to the satisfaction of the owner. 9. TRAFFIC CONTROL PLAN a. Prior to commencing work, the Permittee shall develop and submit to the Department for acceptance, a Traffic Control Plan (TCP) for any accommodation work that will affect traffic movement or safety. The Permittee shall implement the TCP and utilize traffic control devices as necessary to ensure the safe and expeditious movement of traffic around and through the work site. b. The Pernittee shall develop the TCP, and Methods of Handling Traffic (MHT's) included therein, in conformance with the Manual on Uniform Traffic Control Devices (MUTCD), the Colorado Supplement thereto adopted by the Commission pursuant to sections 424-104 and 424-105 CRS, the Department's standard specifications for temporary traffic control and the Department's standard plans for signing - Standard Plans S 630-1 and S 630-2. The TCP shall include provisions for the passage of emergency vehicles through the work zone, and shall conform to the requirements of the Americans with Disabilities Act. The TCP and MHT's shall contain sufficient detail to demonstrate conformity with all applicable requirements. c. The Permittee shall have a competent person at the work site at all times in responsible charge of temporary traffic control. In situations where the TCP goes beyond any Typical Application shown in the MUTCD, or particularly dangerous roadway or traffic conditions exist, the Department may require the Permittee to have a Traffic Control Supervisor (TCS) develop or approve the TCP or to have a TCS on -site during work. The TCS shall be certified as a worksite traffic supervisor by either the American Traffic Safety Services Association (ATSSA) or the Colorado Contractors Association (CCA), and shall have a current CDOT flaggers' certification card. The TCS shall be responsible for the planning, preparation, coordination, implementation, and inspection of the TCP. d. The Permittee shall not start the permitted work before the Department accepts the TCP. e. The Department may review and order changes to the TCP and MHT's during performance of the work, as required. f. The Permittee shall comply with the TCP at all times during performance of the work. g. The Permittee shall keep a copy of the TCP at the work site at all times during performance of the work for inspection. h. The TCP shall ensure that closure of intersecting streets, mad approaches and other access points is minimized. On heavily traveled highways, the Department will not permit operations that interfere with traffic during periods of peak traffic flow. 3. When Permittee operations coincide with highway construction or maintenance operations, the Permittee shall develop and implement the TCP in cooperation and coordination with the highway agency and/or its contractors and as otherwise directed by the Department in the permit. All flaggers shall have a current CDOT flagger certification card and shall be capable of communicating with the traveling public and others at the work site. 10. NCHRP 350 CRASHWORTHINESS REQUIREMENTS FOR WORK ZONE TRAFFIC CONTROL DEVICES Work zone devices designated by FHWA as: Category I, including but not limited to single -piece drums, tubes, cones and delineators; Category H, including but not limited to barricades, vertical panels with light, drums or cones with light, portable sign supports, intrusion detectors and type III barricades; or as Category III, including but not limited to concrete barriers, fixed sign supports, crash cushions, and other work zone devices not meeting the definitions of Category I or II; shall meet NCI-IRP 350 crash test requirements. The Permittee, or their contractor shall obtain and make available upon request, the manufacturer's written NCHRP 350 certification, or as applicable, the FHWA Acceptance Letter, for each type of device. FHWA Acceptance Letters for Category II or Category III Work Zone Devices may be accessed through the FHWA website at htw;,, sato). th watdoLgewroadway dcp /road hardware.wzd.htm 11. WORKER SAFETY AND HEALTH a. All workers within the State Highway right of way shall comply with their employer's safety and health policies/procedures and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. b. Personal protective equipment (PPE) (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers in the SH ROW, except when in their vehicles, shall wear the following personal protective equipment: 1) Head protection that complies with the ANSI Z89.1 standard; 2) At all construction sites or whenever there is danger of injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41; 3) High visibility apparel, which shall, at a minimum comply with the Class 2 specifications of the ANSI/1SEA 107standard. 02/06 CDOT Permit Form 333 and Standard Provisions Page 3 of 9 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS Class 3 apparel shall be considered for use at night or in particularly hazardous situations 4) The most recent version of the ANSI standards listed above shall apply 12 ADA REQUIREMENTS The Permittee shall comply with the applicable provisions of the Americans With Disabilities Act, with respect to both permanent facilities Installations and temporary work zones 13 CLEAR ROADSIDE CONSIDERATIONS a CDOT is committed to provide a roadside area that is as free as practical from nontraverseable hazards and fixed objects ("clear zone") New above ground installations may be permitted within the clear zone only upon a showing that no feasible alternate locations exist Permittee must utilize appropriate countermeasures to minimize hazards b Permittee shall remove materials and equipment from the highway ROW at the close of daily operations The traffic control plan must include protective measures where materials and equipment may be stored on ROW Protection of open trenches and other excavations within highway ROW shall be addressed m the Permittee's traffic control plan All excavations shall be closed at the end of daily operations, and no open excavation will be allowed in the clear zone after dark The Pcrnuttee agrees to promptly undertake mitigating or corrective actions acceptable to the Department upon notification by CDOT that the installation permitted herein has resulted in a hazardous situation for highway users 14 GENERAL CONSTRUCTION REQUIREMENTS a Work shall not be performed at night or on Saturdays, Sundays, or holidays without prior authorization or unless otherwise specified in this permit. CDOT may restrict work on ROW during adverse weather conditions or during periods of high traffic volume b Those areas within ROW, which must be disturbed by permit operations, shall be kept to a practical minimum Permittee shall not spray, cut, or trim trees or other landscaping elements within highway ROW, unless such work is otherwise specified In this permit, or clearly indicated on the approved plans Cleated or tracked equipment shall not work on or move over paved surfaces without mats, or pads on tracks c Material removed from any portion of the roadway prism must be replaced in like kind with equal or better compaction Segregation of material is not permitted The permitted facility shall be of durable materials In conformity with accepted practice or industry standards, designed for long service life, and relatively free from routine servicmg or maintenance d Construction or compaction by means of jetting, puddling, or water flooding is prohibited within all highway ROW e Thrust blocks are required on all vertical and horizontal bends in pressure pipes f Meters shall not be placed on highway ROW except within corporate limits where municipal regulations allow such use 15 ALIGNMENT, COVER, CLEARANCE a Location and ahgnment of Pemmttee's facilities shall only be as specified in tlus permit or as otherwise indicated in the approved plans or work sketch (EXHIBIT A) b Parallel installations will not be permitted within roadways (including curbing and/or shoulders) or median areas, except within corporate boundaries, subject to municipal regulations e d Parallel installations should be located as near as practicable to the ROW line Crossings shall be as nearly perpendicular to the highway as feasible Where no feasible alternate locations exist, the Department may permit parallel installations along roadside areas within 15 feet from edge of shoulder or back of curb In these cases, the facility must be so located and safeguarded as to avoid potential conflict with necessary highway appurtenances (signs, guard rail, delineators, etc ) Specific safeguards such as increasing depth of cover to 60 inches, capping, or encasement, shall be specified in this permit's Special Provisions e Parallel installations shall follow a uniform alignment, wherever practical Due consideration must be given to conserving space available for future utility accommodations The standard allowable deviation from the approved horizontal alignment is ± 18 mches f Minimum cover shall conform to the Special Provisions Normal specified cover will be 48 niches or greater, reduced cover may be approved where site conditions warrant, subject to other safeguards as may be specified or approved in the permit. Minimum overhead clearance shall conform to the Special Provisions, consistent with Utility Accommodation Code criteria 16 PAVEMENT CUTS AND REPAIRS Paved surfaces shall not be cut unless otherwise specified in this permit No more than one half the width of the roadbed may be opened at a time, when otherwise permitted Pavement shalt be sawed or wheel -cut to a neat line Pavement shall be replaced to a design equal to or greater than that of the surrounding undisturbed pavement structure Pavement repair shall conform to the Special Provisions or the approved plans 17 BORING, JACKING, ENCASEMENT Unless otherwise specified, buried crossings shall be bored or jacked beneath the roadway, at least from toe of slope to toe of opposite slope Portals for untrenched crossings more than 5 feet in depth shall be bulk headed m conformance with OSHA construction and safety standards Portal limits of untrenched crossings shall be established safely beyond the highway surface and clear zone and in no case shall the lateral distance from the surfaced area of the highway to the boring or jacking pit be less than the vertical difference in elevation between such surface and the bottom of the pit Water jetting or tunneling is not permitted Water assisted boring may be pernutted as determined by the CDOT Inspector Boring hole shall be oversized to the minimum amount required to allow pull -through of the conduit being installed Resultant voids shall be grouted or otherwise backfilled, subject to CDOT approval Ends of bored sections shall not be covered before being inspected Encasement shall be consistent with Utility Accommodation Code provisions CDOT may require protective casing for shallow installations or certain conduit materials Encased crossings shall extend at least from toe of slope to toe of slope, or the full width between access -control lines on freeways, including the Interstate System 18 INSPECTION AND ACCEPTANCE a CDOT will determine the extent of inspection services necessary for a given installation Permittee shall attend final inspection as may be required. If the initial performance of permitted work was unacceptable, as determined by the Department, the Pemuttee shall perform any reconstruction or improvement of that work as ordered by the Department, in a timely manner and prior to any further constriction If permitted operations are not being carried out in compliance with the terms and conditions of this permit, the Department may order the Permittee to perform whatever corrective measures are necessary to attain compliance with the permit If there is an immediate danger to the public's health, safety or welfare, the Department may order the Permittee to cease all operations and if necessary, to remove all equipment and facilities from the SHROW b Final acceptance does not relieve Permittee of maintenance obligations toward those elements of the highway facility 02/06 CDOT Permit Form 333 and Standard Provisions Page 4 of 9 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS constructed under this permit. Final acceptance begins the two-year warranty period (see requirement under "Operation and Maintenance" below). 19. ENVIRONMENTAL CLEARANCES/PERMITS a. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to their activities and to obtain any clearances that are required directly from the appropriate regulatory agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from CDOT Permitting Offices or may be accessed via the CDOT webpage at http:/iwww.dot.state.co.us/UtilitvProgiarn/Fonns.efm. Failure to comply with regulatory requirements may result in suspension or revocation of your CDOT permit, or enforcement actions by other agencies. b. The Special Provisions of this permit shall list any specific environmental clearances or permits that the Department has been notified by the Permittee or by the administering regulatory agency apply to the operations authorized by this permit. The Special Provisions shall require the Permittee obtain the listed environmental clearances/permits prior to beginning work. c. The Permittee shall comply with all requirements described in the CDOT Environmental Clearances Information Summary, including those pertaining to: 1) Ecological Resources 2) Cultural Resources 3) Discharges of Stormwater or Process Water 4) Hazardous Materials 5) Discharges of Dredged or Fill Material 6) Erosion and Sediment Control 7) Disposal of Drilling Fluids 8) Concrete Washout 9) Spill Reporting 10) Transportation of Hazardous Materials d. Disturbance of any wildlife shall be avoided to the maximum extent practicable. If threatened or endangered species or archeological or historical artifacts are encountered during the progress of a project, work in the subject area shall be halted and the CDOT regional permitting office shall be contacted immediately for direction as to how to proceed. e. All discharges of stormwater or process water are subject to the applicable provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. f. There shall be no disposal of hazardous materials in the state highway right of way. Solid waste shall be removed from the state highway right of way and disposed of at a permitted facility or designated collection point (such as the Permittee's own dumpster). Drilling fluids must be disposed of as described in the ECIS. g. If pre-existing solid waste or hazardous materials contamination (including oil or gasoline contaminated soil, asbestos, chemicals, mine tailings, etc.) are encountered during the performance of work, the Permittee shall halt work in the affected area and immediately contact the CDOT regional permitting office for direction as to how to proceed. h. Spills shall be reported immediately using the CDOT Illicit Discharge Hotline (303) 5124446. Spills on the highway, into waterways, or that may otherwise present an immediate danger to the public, shall be reported by calling 911 or the Colorado State Patrol at (303) 239-4501, and the Colorado Department of Public Health and Environment at 1-(877) 518-5608. RESTORATION OF RIGHT OF WAY Prior to final acceptance, all disturbed portions of highway right of way shall be cleaned up and restored to their original condition, subject to CDOT approval. Seeding, sodding, and planting shall be as specified, or otherwise approved by CDOT. Construction, maintenance and watering requirements shall conform to the CDOT Standard Specifications. Where landscape restoration must be delayed due to seasonal requirements, such work may be authorized by separate permit. Permittee shall use only certified weed -free seed and mulch. Permittee shall clean equipment before transporting it into or out of the state to prevent the migration of noxious weeds. 21. OPERATION AND MAINTENANCE a. Permittee agrees to own and maintain the installation permitted herein. The facility shall be kept in an adequate state of repair and maintained in such a manner as to cause the least interference with the normal operation and maintenance of the highway. b. If any element of the transportation facility, constructed or replaced as a condition of this permit, fails within 24 months due to improper construction or materials, Permittee shall make all repairs immediately as notified in writing by CDOT. c. Routine, periodic maintenance and emergency repairs may be performed under the general terms and conditions of this permit. CDOT shall be given proper advance notice whenever maintenance work will affect the movement or safety of traffic. In an emergency, the CDOT Region office and the State Patrol shall immediately be notified of possible traffic hazards. Emergency procedures shall be coordinated beforehand, where possible. d. Maintenance activities requiring new excavation or other disturbance within highway ROW may require separate permit. Where highway construction or maintenance operations so require, Permittee will shut off lines, remove all combustible materials from the highway right of way, or provide other temporary safeguards. 22. MARKERS, LOCATION AIDS, LOCATION ASSISTANCE a. The utility shall take all practical measures to ensure that buried utility facilities are surface -detectable by standard geophysical methods. Where the utility facilities, by the nature of their material properties, burial depth or other factors, may by themselves not be surface -detectable, the utility shall, where feasible, incorporate detection wire or other detection aids in the installation of those facilities. In instances where detection aids are not feasible or would be ineffective and surface-detectability cannot be ensured, surface markers shall be installed as directed by the Department and as -constructed plans and showing the accurate horizontal and vertical location of the buried facilities shall be provided to the Department+ b. All plowed or trenched installations must include color -coded (using the American Public Works Association color coding system) warning tape placed not less than 12 inches vertically above the top of the line. The warning tape shall be surface -detectable if needed to facilitate detection of the line. c. The utility shall place readily identifiable markers at the right of way line where it is crossed by pipelines carrying transmittants which are flammable, corrosive, expansive, energized, or unstable, particularly if carried at high pressure or potential, except where a vent will serve as a marker. d. The utility shall place markers for longitudinal underground facilities vertically above the facilities or at a known horizontal offset, unless otherwise approved in writing by the Department. Each marker shall provide a fore- and backsight to succeeding and preceding markers. Markers shall be installed at suitable intervals along tangent sections, at angle points or points of curvature and at reasonable intervals along curves. e. The utility shall maintain any markers required by this Code for the life of the installation. 02/06 CDOT Permit Form 333 and Standard Provisions Page 5 of 9 CDOT UTILITY/RELOCATION/SPECIAL, USE PERMIT STANDARD PROVISIONS f The Department may require the utility to submit "as -constructed" plans The Department may enter into an agreement with the utility whereby the Department can rely on those plans for the exact location of the utility for any future excavations, and need not give notice to the utility under Article 1 5 of Title 9, CRS g The utility will comply with the applicable requirements of Article 1 5 of Title 9 CRS, mcludmg any requirement to participate in the State's Notification Association pursuant to 9-1 5-105 C R S All owners of underground utilities within the SHROW, with the exception of the Department itself, must become members of the UNCC Notification Association h In addition to complying with the provisions of Artiiie 1 5 of Title 9 C R S (One -Call Statute) in response to the Department's notification of planned excavations, utility owners shall surface - mark their buried utility facilities that are located within the SHROW in order to facilitate Departmental engineering and design activities, upon reasonable request from the Department, and at no cost to the Department The Permittee shall respond to such request within a reasonable timeframe acceptable to the Department, but no longer than 14 calendar days from the date of request, and the accuracy of the surface marking shall be within 18 inches of either side of the actual location of the buried facility 23 ADJUSTMENTS DUE TO HIGHWAY CONSTRUCTION If for any transportation purpose it becomes necessary to remove, adjust, or relocate this facility, Permittee will do so promptly, at no cost to the CDOT except as provided by law, upon written notice from CDOT and m accordance with the utility relocation permit issued to cover the necessary work The utility shall perform the relocation at or within a tune convenient to and m proper coordination with the project or transportation -related activity, to minimize public mconvemence and cost, as directed by the Department in the permit authorizing the relocation The utility company shall pay for damages caused by the company's delay in the performance of utihty relocation work or interference with the performance of transportation project work done by others Such damages include, but are not limited to, payments made by the Department to any third party based on a claim that performance of the transportation project work was delayed or mterfered with as a direct result of the utility company's failure to timely perform the utility relocation work. Damages resulting from delays in the performance of the utility relocation work or interference with the transportation project work that are caused by events beyond the utility company's ability to reasonably foresee or control (a force majeure) shall not be charged to the utility company 24. ABANDONMENT, RETIREMENT, CHANGE IN OWNERSHIP a The Permittee shall notify the Department in writing of the planned retirement or abandonment of its facility or any portion thereof The Department will notify the Permittee in wntmg if it determines that the facilities may be retired or abandoned m place, along with any special conditions that may apply b Retired facilities shall remain the Permittee's sole responsibility, subject to all provisions of the Utility Accommodation Code and all of the terms and conditions of the permit issued for that facility, mcludmg maintenance and relocation requirements c The Permittee shall promptly remove all abandoned facilities from the SH ROW and promptly restore the SH ROW to pre-existing or other conditions prescnbed by the Department unless the Department in writing expressly allows the facility to remain in place Written notice from the Department, allowing an abandoned facihty to remain in place, may include special conditions d If utility facilities are retired or abandoned m place, the utility shall comply with that decision if directed by the Department 1) cap, plug or fill Ines, 2) furnish suitable location records for any such buned facilities, 3) maintain its own records of such facilities and respond to locate notices/requests from the UNCC and/or excavators, In providing such locates, the utility will indicate to the requesting entity whether or not the subject facilities are retired or abandoned 4) perform any other actions as deemed necessary by the Department to protect the transportation facility and/or the traveling public e If the ownership of utihty facihhes is transferred, both the ongmal Permittee and the new owner shall notify the Department m writing pnor to the change in ownership, and such notice shall state the planned date of change in ownership The notice from the new owner shall include a written statement accepting all terms and conditions of the existing permit, effective upon the planned date of the change in ownership f Utility facilities containing asbestos may not be abandoned in -place Ordinarily, such facilities must be removed from the SHROW when take out of service On a case -by -case basis, the Department may allow such facilities to be retired in -place, with the owner retaining full legal ownership and responsibility for the facilities 25 SUSPENSION AND CANCELLATION a The CDOT inspector may suspend operation due to 1) Non compliance with the provisions of this permit 2) Adverse weather or traffic conditions 3) Concurrent transportation construction or maintenance operations in conflict with the permitted work 4) Any condition deemed unsafe for workers or for the general public b Work may resume when grounds for suspension no longer exist This pernnt is subject to cancellation due to 1) Persistent noncompliance with permit provisions 2) Abandonment or transfer of ownership 3) Superseded by new permit covering the same installation 4) Conflict with necessary planned transportation construction c d Permittee must promptly termmate occupancy upon notice of cancellation of permit, unless a new permit is applied for and granted Where Permittee does not fulfill an obligation to repair or maintain any portion of the highway facility, or control and safely maintain the flow of traffic thereon, CDOT reserves the right, in lieu of canceling this permit, to accomplish the required work by any other appropnate means, and Pernuttee shall be liable for the actual costs thereof 02/06 CDOT Permit Form 333 and Standard Provisions Page 6 of 9 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances Information Summary PURPOSE - This summary is intended to inform entities external to CDOT that may be entering the state highway right-of-way to perform work related to their own facilities (such as Utility, Special Use or Access Permittees), about some of the more commonly encountered environmental permits/clearances that may apply to their activities. This listing is not all-inclusive - additional environmental or cultural resource permits/clearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional information i' there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT — Please Review The Following Information Carefully — Failure to Comply With Regulatory Requirements May Result In Suspension or Revocation of Your CDOT Permit, Or Enforcement Actions By Other Agencies. CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE): General Information — (303) 692-2035 Water Quality Control Division (WQCD): (303) 692-3500 Environmental Permitting Website https://www.colorado.gov/oacific/cdohe/all-permits CDOT Water Quality Program Manager: (303) 757-9343 ittps://www.codot.gov/programs/environmental/water-quality D CDOT Asbestos Project Manager: Phil Kangas, (303) 512-5519 Colorado Office of Archaeology and Historic Preservation: (303) 866-5216 U.S. Army Corps of Engineers, District Regulatory Offices: Omaha District (NE CO), Denver Office (303) 979-4120 http://www.nwo.usace.arrny.mii/Missions/RegulatoryProgram/Colorado.as .�x Sacramento Dist. (Western CO), Grand Junction Office (970) 243-1199 http://www.socusace.army.miuMissionsikegulatory.asp Albuquerque District (SE CO), Pueblo Office (719)-543-9459 http://www.spa.usace.army.mil/Missions/RegulatoryPrograrnandPermits.aspx I COOT Utilities, Special Use and Access Permitting: (303) 757-9654 htjps://www.codot.gov/business/permits Wildlife Resources - Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or suspected threatened or endangered species habitat will require speciai authorization from the CDOT permitting office. If any threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. information about threatened or endangered species may be obtained from the CDOT website, nttp://www.codot.goviDrogramsienvironmentaliwildlifeiguidelines, or the Colorado Parks and Wildlife (CPW) website, http://www.cpw.state.co.us/team/Pages/SOC-Threatener4EndaneeredList.asox. Additional guidance may be provided by the appropriate Region Planning and Environmental Manager (RPEM). Cultural Resources - The applicant must request a file search of the permit area through the Colorado Office of Archaeology and Historic Preservation (OAHP), Denver, to ascertain if historic or archaeological resources have previously been identified (http://www.historicolorado.org/oahp/file search). Inventory of the permit area by a qualified cultural resources specialist may be necessary, per the recommendation of CDOT. If archaeological sites/artifacts or historic resources are known to exist prior to the initiation of the permitted work or are encountered as the project progresses, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by COOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact Information: Contact the OAHP for file searches at +303; 866-5216. Paleontological Resources - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder (rittPs:iicumuseum.coiorado.edu/research paieontoioUyivertebrates/ppiicie ), and the Denver Museum of Nature and Science eittp://www.dmns_org/science/collections/earth-science-collections/) to ascertain if paleontological resources have been previously identified in or near the permit area. Inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. If fossils are encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information: See the museum websites listed above for Paleontological Collections Manager contact information. Contact the CDOT Paleontologist for further information at nicole.peavey state.co.us or (303) 757- 9632. The CDOT Paleontologist will not conduct a comprehensive file search independently of the museums. Hazardous Materials. Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved Certificate of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25-15-301 et al, and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) prohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entities entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials contamination (including oil or petroleum contaminated soil, asbestos, chemicals, mine tailings, etc.) is encountered during the performance of work, the permittee shall halt work in the affected area and immediately contact the CDOT Regional Permitting Office for direction as to how to proceed. Contact Information: Theresa Santangelo-Dreiling, CDOT Hazardous Materials Management Supervisor: (303)512-5524_ Asbestos Containing Materials, Asbestos Contaminated Soil - All work on asbestos containing materials (ACM) must comply with the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) Regulation 8. Disposal of ACM, and work done in ` asbestos -contaminated soil, must comply with the CDPHE Hazardous Materials and Waste Management Division's {HMWMD Solid Environmental Clearances Information Page 1 of 3 Colorado Department of August Waste Regulations. The application for any CDOT permit must specifically identify any ACM involved in the work for which authorization is being requested. Additional guidance or requirements may be specified in the permit special provisions. Contact Info: CDPHE APCD and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additional information concerning clearance on CDOT projects is available from the CDOT Asbestos Project Manager (303) 512- 5519, or Theresa Santan aelo-Dreiling, Hazardous Materials Management Supervisor: , 303 ) 512-5524. Transportation of Hazardous Materials - No person may offer or accept a hazardous material for transportation in commerce unless that person is registered in conformance with the United States Department of Transportation regulations at 49 CFR, Part 171. The hazardous material be properly classed, described, packaged, marked, labeled, and in condition for shipment as required or must authorized by applicable requirements, or an exemption, approval or registration has been issued. Vehicles requiring a placard, must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact Information: For authorization and info call the Federal Motor Safety Carrier Administration, US DOT for inter- and intra-state HAZMAT more Registration (1303) 969-6748. Colorado Public Utilities Commission: O03) 894-2868. Discharge of Dredged or Fill Material — 404 Permits Administered By the U.S. Army Corps of Engineers, and Section 401 Water Quality Certifications Issued by the CDPHE WQCD - Corps of Engineers 404 permits are required for the discharge of dredged or fill materials into waters of the United States, including wetlands. There are various types of 404 permits, including nationwide permits, which are issued for activities with relatively minor impacts. For example, there is a nationwide permit for utility line activities (nwp #12). Depending upon the specific circumstances, it is possible that either a "general" or "individual" 404 permit would be required. If an individual 404 permit is required, section 401 water quality certification from the CDPHE WQCD is also required. Contact the appropriate Corps District Regulatory Office for information about what type of 404 permit may be required (contact information above. Contact the CDPHE Water Quality Control Division at (303) 692-3500. Working on or in any stream or its bank - In order to protect and preserve the state's fish and wildlife resources from actions that may obstruct, diminish, destroy, change, modify, or vary a natural existing stream or its banks or tributaries, it may be necessary to obtain a Senate Bill 40 certification from the Colorado Department of Natural Resources. A stream is defined as 1) represented by a solid blue line on USGS 7.5' quadrangle maps; and/or 2) intermittent streams providing live water beneficial to fish and wildlife; and/or 3) segments of streams supporting 25% or more cover within 100 yards upstream or downstream of the project; and/or 4) segments of streams having wetlands present within 200 yards upstream or downstream of the project measured by valley length. The CPW application, as per guidelines agreed upon by CDOT and CPW, can be accessed at nttps://www.codot.gov/programs/environmental/ .Nildlife/guidelines. Stormwater Construction Permit (SCP) and Stormwater Discharge From Industrial Facilities - Discharges of stormwater runoff from construction sites disturbing one acre or more - or certain types of industrial facilities, such as concrete batch plants - require a CDPS Stormwater Permit. Contact Information: Contact the CDPHE Water Quality Control Division at (303) 692-3500. Website: https://wvvw.coiorado.yovipacific/cdpheiwq-construction-yenerai-permits and hops.ricoloraao.govipacific/cciphe/wu-commerce-ana- industrv-permits. Construction Dewaterinq (Discharge or Infiltration) and Remediation Activities - Discharges of water encountered during excavation or work in wet areas may require a Construction Dewatering or Remediation Activities Discharge Permit. Contact Information: For Construction Dewatering and Remediation Activities Discharge Permits, contact the CDPHE WQCD at (303) 692- 3500. For Applications and Instructions (CDPHE website): https://www.colorado.gov/pacific/cdphe/w4-construction-general-permits. Municipal Separate Storm Sewer System (MS4) Discharge Permit - Discharges from the storm sewer systems of larger municipalities, and from the CDOT highway drainage system that lies within those municipalities, are subject to MS4 Permits issued by the CDPHE WQCD. For facilities that lie within the boundaries of a municipality that is subject to an MS4 permit, the owner of such facility should contact the municipality regarding stormwater related clearances that have been established under that may municipality's MS4 permit. All discharges to the CDOT highway drainage system or within the Right of Way (ROW) must comply with the applicable provisions of the Colorado Water Quality Control Act, the Water Quality Control Commission (WQCC) Regulations (https.i/www.colorado.gov/pacific/cdphe/wqcc-regulations-andpolicies-and-water-quality-statutes) and the CDOT MS4 Permit # COS - 000005 (https://www.codot.gov/programs/environmental/water-quality/document. ). Discharges are subject to inspection by CDOT and CDPHE. Contact the CDPHE Water Quality Control Division at (303) 692-3500 for a listing of municipalities required to obtain MS4 Permits, or go to https://www.colorado.gov/pacific/cdphe/wq-municipal-ms4-permits. For CDOT-related MS4 regulations, go to: https:irwv '..codot.gov/programs/environmental/water-gL �lihr/storm vater-proqra ms. html. General Prohibition — Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but are not limited to, substances such as wash water, paint, automotive fluids, solvents, oils or soaps and sediment. Contact Information: Contact the CDPHE Water Quality Control Division at 303,} 692-3500. General Authorization - Allowable Non-Stormwater Discharges - Unless otherwise identified by CDOT or the WQCD as significant sources of pollutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, irrigation water, uncontaminated springs, footing drains, water line flushing, flows from riparian habitats and wetlands, and flow from firefighting activities. Allowable non-stormwater discharges can be found under Illicit Discharge PDD at: -ittps://www.codot.qov/programs/ environmental/water-quality/stormwater-programs.html. Contact Information: The CDPHE Water Quality Control Division (telephone #'s listed above). Erosion and Sediment Control Practices - For activities requiring a Stormwater Construction Permit, erosion control requirements i will be specified in that permit. In situations where a stormwater permit is not required, all reasonable measures should be taken to minimize erosion and sedimentation according to CDOT Standard Specifications 107.25, 208, 213 and 216 (https.inivwww.cuuot.gov/ nustnessldest nskpport/20i 1-construction-specifications/2Oi i-Specsi2ul 1 -specs -boo ). All disturbances require a stabilization plan, native seeding or landscape design plan according to applicable COOT Standard Specifications 212-217 and 623. The CDOT Erosion Control and Stormwater Quality Guide (available from the Bid Plans Office at (303) 757-9313) should be used to design erosion controls and restore disturbed vegetation. Environmental Clearances Information Page 1 of 3 Colorado Department of August IDisposal of Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as "discharges' or "solid wastes," and in general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being separated from fluids or after infiltration of the water, provided: 1) the drilling fluid consists of only water and bentonite clay, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, 3) the solids are covered and the area restored as required by CDOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: Contact CDPHE (telephone #'s listed above). Noxious Weeds and Invasive Species Management Plan - Noxious Weeds and Invasive Species guidance can be found by contacting the Colorado Department of Agriculture (https://www.colorado.gov/pacificiagconservation/noxiousweeds) and the Colorado Division of Parks and Wildlife (htto://cow.state.co.us/aboutus/Paees/RS-NoxiousWeeds.aspx). In either case, management plans involving the control of noxious weeds associated with the permitted activity and cleaning of equipment will be required. Concrete Washout - Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, inlets, receiving waters, or in the CDOT ROW. Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, drainageways, anc inlets. Concrete washout shall only be performed as specified by the CDOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact Information: Contact CDPHE or find additional information on the CDOT website: httios://www.codot.gov/business/designsupkort/2011-constructior apeciticatjons/2x11-Sp and refer to the specifications and their revisions for sections 101, 107 and 208. Spill Reporting - Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain or buried. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4446 (4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, into waterways, any spill in the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1-877-518-5608. More information can be found at https://www.colorado.gov/pacific/cdphe/emergency- / ;po�tin Environmental Clearances Information Fage 1 of 3 Colorado Department of August CO ORA Department of Transportatior What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowmett flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking into the Bound Why is stormwater runoff a problem) Stormwater can pick up debris, chemicals, dirt and other pollutants and flow Into Coors storm drain system or directly into a stream, river, lake, wetland or reservoir. Anything that enters CDOT's storm drain system is discharged untreated into the waterways we use for fishing, swimming, and providing drinking water Tips for Reporting an Illicit Discharge Call the :Ilion discharge hotline at (303) 512-4426 From a safe distance try to estimate the amount of the discharge. identify characteristics of the discharge (color, odor, algae, etc.). Obtain information on the vehicle dumping the waste (if applicable). Do not approach! Call *CAP for illicit dumping. if possible, take a photo, record a license plate. For more information on CDOT Utility Permits: https:/, www.codot.ov businesslpermats'ut'litte speciafuse For more information on CDOT Access Permits: httpsuwwwspdot_gpvjbusinessipermitslaccess permits For more information on COOT Water Quality Program: Water Quaht-y Program Manager 4201 E. Arkansas Ave. Shumate Building Denver, Colorado 80222 303-757-9343 Department of Tiansportation Water L. uallt, I tunrara Industrial tat Miles F rt }Qra m COOT has a Municipal Separate Storm Sewer System permit, otherwise known as (MS4) from the Colorado Department of Public Health and Environment.. The permit states that only stormwater can be discharged from C0OT's storm drain system =.w.i pipe ens TOME IVA-MYOSIN TREATMENTPLANT 111 a storm dr•in PiPS TOTNEIACAL MATINR0DY As part of the permit, COOT has several different programs to prevent pollutants from entering into the storm drain system: Construction Site Program • New Development Redevelopment Program Illicit Discharge Program • Industrial Facilities Program • Public Education and Outreach Program • Pollution Prevention and Good Housekeeping Program • Wet Weather Monitoring Program CO _ORADO Department of Transportation Control Measures for Industrial Facilities Industrial facilities can use control measures (CM) otherwise known as Best Management Practices (BMP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering into CD0T's storm drain system. Control Measures also include treatment, operating procedures, and practices to control site run off which can include structural and non-structural contrors. cltrAT) T$£ 6R UNTLET I et Del !S THERE A M! a 7H45 THE APO IS THE Ma ►wGnaT MALNTAPtED? V In compliance!! COOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned tine, facility, or system producing, transmitting or distributing the following: / Communications 1 Cable television f Power • Electricity if Light ✓ Heat Gas 7 Oil Crude Products ✓ Water ✓ Stream I Waste Stormwater not connected with highway drainage ✓ Similar Commodity CO.O ALJO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work in the state highway right-of-way win require some type of environmental permit or clearance for that work. CDOT has put together an Environmental Clearances Information Summary for those applying for a COOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: https://www.codot.goyhmgramilenviro n mental/resources/gu idance- standardlEnvironmental%20Clearances% 20l nfo% 2 0 Su m m a ry . pd f Seed Mix 4 - Brown Elevation: Low Temperature: Warm Humidity: Average Grasses 1 Big Bluestem — 15% (3 6 lbs/acre) 2 Fringed Brome — 13% (1 9 lbs/acre) 3 Sand Lovegrass — 12% (0 3 lbs/acre) 4 Green Sprangletop — 10% (0 6 lbs/acre) 5 Western Wheatgrass — 10% (3 1 lbs/acre) 6 Buffalograss — 10% (6 2 lbs/acre) 7 Sand Dropseed — 8% (0 1 lbs/acre) Forbs/Shrubs/Flowering 1 Gaillardia — 7% (1 6 lbs/acre) 2 California Poppy — 5% (0 6 lbs/acre) 3. Desert Verbena — 4% (0 3 lbs/acre) 4 Palmer Penstemon — 4% (0.2 lbs/acre) 5. Indian Blanket — 2% (0 3 lbs/acre) Seeding Application: Drill seed 0 25" to 0 50" into the topsoil In areas that are not accessible to drill, hand broadcast at triple the above rate and rake 0 25" to 0 50" into the topsoil Mulching Application: 15 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre Note: Hydroseeding and/or Hydromulching will not be allowed CDOT State Hicihwav Witty Accommodation Cade 2009 34435 the utility shall replace excavated portions of the base and subgrade with flowable backfill, or as otherwise directed by the Department, and 34436 the utility shall trim all overbreaks or incidental damage of existing pavement back to a neat ]me before patching, and 3.4437 the utility shall repair all surface gouges or other minor damage in a manner acceptable to the Department, and 34438 the utility shall restore all pre-existmg pavement markings in and adjacent to resurfaced areas 3 4 5 Trenched Construction and Backfill 3 4 5 1 The utility shall construct vertical -sided trenches, of uniform width, and no wider than the line diameter plus three feet, unless the utility demonstrates to the Department's satisfaction that such construction is impracticable 3452 Shoring or bulkheadmg shall conform with all applicable Federal, State and local jurisdiction construction and safety standards 34.53 The utility shall provide drainage from excavation areas 3454 The utility shall not perform construction or compaction by means of jetting, puddling, or water flooding within SH ROW, however, a limited amount of puddling may be allowed up to the spnnglme of the pipe when free -flowing granular backfill materials are used, when necessary to obtain proper compaction of pipeline bedding 3455 Unless otherwise directed or approved by the Department, the utility shall backfill trenches as follows 3455.1 replace excavated material with flowable backfill as specified by the Department within toes of slopes; and/or 34552 place backfill in 6 inch layers, each consolidated by mechanical tamping and controlled addition of moisture to a density equal to or greater than that of the surrounding undisturbed soil outside toes of slopes 34 6 Trenchless Installations 3.4 6 1 Portal limits of untrenched crossings shall be established safely beyond the highway surface and clear zone, and m no case shall the lateral distance from the surfaced area of the highway to the boring or jacking pit be less than the vertical difference in elevation between such surface and the bottom of the pit U 55 CDOT Slate Highway Utility Accommodation Code 2009 3462 Shoring or bulkheadmg shall conform with applicable Federal, State and local jurisdiction construction and safety standards 3463 The utility shall not use water jetting or tunnelmg, but water -assisted or wet boring may be permitted if determined by the Department to not result in excessive erosion or unacceptable moisture conditions in the roadway subgrade 3464 The boring hole shall be oversized to the minimum amount required to allow pull - through of the conduct bemg installed, based upon equipment and product manufacturer's specifications If the oversize excavation is not already filled by the drilling slurry after product pull through, the void shall be grouted to the satisfaction of the Department Grout or other approved backfill matenal shall be used for pipe of 12 inches or more in diameter, and for overbreaks, unused holes or abandoned pipe The composition of the grout shall be a cement mortar, a slurry of fine sand or fine granular materials, subject to Department approval 3465 The utility shall follow manufacturer's guidelines and mdustry standards for equipment set-up and operation. The utility shall assess soil conditions to determine the most appropnate installation technique Underground borepaths or tunnels shall be tracked and recorded by the utility Failed bores shall be appropriately abandoned by the utility 3,466 Drilling fluids shall be prepared and used according to fluid and drilling equipment manufacturer guidelines The utility shall use fluid containment pits at both bore entry and exit points, and shall use appropriate operational controls in order to avoid heaving or loss of drilling fluids from the bore 3466 I Antifreeze additives shall be non-toxic and biodegradable products 346.62 Depending upon chemical composition or the specific method of disposal, improperly disposed drilling fluids may be classified as solid wastes or illicit discharges per Section 3 1 7, and in general, shall be pumped or vacuumed from the construction area, removed from the SH ROW and disposed of at permitted facilities that specifically accept such wastes 34663 Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is expressly prohibited 34664 Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being separated from fluids or after infiltration of the water, provided 34664.1 the drilling fluid consists of only water and bentonite clay, or 346642 if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling, and 56 o O CDOT State Hfghwav Uliltty Accommodation Code 2009 3.4.6 6 4.3 the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, and 3.4.6 6.4 4 the solids are covered and the area restored as required by permit requirements 3 4 7 Utility Installations Near Drainage Ways and Watercourses 3 4 7 1 The utility shall not install any facility along or across the ROW of an imgation ditch or canal company without first obtaining the written approval of such company 3 4.7 2 The utility shall install facilities that cross a stream or other drainage only at a point beneath the bed of that watercourse and only at a depth that adequately allows for scour or ditch maintenance requirements. The utility shall also take the added measures to protect such lines that the Department deems necessary in areas subject to erosion or other disturbance 3 4 7 3 In establishing the depth of cover below an unpaved channel, the Department will consider potential scour, ditch maintenance operations and/or future needs to increase the channel capacity. The utility line shall be installed a minimum of three feet below the lowest expected level of scour or degradation 3 4 7 4 Utility construction operations within or near live streams, ditches, wetlands or other bodies of water shall include adequate provision to protect or maintain surface and/or ground water quality, and may require appropriate clearances as described in Section 317 3 4 7 5 The utility shall not install utility lines within culverts where the primary purpose of that culvert is to carry drainage. For culverts or culvert -like structures where the primary purpose of the culvert is something other than drainage, such as providing passage for stock, wildlife, pedestrians or vehicles, utility installations shall be addressed through Section 3 3 10 3 4 7 6 In order to avoid any interference with the operations or maintenance of either utility lines or of drainage structures, the utility shall not install utility lines inside any such drainage structure or inside the trench that surrounds any drainage structure, and shall maintain a horizontal and vertical clearance from any such drainage structure or surrounding trench if further directed to do so by the Department in the utility permit 3 4 8 Protection, Construction and Restoration of Highway Property 3.4 8 1 The utility shall avoid disturbing or damaging all highway property, and shall be responsible for the prompt reconstruction, alteration, repair or maintenance of highway property, to repair any damage caused by the utility work, and to restore the SH ROW to pre-existing or better conditions as may be specified in the permit 57 State Highway Utility Permit 1 Attachment to Permit No 4190090 - Additional Terms and Conditions Version 5 1 GENERAL 2 This permit is issued in accordance with the State Highway Utility Code and is based in part upon the information submitted by the Permittee This permit is only for the use and purpose stated in the Application and Permit A copy of the State Highway Utility Code can be downloaded at http //www.coloradodot info/business/pernuts/utilitiesspecialuse/2CCR_601_18 pdf/view 3 Please refer to this permit number in all communications and correspondence 4 The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required to proceed with permitted work Approval of this utility/special use permit does not constitute venfication of this action by the Permittee 5 The Permittee, his or her heirs, successors -in -interest, assigns, and occupants of the Utility/Construction/ Landscape/Special Use permitted by this permit shall be responsible for meeting the terms and conditions of this permit 6 Before work begins, a certificate of insurance naming the Colorado Department of Transportation (CDOT) as an additional insured is required to be submitted to CDOT Region 4 Utilities Permits 1420 2nd Street Greeley, CO 80631 Description should include this permit number Insurance should be in effect through 2 -year warranty period from permit issue date and as long as installation exists in CDOT right-of-way. See attached Standard Terms 3.A through 3 H , inclusive 7 READ ALL ADDITIONAL STANDARD REQUIREMENTS OF THIS PERMIT AND OTHER TERMS AND CONDITIONS ON THESE ATTACHED SHEETS A COPY OF THIS PERMIT, INCLUDING ALL TERMS AND CONDITIONS, MUST BE ON THE JOB SITE WITH THE CONTRACTOR Call for an inspection of forms at least one working day prior to placing any concrete The Colorado Department of Transportation inspection is not an approval of the grade or alignment of the work The contractor and/or engineer is responsible for the proper grade and alignment Minor changes or additions may be ordered by the field inspector to meet field conditions Any survey monuments or markers disturbed during the execution of this permit shall be repaired immediately at the expense of the Permittee 8 NOTIFY THE DEPARTMENT OF TRANSPORTATION INSPECTOR CHIP HOPKINSON at [970] 590-5745 TWO WORKING DAYS BEFORE STARTING THE WORK OR RESUMING SUSPENDED WORK 9 On -premise and off -premise signing not in CDOT nght-of-way shall comply with the current Colorado Outdoor Advertising Act CRS 43-1-401, Rules and Regulations Pertaining to Outdoor Advertising. For questions, please contact Outdoor Advertising Inspector Ally Mattson at 970-350-2148. n n State Highway Utility Permit 2 Attachment to Permit No 4190090 - Additional Terms and Conditions Version 5 10 All work is to conform to the plans on file with the Colorado Department of Transportation or as modified by this Permit (IF DISCREPANCIES ARISE, THIS PERMIT SHALL TAKE PRECEDENCE OVER THE PLANS) The Colorado Department of Transportation plan review is only for the general conformance with the Colorado Department of Transportation design and code requirements The Colorado Department of Transportation is not responsible of the accuracy and adequacy of the design, of dimensions, and elevations which shall be confirmed and correlated at the job site The Colorado Department of Transportation, through the approval of this document, assumes no responsibility other than stated above for the completeness and/or accuracy of the plans 11 The contractor shall follow the applicable construction specifications set forth by the Department of Transportation in the latest manual, Standard Specifications for Road and Bridge Construction, the M & S Standards, and the M U T.C.D. 12 Any damage to any present highway facilities shall be repaired immediately and prior to continuing other work Any mud or other matenal tracked or otherwise deposited on the roadway shall be removed daily or as ordered by the Inspector 13 CDOT will determine the extent of inspection services for the work A daily inspection may be done by the Colorado Department of Transportation from the time work begins inside the highway right-of-way until the job is completed and right-of-way restored to its onginal condition 14 Water, storm sewer, sanitary sewer, gas, electrical, landscaping, telephone, traffic signal installations and fiber optic installations will require individual additional permits 15. Any surveying required as a result of this permit is the responsibility of the Permittee 16 It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details The ECIS may be obtained CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction-Environmental Guidance webpage at http //www dot state co us/environmental/Forms/asp FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations Prohibited discharges include substance such as wash water, paint, automotive fluids, solvents, oils or soaps Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, imgation water, springs, footing drains, waterline flushing, State Highway Utility Permit 3 Attachment to Permit No 4190090 - Additional Terms and Conditions Version 5 flows from npanan habitats and wetlands, and flow from fire fighting activities ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins For additional information and forms, go to the CDPHE website at http //cdphe state co us/wq/PermitsUnit/wqu 17 By accepting the permit, the permittee stipulates and agrees to fully protect, defend, indemnify, and hold harmless, to the extent allowed by law, the Issuing Authonty and each of the Authority's directors, officers, employees, agents, and representatives, from and against any and all claims, costs (including but not limited to all reasonable fees and charges of engineers, architects, attorneys, and other professionals or expert witnesses and all court or other dispute resolution costs directly incurred by reason of claims directly brought against the Issuing Authonty), losses, damages, pre- or post judgment interest, causes of action, permittee's failure to obtain, or disregard of, any applicable federal, state, or local environmental permits, approvals, authorizations, or clearances, or in meeting or complying with any applicable federal, state, or local environmental law, regulation, condition, or requirements in connection with any activities authorized by this Utility Permit 18 The permittee shall assume full responsibility for installation of and the resolution of any unforeseen problems regarding the installation of this facility 19. The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required to proceed with permitted work Approval of this utility/special use permit does not constitute verification of this action by the Permittee 20 DRAINAGE, WATER QUALITY CONTROL, ENVIRONMENTAL 21 All disturbed landscaping is to be restored to original or better condition 22 Areas of roadway and right-of-way disturbed during this installation or work shall be restored to insure proper drainage and erosion control 23 The Permittee is responsible for compliance with all Federal, State, and local environmental regulations The Permittee should have a qualified environmental consultant on staff or hire a qualified environmental consulting firm to assess the proposed project area for potential environmental impacts and obtain any necessary permits prior to disturbance Environmental impacts include, but are not limited to, wetlands, water quality, threatened or endangered flora and fauna, cultural resources including both archaeological and paleontological resources, and hazardous waste that can affect both human health and the natural environment Should enforcement action(s) be taken by any agency with jurisdiction, liability for noncompliance with any environmental regulation is the sole responsibility of the Permittee 24 TRAFFIC 25 No storage of materials or equipment will be allowed within CDOT right-of-way or 30 feet off the edge of the raveled way, whichever is greater 26 TRAFFIC CONTROL State Highway Utility Permit 4 Attachment to Permit No 4190090 - Additional Terms and Conditions Version 5 27 No work will be allowed at night, or on Saturdays, Sundays, and legal holidays without prior authonzation from the Department The Department may also restrict work within the State Highway right-of-way during adverse weather conditions. 28 No equipment will be allowed m the mam lanes of the roadway during construction 29 All work will be conducted from outside of CDOT right-of-way to outside of CDOT right-of-way Therefore, no traffic control is required for this installation 30 MAINTENANCE OF UTILITY 31 Maintenance work may be done anytime within daylight hours as long as no mterference to traffic is caused 32. MATERIALS 33 Disturbed right-of-way area, where applicable, must be top soiled, fertilized, mulched, and reseeded with Department of Transportation Specification grass seed mix, which meets specifications 34 Please refer to attached sheet for CDOT seeding specifications for site revegetation 35 EARTHWORK 36 Conduit/casing shall be a minimum depth of 4 feet for all utilities except "wet" utilities, which must be placed to a minimum depth of 4 5 feet 37 All cable/conduit shall be installed by directional bore No trenching shall be permitted 38. MISCELLANEOUS 39 The Utility shall design and construct all buried facilities, including pipelines, conduits and casings, to withstand the full range of exptected internal and external pressures and loads, including internal pressures ranging from maximum expected pressure to zero pressure, and external loads from the highway and superimposed vehicle loads Pipelines shall also be designed and constructed to resist internal and external corrosion 40 All construction vehicles operating in CDOT right-of-way to have mounted flashers. 41 The utility shall avoid disturbing or damaging all highway property, and shall be responsible for the prompt reconstruction, alteration, repair, or maintenance of highway property, as necessary, to repair any damage caused by the accommodation of the utility, and to restore the highway to pre-existing or other conditions as may be specified in a permit or agreement authorizing the accommodation 42 Utility Code, Section 3 4 6, requirements shall apply Copy of section attached 2/19/2019 REF -170119-167878 -- Salesforce - Performance Edition REF -170119-167878 • Close Window • Print This Page • Expand All !Collapse All Permit Information Record Type Permit Number Permittee Permittee Street Permittee City/State/Zip Permittee Phone Permittee Email Permittee Select Permittee Rep Permittee Company Utility Permit 4190090 Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 Permittee Company Shawn Bates Cheyenne Connector Pipeline, Inc Permit Author Web Portal User Received By CDOT Project N umber Project Engineer Utility Project N umber Current Signatory Issuing Authority Activity Description Section Reference Number Complexity Level I Annual Permit? Applicant Applicant Street Applicant City/State/Zip Applicant Phone Applicant Email Applicant Select Applicant Rep Applicant Company Inspector Name Inspector Telephone Patrol Name Installation? f Adjustment? https://socgov.my.salesforce.com/a0r1 JO00006IPUB/p?retURL=/aOr1J0000061PUB REF -170119-167878 Summit Resources C/O Rebecca Lieders 800 8th Ave. Greeley, Colorado 80631 Applicant Company Rebecca Lieders Summit Resources O1O Rebecca Lieders Chip Hopkinson (970) 590-5745 Patrol # 25 Maintenance 1 Section Water Quality Program Manager Regional Environmental Manager Facility & Type of Work (Other) 1/4 2/19/2019 REF -170119-167878 - Salesforce - Performance Edition CD Removal') Maintenance of Existing Facility') SUE/Other Relocation? Description of Work Location ON SH 34 W/O SH 37, KERSEY Additional Remarks Location Property Address Additional Information Intersecting Feature(s) GeoLocation City County Weld County Local Jurisdiction UGcontact Utility Notification Center of Colorado UGphone (800) 922-1987 Special Provisions Time Restrictions Other Provisions Inspection Services Required') Permit Dates Longitudinal') Transverse') Buried? Aerial') Structure Number I Route Number 034 Mile Post 118 500 Side Route Number 2 Mile Post 2 Side 2 Route Number 3 Mile Post 3 Side 3 Route Number 4 Mile Post 4 Side 4 State Highway A Section Category NR -A Days to Complete Minimum Cover Overhead Clearance https //socgov my salesforce com/a0r1J0000061PUB/p?retURL=/a0r1J000006IPUB 2/4 Issue Date Work Start Work Completion Date Expiration insurance Expiration 2/19/2019 REF -170119-167878 - Salesforce - Performance Edition Receive Date 2/15/2019 Requesting Info Start Date 4/1/2019 Application Accepted') Application Accepted as Complete Date Withdrawn? Date Transmitted Amendment/Extension Requested Reason for Request Date Withdrawn 2 -Year Warranty End Date 12/31/2019 Extension Date Project Duration 274 Days Comments Web Status Comments Office Use Notes Comments for Reviewers allisc Permit Status INITIAL REVIEW System Information Created By Utility Permit Application Site Guest Owner Region 4 Utility Permit Applications User, 1/17/201912 53 PM Last Modified By Utility Permit Application Site Guest Region 4 User, 2/15/2019 4 38 PM Notified Inspector of MSA ID Application Submission tir Applicant Contact Notification Sent Previous Expiration Permittee Contact Visible in portal? Notes & Attachments CST -P -1000 -A145 -Model CDOT typical.pdf CST -P-1000 A145_REV 11-27-18 CDOT Typical 11.27 18.pdf Type Attachment Last Modified Utility Permit Application Site Guest User Description Traffic Control Plan View file Type Attachment Last Modified Utility Permit Application Site Guest User Description Traffic Control Plan View file o https //socgov my saiesforce com/a0r1J0000061PUB/p?retURL=/a0r1J0000061PUB 3/4 2/19/2019 REF -170119-167878 - Salesforce - Performance Edition Colorado Department of Transportation COI 10 24.18.pdf Type Attachment Last Modified Utility Permit Application Site Guest User Description Insurance View file Permit History 2/15/2019 4.38 PM Special Use Permit Narrative 1.23.19.docx Type Attachment Last Modified Utility Permit Application Site Guest User Descnption Cover Letter (Letter of Request) View file User Utility Permit Application Site Guest User Action Changed Submission Notification Sent from false to true Changed Record Type from Application - Utility/Special Use Permit to Utility Permit. 2/15/2019 4.36 PM User Utility Permit Application Site Guest User Action Changed End Date from 10/31/2019 to 12/31/2019. 2/15/2019 1:45 PM User Utility Permit Application Site Guest User Action Changed Receive Date from 1/17/2019 to 2/15/2019. 1/17/2019 12:53 PM User Utility Permit Application Site Guest User Action Created. o Copyright © 2000-2019 salesforce corn, inc All nghts reserved o https llsocgov my salesforce com/a0r1J000006IPUB/p9retURL4a0r1J0000061PUB 4/4 AR d CERTIFICATE OF LJA l:l ILUTY INSURANCE DATE (MMIDDIYYYY) 03/05/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder Is an ADDITIONAL INSURED, the polley(les) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s) PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P O Box 10265 Bimrmgham, AL 35202 LON NAp1E CT INC No. Exit, 800-476-2211 I C. No) ADDS INSURER(S) AFFORDING COVERAGE NAIC 8 INSURERA AIG Specialty Insurance Company 26883 INSURED BNN Water Solutions, LLC 370 Van Gordon Street Lakewood, CO 80228 INSURER B Commerce and Industry Insurance Company 19410 INSURER C INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 4U2CB6SF REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INBR LTRVISD TYPE OFINSURANCE ADOLSUSW WVD POLICY NUMBER POLICY EFF POLICY EXP lwwioDrYYYY) (MM/DOiYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 03/01/2019 03/01/2020 EACH EACH OCCURRENCE $ 1,000,000 1 CLAIMS -MADE X OCCUR PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 25,000 PERSONAL & AW INJURY $ 1,000,000 ,, L AGGREGATE UMIT APPLIES PER ��GEj' I POLICY 3P8T- LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBRELIABOJTY — — X ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOSaccident) NON -OWNED AUTOS ONLY CA 3962402 03/01/2019 03/01/2020 (Ea BINEDsUNGLELIMIT it $ 1000,000 BODILY INJURY (Per person) $ BODILY INJURY(Per $ PROPERTY DAMAGE (Per occident) $ $ A X UMBRELLA UAB EXCESS L1AB X OCCUR CLAIMS -MADE I 12335228 03/01/2019 03/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000 000 OED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LtABILRY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFIC�� IMF EXCLUDED? H yes describe under DESCRIPTION OF OPERATIONS below N IA I PE F 1 I 1 E0T� EL EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ _E L DISEASE - POLICY LIMIT 5 A Pollution Legal Liability (Claims Made Basis) 12335226 03101/2019 03/01/2020 Each Loss Limit S 1,000,000 S $ $ S DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101 Additional Remarks Schedule may be attached if more space Is required) Re State Highway Right of Way permit CDOT and Concessionaire are included as Addition Insured (Excluding Workers' Compensation) if required by written contract, subject to policy terms, conditions and exclusions In the event of cancellation by the Insurance companies the policies have been endorsed to provide 30 days Notice of Cancellation (except for non-payment) to the certificate holder shown below CERTIFICATE HOLDER CANCELLATION Colorado Department of Transportation 10601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE 14) ACORD 25 (2016103) Page 1 of 1 O 1988.2015 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD ,�,c®�� CERTIFICATE OF LABIUM( ONSU • .� NCE 103/05/2019 DATE(MMmDRYYY) / THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsementls). PRODUCER MCGRIFF, SEIBELS 8 WILLLAMS, INC P O Box 10265 Birmingham, AL 35202 CONTACT NAME PHONE 600 76 2211 I I JAlC No FsU. (A/C. No) E-MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAIC rf INSURER A Starr Indemnity 8 Liability Company 38318 INSURED Tal(grass Energy GP, LLC 420D W 115th Street, Suite 350 Leawood, KS 66211 INSURER B INSURER C INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER.YKrrsVsC R THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ILTR TYPE OF INSURANCE MD SUER 1�. POLICY NUMBER POLICY EFF _(L1PMlDDrYYYYL(MMlDIJ1YYYYi_ POLICY EXP LIMITS ), COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE$ CLAIMS -MADE OCCUR CO RENTED DAMAGE PREMISES (Ea occurrence) $ MED EXP (Any one person) 5 PERSONAL & ADV INJURY $ GEN'L R AGGREGATE LIMIT APPLIES PER PRO - POLICY ❑ JECT LOC OTHER _ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE — _ LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ SCHEDULED AUTOS) NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Es acadent) 5 BODILY INJURY (Per person) $ BODILY INJURY(Per accidenl S PROPERTY DAMAGE (Per accident) $ $ UMBRELLA L(AB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERJEXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 ii X I ST RUtE ( 1 EB EL EACH ACCIDENT $ 1,000,000 E L DISEASE EA EMPLOYEE $ 1 000 000 EL DISEASE -POLICY LIMIT $ 1,000,000 S $ $ S DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Addrtronal Remarks Schedule, may be attached if more space is required) Re State Highway Right of Way permit CERTIFICATE HOLDER CANCELLATION r,olorado Department of Transportation 0601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE itfikt) Page 1 of 1 © 1988-2015 ACORD CORPORATION All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AC®® CART RRCATE OF LUAB UTlf NSURANCE DATE (MMIDD/YYYY) 03/05/2019 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS ' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT if the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P 0 Box 10265 Birmingham, AL 35202 T CONTACTCOM PHONE 19LC y8EI) 800-476-2211 (A1C, No) E-MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAICA INSURER A .Aspen Insurance UK Limited INSURED Tallgrass Energy GP, LLC 4200 W 115th Street, Suite 350 Leawood KS 66211 INSURER a Starr Indemnity & Liability Company 38318 INSURER C Aegis Insurance Services Ltd INSURER D konshore Specialty Insurance Company 25445 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER.9MMSLTNG REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS RNSR LTR IADOL TYPE OF INSURANCE I INsp sUBR MD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYYJ , LIMITS A X COMMERCIAL GENERAL UAsiLnY ME1902667 0310112019 03/01/2020 EACH OCCURRENCE I $ 4 000,000 X 1 CLAIMS -MADE OCCUR DAMAGE TO AN I tU PREMISES (Ea occurrence) F MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER X POLICY ❑ Pi LOC OTHER GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ $ B AUTOMOBILE X X LIAeLLITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X AU I ULED NON -OWNED AUTOS ONLY SISIPCA08313219 03/01/2019 03/01/2020 Ee�aca MSINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAR _ X OCCUR CLAIMS -MADE XL5236807P 03101/2019 03/01/2020 EACH OCCURRENCE I $ 1,000,000 AGGREGATE S 1,000 000 DED I I RETENTIONS $ B MINCERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETORIFNRTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) if yes describe under DESCRIPTION OF OPERATIONS below Y/N N / A 100 0001534 03/01/2019 03/01/2020 X PER OTH ,STATUTE ER E L EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE 1 000 000 E L DISEASE - POLICY LIMIT S 1,000,000 D Pollution Legal Liability 002025904 03/01/2019 03/01/2020 Each Incident Aggregate $ 1,000,000 S 1,000000 $ 5 $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The CDOT and Concessionaire are included as Add bona Insured (Excluding Workers' Compensation) if required by written contract, subject to policy terms, conditions and exclusions For the General Liability Automobile Liability, and Excess Liability policies, Insurance is pnmary and noncontnbutory over any other collectable insurance if required by written contract subject to policy terms conditions and exclusions In the event of cancellation by the Insurance company the General Liability policy has been endorsed to provide 30 days Notice of Cancellation (except for non-payment) to the certificate holder shown below CERTIFICATE HOLDER CANCELLATION Colorado Department of Transportation 10601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE #1;&) ACORD 25 (2016/03) Page 1 of 1 © 1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD A ®® CERTIFICATE OF LIABILITY INSU;. ,NICE DATEcMMIDDIrYm 03/05/2019 THIS CERTIFICATE IS ISSUED AS A NAATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P 0 Box 10285 Birmingham, AL 35202 CNAAMMEACT PHONE No Ectl, 800.478-2211 NC, No). EMAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAIC C INSURER A .Aspen Insurance UK Limited INSURED Tallgrass Energy GP, LLC Including Cheyenne Connector Pipeline, Inc 4200 W 115th Street, Suite 350 Leawood, KS 66211 INSURER B Starr Indemnity & Liability Company 38318 INSURER C Associated Elec & Gas Ins Svcs Ltd (AEGIS) AA - INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER AKNW9FUJ REVISION NUMBER• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS jSR L TYPE OF INSURANCE ADDL DISD SUER w5ID POLICY NUMBER JMM DOO! OUCY W)JMWDD11 EXP LIMITS A ll • '''.1 -AUTOMOBILE X COMMERCIAL GENERAL uABU.OY ME1902667 0310112019 03/01/2020 EACH OCCURRENCE $ 4,000,000 X I CLAIMS -MADE OCCUR OAMAGET0 RENTED PREMISES Ma occurrence) $ MED EXP (Any one person) I PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER X POLICY JECTT LOC OTHER GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGO $ $ X x LABILITY ANY AUTO x _ AUTOS NON OWNED AUTOS ONLY SISIPCA08313219 03/01/2019 03/01/2020 COMBI ED SINGLE LIMIT lEta BI S 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LAB EXCESS LAB X OCCUR CLAIMS -MADE XL5236807P 03/01/2019 03/01/2020 EACHOCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/AIRTNERIEXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/012020 x I PER I IOTH. I STATUTE ER_ EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 E L DISEASE - POLICY LIMIT S 1 000,00D $ S S S $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may bo attached If more space Is required) Certificate Holder is included as Additional Insured (Excluding Workers' Compensation) and Waiver of Subrogation applies except where not permiss bte by law if required by written contract, subject to policy terms, conditions and exclusions The policies include sudden and accidental pollution coverage subject to policy terms, conditions and exclusions CERTIFICATE HOLDER CANCELLATION � olorado Department of Transportation 4ltn Utility Permit Office J601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE 14) ACORD 25 (2016/03) Page 1 of 1 © 1988-2015 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD 370 Van Gordon Street Lakewood, Colorado 80228 303 763 2981 Project Introduction Cheyenne Connector Pipeline, Inc. Cheyenne Connector, LLC ("Cheyenne") proposes to construct 70 miles of new thirty-six inch (36") natural gas pipelme from a point located within Section 14, Township 2 North, Range 66 West, north to a point located in Section 5, Township 11 North, Range 66 West, Weld County, Colorado This pipeline is anticipated to initially carry up to 600,000 Dth/d of natural gas per day accumulative activities in the surrounding area The permanent easement width will vary based on the segment of the line, but generally will be fifty feet (50') in width The five meter and regulating sites along the pipeline route — Lancaster, Latham, Mewbourn, O'Connor and Connector — will service the line with adequate pressure to move the product to existmg Rockies Express Pipeline, LLC facilities north of Nunn, Colorado The O'Connor meter and regulating site requires a 0.7 - mile twenty-four inch (24") lateral to the thirty-six (36") pipeline ("Project") After reviewing the lands to be crossed, Cheyenne Connector, LLC ("Cheyenne") selected a route from the point of origin at the Lancaster Meter Site located in Section 14, Township 2 North, Range 66 West northeast of the City of Fort Lupton, Colorado During negotiations with landowners along this route, Cheyenne made several alterations to the route both m response to landowner requests, topographical considerations, co -location with existing pipelines and Federal Energy Regulatory Commission ("FERC") Requirements The original route was largely retained as it continues to present the least intrusive path for construction and the most accessible location for service and maintenance during operation The lands concerned with the metering facilities includes the aboveground facilities — Lancaster, Latham, Mewbourn, O'Connor, and Connector — that will be constructed either within existing natural gas facilities or would be directly adjacent to existing natural gas processing and compression facilities The Lancaster and Connector Meter Stations would occur entirely within existing industrial sites Construction of the Mewbourn, Latham, and O'Connor metering facilities would represent a long-term conversion of agricultural and rangeland to industrial land uses These aboveground facilities would affect land use and acreages Where possible, the new aboveground facilities would be located within existing facilities or adjacent to existing roads to minimize impacts and for convenience of access The lands located within the project area are pnmanly agricultural cropland and ranchland with rural residential and some tndustnal use along the proposed facilities In an effort to mitigate disturbance to the surface and to decrease as much as possible the impact to the lands post -construction, Cheyenne will bore all road crossings and all water bodies encountered on the route pursuant to all local, County, State and Federal rules and regulations Cheyenne would use different crossing techniques for waterbodies, depending on the type of waterbody to be traversed Special care will be taken to minimize effects of construction on waterbodies Cheyenne adopts the FERC's Wetland and Waterbody Construction and Mitigation J Procedures ("Procedures") without deviation and will follow mitigation requirements for waterbody and wetland crossmgs For stream and flowing waterbody crossings, Cheyenne would use HDD or boring Cheyenne would open cut non -flowing and intermittent and ephemeral streams Cheyenne will comply with USACE Section 404 nationwide permit (NWP) 12 for construction m creeks and wetlands crossed by the Project To reduce potential impacts from construction on groundwater resources m the Project area, Cheyenne will implement the FERC's Procedures and the FERC's Upland Erosion Control, Revegetation, and Maintenance Plan (Plan) without deviation and will implement the following mitigation measures Wells within 150 feet of construction activities will be staked, fenced, and/or flagged for visibility Additionally, wells within 150 feet of construction activities where landowner permission is provided will be sampled both before and after construction to confirm that no impacts occurred as a result of the Project If a known or unknown well is damaged by construction, Cheyenne will coordinate with the landowner to repair, replace, or remediate the well, if needed. Cheyenne will coordinate a temporary water source for domestic use during the repair and reclamation period if no other potable water is available Should the loss of water affect agricultural or livestock operations, Cheyenne will compensate the affected farmer(s) for any lost revenue from these operations during the reclamation and remediation period for the damaged well Cheyenne may choose to provide a temporary water source to support livestock operations while a new permanent water supply well is constructed or while the existmg affected well is repaired The Project area is located in generally flat to rolling plains with few steep slopes If construction occurs in areas exceeding slopes of 5 percent, Cheyenne will use trench breakers to limit the flow of water along the backfilled trench This will reduce the potential for the trench to act as a preferential pathway for groundwater migration If trench dewatenng is required in these areas, water will be discharged in a level upland area to allow for evaporation and infiltration back to the water table If the water must be discharged to a surface water body, appropriate filtration systems will be used to control any potential increase in total suspended solids (TSS) and all of the proper notifications and permits will be obtained Quality Control Erosion controls will be employed throughout construction m order to protect the easement property and the surrounding lands Cheyenne will employ tracking pads at all access points from roadways and all road crossings involving the ingress and egress of heavy equipment. During construction, Cheyenne will double ditch the pipeline trench. The pipe will be laid m the trench in such a manner as to leave the top of the pipe at least thirty-six inches (36") below the surface of the ground after restoration A Stormwater Management Plan will be secured from the appropriate State Agency and will be followed during construction and subsequently during operation of the pipeline and associated facilities. Cheyenne will begin reclamation of the affected lands as soon as is practical after construction has finished on each parcel of land and will pursue re -grading and reseeding of the grounds until the property has been re-established to a condition comparable to its state prior to entry by Cheyenne After construction, pipeline markers will be mstalled along the route that will contain a telephone number that will allow the public to contact Cheyenne. It is Cheyenne's intention to fence -in all aboveground appurtenances in order to protect the equipment and the public from accidental contact Cheyenne will be operatmg this pipeline on a continuous basis, twenty-four hours a day, seven days a week A momtonng system, overseen by highly trained staff in the Lakewood, Colorado offices will allow Cheyenne to remain alert to all conditions affecting the operation of these assets In the unlikely event of an emergency, Cheyenne will be able to shut down the compromised segment of the pipeline by employing the system of remotely -controlled valves to be installed along the length of the pipeline Federal Permits Applications 1 Certificate of Public Convemence and Necessity Natural Gas Act Sec 7(c) applied to the Federal Energy and Regulatory Commission Submitted March 2018 Anticipated date of FERC Certificate award March 2019 2 Environmental Clearances Impacts on wildlife habitat Cumulative impacts on the environment may result when the environmental effects associated with a proposed project are added to other past, current, and reasonably foreseeable future actions The proposed Project locations are in agricultural, rangeland, and industrial/developed areas. The majority of development similar in nature and scope to the Project is associated with current or planned oil and gas exploration and development as well as midstream and upstream projects This information was obtained from Cheyenne Connector's consultation and coordination with other potential operators in the area during land acquisition and routing studies, as well as the FERC website, state agency websites, and company -specific websites Information concerning other types of commercial and/or residential development within the Project area was obtained through consultations with the Weld County Planning Commission The Cumulative Impact Assessment Area ("CIAA") for fish, wildlife, and vegetation impacts is the extent of HUC 12 watersheds crossed by the Project The Project would disturb approximately 598 2 acres of vegetation and topsoil within the CIAA, which would leave soils vulnerable to wind and water erosion during construction which could result in increased soil movement into surface waters as sediments Additionally, the open cut crossing of 23 streams would result in direct sedimentation into surface waters if construction were to occur during periods of flow This could incrementally reduce the quality of aquatic habitat downstream of construction when considered with existing sediment and runoff burdens from other past, present, and reasonably foreseeable oil and gas and agricultural development This potential incremental increase in sediment burdens from the Project would be temporary as Cheyenne would limit erosion and sedimentation through the development of a SWMP and would revegetated all pipeline ROW following installation. The Project would utilize 4,000,000 gallons (12.27 acre-feet) of water to hydrostatically test the newly constructed pipeline This would not decrease the availability of aquatic habitat in the CIAA as this water would come from existing, permitted water nghts The Project would disturb approximately 598 2 acres of ecological systems within the CIAA Reclamation would restore 427.6 acres of potential habitat within the CIAA The remaining 170 6 acres of ecological systems would remain disturbed for operations This 170 6 acres would represent a long-term incremental increase in habitat loss within the CIAA Additionally, the presence and operation of these aboveground facilities could increase the amount of habitat lost due to displacement effects from noise, human presence, and fragmentation Cheyenne would have limited potential to incrementally impact federally and state listed species and their habitats within the CIAA Pre -construction surveys for western burrowing owls and other protocol level clearance surveys, as requested by the USFWS, would limit the potential for direct loss of protected species or of occupied habitat Reclamation and -revegetation of the ROW following pipeline installation would avoid any permanent loss of habitat for protected wildlife species As no new depletions from the South Platte River are needed and no direct disturbance would occur to the South Platte River, no incremental impact to species reliant on this habitat is anticipated Impacts on historical, archaeological and scenic resources The proposed pipeline route predominantly crosses through dry -land agricultural properties, thereby minimizing any potential impacts to histoncal, archaeological and scenic resources Cheyenne has conducted archaeological surveys m accordance with guidance from the State Historical Preservation Office and has not encountered any historical or archaeological sites The CIAA for cultural resources is the overlapping impacts within the Area of Potential Effects (APE), since impacts to cultural resources are generally site -specific and not additive across a landscape As no past, present, or reasonably foreseeable future actions within the APE would overlap with potential Project impacts to cultural resources, no cumulative impacts are anticipated fiSiIE5: -- AtxmtNN TTUPORARY onnowsroser (T'P.) .. COOT IOUNI-OF-10 01 (MI) 1. CON 1*POT 0k SHALL VErgT /ALL LASING OWEt670u5. ELEVATIONS. APO �.�.« _ _ CONDFITON5 M MID PRIOR TO STINT Or POW 7 / i.e. ..L•.-. * -seta ' . - • Air 1 2. SIZES OF ENCAVATON PITS APE APPROXIMATE. C:OMPA EIR TO DE`...1GN ANt: MUMOS4A APPROVED DACVADOA, OC/IEHM. %OrING on CO SE * • '-S cl i , 7�._ r APPROVED SNOPOC orti sS TO SAFELY PtRcORY w RK t AI■S w r ■■ ■■ M al ■■ a— a a ■■ a i i a I■r _ .w4 Ar sr a a a - as a all a a S •- _ i i 4/.L i aill Wm /""3 ■t S 4r• a 4n a a •e nn P1 r Or IPE_ O.D. PIP[• tax mom O� MAC S 1.5 DECK ER 3 r r gm A Oa~ I{ , IAMB�C CONTRACTORTI OL7ERIAINE flat RACT OR SEY1lLAND $1M 1 ► 1Y s o7T F i '- ALC.? SIT CENTER ', .` .. i /� PROPOSED SC BORE 240 _ — -, .'c DURING CONSTRUCTION AND EMEFE LL AC TTCS. • a ' •A^ : •N 1 S CONTRACTOR IS RESPCNSIAF FOR CAWNG STATE. ONE -CALL Nib LOCATW, - ALL UROERCROU►O Ui1UTI3S PRIOP TO BES 444916 CONSTRUCTION - t e. r 1s THE COIJTRACTOR•'s oEsPo 4s181JTr To ova° AND PROTECT ANY I} _• -•.. tCENING TNT or .� ,.-. -- , _. ....._ — - _... . .l FORECN UTILITY THAT MAY BE AP MAD NY 111E sotruc oPERATXX4S. 1 • T - I I •'• 7_ LOCATIONS OF IJTLITLS ARE APPROXIMATE. BEFORE POADt OR HEAVY r COuLr'tCCMT TV USED FOR ►S1TrOS1`S or DICAW:110N on OTHER NCRK NEN, THE MUMS SHOWN ON IWS MAD. THE EXACT LOCATION AND OLPTH Or ar.t •� •• w w a .■ ■�r w w w �■ w w r�ItaRC w i 4.* a ■Is a 010 ..• A* +s w .,r �.• 4T4R +•. 4I'R ..� MS aI� elso .. - w PS •1,• .+ .w . =-- _, - TO'C11NL Mat OPTIC uM MattOWTO1 a ss1 flirt SHOLLD BE ?IRST DETERMINED Br NAM C7tCAVATCN OP IMIROVIC a SR S CONTRACTOR SHAM IAMRiTAR+ MNBfJM 'o twee COSLR **MC o(sc is w M PRRIMNIDET MOOT {M) cern R1L1gt Or I1Rv. ID vwrTE t THE INIECATr'i of TK ROAO. R S TwC c -etc ACTon AGP0NsmVry to ASSiS5 hUlt) cpryowls,* m JNS no y[th. - S C04►ETilt�' PRIOR TO SORE OPERATIONS. CONTRACTOR 4W1 onosroC IF 10 FM unajY mint as surname worn no FIELD CO►/DMONS AND K • y A ■ MI ID` a t ■ a a �f OVEA•(AO [F '_`'\‘ • TOTHERS }f RIOFD, BE DEEPER TO ale"ale"T?TE WIEGR h or THE ROADrAv IJN T. All UWIC€QGROUNU URBUTES OR 8TRUCTURES REPORTED Fr' THE OM".'E4 ( - AND THOSE SHOWN ON THE ;MEOWSEXA$'WED ARE Mane 44 T1�1R APPROXIMATE LOCATION MO MOO. nit CON1 iCTOR IS REOUTRLL j _` • TO TARE DUE PRECAUTION/4W MEASURES TO PROTECT THE UTUT ES OR STRUCTURES SHOWII AN0 ANA' OTQ11 R on TIn OP STR UMACS FOUNO AT . _ L. THE SOr1 yy1&L OE THE CON'RACTOICS RCSPO/t5f8U1T TQ Wynn THE ONMERS OF THE Linn oR STRUCTURE5 CONCERNED BEFORE STAR Mir, a s ■ - . , - - ✓ WORK CONSTRUCTION CONTRACTOR AGREES THAT Tv ACCORDANCE Tin -mason ti commis art n cons PRAC7Cts. CONSTRUCTION CONtRAr't ., or R[OUNED TO ASS:JTAE OOI1PLilE R4SPOkSIBIAJTT FOR 08 S tT w co COMMONS MARCTHE MIME CF CONSTRUCTION Or T1( /RpJECT, n o yam•a • `` TLIM4JlIMPr wORKSYAC( r N►.) 1 -" IDOL re ANA Mir , tw , :• -. v ilil MCI AAB E MOC 70 Or ILL cownnPERSOIu AND ANDPROP mot SHALL BE MAOC APPLY CO►NTuuou5Lr AND NOT or UNTIED 1O wpaAu r U TIED To Mena. wORIORG HOURS. COMPACTOR AND SUHCOKTRACTORS PERIGRI►NC SUBSURFACE EXC■ST10NS St4411 COM$P..• *1114 Aa OSHA IZEOU1RETJE]+TS dAM Ae Mnai - a - 240' - -- - - - - - - - - - • 46'410 4880 - 103' 128' - 4 E80 • - 4570 • i INrr 34 ro OF OIo118RntN I NI i wry 34 toEoa Or EXCIIWATON n. I 4670 • moo ' .• !}� 4850 I 45,40`�a 4830 >b 1 s �(��j rid prill (dl;. 5S3. -1 ` SS� {q C r �y iS F7 4!1110 4050 AR 1\• 4620 4' WIN KI COT i[i 46 114COIAER 14640 b — 1 - - wrolooL TOP EL air _ -- - •610 I — —_ - 3. ON. s I•N- . _ _ ; 4810 fAPP'ER PIPE 4 O 36.00- 0.0- 4 0.70z. ILL vow Prt RI CPNSC PIT API Sr . x -- m. SAM.. nu • ARO IS 4 201At2 I 4090 4SRO 4000 , BBO 4310 4 4 4370 -..t.400 0+00 1.0c: !lt 3 iC0 3440 Apr APO`�� a jj r 't' 35424 I N0R720H'K VERTICAL r / w l7 0 10' 2D' 441 0 10 10r 4i/ ••,, I' Al, -� riersSammsrlmiwWffla104 'SCALE IN Fill MA.? PI U t z A 051Otr20'9 • • �.MSDONNELL. MSDO TALLGRASS E ENERGY COOT NWY 34 BORE CROSSING SITE PLAN a PROFILE (MP 26.21 , t • - - - . _ 111 • o INI/O es ae+ - - e■S Fat POST U - e eft, Al la w AR wi _w As a � M eT+ at a Ili •..r .a • ► r • .. 314-100Q!S00`OS2! aanwl TaTwt - 4414 • 4 mr .N.I■ NS • «.. 1 MS APPAa 1i)) rot coodsmcnowREVISIONS Vallo, ¢� p lit _ �y� _ r�►; N G5 4 4 i Leo=PIIJedG IN Doha(oidtonHuujwgxboxnpwoNzzEiwblNggsH('oa6O/xoqul 0/nlllewiwap•ail ew/1adpq Ch'g I% .% \,V 1dJ i 3 -to i° r3 J-21 oi JNd'6Lmil L'e ain)de3 asf IepadS^A1!Ilun PE WH auliadid Jopauuoo auueAay0 6 L0Z/6 L/C 02/22/2019 Quality Control Plan - Inadvertent Fluid Release Conventional Bore Cheyenne Connector — Pipeline Installation RE: CDOT Crossings — 36" Conventional Bore Hanging H is working with Tallgrass Energy to build the Cheyenne Connector Pipeline which crosses several Colorado state highways. As currently designed, these highways will be crossed by means of conventional bore, a method that does not utilize drilling fluids. Being that this method requires no drilling fluids, the threat of an inadvertent fluid release is non-existent. Below is a step-by-step explanation of our proposed installation method. 1. Before any excavation takes place, all locates will be called in and all utilities within the work zone will be potholed and their depths verified. 2. All environmental BMPs will then be installed in accordance with the approved environmental drawings provided by Tallgrass. 3. Should groundwater be present at any of the CDOT crossing work sites, Hanging H would install dewatering wells prior to performing any excavations. Hanging H would activate the wells prior to performing any excavations so that the groundwater is drawn down by the time the bore pits are ready to be excavated. 4. Crew will then excavate the bore pits on each side of the crossing using an excavator (CAT 336 size or equivalent). Hanging H will use trench boxes for shoring the excavation. 5. Hanging H will use a tracked boring machine to complete the crossing. The entry pit will be dug to specific grade and the tracks will be set up at the bottom of the pit. Before lowering the boring machine into the pit, the plumbness of the track system is checked to ensure that the trajectory of the bore is correct. Once the designed trajectory is confirmed, the boring machine is lowered onto the track system. 6. The boring machine auger will then be inserted into a piece of 36" sacrificial pipe. The sacrificial pipe will then be lowered into the pit using a pipelayer (CAT 583 or equivalent) and the auger will be connected to the boring machine. The pipelayer will support the sacrificial pipe, further ensuring the crossing will be completed at the designed trajectory. 7. After activating the auger, the boring machine will track forward, pushing the sacrificial pipe into the headwall of the entry pit. The auger will cut into the headwall and convey the bore cuttings through the sacrificial pipe and into the bore pit. Hanging H Companies 1 1912 S. Burlington Blvd, Ste 100, Burlington, WA 98233 1360.726.2334 info@hanginghco.com 1 www.hanginghco.com 8. On longer crossings, the boring machine will disconnect from the auger and track to the back of the entry pit. Another joint of sacrificial pipe with more auger will be lowered into the pit. The auger that was originally attached to the boring machine will be connected to the auger in the new piece of sacrificial pipe. The new piece of sacrificial pipe will be welded to the end of the sacrificial pipe that is sticking out of the headwall of the pit and then X-rayed to ensure a quality weld was made. Steps 7 & 8 would repeat until the crossing was completed. 9. Once the sacrificial pipe bores through the headwall of the exit pit, the auger is disconnected from the boring machine and removed from the sacrificial pipe. 10. The permanent pipe is then lowered into the entry pit and welded onto the sacrificial pipe. The boring machine then tracks ahead, pushing the permanent pipe into place while pushing the sacrificial pipe out into the exit pit. 11. The sacrificial pipe is then cut and removed from the exit pit. 12. On longer crossings, steps 10 and 11 may repeat. The welds made on the permanent pipe will be X-rayed and coated prior to being pushed into place. 13. After all permanent pipe is installed, the boring machine and track system is removed from the entry pit. 14. Prior to backfilling the bore pits, pipe that has engineered and bent to get the line from the depth of cover required for the crossing to the depth of cover required on each side of the crossing, is welded onto the crossing pipe in both the entry and exit pit. 15. The pits are then backfilled and compacted. As mentioned above, this method of installation does not require any drilling fluids. This method also does not leave any voids throughout the crossing like horizontal directional drills. The cutting head of the auger is sized to match the outside diameter of the pipe, leaving no voids or pockets that could result in future settlement issue. If at any time you require further information, please do not hesitate to contact me. Sincerely, Kasey Entrikin Project Manager Hanging H Companies 1912 S Burlington Blvd. Suite 100 Burlington, WA 98233 Cell: 360.661.0696 E-mail: kentrikin@hanginghco.com Website: http://hanginghco.com Hanging H Companies 11912 S. Burlington Blvd, Ste 100, Burlington, WA 98233 1 360.726.2334 info@hanginghco.com I www.hanginghco.com COLORADO DEPARTMENT OF TRANSPORTATION UTILITY PERMIT APPUCANT Name: Summit Resources C/0 Rebecca Ueders DEPARTMENT Date Issued: USE ONLY 03/12/2019 PERMITTEE Name: Cheyenne Connector Pipeline, Inc ♦ REP: Shawn Bates REP: Rebecca Lieders + ! Permit #14190091 Milepost(s) Sides) Address: 370 Lakewood, Van Gordon Colorado St 80226 Address: 800 Greeley, 8th Ave. Colorado 80631 S.H.# 014 158.330 Reglon:4 Email: shawn.bates.tallgrassenergyip.com Email: S.H. Section : C Telephone: (303) 763-2981 Telephone: 479-306-8807 Patrol: 20 NOTICE TO PERMITTEE: For underground facility location information, contact the Utility Notification Center of Colorado (UNCC). Pursuant to 9-1.s-103 C.R.S. you shaH not make or begin excavation without first notifying the UNCC and if necessary, then notifying the tier two members having underground facilities in the area of such excavation. Notification shall also be given to the CDOT regional permitting office, or as otherwise directed by this Permit's Special Provisions. Notice of the commencement, extent and duration of the excavation work shall be given at least two business days prior thereto, not including the day of actual notice. The UNCC ma y be called a11.800-421.1487. ACTIVITY DESCRIPTION (Furnished by Permittee i PURPOSE a Installation NI Adjustment • Removal ■ Relocation ■ SUE/Other • Maintenance of Existing Facility FACILITY (Type, size, class of transmittant, design pressure or etc. ) 36" Natural Gas Pipeline DESCRIPTION OF WORK: Bore under Hwy 14 to Install a 36" Natural Gas Pipeline NATURE OF INSTALLATION: ■ Longitudinal ■ Transverse (Crossing) F2 Buried ■ Aerial/Ground-mounted LOCATION: 5138' East of CR 43 MM 158.33 County: Weld County City/Town: ADDITIONAL REMARKS: No Traffic control will be allowed on Hwy 14 for the Bore. Only approved TCP with 568 for equipment move SPECIAL PROVISIONS (corny►leted by the Department) The Special Provisions are terms and conditions of this permit. Any The Inspector Work Work work CDOT is time shall inspector Email: to be restrictions: completed only be in is Mike Daylight accordance Shepherd on or before: Hours. with Telephone: 07/10/2019 the approved (970) or plans 381-5143 within and special 120 days, provisions (as applicable) as set forth in this permit and its attachments. Designated minimum cover is 4 feet Designated overhead clearance is 24 feet (Also SEE ATTACHED STANDARD PROVISIONS, AND ADDITIONAL SPECIAL PROVISIONS), (TRAFFIC CONTROL MUST CONFORM TO THE MUTCD) Other: No Traffic control will be allowed on Hwy 14 for the Bore. Only approved TCP with 568 for equipment move Permittee exhibit, working Insurance hours. is prohibited certificate(s), from commencing and traffic any work control plan within must highway be available ROW prior on site to during issuance of work. a fully High endorsed visibility and vests validated are required permit. at all Permit, times during plan 1. Your request to use and/or occupy state highway system rights of way as described above is granted subject to the terms and conditions of ttds psmilt, including the 2. To against to facilities loss Standard and Special Provisions the extent authorized by law, any loss and/or damages or death of any person whomsoever, or any part thereof, including and/or damage arises from Permittee to the as shown the but sole on the permit hereby assumes, property of the State arising at any time, not limited to installation, negligence or willful and ail attachment releases and of Colorado, caused by adjustment, conduct of hereto. agrees to indemnify, third parties or the or growing out of the relocation, the State of Colorado defend, protect, and save the State of Colorado Permittee's facilities, and all loss and/or damage occupation of Colorado State Highway rights of maintenance or operation, or removal of existing or its employees or agents. on way facilities, harmless account by from and of injury Permittee's unless such 3. Failure Department by the Permittee to comply of Transportation. with any of the included tears or conditions may subject this permit to suspension or cancellation, at the discretion of the 4. THIS PERMIT IS NOT VALID UNTIL FULLY ENDORSED BY ALL PARTIES, WiTH DATE OF ISSUE AFFIXED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPARTMENT. A FULLY EXECUTED COPY OF THIS PERMIT MUST BE ON FILE AT THE TRANSPORTATION REGION OFFICE. 5. In has accepting this permit the undersigned, read, understands and accepts representing the Permittee, verifies that all the included conditions. he or she has the authority to sign for and bind the Permittee, and that he or she COOT Signature: Date Perrnittee Signature Date - 03/22/19 t 3 e2St - Chief COLORADO Engineer, DEPARTMENT Regional Transportation OF TRANSPORTATION Director or Designee Print Name le Shawn Bates, Sr. Agent Land & ROW Distribution: Region File (Original) Permittee/Applicant Mtce Patrol Supvr. Mtce Landscaping Supvr Inspector CDOT Form # 0333 01/09 Previous versions are obsolete and should not be used. The following Standard Provisions are terms and conditions of this permit' Effective March 1, 2006 Utility work authonzed under this permit shall comply with the requirements of the State Highway Utihty Accommodation Code, and applicable federal, state, local, and industry codes and regulations Construction of any portion of the highway facility, including the pavement structure, subsurface support, drainage, landscaping elements and all appurtenant features, shall comply with the provisions of the CDOT Standard Specifications for Road and Bridge Construction, and with the Colorado Standard Plans (M & S Standards) 1 COMMENCEMENT AND COMPLETION Work on highway Right of Way (ROW) shall not commence pnor to issuance of a fully endorsed and validated permit Permittee shall notify the CDOT inspector a At least 2 working days prior to commencing work, or resuming operations which have been suspended for five or more consecutive working days b When suspending operations for 5 or more working days c Upon completion of work Work shall not proceed beyond a completion date specified m the Special Provisions without written approval of the Department 2 PLANS, PLAN REVISIONS, ALTERED WORK Plans or work sketch (EXHIBIT A) are subject to CDOT approval A copy of the approved plans or sketch must be available on site during work Plan revisions or altered work differing in scope or nature from that authorized under this permit, are subject to CDOT prior approval Permittee shall promptly notify the CDOT inspector of changed or unforeseen conditions, which may occur on the job 3 INSURANCE insurance Requirements for Utility and Special -Use Permits (Revised 7-05 per State Requirements) A. The Permittee shall obtain, and maintain at all times during the performance of work authorized by this Permit, insurance in the following kinds and amounts The Permittee shall require any Contractor working for them within the State Highway Right of Way to obtain like coverage The Permittee shall also require any Contractor or Consultant performing work described in sub- paragraph 4) below, to obtain Professional Liability Insurance 1) Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all employees acting within the course and scope of their employment and work on the activities authonzed by this Permit 2) Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent Consultants, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows a S1,000,000 eac.hoccurrence, b S2,000,000 general aggregate, c S2,000,000 products and completed operations aggregate, and d $50,000 any one fire e For any permanent Pernuttee-owned installations located within the State Highway Right of Way, highway repairs, or site restoration, Completed Operations coverage shall be provided for a minimum period of one year following final acceptance of work If any aggregate hmit is reduced below 1,000,000 because of claims made or paid, the Pernuttee, or as applicable - their Contractor, shall immediately obtain additional insurance to restore the full aggregate limit and furnish to CDOT a certificate or other document satisfactory to CDOT showing compliance with this provision 3) Automobile Liability Insurance covering any auto (including owned, hired and non -owned autos) with a minimum limit as follows S1,000,000 each accident combined single limit 4) For any a) engineering design, b) construction inspection, or, c) traffic control plans approved by a Traffic Control Supervisor, done in association with the operations or installations authorized by this permit, Professional Liability Insurance with minimum limits of liability of not less than $1,000,000 Each Claim and S1,000,000 Annual Aggregate If the policy is written on a Claims Made form, thePermittee, or, as applicable —their Consultant or Contractor, shall renew and maintain Professional Liability Insurance for a minimum of two years following final acceptance of the work, or provide a project specific Policy with a two year extended reporting provision 5) Pollution Legal Liability Insurance with minimum limits of liability of S1,000,000 Each Claim and $1,000,000 Annual Aggregate CDOT shall be named as an additional insured to the Pollution Legal Liability policy If the Policy is a component of the Professional Liability Policy, the Additional Insured requirement is waived, and the Policy shall be written on a Claims Made form, with an extended reporting period of at least two year following final acceptance of the work 6) Umbrella or Excess Liability Insurance with minimum limits of $1,000,000 This policy shall become pnmary (drop down) in the event the primary Liability Policy limits are impaired or exhausted The Policy shall be written on an Occurrence form and shall be following form of the primary The following form Excess Liability shall include CDOT as an additional insured B CDOT shall be named as additional insured on the Commercial General Liability and Automobile Liability Insurance policies Completed operations additional insured coverage shall be on endorsements CG 2010 11/85, CG 2037, or equivalent Coverage required by the Permit will be primary over any msurance or self- insurance program earned by the State of Colorado C The Insurance shall Include provisions preventing cancellation or non -renewal without at least 30 days prior notice to CDOT by certified mail D The Permrttee, or, as applicable — their Contractor or Consultant, will require all insurance policies in any way related to the Permit and secured and maintained by the Permrttee, Contractor or Consultant, to include clauses stating that each earner will waive all rights of recovery, under subrogation or otherwise, against CDOT, its agencies, institutions, organizations, officers, agents, employees and volunteers E All policies evidencing the insurance coverages required hereunder shall be issued by insurance companies satisfactory to CDOT F The Permittee, or as applicable - their Contractor or Consultant, shall provide certificates showing insurance coverage required by this Permit to CDOT prior to commencing work. No later than 15 days prior to the expiration date of any such coverage, the Permittee, Contractor or Consultant, shall deliver CDOT certificates of insurance evidencing renewals thereof At any time during the term of this contract, CDOT may request in writing, and the Permittee, Contractor or Consultant, shall thereupon within 10 days supply to CDOT, evidence satisfactory to CDOT of compliance with the provisions of this section G Notwithstanding subsection A of this section, if the Permittee is a "public entity" within the meaning of the Colorado Governmental Immumty Act CRS 24-10-101, et seq , as amended ("Act'), the Pernuttee shall at all times during the term of this permit maintain only such liability insurance, by commercial policy or self- insurance, as is necessary to meet its liabilities under the Act Upon request by CDOT, the Permittee shall show proof of such insurance satisfactory to CDOT Public entity Permittees are not required to name CDOT as an Additional Insured H If the Pernuttee engages a Contractor and/or Consultant to act rnrienenriently from the Permittee nn the nerrmtteri work that CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS Contractor and/or Consultant shall be required to provide an endorsement naming CDOT as an Additional Insured on their Commercial General Lability, Auto Liability, Pollution Legal Liability and Umbrella or Excess Liability policies. 4. WORK WHERE DEPARTMENT LACKS AUTHORITY Utility work within municipal boundaries (pursuant to 43-2-135 CRS), on certain public lands, or on private property, may require separate approval of the appropriate jurisdictional agency or property owner. 5. INSTALLATIONS ON FREEWAYS CDOT may permit utility accommodations on freeways, including but not limited to the Interstate System, only in accordance with Utility Accommodation Code provisions. Special case exceptions as defined therein may be permitted only in accordance with FHWA-approved Departmental policy. 6. JOINT USE ALTERNATIVES As directed or approved by CDOT, if necessary for the safe and efficient use of the ROW, Permittee shall utilize joint use facilities such as the placement of two or more separate lines in a common trench, or attachment to the same overhead support. The Permittee will be responsible for proper coordination with other affected utilities. 7. ATTACHMENT TO HIGHWAY STRUCTURES Permittee is responsible for designing structure attachments, subject to the approval of the CDOT Staff Bridge Design Engineer. 8. DRAINAGEWAYS AND WATERCOURSES The flow of water shall not ever be impaired or interrupted. Where possible, --ossings of ditches, canals or water -carrying structures shall be bored or ,Iked beneath. Irrigation ditch or canal crossings require approval of the ditch mpany or owner. Permittee shall repair damage to any drainage facility to the satisfaction of the owner. 9. TRAFFIC CONTROL PLAN a. Prior to commencing work, the Permittee shall develop and submit to the Department for acceptance, a Traffic Control Plan (TCP) for any accommodation work that will affect traffic movement or safety. The Permittee shall implement the TCP and utilize traffic control devices as necessary to ensure the safe and expeditious movement of traffic around and through the work site. b. The Pennittee shall develop the TCP, and Methods of Handling Traffic (MI IT's) included therein, in conformance with the Manual on Uniform Traffic Control Devices (MUTCD), the Colorado Supplement thereto adopted by the Commission pursuant to sections 42-4-104 and 42-4-105 CRS, the Department's standard specifications for temporary traffic control and the Department's standard plans for signing - Standard Plans S 630-1 and S 630-2. The TCP shall include provisions for the passage of emergency vehicles through the work zone, and shall conform to the requirements of the Americans with Disabilities Act. The TCP and MHT's shall contain sufficient detail to demonstrate conformity with all applicable requirements. c. The Permittee shall have a competent person at the work site at all times in responsible charge of temporary traffic control. In situations where the TCP goes beyond any Typical Application shown in the MUTCD, or particularly dangerous roadway or traffic conditions exist, the Department may require the Permittee to have a Traffic Control Supervisor (TCS) develop or approve the TCP or to have a TCS on -site during work. The TCS shall be certified as a worksite traffic supervisor by either the American Traffic Safety Services Association (ATSSA) or the Colorado Contractors Association (CCA), and shall have a current CDOT flaggers' certification cad. The TCS shall be responsible for the planning, preparation, coordination, implementation, and inspection of the TCP. d. The Permittee shall not start the permitted work before the Department accepts the TCP. e. The Department may review and order changes to the TCP and MHT's during performance of the work, as required. f. The Permittee shall comply with the TCP at all times during paformancc of the work. g. The Permittee shall keep a copy of the TCP at the work site at all times during performance of the work for inspection. h. The TCP shall ensure that closure of intersecting streets, road approaches and other access points is minimized. On heavily traveled highways, the Department will not permit operations that interfere with traffic during periods of peak traffic flow. When Permittee operations coincide with highway construction or maintenance operations, the Permittee shall develop and implement the TCP in cooperation and coordination with the highway agency and/or its contractors and as otherwise directed by the Department in the permit. All flaggers shall have a current CDOT flagger certification card and shall be capable of communicating with the traveling public and others at the work site. 10. NCHRP 350 CRASHWORTHINESS REQUIREMENTS FOR WORK ZONE TRAFFIC CONTROL DEVICES Work zone devices designated by FHWA as: Category I, including but not limited to single -piece drums, tubes, cones and delineators; Category II, including but not limited to barricades, vertical panels with light, drums or cones with light, portable sign supports, intrusion detectors and type III barricades; or as Category III, including but not limited to concrete barriers, fixed sign supports, crash cushions, and other work zone devices not meeting the definitions of Category I or H; shall meet NCHRP 350 crash test requirements. The Permittee, or their contractor shall obtain and make available upon request, the manufacturer's written NCHRP 350 certification, or as applicable, the FHWA Acceptance Letter, for each type of device. FHWA Acceptance Letters for Category H or Category Ill Work Zone Devices may be accessed through the FHWA website at nup:J satety.thwa.dot.gov;roadway dLpv'road hrr varelwzd.htm 11. WORKER SAFETY AND HEALTH a. All workers within the State Highway right of way shall comply with their employer's safety and health policies/procedures and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. b. Personal protective equipment (PPE) (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers in the SH ROW, except when in their vehicles, shall wear the following personal protective equipment: 1) Head protection that complies with the ANSI 289.1 standard; 2) At all construction sites or whenever there is danger of injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41; 3) High visibility apparel, which shall, at a comply with the Class 2 specifications of the ANSI/ISEA 107standard. 02/06 CDOT Permit Form 333 and Standard Provisions Page 3 of 9 minimum CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS Class 3 apparel shall be considered for use at night or in particularly hazardous situations 4) The most recent version of the ANSI standards listed above shall apply 12 ADA REQUIREMENTS The Pernuttee shall comply with the apphcable provisions of the Americans With Disabilities Act, with respect to both permanent facilities installations and temporary work zones 13 CLEAR ROADSIDE CONSIDERATIONS a CDOT is committed to provide a roadside area that is as free as practical from nontraverseable hazards and fixed objects ("clear zone") New above ground mstallations may be permitted within the clear zone only upon a showing that no feasible alternate locations exist Permittee must utilize appropriate countermeasures to minimize hazards b Permittee shall remove materials and equipment from the highway ROW at the close of daily operations The traffic control plan must include protective measures where materials and equipment may be stored on ROW Protection of open trenches and other excavations within highway ROW shall be addressed in the Pernuttee's traffic control plan All excavations shall be closed at the end of daily operations, and no open excavation will be allowed in the clear zone after dark The Permittee agrees to promptly undertake mitigating or corrective actions acceptable to the Department upon notification by CDOT that the installation permitted herein has resulted in a hazardous situation for highway users 14 GENERAL CONSTRUCTION REQUIREMENTS a Work shall not be performed at night or on Saturdays, Sundays, or holidays without prior authorization or unless otherwise specified in this permit CDOT may restrict work on ROW during adverse weather conditions or during periods of high traffic volume b Those areas within ROW, which must be disturbed by permit operations, shall be kept to a practical minimum Permittee shall not spray, cut, or trim trees or other landscaping elements within highway ROW, unless such work is otherwise specified in this permit, or clearly indicated on the approved plans Cleated or tracked equipment shall not work on or move over paved surfaces without mats, or pads on tracks c Material removed from any portion of the roadway prism must be replaced in like kind with equal or better compaction Segregation of material is not permitted The permitted facility shall be of durable materials in conformity with accepted practice or industry standards, designed for long service life, and relatively free from routine servicing or maintenance d Construction or compaction by means of jetting, puddling, or water flooding is prohibited within all highway ROW e Thrust blocks are required on all vertical and horizontal bends in pressure pipes f Meters shall not be placed on highway ROW except within corporate limits where municipal regulations allow such use 15 ALIGNMENT, COVER, CLEARANCE a Location and alignment of Permmttee's facilities shall only be as specified in this pemut or as otherwise indicated in the approved plans or work sketch (EXHIBIT A) b Parallel installations will not be permitted within roadways (including curbing and/or shoulders) or median areas, except within corporate boundaries, subject to municipal regulations Parallel installations should be located as near as practicable to the ROW line Crossings shall be as nearly perpendicular to the highway as feasible d Where no feasible alternate locations exist, the Department may permit parallel installations along roadside areas within 15 feet from edge of shoulder or back of curb In these cases, the facility must be so located and safeguarded as to avoid potential conflict with necessary highway appurtenances (signs, guard rail, delineators, etc ) Specific safeguards such as increasing depth of cover to 60 inches, capping, or encasement, shall be specified in this permit's Special Provisions e Parallel installations shall follow a uniform alignment, wherever practical Due consideration must be given to conserving space available for future utility accommodations The standard allowable deviation from the approved horizontal alignment is f 18 inches f Minimum cover shall conform to the Special Provisions Normal specified cover will be 48 inches or greater reduced cover may be approved where site conditions warrant, subject to other safeguards as may be specified or approved in the pemut Minimum overhead clearance shall conform to the Special Provisions, consistent with Utility Accommodation Code criteria 16 PAVEMENT CUTS AND REPAIRS Paved surfaces shall not be cut unless otherwise specified m this permit No more than one half the width of the roadbed may be opened at a time, when otherwise permitted Pavement shall be sawed or wheel -cut to a neat line Pavement shall be replaced to a design equal to or greater than that of the surrounding undisturbed pavement structure Pavement repair shall conform to the Special Provisions or the approved plans 17. BORING, JACKING, ENCASEMENT Unless otherwise specified, burred crossings shall be bored or jacked beneath ; k the roadway, at least from toe of slope to toe of opposite slope Portals for untrenched crossings more than 5 feet in depth shall be bulk headed in conformance with OSHA construction and safety standards Portal limits of untrenched crossings shall be established safely beyond the highway surface and clear zone and in no case shall the lateral distance from the surfaced area of the highway to the boring or jacking pit be less than the vertical difference in elevation between such surface and the bottom of the pit. Water jetting or tunneling is not permitted Water assisted boring may be permitted as determined by the CDOT Inspector Boring hole shall be oversized to the minimum amount required to allow pull -through of the conduit being installed Resultant voids shall be grouted or otherwise backfilled, subject to CDOT approval Ends of bored sections shall not be covered before being inspected Encasement shall be consistent with Utility Accommodation Code provisions CDOT may require protective casing for shallow installations or certain conduit materials Encased crossings shall extend at least from toe of slope to toe of slope, or the full width between access -control ]rues on freeways, mcludmg the Interstate System 18 INSPECTION AND ACCEPTANCE a CDOT will determine the extent of inspection services necessary for a given installation Pemuttee shall attend final inspection as may be required If the initial performance of permitted work was unacceptable, as determined by the Department, the Pemuttee shall perform any reconstruction or improvement of that work as ordered by the Department, in a timely manner and prior to any further construction If permitted operations are not being carried out in compliance with the terms and conditions of this permit, the Department may order the Permittee to perform whatever corrective measures are necessary to attain compliance with the permit If there is an immediate danger to the public's health, safety or welfare, the Department may order the Permittee to cease all operations and if necessary, to remove all equipment and facilities from the SHROW b Final acceptance does not relieve Pemuttee of maintenance obligations toward those elements of the highway facihty 02/06 CDOT Permit Form 333 and Standard Provisions Page 4 of 9 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS constructed under this permit. Final acceptance begins the two-year warranty period (see requirement under "Operation and Maintenance" below). 19. ENVIRONMENTAL CLEARANCES/PERMITS a. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to their activities and to obtain any clearances that are required directly from the appropriate regulatory agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from CDOT Permitting Offices or may be accessed via the CDOT webpage at http://www.dot.state.co.us/UtilityPrograrrvForms.cfm. Failure to comply with regulatory requirements may result in suspension or revocation of your CDOT permit, or enforcement actions by other agencies. b. The Special Provisions of this permit shall list any specific environmental clearances or permits that the Department has been notified by the Pernttee or by the administering regulatory agency apply to the operations authorized by this permit. The Special Provisions shall require the Permittee obtain the listed environmental clearances/permits prior to beginning work. c. The Permittee shall comply with all requirements described in the CDOT Environmental Clearances Information Summary, including those pertaining to: 1) Ecological Resources 2) Cultural Resources 3) Discharges of Stormwater or Process Water 4) Hazardous Materials 5) Discharges of Dredged or Fill Material 6) Erosion and Sediment Control 7) Disposal of Drilling Fluids 8) Concrete Washout 9) Spill Reporting 10) Transportation of Hazardous Materials d. Disturbance of any wildlife shall be avoided to the maximum extent practicable. If threatened or endangered species or archeological or historical artifacts are encountered during the progress of a project, work in the subject area shall be halted and the CDOT regional permitting office shall be contacted immediately for direction as to how to proceed. e. All discharges of stormwater or process water are subject to the applicable provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. f. There shall be no disposal of hazardous materials in the state highway right of way. Solid waste shall be removed from the state highway right of way and disposed of at a permitted facility or designated collection point (such as the Permittee's own dumpster). Drilling fluids must be disposed of as described in the ECIS. g. If pre-existing solid waste or hazardous materials contamination (including oil or gasoline contaminated soil, asbestos, chemicals, mine tailings, etc.) are encountered during the performance of work, the Permittec shall halt work in the affected area and immediately contact the CDOT regional permitting office for direction as to how to proceed. h. Spills shall be reported immediately using the CDOT Illicit Discharge Hotline (303) 512-4446. Spills on the highway, into waterways, or that may otherwise present an immediate danger to the public, shall be reported by calling 911 or the Colorado State Patrol at (303) 2394501, and the Colorado Department of Public Health and Environment at 1-(877) 518-5608. RESTORATION OF RIGHT OF WAY Prior to final acceptance, all disturbed portions of highway right of way shall be cleaned up and restored to their original condition, subject to CDOT approval. Seeding, sodding, and planting shall be as specified, or otherwise approved by CDOT. Construction, maintenance and watering requirements shall conform to the CDOT Standard Specifications. Where landscape restoration must be delayed due to seasonal requirements, such work may be authorized by separate permit. Permittee shall use only certified weed -free seed and mulch. Permittee shall clean equipment before transporting it into or out of the state to prevent the migration of noxious weeds. 21. OPERATION AND MAINTENANCE a. Permittee agrees to own and maintain the installation permitted herein. The facility shall be kept in an adequate state of repair and maintained in such a manner as to cause the least interference with the normal operation and maintenance of the highway. b. If any element of the transportation facility, constructed or replaced as a condition of this permit, fails within 24 months due to improper construction or materials, Permittee shall make all repairs immediately as notified in writing by CDOT. c. Routine, periodic maintenance and emergency repairs may be performed under the general terms and conditions of this permit. CDOT shall be given proper advance notice whenever maintenance work will affect the movement or safety of traffic. In an emergency, the CDOT Region office and the State Patrol shall immediately be notified of possible traffic hazards. Emergency procedures shall be coordinated beforehand, where possible. d. Maintenance activities requiring new excavation or other disturbance within highway ROW may require separate permit. Where highway construction or maintenance operations so require, Permittee will shut off lines, remove all combustible materials f, um the highway right of way, or provide other temporary safeguards. 22. MARKERS, LOCATION AIDS, LOCATION ASSISTANCE a. The utility shall take all practical measures to ensure that buried utility facilities are surface -detectable by standard geophysical methods. Where the utility facilities, by the nature of their material properties, burial depth or other factors, may by themselves not be surface -detectable, the utility shall, where feasible, incorporate detection wire or other detection aids in the installation of those facilities. In instances where detection aids are not feasible or would be ineffective and surface-detectability cannot be ensured, surface markers shall be installed as directed by the Department and as -constructed plans and showing the accurate horizontal and vertical location of the buried facilities shall be provided to the Department. b. All plowed or trenched installations must include color -coded (using the American Public Works Association color coding system) warning tape placed not less than 12 inches vertically above the top of the line. The warning tape shall be surface -detectable if needed to facilitate detection of the line. c. The utility shall place readily identifiable markets at the right of way line where it is crossed by pipelines carrying transmittants which are flammable, corrosive, expansive, energized, or unstable, particularly if carried at high pressure or potential, except where a vent will serve as a marker. d. The utility shall place markers for longitudinal underground facilities vertically above the facilities or at a known horizontal offset, unless otherwise approved in writing by the Department. Each marker shall provide a fore- and backsight to succeeding and preceding markers. Markers shall be installed at suitable intervals along tangent sections, at angle points or points of curvature and at reasonable intervals along curves. e. The utility shall maintain any markers required by this Code for the life of the installation. 02`06 CDOT Permit Form 333 and Standard Provisions Page 5 of 9 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS f The Department may require the utility to submit "as -constructed" plans The Department may enter into an agreement with the utility whereby the Department can rely on those plans for the exact location of the utility for any future excavations, and need not give notice to the utility under Article 1 5 of Title 9, C R S g The utility will comply with the applicable requirements of Article 1 5 of Title 9 C R.S , including any requirement to participate in the State's Notification Association pursuant to 9-1 5-105 C R S All owners of underground utilities within the SHROW, with the exception of the Department itself, must become members of the UNCC Notification Association h In addition to complying with the provisions of Article 1 5 of Title 9 C R S (One -Call Statute) in response to the Department's notification of planned excavations, utility owners shall surface - mark their buried utility facilities that are located within the SHROW in order to facilitate Departmental engineering and design activities, upon reasonable request from the Department, and at no cost to the Department The Permittee shall respond to such request within a reasonable timeframe acceptable to the Department, but no longer than 14 calendar days from the date of request, and the accuracy of the surface marking shall be within 18 inches of either side of the actual location of the boned facility 23 ADJUSTMENTS DUE TO HIGHWAY CONSTRUCTION If for any transportation purpose it becomes necessary to remove, adjust, or relocate this facility, Permittee will do so promptly, at no cost to the CDOT except as provided by law, upon written notice from CDOT and in accordance with the utility relocation permit issued to cover the necessary work The utility shall perform the relocation at or within a time convenient to and in proper coordination with the project or transportation -related activity, to muumize public inconvenience and cost, as directed by the Department in the permit authorizing the relocation The utility company shall pay for damages caused by the company's delay in the performance of utility relocation work or interference with the performance of transportation project work done by others Such damages include, but are not limited to, payments made by the Department to any third party based on a claim that performance of the transportation project work was delayed or interfered with as a direct result of the utility company's failure to timely perform the utility relocation work Damages resulting from delays in the performance of the utility relocation work or interference with the transportation project work that are caused by events beyond the utility company's ability to reasonably foresee or control (a force majeure) shall not be charged to the utility company 24 ABANDONMENT, RETIREMENT, CHANGE IN OWNERSHIP a The Permittee shall notify the Department in writing of the planned retirement or abandonment of its fatality or any portion thereof The Department will notify the Permittee in writing if it determines that the facilities maybe retired or abandoned in place, along with any special conditions that may apply b Retired facilities shall remain the Permittec's sole responsibility, subject to all provisions of the Utility Accommodation Code and all of the terms and conditions of the permit issued for that facility, including maintenance and relocation requirements c The Pennittee shall promptly remove all abandoned facilities from the SH ROW and promptly restore the SH ROW to pre-existing or other conditions prescribed by the Department unless the Department in writing expressly allows the facility to remain in place Wntten notice from the Department, allowing an abandoned facility to remain in place, may include special conditions d If utility facilities are retired or abandoned in place, the utility shall comply with that decision if directed by the Department 1) cap, plug or fill lines, 2) funush suitable location records for any such boned facilities, 3) maintain its own records of such facilities and respond to locate notices/requests from the UNCC and/or excavators, In providing such locates, the utility will indicate to the requesting entity whether or not the subject facilities are retired or abandoned 4) perform any other actions as deemed necessary by the Department to protect the transportation facility and/or the traveling public e If the ownership of utility facilities is transferred, both the original Permittee and the new owner shall notify the Department in writing prior to the change in ownership, and such notice shall state the planned date of change in ownership The notice from the new owner shall include a written statement accepting all terms and conditions of the existing pemut, effective upon the planned date of the change in ownership f Utility facilities containing asbestos may not be abandoned in -place Ordinarily, such facilities must be removed from the SHROW when take out of service On a case -by -case basis, the Department may allow such facilities to be retired in -place, with the owner retaining full legal ownership and responsibility for the facilities 25 SUSPENSION AND CANCELLATION a The CDOT inspector may suspend operation due to 1) Non compliance with the provisions of this permit 2) Adverse weather or traffic conditions 3) Concurrent transportation construction or maintenance operations in conflict with the permitted work 4) Any condition deemed unsafe for workers or for the general public b Work may resume when grounds for suspension no longer exist This permit is subject to cancellation due to I) Persistent noncomphance with permit provisions 2) Abandonment or transfer of ownership 3) Superseded by new permit covering the same installation 4) Conflict with necessary planned transportation construction c Permittee must promptly terminate occupancy upon notice of cancellation ofperrnrt, unless a new permit is applied for and granted d Where Pernuttee does not fulfill an obligation to repair or maintain any portion of the highway facility, or control and safely maintain the flow of traffic thereon, CDOT reserves the right, in lieu of canceling this permit, to accomplish the required work by any other appropriate means, and Permittee shall be liable for the actual costs thereof 02/06 CI3OT Permit Form 333 and Standard Provisions Page 6 of 9 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances Information Summary PURPOSE - This summary is intended to inform entities external to CDOT that may be entering the state highway right-of-way to perform work related to their own facilities (such as Utility, Special Use or Access Permittees), about some of the more commonly encountered environmental permits/clearances that may apply to their activities. This listing is not all-inclusive - additional environmental or cultural resource permits/clearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT — Please Review The Following information Carefully - Failure to Comply With Regulatory Requirements May Result In Suspension or Revocation of Your CDOT Permit, Or Enforcement Actions By Other Agencies. CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE): General Information — (303) 692-2035 Water Quality Control Division (WQCD): (303) 692-3500 Environmental Permitting Website https://www nnHHrado.gov/pacific/cdphe/all-permits C1 CDOT Water Quality Program Manager (303) 757-9343 ittps://www.codot.gov/programs/environmental/water-quality CDOT Asbestos Project Manager: Phil Kangas, (303) 512-5519 [] Colorado Office of Archaeology and Historic Preservation: (303) 866-5216 LI U.S. Army Corps of Engineers, District Regulatory Offices: Omaha District (NE CO), Denver Office (303) 979-4120 ~ttp://www.mvo.usace.nrm‘f mifiissions/RequlatoryPrerirrIrn'flnlorado.aspx Sacramento Dist. (Western CO), Grand Junction Office (970) 243-1199 nttp://www.spk.usace.army.mii/Missions/Regulatory.aspx Albuquerque District (SE CO), Pueblo Office (719)-543-9459 http://www.spa. usace.army.mil/MissionslReguiatoryProgramandPermits.aspx O CDOT Utilities, S:ecial Use and Access Permitting: (303) 757-9654 https://www.codot.gov/husiness/permits Wildlife Resources - Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. If any threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Information about threatened or endangered species may be obtained from the CDOT website, nttp://www.codot.gov/programs/environmental/wildlife/guidelines, or the Colorado Parks and Wildlife (CPW) website, http'm^^A'w cpw.stnte.co.us/leam/Pagcs/SOC-ThreatenedEndangeredList.aspx. Additional guidance may be provided by the appropriate Region Planning and Environmental Manager (RPEM). Cultural Resources - The applicant must request a file search of the permit area through the Colorado Office of Archaeology and Historic Preservation (DAMP), Denver, to ascertain if historic or archaeological resources have previously been identified Ottp://www.historycolorado.org/oahp/file-beafu ). Inventory of the permit area by a qualified cultural resources specialist may be necessary, per the recommendation of CDOT. If archaeological sites/artifacts or historic resources are known to exist prior to the initiation of the permitted work or are encountered as the project progresses, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Ervironmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact information: Contact the OAHP for file searches at h 303) 866-5216. Paleontological Resources - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder (nttps://cumuseum.coiorado.eduiresearchipaleontology/vertebrates/policies), and the Denver Museum of Nature and Science (nttp://www.dmns.orq/science/collections/earth-science-collections/) to ascertain if paleontological resources have been previously identified in or near the permit area. Inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. if fossils are encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information: See the museum websites listed above for Paleontological Collections Manager contact information. Contact the COOT Paleontologist for further information at nicole.peaveyAstate.co.us or (303) 757- 9632. The CDOT Paleontologist will not conduct a comprehensive file search independently of the museums. Hazardous Materials. Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved Certificate of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25-15-301 et al, and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) prohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entities entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials contamination (including oil or petroleum contaminated soil, asbestos, chemicals, mine tailings, etc.) is encountered during the performance of work, the permittee shall halt work in the affected area and immediately contact the COOT Regional Permitting Office for direction as to how to proceed. Contact Information: Theresa Santangelo-Dreiling, CDOT Hazardous Materials Management Supervisor: (303)512-5524. Asbestos Containing Materials. Asbestos Contaminated Soil - All work on asbestos containing materials (ACM) must comply with the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) Regulation 8. Disposal of ACM, and work done in I asbestos -contaminated soil, must comply with the CDPHE Hazardous Materials and Waste Management Division's HMWMD) Solid Environmental Clearances Information Page 1 of 3 Colorado Department of August Info: Waste authorization CDPHE Regulations. is APCD being The and requested. application HMWMD Additional for Regulations any CDOT guidance can permit or be accessed must requirements specifically via may the CDPHE identify be specified any Environmental ACM in the involved permit Permitting in special the work Website provisions. for listed which Contact above. Additional information concerning clearance on CDOT projects is available from the CDOT Asbestos Project Manager (303) 512- 5519, or Theresa Santar jelo-Dreilinc, Hazardous Materials Management Supervisor: _303) 512-5524. Transportation of Hazardous Materials - No person may offer or accept a hazardous material for transportation in commerce unless that person is registered in conformance with the United States Department of Transportation regulations at 49 CFR, Part 171. The hazardous authorized obtain authorization material by applicable must and be requirements, a State properly HAZMAT classed, or an Permit exemption, described, from the packaged, approval Colorado or Public marked, registration Utilities labeled, has Commission. and been in issued. condition Contact Vehicles for shipment Information: requiring as a required placard, For or must authorization and more info call the Federal Motor Safety Carrier Administration, US DOT for inter- and intra-state HAZMAT Registration (303) 969-6748. Colorado Public Utilities Commission: (303) 894-2868. Discharge of Dredged or Fill Material — 404 Permits Administered By the U.S. Army Corps of Engineers, and Section 401 Water Quality Certifications Issued by the CDPHE WQCD - Corps of Engineers 404 permits are required for the discharge of dredged or fill materials into waters issued of the for United States, including wetlands. There are various types of 404 permits, including line nationwide would activities be required. Contact permits, (nwp #12). If which an individual Depending are 404 upon permit activities the specific is required, with relatively circumstances, section minor 401 it impacts. water is possible quality For that example, certification either there a "general" from is the a nationwide or CDPHE "individual" WQCD permit 404 is for also permit utility required. the appropriate Corps District Regulatory Office for information about what type of 404 permit may be required (contact information above). Contact the CDPHE Water Quality Control Division at (303) 692-3500. Working on or In any stream or Its bank - In order to protect and preserve the state's fish and wildlife resources from actions that may obtain solid obstruct, blue a Senate line diminish, on Bill USGS 40 certification destroy, 7.5 quadrangle change, from the modify, maps; Colorado and/or or vary Department 2) a intermittent natural existing of Natural streams stream Resources. providing or its banks live A stream water or tributaries, beneficial is defined it to as may fish 1) be represented and necessary wildlife; by and/or to a 3) streams application, segments having of as per streams wetlands guidelines supporting present agreed within 25% upon or 200 more by yards COOT cover upstream and within CPW, 100 or downstream can yards be upstream accessed of the or at project httpsJ/www.codot,gov/programs/environmental/ downstream measured of the by project; valley length. and/or The 4) segments CPW of Nildlife/guidelines. Stormwater Construction Permit (SCP) and Stormwater Discharge From Industrial Facilities - Discharges of stormwater runoff from construction sites disturbing one acre or more - or certain types of industrial facilities, such as ccncrete batch plants - require a CDPS Stormwater Permit. Contact Information: Contact the CDPHE Water Quality Control Division at (303) 692-3500. Website: rthps://wwvv.culoraao.yovipacific/cdphe/wu-construction-yeneral-permits and naps://colorado.govipacific/cdpne/wq-commerce-and- industry-permits. Construction Dewatering (Discharge or Infiltration) and Remedlation Activities - Discharges of water encountered during excavation Information: 3500. For Applications or work For Construction in wet and areas Instructions Dewatering may require (CDPHE and a Construction Remediation websitej: https://www.colorado.gov/pacific/cdphe/wq-construction-general Dewatering Activities Discharge or Remediation Permits, Activities contact Discharge the CDPHE Permit. WQCD Contact at (303) permits. 692- Municipal Separate Storm Sewer System (MS4) Discharge Permit - Discharges from the storm sewer systems of larger municipalities, by facility the CDPHE should and contact WQCD. from the For the municipality CDOT facilities highway that regarding lie drainage within stormwater the system boundaries related that lies of clearances a within municipality those that municipalities, that may is have subject been are to subject an established MS4 to permit, MS4 under the Permits that owner issued of such municipality's the (https://www.colorado.gov/pacific/cdphe/wcicc-regulations-and-policies-and-water-quality-statutes) applicable MS4 provisions permit. of All the discharges Colorado to Water the CDOT Quality highway Control drainage Act, the Water system Quality or within Control the Right Commission and of Way the COOT (ROW) (WQCC) MS4 must Regulations Permit comply # with COS - 000005 (httjps://www_codot_gov/programs/environmental/water-quality/documents). Discharges are subject to inspection by CDOT and MS4 CDPHE. Permits, Contact or go to the https://vwvw.colorado.gov/pacific/cdphe/wq-municipal-ms4-permits. CDPHE Water Quality Control Division at (303) 692-3500 for a listing For CDOT-related of municipalities MS4 required regulations, to obtain go to: https://www.codot.gov/programs/enviror mental/water-guality/stormwater-proorams.html. General Prohibition — Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but are not limited to, substances such as wash water, paint, automotive fluids, solvents, oils or soaps and sediment. Contact Information: Contact the CDPHE Water Quality Control Division at (303) 692-3500. General Authorization - Allowable Non-Stormwater Discharges - Unless otherwise identified by CDOT or the WQCD as significant sources of pollutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm uncontaminated activities. sewers, Allowable discharges springs, non-stormwater footing from potable drains, discharges water water sources, line can flushing, be foundation found flows under drains, from Illicit riparian air Discharge conditioning habitats PDD and condensation, at: wetlands, nttps://www.codotgoviorograms/ and irrigation flow from water, firefighting environmental/water-quality/stormwater-nrograms.html. Contact Information: The CDPHE Water Quality Control Division (telephone #'s listed above). Erosion and Sediment Control Practices - For activities requiring a Stormwater Construction Permit, erosion control requirements will minimize be specified erosion in that and sedimentation permit. In situations according where to a CDOT stormwater Standard permit Specifications is not required, 107.25, all reasonable 208, 213 measures and 216 (https://www.codot.gov/ should be taken to bustnessidesignsupportr2011-construction-specif�aLtons/2U 11-Specsr2U 1 i -specs-boo ). AM disturbances require a stabilization plan, native seeding or landscape design plan according to applicable CDOT Standard Specifications 212-217 and 623. The CDOT Erosion Control erosion controls and and Stormwater restore disturbed Quality Guide vegetation. (available from the Bid Plans Office at (303) 757-9313) should be used to design Environmental Clearances Information Page 1 of 3 Colorado Department of August IDisposal of Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as "discharges" or "solid wastes," and in general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being separated from fluids or after infiltration of the water, provided: 1) the drilling fluid consists of only water and bentonite clay, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely tc pose a nuisance to future work in the area, 3) the solids are covered and the area restored as required by CDOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: Contact CDPHE (telephone #'s listed above). Noxious Weeds and Invasive Species Management Plan - Noxious Weeds and Invasive Species guidance can be found by contacting the Colorado Department of Agriculture (nttps://www.colorado.gov/pacificiagconservation/noxirmqweeds) and the Colorado Division of Parks and Wildlife (http://cpw.state.co.us/aboutus/Paqes/RS-NoxiousWeeds.aspx). In either case, management plans involvinc.; the control of noxious weeds associated with the permitted activity and cleaning of equipment will be required. Concrete Washout - Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, inlets, receiving waters, or in the CDOT ROW. Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, drainageways, and inlets. Concrete washout shall only be performed as specified by the CDOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact Information: Contact CDPHE or find additional information on the CDOT website: https://www codot.gov/bus±^ass/csignsupportl2011-constructionv specitication: x'011-Suecs and refer to the specifications and their revisions for sections 101, 107 and 208. Spill Reporting - Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain or buried. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4446 (4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, into waterways, any spill in the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1-877-518-5608. More information can be found at https://www.colorado.govlpacificrcdphe/emeryencyu urrg-line Environmental Clearances Information Page 1 of 3 Colorado Department of August Seed Mix 4 - Brown Elevation: Low Temperature: Warm Humidity: Average Grasses 1 Big Bluestem — 15% (3 6 lbs/acre) 2 Fringed Brome — 13% (1 9 lbs/acre) 3 Sand Lovegrass — 12% (03 lbs/acre) 4 Green Sprangletop — 10% (0.6 lbs/acre) 5. Western Wheatgrass — 10% (3 1 lbs/acre) 6. Buffalograss — 10% (6.2 lbs/acre) 7 Sand Dropseed —8% (0 1 lbs/acre) Forbs/Shrubs/Flowering 1 Gaillardia — 7% (1 6 lbs/acre) 2. California Poppy — 5% (0.6 lbs/acre) 3 Desert Verbena —4% (0 3 lbs/acre) 4. Palmer Penstemon — 4% (0 2 lbs/acre) 5. Indian Blanket — 2% (0 3 lbs/acre) Seeding Application: Drill seed 0 25" to 0 50" into the topsoil In areas that are not accessible to drill, hand broadcast at triple the above rate and rake 0 25" to 0.50" into the topsoil. Mulching Application: 15 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre Note: Hydroseeding and/or Hydromulching will not be allowed o O CDOT Stale Highway UldllvAccommodation Coda 2009 34435 the utility shall replace excavated portions of the base and subgrade with flowable backfill, or as otherwise directed by the Department, and 3 4.4.3.6 the utility shall trim all overbreaks or incidental damage of existing pavement back to a neat line before patching; and 34437 the utility shall repair all surface gouges or other minor damage in a manner acceptable to the Department, and 34438 the utility shall restore all pre-existing pavement markmgs in and adjacent to resurfaced areas 345 Trenched Construction and Backfill 3 4.5 1 The utility shall construct vertical -sided trenches, of uniform width, and no wider than the line diameter plus three feet, unless the utility demonstrates to the Department's satisfaction that such construction is impracticable 3452 Shoring or bulkheading shall conform with all applicable Federal, State and local jurisdiction construction and safety standards 345.3 The utility shall provide drainage from excavation areas 3.454 The utility shall not perform construction or compaction by means of jetting, puddling, or water flooding within SH ROW, however, a limited amount of puddling may be allowed up to the springhne of the pipe when free -flowing granular backfill materials are used, when necessary to obtain proper compaction of pipeline bedding 3455 Unless otherwise directed or approved by the Department, the utility shall backfill trenches as follows 3 4 5 5 1 replace excavated material with flowable backfill as specified by the Department within toes of slopes; and/or 3.4552 place backfill in 6 inch layers, each consolidated by mechanical tamping and controlled addition of moisture to a density equal to or greater than that of the surrounding undisturbed soil outside toes of slopes 346 Trenchless Installations 3.461 Portal limits of untrenched crossings shall be established safely beyond the highway surface and clear zone, and in no case shall the lateral distance from the surfaced area of the highway to the boring or jacking pit be less than the vertical difference in elevation between such surface and the bottom of the pit. O 55 COOT Slate Highway Utility Accommodation Code 2009 3462 Shoring or bulkheadmg shall conform with applicable Federal, State and local jurisdiction construction and safety standards 3463 The utility shall not use water jetting or tunneling, but water -assisted or wet boring may be permitted if determined by the Department to not result in excessive erosion or unacceptable moisture conditions in the roadway subgrade 3464 The boring hole shall be oversized to the minimum amount required to allow pull - through of the conduit being installed, based upon equipment and product manufacturer's specifications If the oversize excavation is not already filled by the drilling slurry after product pull through, the void shall be grouted to the satisfaction of the Department Grout or other approved backfill material shall be used for pipe of 12 Inches or more in diameter, and for overbreaks, unused holes or abandoned pipe The composition of the grout shall be a cement mortar, a slurry of fine sand or fine granular materials, subject to Department approval 3465 The utility shall follow manufacturer's guidelines and industry standards for equipment set-up and operation The utility shall assess soil conditions to determine the most appropriate installation technique Underground borepaths or tunnels shall be tracked and recorded by the utility Failed bores shall be appropriately abandoned by the utility 34 6 6 Drilling fluids shall be prepared and used according to fluid and drilling equipment manufacturer guidelines The utility shall use fluid containment pits at both bore entry and exit points, and shall use appropriate operational controls in order to avoid heaving or loss of drilling fluids from the bore 3 4 6 6 1 Antifreeze additives shall be non-toxic and biodegradable products 34,662 Depending upon chemical composition or the specific method of disposal, improperly disposed dnllmg fluids may be classified as solid wastes or illicit discharges per Section 3 1 7, and in general, shall be pumped or vacuumed from the construction area, removed from the SH ROW and disposed of at permitted facilities that specifically accept such wastes 34663 Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is expressly prohibited 34664 Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being separated from fluids or after infiltration of the water, provided - 346641 the drilling fluid consists of only water and bentonite clay, or 346642 if required for proper drilling properties, small quantities of polymer additives that are approved for use in dnnking water well drilling, and 56 O 0 COOT State Hiahwav Utility Accommodation Code 2009 3.4 6.6.4.3 the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area; and 3.4.6 6 4 4 the solids are covered and the area restored as required by permit requirements 3 4 7 Utility Installations Near Drainage Ways and Watercourses 3 4 7 1 The utility shall not install any facility along or across the ROW of an imgation ditch or canal company without first obtaining the written approval of such company. 3 4 7 2 The utility shall install facilities that cross a stream or other drainage only at a point beneath the bed of that watercourse and only at a depth that adequately allows for scour or ditch maintenance requirements The utility shall also take the added measures to protect such lines that the Department deems necessary in areas subject to erosion or other disturbance 3 4 7 3 In establishing the depth of cover below an unpaved channel, the Department will consider potential scour, ditch maintenance operations and/or future needs to increase the channel capacity The utility line shall be installed a minimum of three feet below the lowest expected level of scour or degradation 3 4.7.4 Utility construction operations within or near live streams, ditches, wetlands or other bodies of water shall include adequate provision to protect or maintain surface and/or ground water quality, and may require appropriate clearances as described in Section 317 3 4 7 5 The utility shall not install utility lines within culverts where the primary purpose of that culvert is to carry drainage For culverts or culvert -like structures where the primary purpose of the culvert is something other than drainage, such as providing passage for stock, wildlife, pedestrians or vehicles, utility installations shall be addressed through Section 3 3.10 3 4 7.6 In order to avoid any interference with the operations or maintenance of either utility lines or of drainage structures, the utility shall not install utility lines inside any such drainage structure or inside the trench that surrounds any drainage structure, and shall maintain a horizontal and vertical clearance from any such drainage structure or surrounding trench if further directed to do so by the Department m the utility permit 3 4 8 Protection, Construction and Restoration of Highway Property 3.4 8 1 The utility shall avoid disturbmg or damaging all highway property, and shall be responsible for the prompt reconstruction, alteration, repair or maintenance of highway property, to repair any damage caused by the utility work, and to restore the SH ROW to pre-existing or better conditions as may be specified in the permit 57 State Highway Utility Permit 1 Attachment to Permit No 4190091 - Additional Terms and Conditions Version 5 1 GENERAL 2 This permit is issued in accordance with the State Highway Utility Code and is based in part upon the information submitted by the Permittee This permit is only for the use and purpose stated m the Application and Permit A copy of the State Highway Utility Code can be downloaded at http //www coloradodot info/business/permits/utilitiesspecialuse/2CCR 601_18 pdf/view 3 Please refer to this permit number in all communications and correspondence 4 The Pernuttee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required to proceed with permitted work Approval of this utility/special use permit does not constitute verification of this action by the Pernuttee 5 The Permittee, his or her heirs, successors -in -interest, assigns, and occupants of the Utility/Construction/ Landscape/Special Use permitted by this permit shall be responsible for meeting the terms and conditions of this permit 6 Before work begins, a certificate of insurance naming the Colorado Department of Transportation (CDOT) as an additional insured is required to be submitted to CDOT Region 4 Utilities Permits 1420 2nd Street Greeley, CO 80631 Description should include this permit number Insurance should be in effect through 2 -year warranty period from permit issue date and as long as installation exists in CDOT right-of-way See attached Standard Terms 3.A through 3 H., inclusive. 7 READ ALL ADDITIONAL STANDARD REQUIREMENTS OF THIS PERMIT AND OTHER TERMS AND CONDITIONS ON THESE ATTACHED SHEETS A COPY OF THIS PERMIT, INCLUDING ALL TERMS AND CONDITIONS, MUST BE ON THE JOB SITE WITH THE CONTRACTOR Call for an inspection of forms at least one working day prior to placing any concrete The Colorado Department of Transportation inspection is not an approval of the grade or alignment of the work The contractor and/or engineer is responsible for the proper grade and alignment Minor changes or additions may be ordered by the field inspector to meet field conditions Any survey monuments or markers disturbed dunng the execution of this permit shall be repaired immediately at the expense of the Permittee 8 NOTIFY THE DEPARTMENT OF TRANSPORTATION INSPECTOR Mike Shepherd at [970] 381- 5143 TWO WORKING DAYS BEFORE STARTING THE WORK OR RESUMING SUSPENDED WORK 9 On -premise and off -premise signing not in CDOT right-of-way shall comply with the current Colorado Outdoor Advertising Act CRS 43-1-401, Rules and Regulations Pertaining to Outdoor Advertising For questions, please contact Outdoor Advertising Inspector Ally Mattson at 970-350-2148 State Highway Utility Permit 2 Attachment to Permit No 4190091 - Additional Terms and Conditions Version 5 10 All work is to conform to the plans on file with the Colorado Department of Transportation or as modified by this Permit (IF DISCREPANCIES ARISE, THIS PERMIT SHALL TAKE PRECEDENCE OVER THE PLANS) The Colorado Department of Transportation plan review is only for the general conformance with the Colorado Department of Transportation design and code requirements The Colorado Department of Transportation is not responsible of the accuracy and adequacy of the design, of dimensions, and elevations which shall be confirmed and correlated at the job site The Colorado Department of Transportation, through the approval of this document, assumes no responsibility other than stated above for the completeness and/or accuracy of the plans. 11 The contractor shall follow the applicable construction specifications set forth by the Department of Transportation in the latest manual, Standard Specifications for Road and Bridge Construction, the M & S Standards, and the M U T C D 12 Any damage to any present highway facilities shall be repaired immediately and prior to continuing other work Any mud or other material tracked or otherwise deposited on the roadway shall be removed daily or as ordered by the Inspector 13 CDOT will determine the extent of inspection services for the work A daily inspection may be done by the Colorado Department of Transportation from the time work begins inside the highway right-of-way until the job is completed and right-of-way restored to its original condition. 14 Water, storm sewer, sanitary sewer, gas, electrical, landscaping, telephone, traffic signal installations and fiber optic installations will require individual additional permits 15 Any surveying required as a result of this permit is the responsibility of the Permittee 16 It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details The ECIS may be obtained CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction-Environmental Guidance webpage at http //www dot.state.co.us/environmental/Forms/asp FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substance such as• wash water, paint, automotive fluids, solvents, oils or soaps Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, imgation water, springs, footing drains, waterline flushing, State Highway Utility Permit 3 Attachment to Permit No 4190091 - Additional Terms and Conditions Version 5 flows from riparian habitats and wetlands, and flow from fire fighting activities ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begms For additional information and forms, go to the CDPHE website at http //cdphe state co us/wq/PermitsUnit/wqu 17 By accepting the permit, the permittee stipulates and agrees to fully protect, defend, mdemnify, and hold harmless, to the extent allowed by law, the Issuing Authority and each of the Authority's directors, officers, employees, agents, and representatives, from and against any and all claims, costs (including but not limited to all reasonable fees and charges of engineers, architects, attorneys, and other professionals or expert witnesses and all court or other dispute resolution costs directly incurred by reason of claims directly brought against the Issuing Authority), losses, damages, pre- or post judgment interest, causes of action, permittee's failure to obtam, or disregard of, any applicable federal, state, or local environmental permits, approvals, authorizations, or clearances, or in meeting or complying with any applicable federal, state, or local environmental law, regulation, condition, or requirements in connection with any activities authorized by this Utility Permit 18. The permittee shall assume full responsibility for installation of and the resolution of any unforeseen problems regarding the installation of this facility 19 The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required to proceed with permitted work Approval of this utility/special use permit does not constitute verification of this action by the Permittee 20 DRAINAGE, WATER QUALITY CONTROL, ENVIRONMENTAL 21 All disturbed landscaping is to be restored to original or better condition. 22 Areas of roadway and nght-of-way disturbed during this installation or work shall be restored to insure proper drainage and erosion control. 23 The Permittee is responsible for compliance with all Federal, State, and local environmental regulations The Permittee should have a qualified environmental consultant on staff or hire a qualified environmental consulting firm to assess the proposed project area for potential environmental impacts and obtain any necessary permits pnor to disturbance Environmental impacts include, but are not limited to, wetlands, water quality, threatened or endangered flora and fauna, cultural resources including both archaeological and paleontological resources, and hazardous waste that can affect both human health and the natural environment Should enforcement action(s) be taken by any agency with jurisdiction, liability for noncompliance with any environmental regulation is the sole responsibility of the Permittee 24 TRAFFIC 25 No storage of matenals or equipment will be allowed within CDOT right-of-way or 30 feet off the edge of the raveled way, whichever is greater 26. TRAFFIC CONTROL State Highway Utility Permit 4 Attachment to Penmt No 4190091 - Additional Terms and Conditions Version 5 J 27 No work will be allowed at night, or on Saturdays, Sundays, and legal holidays without prior authorization from the Department The Department may also restrict work within the State Highway right-of-way during adverse weather conditions 28 No equipment will be allowed in the main lanes of the roadway during construction 29 All work will be conducted from outside of CDOT right-of-way to outside of CDOT right-of-way. Therefore, no traffic control is required for this installation 30 MAINTENANCE OF UTILITY 31 Maintenance work may be done anytime within daylight hours as long as no interference to traffic is caused 32 MATERIALS 33 Disturbed right-of-way area, where applicable, must be top soiled, fertilized, mulched, and reseeded with Department of Transportation Specification grass seed mix, which meets specifications 34 Please refer to attached sheet for CDOT seeding specifications for site revegetation. 35 EARTHWORK 36 Conduit/casing shall be a minimum depth of 4 feet for all utilities except "wet" utilities, which must be placed to a minimum depth of 4 5 feet. 37 All cable/conduit shall be installed by directional bore No trenching shall be permitted 38 MISCELLANEOUS 39 The Utility shall design and construct all buried facilities, includmg pipelines, conduits and casings, to withstand the full range of exptected internal and external pressures and loads, including internal pressures ranging from maximum expected pressure to zero pressure, and external loads from the highway and superimposed vehicle loads Pipelines shall also be designed and constructed to resist internal and external corrosion 40 All construction vehicles operating m CDOT right-of-way to have mounted flashers 41 The utility shall avoid disturbing or damaging all highway property, and shall be responsible for the prompt reconstruction, alteration, repair, or maintenance of highway property, as necessary, to repair any damage caused by the accommodation of the utility, and to restore the highway to pre-existmg or other conditions as may be specified in a permit or agreement authorizing the accommodation 42 Utility Code, Section 3 4.6, requirements shall apply Copy of section attached 2/19/2019 REF -150219-168308 - Salesforce - Performance Editior REF -150219-168308 • Close Window • Print This Page • Expand All I Collapse All Permit Information Record Type Permit Number Permittee Permittee Street Permittee City/State/Zip Permittee Phone Permittee Email Permittee Select Permittee Rep Permittee Company Utility Permit 4190091 Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 Permittee Company Shawn Bates Cheyenne Connector Pipeline, Inc Permit Author Web Portal User Received By CDOT Project N umber Project Engineer Utility Project N umber Current Signatory Issuing Authority Activity Description Section Installation? 1 Adjustment? https://socgov.my.salesforce.com/a0r1 J0000061Rai/p?retURL=/a0r1 J000006IRai Reference Number Complexity Level Annual Permit? Applicant Applicant Street Applicant City/State/Zip Applicant Phone Applicant Email Applicant Select Applicant Rep Applicant Company REF -150219-168308 I Summit Resources C/O Rebecca Lieders 800 8th Ave. Greeley, Colorado 80631 Applicant Company Rebecca Lieders Summit Resources C/O Rebecca Lieders Inspector Name Mike Shepherd Inspector Telephone (970) 381-5143 Patrol Name Patrol # 20 Maintenance 1 Section Water Quality Program Manager Regional Environmental Manager Facility & Type of Work (Other) PECEIVED FEB 15 2019 CDOT R-4 TRAFFIC 1/4 2/19/2019 REF -150219-168308 - Salesforce - Performance Edition o Removal? Maintenance of ' Existing Facility? SUE/Other Relocation? Description of Work Location Additional Remarks Location Property Address Additional Information Intersecting Feature(s) GeoLocation ON SH 14 E/O CR 43 City OCounty Weld County Local Jurisdiction UGcontact Utility Notification Center of Colorado UGphone (800) 922-1987 Special Provisions Time Restrictions Other Provisions Inspection Services Required? Permit Dates https //socgov my salesforce com/a0r1J0000061Rai/pretURL4a0r1J0000061Ral 2/4 Longitudinal? Transverse? Buried? Aerial? Structure Number I Route Number 014 Mile Post 159 000 Side Route Number 2 Mile Post 2 Side 2 Route Number 3 Mile Post 3 Side 3 Route Number 4 Mile Post 4 Side 4 State Highway C Section Category R -A Days to Complete Minimum Cover Overhead Clearance 2/19/2019 REF -150219-168308 - Salesforce - Performance Edition Issue Date Work Start Work Completion Date Expiration Insurance Expiration Extension Date Comments Web Status Comments Office Use Notes Comments for Reviewers MISC Permit Status INITIAL REVIEW Receive Date 2/15/2019 Start Date 4/1/2019 Application Accepted as Complete Date Requesting Info Application Accepted? Withdrawn? Date Transmitted Amendment/Extension Requested Reason for Request Date Withdrawn 2 -Year Warranty End Date 12/31/2019 Project Duration 274 Days System Information Created By Utility Permit Application Site Guest Owner Region 4 Utility Permit Applications User, 2/15/2019 3 00 PM Last Modified By Utility Permit Application Site Guest Region 4 User, 2/15/2019 4 43 PM Notified Inspector of MSA ID Application Submission 1 Applicant Contact Notification Sent Previous Expiration Permittee Contact Visible In portal? Notes & Attachments CST-P-1000-A145_REV 11-27-18 CDOT Typical 11.27.18.pdf Type Attachment Last Modified Utility Permit Application Site Guest User Description Traffic Control Plan View file CST -P -1000 -A145 -Model CDOT typical.pdf Type Attachment Last Modified Utility Permit Application Site Guest User Description Traffic Control Plan View file O O https //socgov my salesforce com/a0r1J000006IRal/p9retURL4a0r1J000006IRai 3/4 2/19/2019 REF -150219-168308 - Salesforce - Performance Edition Colorado Department of Transportation COI 10.24.18.pdf Type Attachment Last Modified Utility Permit Application Site Guest User Descnption Insurance View file Permit History 2/15/2019 4:43 PM Special Use Permit Narrative 1.23.19.docx Type Attachment Last Modified Utility Permit Application Site Guest User Description Cover Letter (Letter of Request) View file User Utility Permit Application Site Guest User Action Changed Submission Notification Sent from false to true Changed End Date from 10/31/2019 to 12/31/2019 Changed Record Type from Application - Utility/Special Use Permit to Utility Permit. 2/15/2019 3.23 PM User Utility Permit Application Site Guest User Action Changed End Date from 7/19/2012 to 10/31/2019 Changed Start Date from 1/19/2004 to 4/1/2019 2/15/2019 3:00 PM User Utility Permit Application Site Guest User Action Created. Copynght © 2000-2019 salesforce corn, inc All nghts reserved o O httpsJ/socgov my salesforce com/a0r1J0000061Rai/p''retURL=/a0r1J0000061Rai 4/4 0 AC ®� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ODIYYYY) 03/05/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS ' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer nghts to the certificate holder In Ileu of such endorsement(s). PRODUCER MCGRIFF, SEIBELS & WILLIAMS INC P O Box 10265 Birmingham, AL 35202 CONTACT NAME _ A/C. PHONE 800476-2211 Ex() 80D476-2211 I (AX A/C112) EMAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAIC S INSURER A .AIG Specialty Insurance Company 26883 INSURED BNN Water Solutions LLC 370 Van Gordon Street Lakewood CO 80228 INSURER s Commerce end Industry Insurance Company 19410 INSURER C INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 4U2cB6sF REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS tLTR (�POLICIES TYPE OF INSURANCE I P�5D OL SNND POLICY NUMBER (MMUDDIYYYY) (MM/DD/YYICY YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 12335226 03/01/2019 03/01/2020 EACH OCCURRENCE -DAMAGE $ 1,000,000 CLAIMS -MADE X OCCUR TO RENTE5 PREMISES(Eaoccurrence) $ 300,000 MED EXP (Any one person) $ 25,000 PERSONAL & ADV INJURY $ 1,000,000 GEEN L AGGREGATE LIMIT POLICY JECPRO- -X1T OTHER. APPLIES PER LOC GENERAL AGGREGATE $ 2 000 000 PRODUCTS - COMP/OP AGG $ 2 000 0001 $ B AUTOMOBILE X LLABILI ANY AUTO Y X SCHEDULED AUTOS NON AUTOS -OWNED ONLY CA 3962402 03/01/2019 03/01/2020 CO BINEDtSINGLE LIMIT s 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LAB EXCESS LULB X OCCUR CLAIMS MADE 12335228 03/01/2019 03/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1 000,000 DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Kyes descnbe under DESCRIPTION OF OPERATIONS below N IA ( l STATUTE 1 I ER E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ - E L DISEASE - POLICY LIMIT $ A Pollution Legal Liability (Claims Made Basis) 12335226 03/01/2019 03/01/2020 Each Loss Limit s 1,000,000 $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re State Highway Right of Way permit COOT and Concessionaire are included as Additional Insured (Excluding Workers' Compensation) if required by written contract, subject to policy terms, conditions and exclusions In the event of cancellation by the Insurance companies the policies have been endorsed to provide 30 days Notice of Cancellation (except for non-payment) to the certificate holder shown below CERTIFICATE HOLDER Colorado Department of Transportation 10601 West 10th Street Greeley, CO 80634 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) Page 1 of 1 ® 1988-2015 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD 1A 1® CERTIFICATE OF LIABILITY' INSURANCE DATE(MMIDIJlYYYY) 03/0512019 F THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the poltcy(tes) must have ADDITIONAL INSURED provisions or be endorsed if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P O Box 10265 Birmingham, AL 35202 CONTACT PHONE 800476-2211 FAX ,(AIC. No. Eat). I (A/C, No) E-PAAIL ADDRESS INSURERS) AFFORDING COVERAGE HAIL 0 INSURER A Starr Indemnity & Liability Company 38318 INSURED Tallgrass Energy GP, LLC 4200 W 115th Street, Suite 350 Leawood, KS 66211 INSURER B INSURER c INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER vicrrsvsc REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LIR TYPE OF INSURANCE IADDL I INS') 9UBR MD POLICY EFF POLICY EXP POLICY NUMBER (MM/DDIYYYYJ (MM/DD/YYYY) LIMBS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ I CLAIMS -MADE OCCUR DAMAGEPREMISES (E RENTED (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY S _ GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ PRODUCTS COMP/OP S S 'r AUTOMOBILE — — LLABIUTY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY (Per person) S BODILY INJURY(Per accident) S PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DED I 1 RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROPRIETORIPARIFXECUTIVE Y ( N RTNE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 H- X I STATUTE RI 1 T E L EACH ACCIDENT $ 1,000 000 E L DISEASE - EA EMPLOYEE $ 1,000 000 E L DISEASE - POLICY LIMIT 15 1 000,000 5 5 S $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mare space Is required) Re State Highway Right of Way permit CERTIFICATE HOLDER CANCELLATION Colorado Department of Transportation 10601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE isat) ACORD 25 (2096/03) Page 1 of 1 © 1988-2015 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD AW R® D® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) Ai 03/05/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS 1 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(Ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s), PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P O Box 10265 Birmingham, AL 35202 NAME PHONE 800476_221i FAX _(A/C No Ext) I (Ale, No) E-MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAIC F INSURER A _Aspen Insurance UK Limited INSURED Tallgrass Energy GP, LLC 4200 W 115th Street, Suite 350 Leawood KS 66211 INSURER B Starr Indemnity & Liability Company 38318 INSURER C .Aegis Insurance Services Ltd INSURER D Ironshore Specialty Insurance Company 25445 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 9MM5LTNG REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS -C INSR LTR TYPE OF INSURANCE ADD SUER INSD wvo POLICY EFF POLICY EXP POLICY NUMBER JMMIDO (MMIDD/YYYYj LIMITS A X COMMERCIAL GENERAL LIABILITY ME1902687 03/01/2019 03/01/2020 EACH OCCURRENCE -DAMAGE $ 4,000,000 X I CLAIMS -MADE OCCUR TO RENTED PREMISES (Ea ocarirenoe) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER X POLICY ❑ JECT LOC OTHER GENERAL AGGREGATE $ 4 000,000 PRODUCTS - COMP/OP AGG S ) $ B AUTOMOBILE X X — LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED ALTOS ONLY —' X SCHEDULED AUTOS NON -OWNED AUTOS ONLY SISIPCA08313219 03/01/2019 03/01/2020 comEIINED SINGLE LIMIT(Ea occident) $ 1,000,0001 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA UAB EXCESS LIAR _ X OCCUR CLAIMS MADE XL5236807P 03/01/2019 03/01/2020 EACH OCCURRENCE S 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTION S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) Byes, desonbe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 I X I STEM I I ER E L EACH ACCIDENT S 1,000,000 E L DISEASE EA EMPLOYEE $ 1 000 000 E L DISEASE - POLICY LIMIT S 1,000,000 D Pollution Legal Liability 002025904 03/01/2019 03/01/2020 Each Incident Aggregate s 1 000,000 $ 1,000 000 S S S DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES (ACORD 101, Additional Remark° Schedule, may be attached If more space le required) The CDOT and Concessionaire are included as Add tone Insured (Excluding Workers' Compensation) if required by written contract, subject to policy terms, conditions and exclusions For the General Liability, Automobile Liability, and Excess Liability policies, Insurance is pnmary and non-contributory over any other collectable insurance if required by written contract subject to policy terms conditions and exclusions In the event of cancellation by the insurance company the General Liability policy has been endorsed to provide 30 days Notice of Cancellation (except for non-payment) to the certificate holder shown below CERTIFICATE HOLDER CANCELLATION 10801Colorado Department of Transportation 10801 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE OM) ACORD 25 (2016/03) Page 1 of 1 © 1988-2015 ACORD CORPORATION All rights reserved. The ACORD name and logo are registered marks of ACORD ®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDnYYY) 03/05/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P O Box 10265 Birmingham, AL 35202 CONTACT NAME PHONE 800476-2211 FAX (ALC, Lo.Ext! I (MC, Not E-MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAIC A INSURER A Aspen Insurance UK Limited INSURED Tallgrass Energy GP, LLC including Cheyenne Connector Pipeline, Inc 4200 W 115th Street, Suite 350 Leawood, KS 66211 INSURER B Stan Indemnity & Liability Company 38318 INSURER C Associated Elec & Gas Ins Svcs 'Ltd (AEGIS) AA - INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER AKNw9FUJ REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IY NSR LTR OF INSURANCE ADISCE0TYPE INSp INSO ty lT) MD POLICY NUMBER EXP IMMMIDDDIIYYYY) IMMIDOnmrY) LIMITS A X COMMERCIAL GENERAL LIABILITY ME1902667 03/01/2019 - 03/01/2020 EACH OCCURRENCE $ 4,000,000 i)AMAGETO RENTED PREMISES (Ea occurrence) $ X I CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE S 4,000,000 ��,EN'L AGGREGATE LIMIT APPLIES PER GRO ^ I POLICY ❑ J LOC 1I OTHER PRODUCTS COMP/OP AGG $ $ n-) AUTOMOBILE X X UABIUTY ANY AUTO OWNED X SCHEDULED AUTOS NON -OWNED AUTOS ONLY SISIPCA08313219 03/01/2019 03/01/2020 COMBINED SINGLE LIMIT Ma accident/ I I $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA UAB EXCESS LIAB _ X OCCUR CLAIMS MADE XL5236807P 03/01/2019 03/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE S 1,000,000 DED I I RETENTION $ S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N ANY PROPRIEEORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 x I I I STATUTEER - - - E L EACH ACCIDENT $ 1,000 000 E L DISEASE EA EMPLOYEE S 1,000,000 E L DISEASE POLICY LIMIT $ 1 000,000 $ S S S S DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate Holder is included as Additional Insured (Excluding Workers' Compensation) and Waiver of Subrogation applies except where not permissible by law if required by wntten contract, subject to policy terms, conditions and exclusions The policies include sudden and accidental pollution coverage subject to policy terms, conditions and exclusions CERTIFICATE HOLDER CANCELLATION ( violorado Department of Transportation ttn Utility Permit Office 0601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE Oge) ACORD 25 (2016/03) Page 1 of 1 © 1988-2015 ACORD CORPORATION All rights reserved. The ACORD name and logo are registered marks of ACORD 370 Van Gordon Street Lakewood, Colorado 80228 303 763 2981 Project Introduction Cheyenne Connector Pipeline, Inc. Cheyenne Connector, LLC ("Cheyenne") proposes to construct 70 miles of new thirty-six inch (36") natural gas pipeline from a point located within Section 14, Township 2 North, Range 66 West, north to a point located in Section 5, Township 11 North, Range 66 West, Weld County, Colorado This pipeline is anticipated to initially carry up to 600,000 Dth/d of natural gas per day accumulative activities in the surrounding area The permanent easement width will vary based on the segment of the line, but generally will be fifty feet (50') in width The five meter and regulating sites along the pipeline route — Lancaster, Latham, Mewbourn, O'Connor and Connector — will service the line with adequate pressure to move the product to existing Rockies Express Pipeline, LLC facilities north of Nunn, Colorado The O'Connor meter and regulating site requires a 0 7 - mile twenty-four inch (24") lateral to the thirty-six (36") pipeline ("Project") After reviewing the lands to be crossed, Cheyenne Connector, LLC ("Cheyenne") selected a route from the point of origin at the Lancaster Meter Site located in Section 14, Township 2 North, Range 66 West northeast of the City of Fort Lupton, Colorado During negotiations with landowners along this route, Cheyenne made several alterations to the route both m response to landowner requests, topographical considerations, co -location with existing pipelines and Federal Energy Regulatory Commission ("FERC") Requirements The original route was largely retained as it continues to present the least intrusive path for construction and the most accessible location for service and maintenance during operation. The lands concerned with the metering facilities includes the aboveground facilities — Lancaster, Latham, Mewbourn, O'Connor, and Connector — that will be constructed either within existing natural gas facilities or would be directly adjacent to existing natural gas processing and compression facilities The Lancaster and Connector Meter Stations would occur entirely within existing industrial sites Construction of the Mewbourn, Latham, and O'Connor metering facilities would represent a long-term conversion of agricultural and rangeland to industrial land uses. These aboveground facilities would affect land use and acreages Where possible, the new aboveground facilities would be located within existing facilities or adjacent to existing roads to minimize impacts and for convenience of access. The lands located within the project area are primarily agricultural cropland and ranchland with rural residential and some industrial use along the proposed facilities In an effort to mitigate disturbance to the surface and to decrease as much as possible the impact to the lands post -construction, Cheyenne will bore all road crossings and all water bodies encountered on the route pursuant to all local, County, State and Federal rules and regulations Cheyenne would use different crossing techniques for waterbodies, depending on the type of waterbody to be traversed Special care will be taken to minimize effects of construction on waterbodies Cheyenne adopts the FERC's Wetland and Waterbody Construction and Mitigation Procedures ("Procedures") without deviation and will follow mitigation requirements for waterbody and wetland crossings For stream and flowing waterbody crossmgs, Cheyenne would use HDD or boring Cheyenne would open cut non -flowing and intermittent and ephemeral streams Cheyenne will comply with USACE Section 404 nationwide permit (NWP) 12 for construction in creeks and wetlands crossed by the Project. To reduce potential impacts from construction on groundwater resources in the Project area, Cheyenne will implement the FERC's Procedures and the FERC's Upland Erosion Control, Revegetation, and Maintenance Plan (Plan) without deviation and will implement the following mitigation measures. Wells within 150 feet of construction activities will be staked, fenced, and/or flagged for visibility Additionally, wells within 150 feet of construction activities where landowner permission is provided will be sampled both before and after construction to confirm that no impacts occurred as a result of the Project If a known or unknown well is damaged by construction, Cheyenne will coordinate with the landowner to repair, replace, or remediate the well, if needed Cheyenne will coordinate a temporary water source for domestic use during the repair and reclamation period if no other potable water is available Should the loss of water affect agricultural or livestock operations, Cheyenne will compensate the affected farmer(s) for any lost revenue from these operations during the reclamation and remediation period for the damaged well. Cheyenne may choose to provide a temporary water source to support livestock operations while a new permanent water supply well is constructed or while the existing affected well is repaired The Project area is located in generally flat to rolling plains with few steep slopes If construction occurs in areas exceeding slopes of 5 percent, Cheyenne will use trench breakers to limit the flow of water along the backfilled trench This will reduce the potential for the trench to act as a preferential pathway for groundwater migration If trench dewatermg is required in these areas, water will be discharged in a level upland area to allow for evaporation and infiltration back to the water table If the water must be discharged to a surface water body, appropriate filtration systems will be used to control any potential increase m total suspended solids (TSS) and all of the proper notifications and permits will be obtained Quality Control Erosion controls will be employed throughout construction in order to protect the easement property and the surrounding lands Cheyenne will employ tracking pads at all access points from roadways and all road crossings involving the ingress and egress of heavy equipment During construction, Cheyenne will double ditch the pipeline trench The pipe will be laid in the trench in such a manner as to leave the top of the pipe at least thirty-six inches (36") below the surface of the ground after restoration A Stormwater Management Plan will be secured from the appropriate State Agency and will be followed during construction and subsequently during operation of the pipeline and associated facilities Cheyenne will begin reclamation of the affected lands as soon as is practical after construction has finished on each parcel of land and will pursue re -grading and reseeding of the grounds until the property has been re-established to a condition comparable to its state prior to entry by Cheyenne After construction, pipeline markers will be installed along the route that will contain a telephone number that will allow the public to contact Cheyenne It is Cheyenne's intention to fence -in all aboveground appurtenances in order to protect the equipment and the public from accidental contact Cheyenne will be operating this pipeline on a continuous basis, twenty-four hours a day, seven days a week A monitoring system, overseen by highly trained staff in the Lakewood, Colorado offices will allow Cheyenne to remain alert to all conditions affecting the operation of these assets In the unlikely event of an emergency, Cheyenne will be able to shut down the compromised segment of the pipeline by employing the system of remotely -controlled valves to be installed along the length of the pipeline Federal Permits Applications 1 Certificate of Public Convenience and Necessity Natural Gas Act Sec 7(c) applied to the Federal Energy and Regulatory Commission Submitted March 2018 Anticipated date of FERC Certificate award March 2019 2 Environmental Clearances Impacts on wildlife habitat Cumulative impacts on the environment may result when the environmental effects associated with a proposed project are added to other past, current, and reasonably foreseeable future actions The proposed Project locations are in agricultural, rangeland, and industrial/developed areas The majority of development similar m nature and scope to the Project is associated with current or planned oil and gas exploration and development as well as midstream and upstream projects This information was obtained from Cheyenne Connector's consultation and coordination with other potential operators in the area during land acquisition and routing studies, as well as the FERC website, state agency websites, and company -specific websites Information concerning other types of commercial and/or residential development within the Project area was obtained through consultations with the Weld County Planning Commission The Cumulative Impact Assessment Area ("CIAA") for fish, wildlife, and vegetation impacts is the extent of HUC 12 watersheds crossed by the Project The Project would disturb approximately 598 2 acres of vegetation and topsoil within the CIAA, which would leave soils vulnerable to wind and water erosion during construction which could result in increased soil movement into surface waters as sediments Additionally, the open cut crossing of 23 streams would result in direct sedimentation into surface waters if construction were to occur during periods of flow This could incrementally reduce the quality of aquatic habitat downstream of construction when considered with existing sediment and runoff burdens from other past, present, and reasonably foreseeable oil and gas and agricultural development This (J potential incremental increase in sediment burdens from the Project would be temporary as Cheyenne would limit erosion and sedimentation through the development of a SWMP and would revegetated all pipeline ROW following installation The Project would utilize 4,000,000 gallons (12 27 acre-feet) of water to hydrostatically test the newly constructed pipeline This would not decrease the availability of aquatic habitat in the CIAA as this water would come from existing, permitted water nghts The Project would disturb approximately 598 2 acres of ecological systems within the CIAA Reclamation would restore 427 6 acres of potential habitat within the CIAA. The remaining 170 6 acres of ecological systems would remain disturbed for operations This 170 6 acres would represent a long-term mcremental increase in habitat loss within the CIAA Additionally, the presence and operation of these aboveground facilities could increase the amount of habitat lost due to displacement effects from noise, human presence, and fragmentation Cheyenne would have limited potential to incrementally impact federally and state listed species and their habitats within the CIAA Pre -construction surveys for western burrowing owls and other protocol level clearance surveys, as requested by the USFWS, would lmut the potential for direct loss of protected species or of occupied habitat. Reclamation and revegetation of the ROW following pipeline installation would avoid any permanent loss of habitat for protected wildlife species As no new depletions from the South Platte River are needed and no direct disturbance would occur to the South Platte River, no incremental impact to species reliant on this habitat is anticipated Impacts on historical, archaeological and scenic resources The proposed pipeline route predominantly crosses through dry -land agricultural properties, thereby minimizing any potential impacts to historical, archaeological and scenic resources Cheyenne has conducted archaeological surveys m accordance with guidance from the State Historical Preservation Office and has not encountered any historical or archaeological sites The CIAA for cultural resources is the overlapping impacts within the Area of Potential Effects (APE), smce impacts to cultural resources are generally site -specific and not additive across a landscape As no past, present, or reasonably foreseeable future actions within the APE would overlap with potential Project impacts to cultural resources, no cumulative impacts are anticipated it a.1 SZOQ902-000VP&t et ar rwi Nrwl. 0 JAI SWAM i T s`JI t101,IIIIIMIN SIOISK7bi .NOCIA3N �� r118MN ale r ell= wttrJllr - - �It �... 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Line Path Po'ygon Circle 30 path L) polygon Measure the cistEnce betviceen two pornts on the ground Map Length: Ground Length: Heading: tr!/j Morse Navigation S 5,496.34 Feet 5,498.30 91.96 degrees Save IL gear '0`43 \atol0 ** https://mail.google.com/mail/u/0/#inbox/QgrcJHsbhNtgmHZZfjjGmdvxGgxbmtnnHvG?projector=1&messagePartid=Q.1 1/1 02/22/2019 Quality Control Plan - Inadvertent Fluid Release Conventional Bore Cheyenne Connector— Pipeline Installation RE: CDOT Crossings — 36" Conventional Bore Hanging H is working with Tallgrass Energy to build the Cheyenne Connector Pipeline which crosses several Colorado state highways. As currently designed, these highways will be crossed by means of conventional bore, a method that does not utilize drilling fluids. Being that this method requires no drilling fluids, the threat of an inadvertent fluid release is non-existent. Below is a step-by-step explanation of our proposed installation method. 1. Before any excavation takes place, all locates will be called in and all utilities within the work zone will be potholed and their depths verified. 2. All environmental BMPs will then be installed in accordance with the approved environmental drawings provided by Tallgrass. 3. Should groundwater be present at any of the CDOT crossing work sites, Hanging H would install dewatering wells prior to performing any excavations. Hanging H would activate the wells prior to performing any excavations so that the groundwater is drawn down by the time the bore pits are ready to be excavated. 4. Crew will then excavate the bore pits on each side of the crossing using an excavator (CAT 336 size or equivalent). Hanging H will use trench boxes for shoring the excavation. 5. Hanging H will use a tracked boring machine to complete the crossing. The entry pit will be dug to specific grade and the tracks will be set up at the bottom of the pit. Before lowering the boring machine into the pit, the plumbness of the track system is checked to ensure that the trajectory of the bore is correct. Once the designed trajectory is confirmed, the boring machine is lowered onto the track system. 6. The boring machine auger will then be inserted into a piece of 36" sacrificial pipe. The sacrificial pipe will then be lowered into the pit using a pipelayer (CAT 583 or equivalent) and the auger will be connected to the boring machine. The pipelayer will support the sacrificial pipe, further ensuring the crossing will be completed at the designed trajectory. 7. After activating the auger, the boring machine will track forward, pushing the sacrificial pipe into the headwall of the entry pit. The auger will cut into the headwall and convey the bore cuttings through the sacrificial pipe and into the bore pit. Hanging H Companies 11912 S. Burl ngton Blvd, Ste 100, Burlington, WA 98233 1360.726.2334 info@hanginghco.com www.hanginghco.com 8. On longer crossings, the boring machine will disconnect from the auger and track to the back of the entry pit. Another joint of sacrificial pipe with more auger will be lowered into the pit. The auger that was originally attached to the boring machine will be connected to the auger in the new piece of sacrificial pipe. The new piece of sacrificial pipe will be welded to the end of the sacrificial pipe that is sticking out of the headwall of the pit and then X-rayed to ensure a quality weld was made. Steps 7 & 8 would repeat until the crossing was completed. 9. Once the sacrificial pipe bores through the headwall of the exit pit, the auger is disconnected from the boring machine and removed from the sacrificial pipe. 10. The permanent pipe is then lowered into the entry pit and welded onto the sacrificial pipe. The boring machine then tracks ahead, pushing the permanent pipe into place while pushing the sacrificial pipe out into the exit pit. 11. The sacrificial pipe is then cut and removed from the exit pit. 12. On longer crossings, steps 10 and 11 may repeat. The welds made on the permanent pipe will be X-rayed and coated prior to being pushed into place. 13. After all permanent pipe is installed, the boring machine and track system is removed from the entry pit. 14. Prior to backfilling the bore pits, pipe that has engineered and bent to get the line from the depth of cover required for the crossing to the depth of cover required on each side of the crossing, is welded onto the crossing pipe in both the entry and exit pit. 15. The pits are then backfilled and compacted. As mentioned above, this method of installation does not require any drilling fluids. This method also does not leave any voids throughout the crossing like horizontal directional drills. The cutting head of the auger is sized to match the outside diameter of the pipe, leaving no voids or pockets that could result in future settlement issue. If at any time you require further information, please do not hesitate to contact me. Sincerely, Kasey Entrikin Project Manager Hanging H Companies 1912 S Burlington Blvd. Suite 100 Burlington, WA 98233 Cell: 360.661.0696 E-mail: kentrikin@hanginghco.com Website: http://hanginghco.com Hanging H Companies 11912 S. Burlington Blvd, Ste 100, Burlington, WA 98233 1360.726.2334 info@hanginghco.com I www.hanginghco.com COLORADO DEPARTMENT OF TRANSPORTATION UTILITY PERMIT PERMiTTEE Name: Cheyenne Connector Pipeline, Inc APPUCANT Name: Summit Resources C/O Rebecca lieders DEPARTMENT Date Issued: USE ONLY 03/19/2019 REP: Shawn Bates REP: Rebecca Lieders Permit # 4190092 Mitepost(s) Side(s) Address: 370 Lakewood, Van Gordon Colorado St 80226 Address: 800 Greeley, 8th Ave. Colorado Suite 204 80631 &Hi 085 292.000 — Region: 4 _--- Email: shawn.betesetallgrassenergylp.corn Email; S.H. Section : L Telephone: (303) 763-2981 a Telephone: 479-306-8807 - Patrol: 20 L NOTICE TO PERMITTEE: For underground facility location information, contact the Utility Notification Center of Colorado (UNCC). Pursuant to 9-1.S-103 C.R.S. you shall not make or begin excavation without first notifying the UNCC and if necessary, then notifying the tier two members having underground facilities In the area of such excavation. Notification shall also be given to the CDOT regional permitting office, or as otherwise directed by this Permit's Special Provisions. Notice of the commencement, extent and duration of the excavation work shall be given at least two business days prior thereto, not including the day of actual notice. The UNCC ape called at 1 -SOD -922.1987 , ACTIVITY DESCRIPTION (Furnished by Permittee PURPOSE / i Installation • Adjustment • Removal • Relocation ■ SUE/Other • Maintenance of Existing Facility FACILITY (Type, size, class of transmittant, design pressure or etc. ) 36" Natural Gas Pipeline DESCRIPTION OF WORK: Bore under Hwy 85 to install 36" Natural gas Pipeline NATURE OF INSTALLATION: Longitudinal Transverse (Crossing) ►i4 Buried • Aerial/Ground-mounted LOCATION: Hwy 85 MM 292. County: Weld County City/Town: ADDITIONAL REMARKS: NO TRAFFIC CONTROL APPROVED WITH THIS PERMIT I SPECIAL PROVISIONS (completed by the Department) The Special Provisions are terms and conditions of this permit. Any work shall only be In accordance with the approved plans and special provisions as set forth in this permit and its attachments. The COOT inspector is Mike Shepherd Telephone: (970) 381-5143 Inspector Email: Work is to be completed on or before: 07/17/2019 or within 120 days, (as applicable) Work time restrictions: Daylight Hours. Designated minimum cover is 4 feet Designated overhead clearance Is 24 feet (ALSO SEE ATTACHED STANDARD PROVISIONS, AND ADDITIONAL SPECIAL PROVISIONS), (TRAFFIC CONTROL MUST CONFORM TO THE MUTCD) Other: NO TRAFFIC CONTROL APPROVED WITH THIS PERMIT Permittee is prohibited from commencing any work within highway ROW prior to issuance of a fully endorsed and validated permit. Permit, plan exhibit, insurance certificate(s), and traffic control plan must be available on site during work. High visibility vests are required at all times during working hours. 1. Your request to use and/or occupy state highway system rights of way as described above is granted subject to the terms and conditions of this permit, Including the Standard and Special Provisions as shown on the permit and all attachments hereto. 2. To the extent authorized by law, Permittee hereby assumes, releases and agrees to indemnify, defend, protect, and save the State of Colorado harmless from and against any loss and/or damages to the property of the State of Colorado, third parties or the Permittee's facilities, and all loss and/or damage on account of Injury to or death of any person whomsoever, arising at any time, caused by or growing out of the occupation of Colorado State Highway rights of way by Permlttee's facilities or any part thereof, including but not limited to installation, adjustment, relocation, maintenance or operation, or removal of existing facilities, unless such loss and/or damage arises from the sole negligence or willful conduct of the State of Colorado or its employees or agents. 3. Failure by the Permittee to comply with any of the included terms or conditions may subject this permit to suspension or cancellation, at the discretion of the Department of Transportation. 4. THIS PERMIT IS NOT VALID UNTIL FULLY ENDORSED BY ALL PARTIES, WITH DATE OF ISSUE AFFIXED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPARTMENT. A FULLY EXECUTED COPY OF THIS PERMIT MUST BE ON FILE AT THE TRANSPORTATION REGION OFFICE. S. in accepting this permit the undersigned, representing the Permittee, verifies that he or she has the authority to sign for and bind the Permittee, and that he or she has read, understands and accept all the included conditions. CDOT Signature: Date � t3oracta)011- Permittee Signature reeS-4? cycc._,aa„„cc COLORADO DEPARTMENT OF TRANSPORTATION Chief Engineer, Regional Transportation Director or Designee Date 03/22/19 Print Name/Title Shawn Bates, Sr. Agent Land & ROW Distribution: Region Fife (Original) Permittee/Applicant Mtce Patrol Supvr. Mtce Landscaping Supvr Inspector CDOT Form # 0333 01/09 Previous versions arc obsolete and should not be used. The followmg Standard Provisions are terms and conditions of this permit: Effective March 1, 2006 Utility work authorized under this permit shall comply with the requirements of the State Highway Utility Accommodation Code, and applicable federal, state, local, and industry codes and regulations Construction of any portion of the highway facility, including the pavement structure, subsurface support, drainage, landscaping elements and all appurtenant features, shall comply with the provisions of the CDOT Standard Specifications for Road and Bridge Construction, and with the Colorado Standard Plans (M & S Standards) 1 COMMENCEMENT AND COMPLETION Work on highway Right of Way (ROW) shall not commence prior to issuance of a fully endorsed and validated permit Permittee shall notify the CDOT inspector a At least 2 working days prior to commencing work, or resuming operations which have been suspended for five or more consecutive working days b When suspending operations for 5 or more working days c Upon completion of work Work shall not proceed beyond a completion date specified in the Special Provisions without written approval of the Department 2 PLANS, PLAN REVISIONS, ALTERED WORK Plans or work sketch (EXHIBIT A) are subject to CDOT approval A copy of the approved plans or sketch must be available on site during work Plan revisions or altered work differing in scope or nature from that authorized under this permit, are subject to CDOT prior approval Pcrnuttec shall promptly notify the CDOT inspector of changed or unforeseen conditions, which may occur on the job 3 INSURANCE Insurance Requirements for Uhhty and Special -Use Permits (Revised 7-05 per State Requirements) A The Permittee shall obtain, and mamtam at all times during the performance of work authorized by this Permit, insurance in the following kinds and amounts The Pernuttee shall require any Contractor working for them within the State Highway Right of Way to obtain like coverage The Permittee shall also require any Contractor or Consultant performing work described in sub- paragraph 4) below, to obtain Professional Liability Insurance 1) Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all employees acting within the course and scope of their employment and work on the activities authorized by this Permit 2) Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, mdependent Consultants, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows a S 1,000,000 each occurrence, b 52,000,000 general aggregate, c 52,000,000 products and completed operations aggregate, and d $50,000 any one fire e For any permanent Permittee-owned installations located within the State Highway Right of Way, highway repairs, or site restoration, Completed Operations coverage shall be provided for a minimum period of one year following final acceptance of work If any aggregate limit is reduced below 1,000,000 because of claims made or paid, the Peruttee, or as applicable - their Contractor, shall immediately obtain additional insurance to restore the full aggregate limit and furnish to CDOT a certificate or other document satisfactory to CDOT showing compliance with this provision 3) Automobile Liability Insurance covering any auto (including owned, hired and non -owned autos) with a minimum limit as follows $1,000,000 each accident combined single limit. 4) For any a) engineering design, b) construction inspection, or, c) traffic control plans approved by a Traffic Control Supervisor, done in association with the operations or installations authorized by this permit, Professional Liability Insurance with minimum limits of liability of not less than $I,000,000 Each Claim and $1,000,000 Annual Aggregate If the policy is written on a Claims Made form, the Permittee, or, as applicable — their Consultant or Contractor, shall renew and maintain Professional Liability Insurance for a minimum of two years following final acceptance of the work, or provide a project specific Policy with a two year extended reporting provision 5) Pollution Legal Liability Insurance with minimum limits of liability of $1,000,000 Each Claim and $1,000,000 Annual Aggregate CDOT shall be named as an additional insured to the Pollution Legal Liability policy If the Pohcy is a component of the Professional Liability Policy, the Additional Insured requirement is waived, and the Policy shall be written on a Claims Made form, with an extended reporting period of at least two year following final acceptance of the work 6) Umbrella or Excess Liability Insurance with minimum limits of $1,000,000 This policy shall become primary (drop down) in the event the primary Liability Policy limits are impaired or exhausted The Policy shall be written on an Occurrence form and shall be following form of the primary The following form Excess Liability shall include CDOT as an additional insured B CDOT shall be named as additional insured on the Commercial General Liability and Automobile Liability Insurance policies Completed operations additional Insured coverage shall be on endorsements CG 2010 11/85, CG 2037, or equivalent Coverage required by the Permit will be prunary over any insurance or self- insurance program earned by the State of Colorado C The Insurance shall include provisions preventing cancellation or non -renewal without at least 30 days prior notice to CDOT by certified mail D The Pernuttee, or, as applicable — their Contractor or Consultant, will require all insurance policies in any way related to the Permit and secured and maintained by the Permittee, Contractor or Consultant, to Include clauses stating that each earner will waive all rights of recovery, under subrogation or otherwise, against CDOT, its agencies, institutions, organizations, officers, agents, employees and volunteers E All policies evidencing the insurance coverages required hereunder shall be issued by msurance companies satisfactory to CDOT F The Permttee, or as applicable - their Contractor or Consultant, shall provide certificates showing insurance coverage required by this Permit to CDOT prior to commencing work No later than 15 days prior to the expiration date of any such coverage, the Permitter, Contractor or Consultant, shall deliver CDOT certificates of insurance evidencing renewals thereof At any time during the term of this contract, CDOT may request in writing, and the Permittee, Contractor or Consultant, shall thereupon within 10 days supply to CDOT, evidence satisfactory to CDOT of compliance with the provisions of this section G Notwithstanding subsection A of this section, if the Permittee is a "public entity" within the meaning of the Colorado Governmental Immunity Act CRS 24-10-101, et seq , as amended ("Act'), the Permmttee shall at all tunes during the term of this permit maintain only such liability insurance, by commercial policy or self- insurance, as is necessary to meet its liabilities under the Act Upon request by CDOT, the Pernnttee shall show proof of such insurance satisfactory to COOT Public entity Peimrttees are not required to name CDOT as an Additional Insured H If the Permittee engages a Contractor and/or Consultant to act indenenrlrritly from the Permitter nn the nermitte,1 work that CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS Contractor and/or Consultant shall be required to provide an endorsement naming CDOT as an Additional Insured on their Commercial General Liability, Auto Liability, Pollution Legal Lability and Umbrella or Excess Liability policies. 4. WORK WHERE DEPARTMENT LACKS AUTHORITY Utility work within municipal boundaries (pursuant to 43-2-135 CRS), on certain public lands, or on private property, may require separate approval of the appropriate jurisdictional agency or property owner. 5. INSTALLATIONS ON FREEWAYS CDOT may permit utility accommodations on freeways, including but not limited to the Interstate System, only in accordance with Utility Accommodation Code provisions. Special case exceptions as defined therein may be permitted only in accordance with FHWA-approved Departmental policy. 6. JOINT USE ALTERNATIVES As directed or approved by CDOT, if necessary for the safe and efficient use of the ROW, Permittee shall utilize joint use facilities such as the placement of two or more separate lines in a common trench, or attachment to the same overhead support. The Permittee will be responsible for proper coordination with other affected utilities. 7. ATTACHMENT TO HIGHWAY STRUCTURES Permittee is responsible for designing structure attachments, subject to the approval of the CDOT Staff Bridge Design Engineer. 8. DRAINAGEWAYS AND WATERCOURSES The flow of water shall not ever be impaired or interrupted. Where possible, crossings of ditches, canals or water -carrying structures shall be bored or ;ked beneath. Irrigation ditch or canal crossings require approval of the ditch mpany or owner. Pennittee shall repair damage to any drainage facility to the satisfaction of the owner. 9. TRAFFIC CONTROL PLAN a. Prior to commencing work, the Permittee shall develop and submit to the Department for acceptance, a Traffic Control Plan (TCP) for any accommodation work that will affect traffic movement or safety. The Permittee shall implement the TCP and utilize traffic control devices as necessary to ensure the safe and expeditious movement of traffic around and through the work site. b. The Permittee shall develop the TCP, and Methods of Handling Traffic (MHT's) included therein, in conformance with the Manual on Uniform Traffic Control Devices (MUTCD), the Colorado Supplement thereto adopted by the Commission pursuant to sections 42-4-104 and 42-4-105 CRS, the Department's standard specifications for temporary traffic control and the Department's standard plans for signing - Standard Plans S 630-1 and S 630-2. The TCP shall include provisions for the passage of emergency vehicles through the work zone, and shall conform to the requirements of the Americans with Disabilities Act. The TCP and MHT's shall contain sufficient detail to demonstrate conformity with all applicable requirements. c. The Permittee shall have a competent person at the work site at all times in responsible charge of temporary traffic control. In situations where the TCP goes beyond any Typical Application shown in the MUTCD, or particularly dangerous roadway or traffic conditions exist, the Department may require the Permittee to have a Traffic Control Supervisor (TCS) develop or approve the TCP or to have a TCS on -site during work. The TCS shall be certified as a worksite traffic supervisor by either the American Traffic Safety Services Association (ATSSA) or the Colorado Contractors Association (CCA), and shall have a current CDOT flaggers' certification card. The TCS shall be responsible for the planning, preparation, coordination, implementation, and inspection of the TCP. d. The Permittee shall not start the permitted work before the Department accepts the TCP. e. The Department may review and order changes to the TCP and MHT's during performance of the work, as required. f. The Permittee shall comply with the TCP at all times during performance of the work. g. The Permittee shall keep a copy of the TCP at the work site at all times during performance of the work for inspection. h. The TCP shall ensure that closure of intersecting streets, road approaches and other access points is minimized. On heavily traveled highways, the Department will not permit operations that interfere with traffic during periods of peak traffic flow. When Permittee operations coincide with highway construction or maintenance operations, the Permittee shall develop and implement the TCP in cooperation and coordination with the highway agency and/or its contractors and as otherwise directed by the Department in thc permit. j. All flaggers shall have a current CDOT flagger certification card and shall be capable of communicating with the traveling public and others at the work site. 10. NCHRP 350 CRASHWORTHINESS REQUIREMENTS FOR WORK ZONE TRAFFIC CONTROL DEVICES Work pone devices designated by FHWA as: Category 1, including but not limited to single -piece drums, tubes, cones and delineators; Category II, including but not limited to barricades, vertical panels with light, drums or cones with light, portable sign supports, intrusion detectors and type III barricades; or as Category III, including but not limited to concrete barriers, fixed sign supports, crash cushions, and other work zone devices not meeting the definitions of Category I or II; shall meet NCHRP 350 crash test requirements. The Permittee, or their contractor shall obtain and make available upon request, the manufacturer's written NCHRP 350 certification, or as applicable, the FHWA Acceptance Letter, for each type of device. FHWA Acceptance Letters for Category It or Category III Work Zone Devices may be accessed through the FHWA website at http:iisafe y.thwa.dotgov/roadway dgfliroad_ hardwareiwzd.htm 11. WORKER SAFETY AND HEALTH a. MI workers within the State Highway right of way shall comply with their employer's safety and health policies/procedures and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. b. Personal protective equipment (PPE) (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers in the SH ROW, except when in their vehicles, shall wear the following personal protective equipment: I) Head protection that complies with the ANSI 289.1 standard; 2) At all construction sites or whenever there is danger of injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41; 3) High visibility apparel, which shall, at a minimum comply with the Class 2 specifications of the ANSI/ISEA 107standard. 02/06 CDOT Permit Form 333 and Standard Provisions Page 3 of 9 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS Class 3 apparel shall be considered for use at night or in particularly hazardous situations 4) The most recent version of the ANSI standards listed above shall apply 12 ADA REQUIREMENTS The Pernuttee shall comply with the applicable provisions of the Americans With Disabilities Act, with respect to both permanent facilities installations and temporary work zones 13 CLEAR ROADSIDE CONSIDERATIONS a CDOT is committed to provide a roadside area that is as free as practical from nontraverseable hazards and fixed objects ("clear zone") New above ground installations may be permitted within the clear zone only upon a showing that no feasible alternate locations exist Permittee must utilize applopnate countermeasures to minimize hazards b Permittee shall remove materials and equipment from the highway ROW at the close of daily operations The traffic control plan must mclude protective measures where materials and equipment may be stored on ROW Protection of open trenches and other excavations within highway ROW shall be addressed in the Permittee's traffic control plan All excavations shall be closed at the end of daily operations, and no open excavation will be allowed in the clear zone after dark The Pennuttee agrees to promptly undertake mitigating or corrective actions acceptable to the Department upon notification by CDOT that the installation permitted herein has resulted in a hazardous situation for highway users 14 GENERAL CONSTRUCTION REQUIREMENTS a Work shall not be performed at night or on Saturdays, Sundays, or holidays without prior authorization or unless otherwise specified in this permit CDOT may restrict work on ROW during adverse weather conditions or during periods of high traffic volume b Those areas within ROW, which must be disturbed by permit operations, shall be kept to a practical minimum Pemuttee shall not spray, cut, or trim trees or other landscaping elements within highway ROW, unless such work is otherwise specified in this permit, or clearly indicated on the approved plans Cleated or tracked equipment shall not work on or move over paved surfaces without mats, or pads on tracks c Material removed from any portion of the roadway prism must be replaced in like kind with equal or better compaction Segregation of material is not permitted The permitted facility shall be of durable materials in conformity with accepted practice or industry standards, designed for long service life, and relatively free from routine servicing or maintenance d Construction or compaction by means of jetting, puddling, or water flooding is prohibited within all highway ROW e Thrust blocks are required on all vertical and horizontal bends m pressure pipes f Meters shall not be placed on highway ROW except within corporate limits where municipal regulations allow such use 15. ALIGNMENT, COVER, CLEARANCE a b Location and alignment of Permittee's facilities shall only be as specified in this permit or as otherwise indicated in the approved plans or work sketch (EXHIBIT A) Parallel installations will not be permitted within roadways (including curbing and/or shoulders) or median areas, except within corporate boundaries, subject to municipal regulations c Parallel installations should be located as near as practicable to the ROW line Crossings shall be as nearly perpendicular to the t highway as feasible d Where no feasible alternate locations exist, the Department may permit parallel installations along roadside areas within 15 feet from edge of shoulder or back of curb in these cases, the facility must be so located and safeguarded as to avoid potential conflict with necessary highway appurtenances (signs, guard rail, delineators, etc ) Specific safeguards such as increasing depth of cover to 60 inches, capping, or encasement, shall be specified in this permit's Special Provisions e Parallel installations shall follow a uniform alignment, wherever practical Due consideration must be given to conserving space available for future utility accommodations The standard allowable deviation from the approved horizontal alignment is ± 18 inches f Minimum cover shall conform to the Special Provisions Normal specified cover will be 48 inches or greater, reduced cover may be approved where site conditions warrant, subject to other safeguards as may be specified or approved in the permit Minimum overhead clearance shall conform to the Special Provisions, consistent with Utility Accommodation Code criteria 16 PAVEMENT CUTS AND REPAIRS Paved surfaces shall not be cut unless otherwise specified in this permit No more than one half the width of the roadbed may be opened at a time, when otherwise permitted Pavement shall be sawed or wheel -cut to a neat line Pavement shall be replaced to a design equal to or greater than that of the surrounding undisturbed pavement structure Pavement repair shall conform to the Special Provisions or the approved plans 17 BORING, JACKING, ENCASEMENT Unless otherwise specified, buried crossings shall be bored or jacked beneath the roadway, at least from toe of slope to toe of opposite slope Portals for untrenched crossings more than 5 feet in depth shall be bulk headed in conformance with OSHA construction and safety standards Portal limits of untrenched crossings shall be established safely beyond the highway surface and clear zone and in no case shall the lateral distance from the surfaced area of the highway to the boring or jacking pit be less than the vertical difference in elevation between such surface and the bottom of the pit Water jetting or tunneling is not permitted Water assisted boring may be permitted as determined by the CDOT Inspector Boring hole shall be oversized to the minimum amount required to allow pull -through of the conduit being installed Resultant voids shall be grouted or otherwise backfilled, subject to CDOT approval Ends of bored sections shall not be covered before being inspected Encasement shall be consistent with Utility Accommodation Code provisions CDOT may require protective casing for shallow installations or certain conduit materials Encased crossings shall extend at least from toe of slope to toe of slope, or die full width between access -control lines on freeways, including the Interstate System 18 INSPECTION AND ACCEPTANCE a CDOT will determine the extent of inspection services necessary for a given installation Permittee shall attend final inspection as may be required. If the initial performance of pemutted work was unacceptable, as determined by the Department, the Permittee shall perform any reconstruction or improvement of that work as ordered by the Department, in a timely manner and pnor to any further construction If permitted operations are not being earned out in compliance with the terms and conditions of this permit, the Department may order the Permittee to perform whatever corrective measures are necessary to attain compliance with the permit If there is an immediate danger to the public's health, safety or welfare, the Department may order the Pernuttee to cease all operations and if necessary, to remove all equipment and facilities from the SHROW b Final acceptance does not relieve Pernuttee of maintenance obligations toward those elements of the lughway facility CDOT Permit Form 333 and Standard Provisions Page 4 of 9 02/06 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS constructed under this permit. Final acceptance begins the two-year warranty period (see requirement under "Operation and Maintenance" below). 19. ENVIRONMENTAL CLEARANCES/PERMITS a. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to their activities and to obtain any clearances that are required directly from the appropriate regulatory agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from CDOT Permitting Offices or may be accessed via the CDOT webpage at tic www.dot.statetco.us/UtilitvPrqvim/Forrns.cfm. Failure to comply with regulatory requirements may result in suspension or revocation of your CDOT permit, or enforcement actions by other agencies. b. The Special Provisions of this permit shall list any specific environmental clearances or permits that the Department has been notified by the Permittee or by the administering regulatory agency apply to the operations authorized by this permit. The Special Provisions shall require the Permittee obtain the listed environmental clearances/permits prior to beginning work. c. The Permittee shall comply with all requirements described in the CDOT Environmental Clearances Information Summary, including those pertaining to: 1) Ecological Resources 2) Cultural Resources 3) Discharges of Stormwater or Process Water 4) Hazardous Materials 5) Discharges of Dredged or Fill Material 6) Erosion and Sediment Control 7) Disposal of Drilling Fluids 8) Concrete Washout 9) Spill Reporting 10) Transportation of Hazardous Materials d. Disturbance of any wildlife shall be avoided to the maximum extent practicable. If threatened or endangered species or archeological or historical artifacts are encountered during the progress of a project, work in the subject area shall be halted and the CDOT regional permitting office shall be contacted immediately for direction as to how to proceed. e. All discharges of stormwater or process water are subject to the applicable provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. g• There shall be no disposal of hazardous materials in the state highway right of way. Solid waste shall be removed from the state highway right of way and disposed of at a permitted facility or designated collection point (such as the Permittee's own dumpster). Drilling fluids must be disposed of as described in the ECIS. If pre-existing solid waste or hazardous materials contamination (including oil or gasoline contaminated soil, asbestos, chemicals, mine tailings, etc.) are encountered during the performance of work, the Permittee shall halt work in the affected area and immediately contact the CDOT regional permitting office for direction as to how to proceed. h. Spills shall be reported immediately using the CDOT Illicit Discharge Hotline (303) 512 4446. Spills on the highway, into waterways, or that may otherwise present an immediate danger to the public, shall be reported by calling 911 or the Colorado State Patrol at (303) 239-4501, and the Colorado Department of Public Health and Environment at 1-(877) 518-5608. RESTORATION OF RIGHT OF WAY Prior to final acceptance, all disturbed portions of highway right of way shall be cleaned up and restored to their original condition, subject to CDOT approval. Seeding, sodding, and planting shall be as specified, or otherwise approved by CDOT. Construction, maintenance and watering requirements shall conform to the CDOT Standard Specifications. Where landscape restoration must be delayed due to seasonal requirements, such work may be authorized by separate permit. Permittee shall use only certified weed -free seed and mulch. Permittee shall clean equipment before transporting it into or out of the state to prevent the migration of noxious weeds. 21. OPERATION AND MAINTENANCE a. Permittee agrees to own and maintain the installation permitted herein. The facility shall be kept in an adequate state of repair and maintained in such a manner as to cause the least interference with the normal operation and maintenance of the highway. b. If any element of the transportation facility, constructed or replaced as a condition of this permit, fails within 24 months due to improper construction or materials, Permitter shall make all repairs immediately as notified in writing by CDOT. c. Routine, periodic maintenance and emergency repairs may be performed under the general terms and conditions of this permit. CDOT shall be given proper advance notice whenever maintenance work will affect the movement or safety of traffic. In an emergency, the CDOT Region office and the State Patrol shall immediately be notified of possible traffic hazards. Emergency procedures shall be coordinated beforehand, where possible. d. Maintenance activities requiring new excavation or other disturbance within highway ROW may require separate permit. Where highway construction or maintenance operations so require, Permittee will shut off lines, remove all combustible materials from the highway right of way, or provide other temporary safeguards. 22. MARKERS, LOCATION AIDS, LOCATION ASSISTANCE a. The utility shall take all practical measures to ensure that buried utility facilities are surface -detectable by standard geophysical methods. Where the utility facilities, by the nature of their material properties, burial depth or other factors, may by themselves not be surface -detectable, the utility shall, where feasible, incorporate detection wire or other detection aids in the installation of those facilities. In instances where detection aids are not feasible or would be ineffective and surface-detectability cannot be ensured, surface markers shall be installed as directed by the Department and as -constructed plans and showing the accurate horizontal and vertical location of the buried facilities shall be provided to the Department. b. All plowed or trenched installations must include color -coded (using the American Public Works Association color coding system) warning tape placed not less than 12 inches vertically above the top of the line. The warning tape shall be surface -detectable if needed to facilitate detection of the line. c. The utility shall place readily identifiable markers at the right of way line where it is crossed by pipelines carrying transmittants which are flammable, corrosive, expansive, energized, or unstable, particularly if carried at high pressure or potential, except where a vent will serve as a marker. d. The utility shall place markers for longitudinal underground facilities vertically above the facilities or at a known horizontal offset, unless otherwise approved in writing by the Department. Each marker shall provide a fore- and backsight to succeeding and preceding markers. Markers shall be installed at suitable intervals along tangent sections, at angle points or points of curvature and at reasonable intervals along curves. e. The utility shall maintain any markers required by this Code for the life of the installation. 02/06 CDOT Permit Form 333 and Standard Provisions Page 5 of 9 CDOT UTILITY/RELOCATION/SPECIAL USE PERMIT STANDARD PROVISIONS f The Department may require the utility to submit "as -constructed" plans The Department may enter into an agreement with the utility whereby the Department can rely on those plans for the exact location of the utrhty for any future excavations, and need not give notice to the utility under Article 1 5 of Title 9, C R S g The utility will comply with the applicable requirements of Article 1 5 of Title 9 CRS, including any requirement to participate in the State's Notification Association pursuant to 9-1 5-105 C R S All owners of underground utilities within the SHROW, with the exception of the Department itself, must become members of the UNCC Notification Association h in addition to complying with the provisions of Article 1 5 of Title 9 C RS (One -Call Statute) in response to the Department's notification of planned excavations, utility owners shall surface - mark their boned utility facilities that are located within the SHROW in order to facilitate Departmental engineering and design activities, upon reasonable request from the Department, and at no cost to the Department The Permittee shall respond to such request within a reasonable timeframe acceptable to the Department, but no longer than 14 calendar days from the date of request, and the accuracy of the surface marking shall be within 18 inches of either side of the actual location of the buried facility 23. ADJUSTMENTS DUE TO HIGHWAY CONSTRUCTION If for any transportation purpose it becomes necessary to remove, adjust, or relocate this facility, Permittee will do so promptly, at no cost to the CDOT except as provided by law, upon written notice from CDOT and in accordance with the utility relocation permit issued to cover the necessary work The utility shall perform the relocation at or within a time convenient to and in proper coordination with the project or transportation -related activity, to minimize public inconvenience and cost, as directed by the Department m the pemut authorizing the relocation The utility company shall pay for damages caused by the company's delay m the performance of utility relocation work or interference with the performance of transportation project work done by others Such damages Include, but are not limited to, payments made by the Department to any third party based on a claim that performance of the transportation project work was delayed or interfered with as a direct result of the utility company's failure to timely perform the utility relocation work Damages resulting from delays m the performance of the utihty relocation work or interference with the transportation project work that are caused by events beyond the utility company's ability to reasonably foresee or control (a force majeure) shall not be charged to the utility company 24 ABANDONMENT, RETIREMENT, CHANGE IN OWNERSHIP a The Pemuttee shall notify the Department in writing of the planned retirement or abandonment of its facility or any portion thereof The Department will notify the Permittee in wntmg if it determines that the facilities may be retired or abandoned in place, along with any special conditions that may apply b Retired facilities shall remain the Permittee's sole responsibility, subject to all provisions of the Utility Accommodation Code and all of the terms and conditions of the permit issued for that facility, including maintenance and relocation requirements c The Permittee shall promptly remove all abandoned facilities from the SH ROW and promptly restore the SH ROW to pre-existmg or other conditions prescribed by the Department unless the Department in writing expressly allows the facility to remain in place Wntten notice from the Department, allowing an abandoned facility to remam in place, may include special conditions d If utility facilities are retired or abandoned in place, the utility shall comply with that decision if directed by the Department 1) cap, plug or fill lines, 2) furnish suitable location records for any such boned facilities, 3) maintain its own records of such facilities and respond to locate notices/requests from the UNCC and/or excavators, In providing such locates, the utility will indicate to the requesting entity whether or not the subject facilities are retired or abandoned 4) perform any other actions as deemed necessary by the Department to protect the transportation facihty and/or the traveling public e If the ownership of utility facilities is transferred, both the original Permrttee and the new owner shall notify the Department in writing prior to the change in ownership, and such notice shall state the planned date of change in ownership The notice from the new owner shall include a wntten statement accepting all terms and conditions of the existing permit, effective upon the planned date of the change in ownership f Utility facilities containing asbestos may not be abandoned in -place Ordmanly, such facilities must be removed from the SHROW when take out of service On a case -by -case basis, the Department may allow such facilities to be retired in -place, with the owner retaining full legal ownership and responsibility for the facilities 25 SUSPENSION AND CANCELLATION a The CDOT inspector may suspend operation due to 1) Non compliance with the provisions of this permit 2) Adverse weather or traffic conditions 3) Concurrent transportation construction or maintenance operations in conflict with the permitted work 4) Any condition deemed unsafe for workers or for the general public b Work may resume when grounds for suspension no longer exist This permit is subject to cancellation due to 1) Persistent noncompliance with permit provisions 2) Abandonment or transfer of ownership 3) Superseded by new permit covering the same installation 4) Conflict with necessary planned transportation construction c Permittee must promptly terminate occupancy upon notice of cancellation of permit, unless a new permit is applied for and granted d Where Pemuttee does not fulfill an obligation to repair or maintain any portion of the highway facility, or control and safely maintain the flow of traffic thereon, CDOT reserves the right, m lieu of canceling this permit, to accomplish the required work by any other appropriate means, and Permittee shall be liable for the actual costs thereof 02/06 CDOT Permit Form 333 and Standard Provisions Page 6 of 9 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances Information Summary PURPOSE - This summary is intended to inform entities external to CDOT that may be entering the state highway right-of-way to perform encountered work related environmental to their own permits/clearances facilities (such that as Utility, may apply Special to their Use or activities. Access This Permittees), listing about is not all-inclusive some of the - additional more commonly environmental agencies specific Requirements should activity. or IMPORTANT May be cultural contacted Result resource In for — Suspension Please additional permits/clearances Review information or The Revocation Following may if there be required of is information Your any CDOT in uncertainty certain Permit, Carefully instances. about Or what - Enforcement Failure Appropriate permits/clearances to Comply Actions local, state With By are Regulatory Other and required federal Agencies. for a CLEARANCE may • be Colorado contacted Water Environmental Department CONTACTS Quality for additional Control Permitting of Public - information: Division As indicated Health Website (WQCD): and https://vv in the Environment (303) permit/clearance 692-3500 w colorado.gov/pacific/cdphe/all-permits (CDPHE): descriptions General listed Information below, the — (303) following 692-2035 individuals or agencies CDOT Water Quality Program Manager: (303) 757-9343 ittps://www.codot.gpv/programs/environmental/water-quality ■ CDOT Colorado Asbestos Office of Project Archaeology Manager: and Phil Historic Kangas, Preservation: (3C3) 512-5519 (303) 866-5216 U.S. Omaha http://www.nwo.usace.army.mil/Missions/RegulatoryProgram/Coloradu.aspx Army District Corps (NE of Engineers, CO), Denver District Office Regulatory (303) 979-4120 Offices: Sacramento http://www.spk.t Dist. Jsnre.army.mil/Miss►ens!Regulatory (Western CO), Grand Junction Office a (970) pY 243-1199 Albuquerque http:eiwww.spa.usace.army.mil/McssionsiRegulatoryfrogramandPermits.aspx District (SE CO), Pueblo Office (719)-543-9459 ..J CDOT Utilities, Special Use and Access Permitting: (3031757-9654 https://ww.w.codot. ov/business/ ermitc Wildlife Resources - Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or suspected threatened the COOT threatened or endangered Regional or endangered Permitting species are Office species encountered habitat Region during will Planning require the progress special authorization of the permitted from the work, CDOT work in permitting the subject office. area If shall any be halted and and and Environmental Manager shall be contacted immediately. Authorization be obtained from must the be CDOT provided website, by CDOT http://www.codot.gov/programs/environmental/wildlife/guidelines, prior to the ccntinuation of work. Information about threatened or or the endangered Colorado species Parks and may Wildlife http://www.cpw.state.co.us/team/Pages/SOC-ThreatenedEndangeredList.asex. (CPW) website, Additional guidance may be provided by the appropriate Region Planning and Environmental Manager (RPEM). Cultural Resources - The applicant must request a file search of the permit area through the Colorado Office of Archaeology and Historic (http:nnwww.nistory_coiorado.orgioahpifiie-search). Preservation (OAHP), Denver, to ascertain Inventory if historic of or the archaeological permit area by resources a qualified have cultural previously resources been identified specialist may be initiation necessary, Regional provided RPEM. of Contact Permitting by per the CDOT the permitted Information: recommendation prior Office work to the and or Region continuation Contact are of encountered CDOT. Planning the of OAHP If work. archaeological and as for Ervironmental Additional the file project searches sites/artifacts guidance progresses, at Manager d 3031866-5216. may all shall or be historic work provided be in contacted the resources by subject the immediately. Regional are area known shall Permitting to be Authorization exist halted prior Office and to the must and the CDOT be Paleontological Resources - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder (https://cumuseum.colorado.edu/research/paleontology/vertebrates/policies), and the Denver Museum of Nature and Science (http://www.dmns.org/science/collections/earth-science-collections/) to ascertain if paleontological resources have been previously identified in or near the permit area. Inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation CDOT must be Regional provided Permitting of by CDOT. CDOT If Office prior fossils to and the are Region continuation encountered Planning of during and work. the Environmental Additional permitted guidance work, Manager all may work shall be in the be provided contacted subject by area immediately. the Regional shall be Permitting halted Authorization and the Office in the Permit Special Provisions. Contact information: See the museum websites listed above for Paleontological Collections Manager contact information. Contact the CDOT Paleontologist for further information at n!colepeavey@ ct te.co.us or (303) 757- 9632. The CDOT Paleontologist will not conduct a com.irehensive file search independently of the museums. Hazardous Materials. Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations Pertaining of Designation to Solid (a landfill Waste permit). Disposal The Sites Colorado and Facilities Hazardous (6 CCR Waste 1007-2), Act C.R.S. prohibit 25-15-301 solid waste et al, disposal and the without Colorado an approved Hazardous Certificate Waste Regulations are no (6 CCR landfills 1007-3) TSD prohibit the transfer, the State storage Highway or disposal Right (TSD) Way. of hazardous Therefore, waste except at permitted TSD sites. There generated permitted permitted facility by the activities or designated or of entities collection sites within entering point the (e.g., State for Highway solid waste, Right a of of utility Way or construction must be all removed company's solid or from hazardous the own ROW dumpster). wastes and disposed that If pre-existing might of at be a solid etc.) is waste encountered or hazardous during materials the performance contamination of work, (including the perrnittee oil or petroleum shall halt contaminated work in the affected soil, asbestos, area and chemicals, immediately mine contact tailings, the CDOT Hazardous Regional Materials Permitting Management Office for Supervisor: direction as +303, to how 512-5524. to proceed. Contact information: Theresa Santangelo-Dreiling, CDOT Asbestos Containing Materials, Asbestos Contaminated Soil - All work on asbestos containing materials (ACM) must comply with the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) Regulation 8. Disposal of ACM, and work done in I asbestos -contaminated soil must comply with the CDPHE Hazardous Materials and Waste Management Division's '_HMWMD) Solid Environmental Clearances Information Page 1 of 3 Colorado Department of August Waste Regulations. The application for any CDOT permit must specifically identify any ACM involved in the work for which authorization is being requested. Additional guidance or requirements may be specified in the permit special provisions. Contact Info: CDPHE APCD and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additional information concerning clearance on CDOT projects is available from the CDOT Asbestos Project Manager (303) 512- 5519 or Theresa Santan ielo-Dreiling. Hazardous Materials Manauement Supervisor: ; 303 512-5524. Transportation of Hazardous Materials - No person may offer or accept a hazardous material for transportation in commerce unless that person is registered in conformance with the United States Department of Transportation regulations at 49 CFR, Part 171. The hazardous material must be properly classed, described, packaged, marked, labeled, and in condition for shipment as required or authorized by applicable requirements, or an exemption, approval or registration has been issued. Vehicles requiring a placard, must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact Information: For authorization and more info call the Federal Motor Safety Carrier Administration, US DOT for inter- and intra-state HAZMAT Registration (303 969-6748. Colorado Public Utilities Commission: (303J 894-2868. Discharge of Dredged or Fill Material — 404 Permits Administered By the U.S. Army Corps of Engineers, and Section 401 Water Quality Certifications Issued by the CDPHE WQCD - Corps of Engineers 404 permits are required for the discharge of dredged or fill materials into waters of the United States, including wetlands. There are various types of 404 permits, including nationwide permits, which are issued for activities with relatively minor impacts. For example, there is a nationwide permit for utility line activities (nwp #12). Depending upon the specific circumstances, it is possible that either a "general" or "individual" 404 permit would be required. If an individual 404 permit is required, section 401 water quality certification from the CDPHE WQCD is also required. Contact the appropriate Corps District Regulatory Office for information about what type of 404 permit may be required (contact information above . Contact the CDPHE Water Quality Control Division at4303) 303) 692-3500. Working on or in any stream or its bank - In order to protect and preserve the state's fish and wildlife resources from actions that may obstruct, diminish, destroy, change, modify, or vary a natural existing stream or its banks or tributaries, it may be necessary to obtain a Senate Bill 40 certification from the Colorado Department of Natural Resources. A stream is defined as 1) represented by a solid blue line on USGS 7.5' quadrangle maps; and/or 2) intermittent streams providing live water beneficial to fish and wildlife; and/or 3) segments of streams supporting 25% or more cover within 100 yards upstream or downstream of the project; and/or 4) segments of streams having wetlands present within 200 yards upstream or downstream of the project measured by valley length. The CPW application, as per guidelines agreed upon by CDOT and CPW, can be accessed at httos://www.codot.gov/programs/environmental/ wildlife/quidelin Stormwater Construction Permit (SCP) and Stormwater Discharge From Industrial Facilities - Discharges of stormwater runoff from construction sites disturbing one acre or more - or certain types of industrial facilities, such as concrete batch plants - require a CDPS Stormwater Permit. Contact Information: Contact the CDPHE Water Quality Control Division at (303) 692-3500. Website: https://www.colorado.yovipacltic/capneiwe-construction-genera►-permits and https://coloraao1gov/oacificicdphe/wn-commerce-and- industry-permits. Construction Dewatering (Discharge or Infiltration) and Remediation Activities - Discharges of water encountered during excavation or work in wet areas may require a Construction Dewatering or Remediation Activities Discharge Permit. Contact Information: For Construction Dewatering and Remediation Activities Discharge Permits, contact the CDPHE WQCD at (303) 692- 3500. For Applications and Instructions (CDPHE website ): rates:/lwww.cr -3do, ovi acific/cd hi Action Arai -per: Municipal Separate Storm Sewer System (MS4) Discharge Permit • Discharges from the storm sewer systems of larger municipalities, and from the CDOT highway drainage system that lies within those municipalities, are subject to MS4 Permits issued by the CDPHE WQCD. For facilities that lie within the boundaries of a municipality that is subject to an MS4 permit, the owner of such facility should contact the municipality regarding stormwater related clearances that may have been established under that municipality's MS4 permit. All discharges to the CDOT highway drainage system or within the Right of Way (ROW) must comply with the applicable provisions of the Colorado Water Quality Control Act, the Water Quality Control Commission (WQCC) Regulations (hups://www.coloraao.govipaciticicupoeiwgec-regulations-anci-policles-anci-water-Qualsty-statutes) anc the CDOT MS4 Permit # COS - 000005 (ntttps://www.codot.gov/programs/environmental/water-quality/document: ). Discharges are subject to inspection by CDOT and CDPHE. Contact the CDPHE Water Quality Control Division at (303) 692-3500 for a listing of municipalities required to obtain MS4 Permits, or go to https://www.colorado.gov/pacific/cdphe/wq-municipal-ms4-perrnscs. For COOT -related MS4 regulations, go to: nttps:iiwww.codot.qov/programs/environmenta l/water-quality/stormwater-oroorams. html. - ---mac . _ ,�_._._.P.� _ - General Prohibition — Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but are not limited to, substances such as wash water, paint, automotive fluids, solvents, oils or soaps and sediment. Contact Information: Contact the CDPHE Water Quality Control Division at (303) 692-3500. General Authorization - Allowable Non-Stormwater Discharges - Unless otherwise identified by CDOT or the WQCD as significant sources of pollutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, irrigation water, uncontaminated springs, footing drains, water line flushing, flows from riparian habitats and wetlands, and flow from firefighting activities. Allowable non-stormwater discharges can be found under Illicit Discharge PDD at: ,nttps.//www.codot.Qov/programc Anvironmental/water-quality/stormwater-pros ams.html. Contact Information: The CDPHE Water Quality Control Division (telephone #'s listed above). Erosion and Sediment Control Practices - For activities requiring a Stormwater Construction Permit, erosion control requirements will be specified in that permit. In situations where a stormwater permit is not required, all reasonable measures should be taken to minimize erosion and sedimentation according to CDOT Standard Specifications 107.25, 208, 213 and 216 ( rs:i/www.codot.gov/ business/designsupporti2011-construction-specifications/2011-Specsi2011-specs-boot ). All disturbances require a stabilization plan, native seeding or landscape design plan according to applicable CDOT Standard Specifications 212-217 and 623. The CDOT Erosion Control and Stormwater Quality Guide (available from the Bid Plans Office at (303) 757-9313) should be used to design erosion controls and restore disturbed ve.;etation. 1 Environmental Clearances Information Page 1 of 3 Colorado Department of August Disposal of Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as "discharges" or "solid wastes," and in general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being separated from fluids or after infiltration of the water, provided: 1) the drilling fluid consists of only water and bentonite clay, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, 3) the solids are covered and the area restored as required by CDOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: Contact CDPHE ctelephone #'s listed above). Noxious Weeds and Invasive Species Management Plan — Noxious Weeds and Invasive Species guidance can be found by contacting the Colorado Department of Agriculture (https://www.colorado.gov/pacific/agconservation/noxHusweeds) and the Colorado Division of Parks and Wildlife (http://cpw.state.co.us/aboutus/Pages/RS-NoxiousWeeds.aspx). In either case, management plans involving the control of noxious weeds associated with the permitted activity and cleaning of equipment will be required. Concrete Washout - Waste generated from concrete a3tivities shall NOT be allowed to flow into the drainage ways, inlets, receiving waters, or in the CDOT ROW. Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, drainageways, and inlets. Concrete washout shall only be performed as specified by the CDOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact information: Contact CDPHE or find additional information on the CDOT website: https:/!www.codot.gov/business/designsupport/2011-consauctsory specifications/ 201 1 -Specs and refer to the specifications and their revisions for sections 101, 107 and 208. Spill Reporting - Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain or buried. All spills shall be reported to the CDOT (licit Discharge Hotline at (303) 512-4446 (4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, into waterways, any spill in the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1-877-518-5608. More information can be found at https://www.colorado.yovivacirioicuprne;erme(gency- • Environmental Clearances Information Page 1 of 3 Colorado Department of August CO ORA. C: Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowmelt flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking into the ground Why is stormwater runoff a problem? Stormwater can pick up debris, chemicals, dirt and other pollutants and flow into CDOT's storm drain system or directly into a stream, river, lake, wetland or reservoir. Anything that enters CDOT's storm drain system is discharged untreated into the waterways we use for fishing, swimming, and providing drinking water CDrt'ddger1 �pt�iI. dirt. Slurry, 1 r • 41+ • K`.r'i•r�i. t;sc=L,'1g,' fir'^;7► i-'nat, !lido tst! "...,•?; �. +vef►, santt, any 'i'duLtr: ji, * Tips for Reporting an Illicit Discharge Call the discharge hotline at (303) 512-4426 From a safe distance try to estimate the amount of the discharge. identify characteristics of the discharge (color, odor, algae, etc.). Obtain information on the vehicle dumping the waste (if applicable). Do not approach! Call *P for illicit dumping. If possible, take a photo, record a license plate. For more information on COOT Utility Permits: htt s:liwww.codot.a vypusinesslaQr{n�tsut� tulle say!! For more information on CDOT Access Permits: baps:j www.r odot. ov businesslpermitsiaccess permits For more information on CDOT Water Quality Program: Water Quality Program Manager 4201 E. Arkansas Ave. Shumate Budding Denver, Colorado 80222 303-757-9343 Departznen:of T la fSportat tox"t %ester 1.polity I riarani Industrial tat Unties 1 , t RIFelul COOT has a Municipal Separate Storm Sewer System permit, otherwise known as (MS4) from the Colorado Department of Public Health and Environment. The permit states that only stormwater can be discharged from COOT's storm drain system try pip* . TO THE WASTEWATER TREATMENT PLANT Ness storm drain PIP* TWINE LOCAL lIMINMIODY As part of the permit, COOT has several different programs to prevent pollutants from entering into the storm drain system: Construction Site Program • New Development Redevelopment Program • Illicit Discharge Program • Industrial Facilities Program • Public Education and Outreach Program • Pollution Prevention and Good Housekeeping g • Wet Weather Monitoring Program COt.0RADO Department of Transportation Control Measures for Industrial Facilities Industrial facilities can use control measures (CM} otherwise known as Best Management Practices (BMP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering into CD0T's storm drain system. Control Measures also include treatment, operating procedures, and practices to control site run off which can include structural and non-structural controls. THE 6AUNTLET .i PZATn AKE NOE a net.Amer m Y aTHIS Tit MPS at RJR nc ti THE ear "en', MARRAINUR COOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following: ✓ Communications ✓ Cable television • Power ✓ Electricity 1 Light ✓ Heat Gas ✓ Oil ✓ Crude Products ✓ Water ✓ Stream Waste ✓ Stormwater not connected with highway drainage 1 Similar Commodity C O _U AuO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work in the state highway right-of-way will require some type of environmental permit or clearance for that work. COOT has put together an Environmental Clearances Information Summary for those applying for a COOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: https://www.codot.goviprogramVenviro nmental[resou rcesjgu idance . standards/Environmental%2ox1ea ra nces% 241 nfo%2osumma ry. pdf Seed Mix 4 - Brown Elevation: Low Temperature: Warm Humidity: Average Grasses 1 Big Bluestem — 15% (3.6 lbs/acre) 2 Fringed Brome — 13% (1 9 lbs/acre) 3. Sand Lovegrass — 12% (0 3 lbs/acre) 4. Green Sprangletop — 10% (0.6 lbs/acre) 5 Western Wheatgrass — 10% (3 1 lbs/acre) 6 Buffalograss — 10% (6 2 lbs/acre) 7 Sand Dropseed —8% (0 1 lbs/acre) Forbs/Shrubs/Flowering 1. Gaillardia — 7% (1 6 lbs/acre) 2 California Poppy -5% (0 6 lbs/acre) 3 Desert Verbena — 4% (0 3 lbs/acre) 4. Palmer Penstemon — 4% (0 2 lbs/acre) 5. Indian Blanket — 2% (0 3 lbs/acre) Seeding Application: Drill seed 0.25" to 0 50" into the topsoil In areas that are not accessible to drill, hand broadcast at triple the above rate and rake 0.25" to 0 50" into the topsoil. \ Mulching Application: 15 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre. Note: Hydroseeding and/or Hydromulching will not be allowed. o CDOT State Highway Utility Accommodation Code 2009 3 4 4 3 5 the utility shall replace excavated portions of the base and subgrade with flowable backfill, or as otherwise directed by the Department, and 34436 the utility shall trim all overbrcaks or incidental damage of existing pavement back to a neat line before patching, and 344.37 the utility shall repair all surface gouges or other minor damage in a manner acceptable to the Department, and 34438 the utility shall restore all pre-existing pavement markings in and adjacent to resurfaced areas 345 Trenched Construction and Backfill 3 4 5 1 The utility shall construct vertical -sided trenches, of uniform width, and no wider than the lme diameter plus three feet, unless the utility demonstrates to the Department's satisfaction that such construction is impracticable 3452 Shoring or bulkheading shall conform with all applicable Federal, State and local jurisdiction construction and safety standards 3 4 5 3 The utility shall provide drainage from excavation areas 3 4 5 4 The utility shall not perform construction or compaction by means of jetting, puddling, or water flooding within SH ROW, however, a limited amount of puddling may be allowed up to the spnngline of the pipe when free -flowing granular backfill materials are used, when necessary to obtain proper compaction of pipeline bedding 3 4 5 5 Unless otherwise directed or approved by the Department, the utility shall backfill trenches as follows 3 4 5 5 I replace excavated material with flowable backfill as specified by the Department within toes of slopes, and/or 3 4 5 5 2 place backfill in 6 inch layers, each consolidated by mechanical tamping and controlled addition of moisture to a density equal to or greater than that of the surrounding undisturbed soil outside toes of slopes 346 Trencliless Installations 3 4 6 1 Portal limits of untrenched crossings shall be established safely beyond the highway surface and clear zone, and in no case shall the lateral distance from the surfaced area of the highway to the boring or jacking pit be less than the vertical difference in elevation between such surface and the bottom of the pit 55 CDOT Stale Highway Utility Acoommedatton Code 2009 3462 Shoring or bulkheading shall conform with applicable Federal, State and local jurisdiction construction and safety standards 3 4 6 3 The utility shall not use water jetting or tunneling, but water -assisted or wet boring may be permitted if determined by the Department to not result in excessive erosion or unacceptable moisture conditions in the roadway subgrade 3464 The boring hole shall be oversized to the minimum amount required to allow pull - through of the conduit being installed, based upon equipment and product manufacturer's specifications If the oversize excavation is not already filled by the dnlling slurry after product pull through, the void shall be grouted to the satisfaction of the Department Grout or other approved backfill material shall be used for pipe of 12 inches or more in diameter, and for overbreaks, unused holes or abandoned pipe The composition of the grout shall be a cement mortar, a slurry of fine sand or fine granular materials, subject to Department approval 3465 The utility shall follow manufacturer's guidelines and industry standards for equipment set-up and operation The utility shall assess soil conditions to determine the most appropriate installation technique Underground borepaths or tunnels shall be tracked and recorded by the utility Failed bores shall be appropriately abandoned by the utility 3466 Drilling fluids shall be prepared and used according to fluid and drilling equipment manufacturer guidelines The utility shall use fluid containment pits at both bore entry and exit points, and shall use appropriate operational controls in order to avoid heaving or loss of drilling fluids from the bore 3 4 6 6 1 Antifreeze additives shall be non-toxic and biodegradable products 34662 Depending upon chemical composition or the specific method of disposal, improperly disposed drilling fluids may be classified as solid wastes or illicit discharges per Section 3 1 7, and in general, shall be pumped or vacuumed from the construction area, removed from the SH ROW and disposed of at permitted facilities that specifically accept such wastes 34663 Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is expressly prohibited 34664 Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being separated from fluids or after infiltration of the water, provided 3 4 6 6 4 1 the drilling fluid consists of only water and bentonite clay, or 346642 if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling, and 56 CDOT State Highway Utility Accommodation Code 2009 3 4 6 6.4 3 the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, and 3 4 6 6 4 4 the solids are covered and the area restored as required by permit requirements 3 4 7 Utility Installations Near Drainage Ways and Watercourses 3 4 7 1 The utility shall not install any facility along or across the ROW of an irrigation ditch or canal company without first obtaining the written approval of such company 3 4 7 2 The utility shall install facilities that cross a stream or other drainage only at a point beneath the bed of that watercourse and only at a depth that adequately allows for scour or ditch maintenance requirements The utility shall also take the added measures to protect such lines that the Department deems necessary in areas subject to erosion or other disturbance 3 4 7 3 In establishing the depth of cover below an unpaved channel, the Department will consider potential scour, ditch maintenance operations and/or future needs to increase the channel capacity The utility line shall be installed a minimum of three feet below the lowest expected level of scour or degradation 3 4 7 4 Utility construction operations within or near live streams, ditches, wetlands or other bodies of water shall include adequate provision to protect or maintain surface and/or ground water quality, and may require appropriate clearances as described in Section 317 3 4 7 5 The utility shall not install utility lines within culverts where the primary purpose of that culvert is to carry drainage For culverts or culvert -like structures where the primary purpose of the culvert is something other than dramage, such as providing passage for stock, wildlife, pedestnans or vehicles, utility installations shall be addressed through Section 3 3 10 3 4 7 6 In order to avoid any interference with the operations or maintenance of either utility lines or of drainage structures, the utility shall not install utility lines inside any such drainage structure or inside the trench that surrounds any drainage structure, and shall maintain a horizontal and vertical clearance from any such drainage structure or surrounding trench if further directed to do so by the Department in the utility permit 3 4 8 Protection, Construction and Restoration of Highway Property 3 4 8 1 The utility shall avoid disturbing or damaging all highway property, and shall be responsible for the prompt reconstruction, alteration, repair or maintenance of highway property, to repair any damage caused by the utility work, and to restore the SH ROW to pre-existing or better conditions as may be specified in the permit 57 State Highway Utility Permit 1 Attachment to Permit No 4190092 - Additional Terms and Conditions Version 5 1 GENERAL 2 This permit is issued in accordance with the State Highway Utility Code and is based in part upon the information submitted by the Permittee This permit is only for the use and purpose stated m the Application and Permit A copy of the State Highway Utility Code can be downloaded at http.//www coloradodot info/business/permits/utilitiesspecialuse/2CCR_601_18 pdf/view 3 Please refer to this permit number m all communications and correspondence 4 The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required to proceed with permitted work Approval of this utility/special use permit does not constitute verification of this action by the Permittee 5. The Permittee, his or her heirs, successors -in -interest, assigns, and occupants of the Utility/Construction/ Landscape/Special Use permitted by this permit shall be responsible for meeting the terms and conditions of this permit. 6 Before work begins, a certificate of insurance naming the Colorado Department of Transportation (CDOT) as an additional insured is required to be submitted to. CDOT Region 4 Utilities Permits 1420 2nd Street Greeley, CO 80631 Descnption should mclude this permit number Insurance should be m effect through 2 -year warranty penod from permit issue date and as long as installation exists in CDOT right-of-way See attached Standard Terms 3 A through 3 H , inclusive 7 READ ALL ADDITIONAL STANDARD REQUIREMENTS OF THIS PERMIT AND OTHER TERMS AND CONDITIONS ON THESE ATTACHED SHEETS A COPY OF THIS PERMIT, INCLUDING ALL TERMS AND CONDITIONS, MUST BE ON THE JOB SITE WITH THE CONTRACTOR Call for an inspection of forms at least one working day prior to placmg any concrete The Colorado Department of Transportation inspection is not an approval of the grade or alignment of the work The contractor and/or engineer is responsible for the proper grade and alignment Minor changes or additions may be ordered by the field inspector to meet field conditions Any survey monuments or markers disturbed during the execution of this permit shall be repaired immediately at the expense of the Pernuttee 8 NOTIFY THE DEPARTMENT OF TRANSPORTATION INSPECTOR Mike Shepherd at [970] 381- 5143 TWO WORKING DAYS BEFORE STARTING THE WORK OR RESUMING SUSPENDED WORK 9 On -premise and off -premise signing not in CDOT right-of-way shall comply with the current Colorado Outdoor Advertising Act CRS 43-1-401, Rules and Regulations Pertaining to Outdoor Advertising For questions, please contact Outdoor Advertising Inspector Ally Mattson at 970-350-2148 State Highway Utility Permit 2 Attachment to Permit No 4190092 - Additional Terms and Conditions Version 5 10 All work is to conform to the plans on file with the Colorado Department of Transportation or as modified by this Permit (IF DISCREPANCIES ARISE, THIS PERMIT SHALL TAKE PRECEDENCE OVER THE PLANS) The Colorado Department of Transportation plan review is only for the general conformance with the Colorado Department of Transportation design and code requirements The Colorado Department of Transportation is not responsible of the accuracy and adequacy of the design, of dimensions, and elevations which shall be confirmed and correlated at the job site The Colorado Department of Transportation, through the approval of this document, assumes no responsibility other than stated above for the completeness and/or accuracy of the plans 11 The contractor shall follow the applicable construction specifications set forth by the Department of Transportation m the latest manual, Standard Specifications for Road and Bndge Construction, the M & S Standards, and the M U T C.D 12 Any damage to any present highway facilities shall be repaired immediately and pnor to continuing other work Any mud or other material tracked or otherwise deposited on the roadway shall be removed daily or as ordered by the Inspector 13 CDOT will determine the extent of inspection services for the work A daily inspection may be done by the Colorado Department of Transportation from the time work begins inside the highway right-of-way until the job is completed and right-of-way restored to its original condition 14 Water, storm sewer, sanitary sewer, gas, electrical, landscaping, telephone, traffic signal installations and fiber optic installations will require individual additional permits 15 Any surveying required as a result of this permit is the responsibility of the Permittee 16 It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details The ECIS may be obtained CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction-Environmental Guidance webpage at http //www dot state co us/environmental/Forms/asp FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations Prohibited discharges mclude substance such as: wash water, paint, automotive fluids, solvents, oils or soaps Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, State Highway Utility Permit Attachment to Permit No 4190092 - Additional Terms and Conditions Version 5 flows from npanan habitats and wetlands, and flow from fire fighting activities ANY OTHER DISCHARGES, including storm water discharges from mdustnal facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins For additional mformation and forms, go to the CDPHE web site at http //cdphe state.co.us/wq/PennitsUnit/wqu 3 a 17 By accepting the permit, the permittee stipulates and agrees to fully protect, defend, indemnify, and hold harmless, to the extent allowed by law, the Issuing Authority and each of the Authority's directors, officers, employees, agents, and representatives, from and against any and all claims, costs (including but not limited to all reasonable fees and charges of engineers, architects, attorneys, and other professionals or expert witnesses and all court or other dispute resolution costs directly incurred by reason of claims directly brought agamst the Issuing Authority), losses, damages, pre- or post judgment mterest, causes of action, permittee's failure to obtain, or disregard of, any applicable federal, state, or local environmental permits, approvals, authonzations, or clearances, or in meeting or complying with any applicable federal, state, or local environmental law, regulation, condition, or requirements in connection with any activities authorized by this Utility Permit 18 The permittee shall assume full responsibility for installation of and the resolution of any unforeseen problems regarding the installation of this facility 19 The Penmttee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required to proceed with permitted work Approval of this utility/special use permit does not constitute verification of this action by the Permittee 20 DRAINAGE, WATER QUALITY CONTROL, ENVIRONMENTAL 21 All disturbed landscaping is to be restored to original or better condition 22 Areas of roadway and right-of-way disturbed during this installation or work shall be restored to insure proper drainage and erosion control 23 The Permittee is responsible for compliance with all Federal, State, and local environmental regulations The Permittee should have a qualified environmental consultant on staff or hire a qualified environmental consulting firm to assess the proposed project area for potential environmental impacts and obtain any necessary permits prior to disturbance. Environmental impacts include, but are not linuted to, wetlands, water quality, threatened or endangered flora and fauna, cultural resources mcluding both archaeological and paleontological resources, and hazardous waste that can affect both human health and the natural environment. Should enforcement action(s) be taken by any agency with junsdiction, liability for noncompliance with any environmental regulation is the sole responsibility of the Permittee 24 TRAFFIC 25 No storage of materials or equipment will be allowed within CDOT right-of-way or 30 feet off the edge of the raveled way, whichever is greater 26. TRAFFIC CONTROL State Highway Utility Permit 4 Attachment to Permit No 4190092 - Additional Terms and Conditions Version 5 27 No work will be allowed at night, or on Saturdays, Sundays, and legal holidays without prior authorization from the Department The Department may also restrict work within the State Highway right-of-way during adverse weather conditions. 28 No equipment will be allowed in the main lanes of the roadway during construction. 29 All work will be conducted from outside of CDOT right-of-way to outside of CDOT right-of-way. Therefore, no traffic control is required for this installation 30 MAINTENANCE OF UTILITY 31 Maintenance work may be done anytime within daylight hours as long as no interference to traffic is caused 32 MATERIALS 33 Disturbed right-of-way area, where applicable, must be top soiled, fertilized, mulched, and reseeded with Department of Transportation Specification grass seed mix, which meets specifications 34 Please refer to attached sheet for CDOT seeding specifications for site revegetation 35 EARTHWORK 36 Conduit/casing shall be a minimum depth of 4 feet for all utilities except "wet" utilities, which must be placed to a minimum depth of 4 5 feet 37 All cable/conduit shall be installed by directional bore No trenching shall be permitted 38 MISCELLANEOUS 39 The Utility shall design and construct all buried facilities, including pipelines, conduits and casings, to withstand the full range of exptected internal and external pressures and loads, mcluding internal pressures ranging from maximum expected pressure to zero pressure, and external loads from the highway and superimposed vehicle loads Pipelines shall also be designed and constructed to resist internal and external corrosion. 40 All construction vehicles operating in CDOT right-of-way to have mounted flashers 41 The utility shall avoid disturbing or damaging all highway property, and shall be responsible for the prompt reconstruction, alteration, repair, or maintenance of highway property, as necessary, to repair any damage caused by the accommodation of the utility, and to restore the highway to pre-existing or other conditions as may be specified in a permit or agreement authorizing the accommodation 42. Utility Code, Section 3 4.6, requirements shall apply Copy of section attached. 2/19/2019 REF -150219-168310 - Salesforce - Performance Edition REF -150219-168310 • Close Window • Print This Page • Expand All f Collapse All Permit Information Record Type Permit Number Permittee Permittee Street Permittee City/State/Zip Permittee Phone Permittee Email Permittee Select Permittee Rep Permittee Company Utility Permit 4190092 Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 Permittee Company Shawn Bates Cheyenne Connector Pipeline, Inc Permit Author Web Portal User Received By CDOT Project N umber Project Engineer Utility Project N umber Current Signatory Issuing Authority Activity Description Section Installation? 1 Adjustment? Reference Number REF -150219-168310 Complexity Level I Annual Permit? Applicant Applicant Street Summit Resources C/O Rebecca Lieders 800 8th Ave. Suite 204 Applicant Greeley, Colorado 80631 City/State/Zip Applicant Phone Applicant Email Applicant Select Applicant Rep Applicant Company Inspector Name Inspector Telephone Patrol Name Applicant Company Rebecca Lieders Summit Resources C/O Rebecca Lieders Mike Shepherd (970) 381-5143 Patrol # 20 Maintenance Section Water Quality Program Manager Regional Environmental Manager Facility & Type of Work (Other) 1 https://socgov.my.salesforce.com/a0r1 J0000061Rb2/p?retURL=/a0r1 J000006IRb2 1/4 2/19/2019 REF -150219-168310 - Salesforce - Performance Edition Removal? Longitudinal? Maintenance of Transverse? Existing Facility? {D O SUE/Other Relocation? Description of Work Location ON SH 85 NW/O 4TH ST, NUNN Additional Remarks Buried? Aerial? Structure Number I Location Property Address Route Number 085 Additional Nunn Mile Post 292 000 Information Intersecting Side Feature(s) GeoLocation City County Weld County Local Jurisdiction UGcontact Utility Notification Center of Colorado UGphone (800) 922-1987 i Special Provisions Time Restrictions Other Provisions Inspection Services Required') Permit Dates Route Number 2 Mile Post 2 Side 2 Route Number 3 Mile Post 3 Side 3 Route Number 4 Mile Post 4 Side 4 State Highway L Section Category E -X Days to Complete Minimum Cover Overhead Clearance https //socgov my salesforce com/a0r1J0000061Rb2/p9retURL=/a0r1J0000061Rb2 2/4 2/19/2019 REF -150219-168310 - Salesforce - Performance Edition Issue Date Work Start Work Completion Date Expiration Insurance Expiration Extension Date Comments Web Status Comments Office Use Notes Comments for Reviewers MISC Permit Status INITIAL REVIEW Receive Date 2/15/2019 Start Date 4/1/2019 Application Accepted as Complete Date Requesting Info Application Accepted Withdrawn? Date Transmitted Amendment/Extension Requested Reason for Request Date Withdrawn 2 -Year Warranty End Date 12/31/2019 Project Duration 274 Days System Information Created By Utility Permit Application Site Guest Owner Region 4 Utility Permit Applications User, 2/15/2019 3 26 PM Last Modified By Utility Permit Application Site Guest Region 4 User, 2/15/2019 4 47 PM Notified Inspector of MSA ID Application Submission 1 Applicant Contact Notification Sent Previous Expiration Permittee Contact Visible in portal? Notes & Attachments State Highway 85_Exhibit_Plan_2.15 pdf Special Use Permit Narrative 1.23.19.docx Type Attachment Last Modified Utility Permit Application Site Guest User Description Plan View file Type Attachment Last Modified Utility Permit Application Site Guest User Description Cover Letter (Letter of Request) View file https //socgov my salesforce com/a0r1 J0000061Rb2Ip?retURL=/a0r1 J0000061Rb2 3/4 2/19/2019 REF -150219-168310 -- Salesforce - Performance Edition CST -P -1000 -A145 -Model CDOT typical.pdf Type Attachment 0 Last Modified Utility Permit Application Site Guest User Description Traffic Control Plan View file Colorado Department of Transportation COI 10 24 18 pdf Type Attachment Last Modified Utility Permit Application Site Guest User Description Insurance View file Permit History 2/15/2019 4:47 PM CST -P-1000 Al45_REV 11.27-18 CDOT Typical 11.27.18.pdf Type Attachment Last Modified Utility Permit Application Site Guest User Description Traffic Control Plan View file User Utility Permit Application Site Guest User Action Changed Submission Notification Sent from false to true. Changed Record Type from Application - Utility/Special Use Permit to Utility Permit. 2/15/2019 4.46 PM User Utility Permit Application Site Guest User Action Changed End Date from 10/31/2019 to 12/31/2019 2/15/2019 3:26 PM User Utility Permit Application Site Guest User Action Created. Copyright © 2000-2019 salesforce corn, Inc All rights reserved 0 https //socgov my salesforce com/a0r1J0000061Rb2/p?retURL=/a0r1J000006IRb2 4/4 AC® ®� CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS 1 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer nghts to the certificate holder in lieu of such endorsement(s) PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P O Box 10265 Birmingham, AL 35202 CONTACT NAME PHONE 600-476-2211 FAX /A/C. Na Era (NC, No) E-MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAIL 6 INSURER A.AIG Specialty Insurance Company 26883 INSURED BNN Water Solutions, LLC 370 Van Gordon Street Lakewood, CO 80228 INSURER B Commerce and Industry Insurance Company 19410 INSURER C INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 4U2CB6SF REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ILI R TYPE OF INSURANCE lNpDWVI) 14 POLICY ET POLICY EXP POLICY NUMBER .�MM/DDhr�rL (MMIDDint� LIMITS A X COMMERCIAL GENERAL LIABILITY 12335226 03/01/2019 03/01/2020 EACH OCCURRENCE 'SAE $ 1,000,000 CLAIMS MADE X OCCUR fURE6TTEU PREMISES (Ea occurrence) $ 300 000 MED EXP (Any one person) $ 25,000 PERSONAL & ADV INJURY $ 1 000 000 GEN X L AGGREGATE LIMIT POLICY ❑ JECT OTHER APPLIES PER LOC GENERAL AGGREGATE $ 2 000 000 PRODUCTS - COMP/OP AGG S 2 000 000 $ B AUTOMOBILE v ,. LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X _ SCHEDULED AUTOS NON AUTOS -OWNED ONLY CA 3962402 03(01/2019 03/01/2020 Ea BINNED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE (Per accident) $ S A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 12335228 03/01/2019 03/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below 'II Al N IA I PER STATUTE I I0TRH E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE S E L DISEASE - POLICY LIMIT $ A Pollution Legal Liability 12335226 03/01/2019 (Claims Made Basis) 03/01/2020 Each Loss Limit $ 1,000,000 $ $ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101 Additional Remarks Schedule, may be attached if more space Is required) Re State Highway Right of Way permit CDOT and Concessionaire are Included as Additiona Insured (Exc uding Workers' Compensation) if required by written contract, subject to policy terms, conditions and exclusions In the event of cancellation by the Insurance companies the policies have been endorsed to provide 30 days Notice of Cancellation (except for non-payment) to the certificate holder shown below CERTIFICATE HOLDER CANCELLATION Colorado Department of Transportation 10601 West 10th Street Greeley, CO 60634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE 04) DATE (MM/DDIYYYY)� 03/05/2019 ACORD 25 (2016/03) Page 1 of 1 © 1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD NAB D CERTIFICATE OF LIA=: ILI`� INSURANCE DA0305/20119 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P O Box 10265 Birmingham, AL 35202 CONTACT PHONE 800-476-2211 FAX I IAIC, No) -1A10,Ne—Ext) E-MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A Starr indemnity & Liability Company 38318 INSURED Taligrass Energy GP LLC 4200 W 115th Street, Suite 350 Leawood, KS 66211 INSURER B INSURER C INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER YKrrSvsC REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INBR LTR OF INSURANCE AISISTYPE INSD INSD 'AND WYO POLICY NUMBER POLICY EFF POLICY EXP (MM/OD (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (My one person) $ PERSONAL & ADV INJURY $ GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ PRODUCTS COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED ^ _ _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Par -accident) $ PROPERTY DAMAGE (Per accident) $ 5 UMBRELLA L1AB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 X I T�UTE SIOTH- I 1Z E L EACH ACCIDENT $ 1,000,000 E L DISEASE EA EMPLOYEE $ 1 000 000 E L DISEASE - POLICY LIMIT - 5 1,000,000 $ $ $ S S DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached It more space is required) Re State Highway Right of Way permit CERTIFICATE HOLDER CANCELLATION (�4 Colorado Department of Transportation i, 10601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE Oh) Page 1 of 1 © 1988.2015 ACORD CORPORATION All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACC3R131 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) JI 03/05/2019 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS l CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder is art ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer nghts to the certificate holder in lieu of such endorsements) PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC P O Box 10265 Birmingham, AL 35202 ' CONTACT PHONE 80076 2211 FAX ms ` (Arc, No) E-MAILADDRESS INSURER(S) AFFORDING COVERAGE NAIC It INSURER A Aspen Insurance UK Limited INSURED Tallgrass Energy GP, LLC 4200 W 115th Street, Suite 350 Leawood, KS 66211 INSURER B Starr Indemnity & Liability Company 38318 INSURER C Aegis Insurance Services Ltd INSURER D konshore Specialty Insurance Company 25445 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 9MM5LTNG REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ICY LTR TYPE OF INSURANCE INS BO POLICY NUMBER I AMMIIDOKYYFY) DIP (MMMIDDr> LIMITS A X COMMERCIAL GENERAL LIABILITY ME1902667 03/01/2019 03/01/2020 EACH OCCURRENCE I S 4,000,000 X 1 CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 4,000,000 GEM_ X Ij AGGREGATE LIMIT APPLIES PER I POLICY JECT LOC OTHER PRODUCTS COMP/OP AGG S $ I B AUTOMOBILE X X LIABILITY ANY AUTO OWNED y SCHEDULED AUTOS AUTOS ONLY SISIPCA08313219 03/01/2019 03/01/2020 IEa aINBIN BD SINGLE LIMIT $ 1 000 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ C X UMBRELLA LIAB EXCESS LIAB _ X OCCUR CLAIMS -MADE XL5236807P 03/01/2019 03/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) if yes describe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 X I STATUTE j I OTH E L EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE $ 1 000,000 E L DISEASE - POLICY LIMIT $ 1,000,000 D Pollution Legal Liability 002025904 03/01/2019 03/01/2020 Each Incident Aggregate S 1,000,000 $ 1,000,000 $ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space is required) The CDOT and Concessionaire are included as Additiona Insured (Excluding Workers' Compensation) if required by written contract, subject to policy terms conditions and exclusions For the General Liability Automobile Liability and Excess Liability policies, Insurance is primary and non-contributory over any other collectable insurance if required by wntten contract subject to policy terms, conditions and exclusions In the event of cancellation by the Insurance company the General Liability policy has been endorsed to provide 30 days Notice of Cancellation (except for non-payment) to the certificate holder shown below CERTIFICATE HOLDER Colorado Department of Transportation 10601 West 10th Street Greeley, CO 80634 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE 14) ACORD 25 (2016/03) Page 1 of 1 © 1988-2015 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD �A� D® CERTIFICATE OF LIABILITY INSURANCE DA 3O5201As r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER MCGRIFF SEIBELS & WILLIAMS, INC P O Box 10265 Birmingham AL 35202 CONTACT ME PHONE 800-476-2211 I FAX No. xi), I tA/C, No) -!Alga E-MAIL ADDREss INSURER(S) AFFORDING COVERAGE NAIC F INSURER A Aspen Insurance UK Limited INSURED Tallgrass Energy GP, LLC Including Cheyenne Connector Pipeline, Inc 4200 W 115th Street, Suite 350 Leawood KS 66211 INSURER B Starr Indemnity & Liability Company 38318 INSURER C Associated Elec & Gas Ins Svcs Ltd (AEGIS) AA - INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER AKNW9FUJ REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IY LTRR TYPE OF INSURANCE IA=D I WVD POLICY NUMBER EXP IMM/DDYKYYY) IMMNDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY ME1902667 03/01/2019 03/01/2020 EACH OCCURRENCE $ 4,000,000 X I CLAIMS MADE OCCUR DAMAI;ETED PREMISES (Ea (Ea occurrence) $ MED EXP (My one person) $ PERSONAL & ADV INJURY $ GEN'L X AGGREGATE LIMIT APPLIES PER POLICY ❑ JECT LOC OTHER GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ $ -B AUTO X X MOBILE UABILITY ANY AUTO OWNED ^ .2_( SCHEDULED AUTOS NON -OWNED AUTOS ONLY SISIPCA08313219 03/01/2019 03/01/2020 MED BIINSINGLELIMIT (E accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE IPeraccident) $ $ C X UMBRELLA LJAB EXCESS LIAB X OCCUR CLAIMS -MADE XL5236807P 03/01/2019 03/01/2020 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I 1 RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' UABILnY N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A 100 0001534 03/01/2019 03/01/2020 x I PER I 10TH ER E L EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE $ 1,000,000 E L DISEASE - POLICY LIMIT $ 1,000,000 S $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate Holder is included as Additional Insured (Excluding Workers' Compensation) and Waiver of Subrogation applies except where not permiss ble by law if required by written contract, subject to policy terms conditions and exclusions The policies Include sudden and accidental pollution coverage subject to policy terms, conditions and exclusions CERTIFICATE HOLDER CANCELLATION CliDolorado Department of Transportation Mtn Utility Permit Office 10601 West 10th Street Greeley, CO 80634 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE Om) ACORD 25 (2016/03) Page 1 of 1 © 1988-2015 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD 370 Van Gordon Street Lakewood, Colorado 80228 303 763 2981 Project Introduction Cheyenne Connector Pipeline, Inc. Cheyenne Connector, LLC ("Cheyenne") proposes to construct 70 miles of new thirty-six inch (36") natural gas pipeline from a point located within Section 14, Township 2 North, Range 66 West, north to a point located in Section 5, Township 11 North, Range 66 West, Weld County, Colorado This pipeline is anticipated to initially carry up to 600,000 Dth/d of natural gas per day accumulative activities in the surrounding area The permanent easement width will vary based on the segment of the line, but generally will be fifty feet (50') in width The five meter and regulating sites along the pipeline route — Lancaster, Latham, Mewboum, O'Connor and Connector — will service the line with adequate pressure to move the product to existing Rockies Express Pipeline, LLC facilities north of Nunn, Colorado The O'Connor meter and regulating site requires a 0 7 - mile twenty-four inch (24") lateral to the thirty-six (36") pipeline ("Project") After reviewing the lands to be crossed, Cheyenne Connector, LLC ("Cheyenne") selected a route from the point of origin at the Lancaster Meter Site located in Section 14, Township 2 North, Range 66 West northeast of the City of Fort Lupton, Colorado During negotiations with landowners along this route, Cheyenne made several alterations to the route both in response to landowner requests, topographical considerations, co -location with existing pipelines and Federal Energy Regulatory Commission ("FERC") Requirements The original route was largely retained as it contmues to present the least intrusive path for construction and the most accessible location for service and maintenance during operation The lands concerned with the metering facilities includes the aboveground facilities — Lancaster, Latham, Mewbourn, O'Connor, and Connector — that will be constructed either within existing natural gas facilities or would be directly adjacent to existing natural gas processing and compression facilities The Lancaster and Connector Meter Stations would occur entirely within existing industrial sites Construction of the Mewbourn, Latham, and O'Connor metering facilities would represent a long-term conversion of agricultural and rangeland to industrial land uses These aboveground facilities would affect land use and acreages. Where possible, the new aboveground facilities would be located within existing facilities or adjacent to existing roads to minimize impacts and for convenience of access The lands located within the project area are pnmarily agricultural cropland and ranchland with rural residential and some industrial use along the proposed facilities In an effort to mitigate disturbance to the surface and to decrease as much as possible the impact to the lands post -construction, Cheyenne will bore all road crossings and all water bodies encountered on the route pursuant to all local, County, State and Federal rules and regulations Cheyenne would use different crossing techniques for waterbodies, depending on the type of waterbody to be traversed Special care will be taken to minunize effects of construction on waterbodies Cheyenne adopts the FERC's Wetland and Waterbody Construction and Mitigation 0 0 Procedures ("Procedures") without deviation and will follow mitigation requirements for waterbody and wetland crossmgs For stream and flowing waterbody crossings, Cheyenne would use HDD or boring Cheyenne would open cut non -flowing and intermittent and ephemeral streams Cheyenne will comply with USACE Section 404 nationwide permit (NWP) 12 for construction in creeks and wetlands crossed by the Project. To reduce potential impacts from construction on groundwater resources in the Project area, Cheyenne will implement the FERC's Procedures and the FERC's Upland Erosion Control, Revegetation, and Maintenance Plan (Plan) without deviation and will implement the following mitigation measures Wells within 150 feet of construction activities will be staked, fenced, and/or flagged for visibility Additionally, wells within 150 feet of construction activities where landowner permission is provided will be sampled both before and after construction to confirm that no impacts occurred as a result of the Project If a known or unknown well is damaged by construction, Cheyenne will coordinate with the landowner to repair, replace, or remediate the well, if needed Cheyenne will coordinate a temporary water source for domestic use during the repair and reclamation period if no other potable water is available Should the loss of water affect agricultural or livestock operations, Cheyenne will compensate the affected farmer(s) for any lost revenue from these operations during the reclamation and remediation period for the damaged well Cheyenne may choose to provide a temporary water source to support livestock operations while a new permanent water supply well is constructed or while the existing affected well is repaired The Project area is located in generally flat to rolling plains with few steep slopes If construction occurs in areas exceeding slopes of 5 percent, Cheyenne will use trench breakers to limit the flow of water along the backfilled trench This will reduce the potential for the trench to act as a preferential pathway for groundwater migration If trench dewatenng is required in these areas, water will be discharged m a level upland area to allow for evaporation and infiltration back to the water table. If the water must be discharged to a surface water body, appropriate filtration systems will be used to control any potential increase in total suspended solids (TSS) and all of the proper notifications and permits will be obtained Quality Control Erosion controls will be employed throughout construction in order to protect the easement property and the surrounding lands Cheyenne will employ tracking pads at all access points from roadways and all road crossings involving the mgress and egress of heavy equipment During construction, Cheyenne will double ditch the pipeline trench The pipe will be laid in the trench in such a manner as to leave the top of the pipe at least thirty-six inches (36") below the surface of the ground after restoration A Stormwater Management Plan will be secured from the appropnate State Agency and will be followed during construction and subsequently during operation of the pipeline and associated facilities Cheyenne will begin reclamation of the affected lands as soon as is practical after construction has finished on each parcel of land and will pursue re -grading and reseeding of the grounds until the property has been re-established to a condition comparable to its state prior to entry by Cheyenne After construction, pipeline markers will be installed along the route that will contain a telephone number that will allow the public to contact Cheyenne It is Cheyenne's intention to fence -in all aboveground appurtenances in order to protect the equipment and the public from accidental contact Cheyenne will be operating this pipeline on a continuous basis, twenty-four hours a day, seven days a week A momtonng system, overseen by highly trained staff m the Lakewood, Colorado offices will allow Cheyenne to remain alert to all conditions affecting the operation of these assets In the unlikely event of an emergency, Cheyenne will be able to shut down the compromised segment of the pipeline by employing the system of remotely -controlled valves to be installed along the length of the pipeline Federal Permits Applications 1. Certificate of Public Convenience and Necessity Natural Gas Act Sec 7(c) applied to the Federal Energy and Regulatory Commission. Submitted March 2018 Anticipated date of FERC Certificate award March 2019 2 Environmental Clearances Impacts on wildlife habitat Cumulative impacts on the environment may result when the environmental effects associated with a proposed project are added to other past, current, and reasonably foreseeable future actions The proposed Project locations are in agncultural, rangeland, and industrial/developed areas The majority of development similar in nature and scope to the Project is associated with current or planned oil and gas exploration and development as well as midstream and upstream projects This information was obtained from Cheyenne Connector's consultation and coordination with other potential operators in the area during land acquisition and routing studies, as well as the FERC website, state agency websites, and company -specific websites Information concerning other types of commercial and/or residential development within the Project area was obtained through consultations with the Weld County Planning Commission The Cumulative Impact Assessment Area ("CIAA") for fish, wildlife, and vegetation impacts is the extent of HUC 12 watersheds crossed by the Project The Project would disturb approximately 598 2 acres of vegetation and topsoil within the CIAA, which would leave soils vulnerable to wind and water erosion dunng construction which could result in increased soil movement into surface waters as sediments Additionally, the open cut crossing of 23 streams would result in direct sedimentation into surface waters if construction were to occur during periods of flow This could incrementally reduce the quality of aquatic habitat downstream of construction when considered with existing sediment and runoff burdens from other past, present, and reasonably foreseeable oil and gas and agricultural development This potential incremental increase in sediment burdens from the Project would be temporary as Cheyenne would limit erosion and sedimentation through the development of a SWMP and would revegetated all pipeline ROW following installation The Project would utilize 4,000,000 gallons (12.27 acre-feet) of water to hydrostatically test the newly constructed pipeline This would not decrease the availability of aquatic habitat in the CIAA as this water would come from existing, pernutted water rights The Project would disturb approximately 598 2 acres of ecological systems within the CIAA Reclamation would restore 427 6 acres of potential habitat within the CIAA The remaining 170.6 acres of ecological systems would remain disturbed for operations This 170 6 acres would represent a long-term incremental increase in habitat loss within the CIAA Additionally, the presence and operation of these aboveground facilities could increase the amount of habitat lost due to displacement effects from noise, human presence, and fragmentation Cheyenne would have limited potential to incrementally impact federally and state listed species and their habitats within the CIAA Pre -construction surveys for western burrowing owls and other protocol level clearance surveys, as requested by the USFWS, would limit the potential for direct loss of protected species or of occupied habitat Reclamation and revegetation of the ROW following pipeline installation would avoid any permanent loss of habitat for protected wildlife species As no new depletions from the South Platte River are needed and no direct disturbance would occur to the South Platte River, no incremental impact to species reliant on this habitat is anticipated Impacts on historical, archaeological and scenic resources The proposed pipeline route predominantly crosses through dry -land agricultural properties, thereby minimizing any potential impacts to historical, archaeological and scenic resources Cheyenne has conducted archaeological surveys in accordance with guidance from the State Historical Preservation Office and has not encountered any histoncal or archaeological sites The CIAA for cultural resources is the overlapping impacts within the Area of Potential Effects (APE), since impacts to cultural resources are generally site -specific and not additive across a landscape As no past, present, or reasonably foreseeable future actions within the APE would overlap with potential Project impacts to cultural resources, no cumulative impacts are anticipated •F ORE7Qi PIPIUNE ` IL= • ! • 1. CONTRACTOR SHALL VERIFY AU. 0,151111CNCI 11C DOILOIt, ttUYATE)N'S. u+n CONOfTTDPGS 3 f1ELD PRIOR TO START OF WORK • rte-- - '-- i F-i F1 ---I- —i 1 1 F --1 1""� 1-^-��•) I • -• sfa IN m am r-, i Mrl l r N D W S r al �"�� I I 1---4 F I • ( I ----I P---.4 -� �- 1 I ---I I I I I I-•••••••-••••4 1.--•--4 II 1 -4 I —I 1.-----•' FF—�- t 1----42. SUES Of EXCAVATION PF'$ AVE APPROXIMATE. A TE. CONTRACTOR TO DESIGN Any; Ur1LTfE OSHA MNROKE1 OtCAVAflON, PERCHING, SLOPING OR CO SE APPRO./ft %WRING DEVICES TO SAPELY PEIRCORM MORx # ) i1p1iM�1W IS WI Wi R� a ■ es Err • - nal 'ta M 1•+4 - n •• . - .w� r - •-r .- .. - . .r.. -I i , e r..,•n�• ..•.r �- .. 1 t I J. °OR A 3r OD PIPE WuI DEGREE Of enTO t3 I.S DEGREES PEP '[t- ' ,I .' .y.,.. r I M M Ul f PPlE la Illi a s GIs i a a y 1 lea COIN[ • ITDIL i i i i r r i i r i i r >� a r a a i r F>• >♦ a RIM taw i ' a i �11 a i i i i!# i i IS i 1, i t / PROPOSED 10' BORE - MY Rltt .4_ CONTRACTOR 10 DETERMINE ETNA. terms AND MCTHDEC 10 MEET ALL i r! i i S i i a tr IN I JMTMLNA cttJ1RAMCES. CONTRACTOR SHALL SUTTICIENMY wwpc itr Pot tUR'NG CONSTRUCI1ON AND WWII ACTNRIES SCR r - - -tyj %15. COk'TIIA,TDR t5 RE°.PONSIULL CALLING STATE ONE -CALL ANO LO Ams-• it r • - - - - -I R • Au UNOERGROtiNO mina TO DE01.1MMG CONSTRU_TIOFL S wr•� ,,M j • .'» 3,08'1 • 0. II 6 NE CONTRACTOR'S RESPONSIBILITY 1G IGOI1KY ANO PROTECT ANY rORL!GY lf&Ft • NAT NAY 11E AFFECTED PY THE BORING OPERATIONS. T i - • — I.D r CAnOF4$ 0► UTILITIES ARE APPROICMA'E. BEFORE POWER OR HEAVY J ii $ 1• — — — — EQUIPMENT K USED FOR PURPOSES o r canes OR OT►ER NORK Km y' - - R Tux JILJT►CS Win ON 'Hfs WP, THE ELM T WCA1tOM AND DEPTH or WI ?14f ./111T115 SHWA) BF FIRST Of.TtRNtwfo W' NANO FXCAWUIDN 04 + IIYDRDN C. i� a a CONTRACTOR SHALL NWNTAiM A (IN 1Wu ,c RAT Or COVCR VALE BENEATH a a a s am a r a a a a a a a a a i a 1' i Om f5, s a i a a i i i i i a i On a au a 0� tom a a a a a a FMS i a a i a a i a a i Cott ROHM or WAY. TO PROTLCo Tut Pf1EONIty Of THE ROAD. R rs THE CONTRACTOR% QF LITY TO ASSESS ft to CON0f W?ks AMO sot CONIPP TENLY PRIOR TO BORE OPIPAPONS- COMRAc OR Sri it DRTLRMNIE M 3 `, 10 PELT MINIMUM CWER IS 3LVRCWENT Wm ON F1L1D L'ONOf11o!NNs NA IF d COOT MOM -Of -MAY MP.)IIII REQUIRED. a DEfDfR TO AWARAW WE iMEORffr 4T T►E ROApwAr. / r CrwrI nnAt mows. - T In OF F14rFilE7fT '' > %-I// t. Na. JID(ROROUND JTWnES OR STPUC'TURfS REPOR'ED BY 'K.OWNER c* THE O ER EAO POKER-'''' �,, ED Mt RIMMED WITH/ OTHERS AND 71505E SHORN ON RECORDS LAMM NCR £WPROCOMATE L0CJITi0N AND Mr. TIE CONTRACTOR IS REQUIRED C>RSi nay 1 ... Ilk TO TAKE DUE PRECWITIOAIARY MEASURES IC PROTECT NE (R1:JTt3 OR T aritie i rip s •* • UIE ` MU:WURf! WON Ale ANY OTHER UTIUT113 0S STRVCTJf$ roul'o Al 'NE SITE. R $HALL BE It CONTRACTOR'S RESIOMSIBtJT' 10 NOWT THE ` STARTING eon. C ONSTRUCIDN CONTRACTOR AGMs N AC.xRt GE?Il1GLLY ACT PS541,ULTION PKM TIGFS, STRIA UFOR B sur.CTOR amiSTr Ml1 OE REQUIRED TO ASWME COMPLETE 518;11TY FOR JO W r .. - •�, i♦ ate• -••! Z .Y r•=^^ 7 a s , w+ �� . * �� 1. } �� + -der s • --'� T .. M ~a* � � M ___ . �- - CONSTRUCTION CONomoNs otaltsc TIE count or coNSRRUCTION OF THE PRWCCT, •• I ADORIONAL TENPOMRY W0156110CL (n') :. "CUEING SANITY Of An PF?NS AND PROPERTY. THAT 1446 REWVEgfi T Will OE Wa '0 APPLY CODUSLY NO MOT 5,E LIMITED TO NORM': NN NT,W H�7U3. CU.YTACCiOR Mo SJOCONTRACIViS PERFOfOf' suasion -ACE aCANa.Ta+is :'+Au oor°Lr Mn' AL Os► A RttotTRENC'�'t ' I rMORPPO �_ ..leea. 1 III %OLE no iiii ZeID' SSeo T t r .t 1Sf . 5,311.7 5370 Starr as fo EaaE OF f IC1M OON Tom' -.—• ft NW es Eo EOM OF OOCAMEIIGN TN 5!370 , 3SO S 7 i 'x350 5140 Si10 \ I . •C NN 4S / ' g . 5,400 SJ0 - 5340 5330 ~' MO YIN CovrFt- I —1114111931-,, - �� i 3320 �_� ` APPROX. `OP EL 5312' (! •- — �' 5310 T' _ 5310 -T�i_" - i" T ' . Lis-ac 7+r moo BORE PET • sxJO 20180'c.►Fna r F"f•f 35Or0 G- X 0767'w.T - RECEIVING Prt 20'x5, 2' 0200 AM SL, Y 70, SAY& fur • Nto 52110 5200 . 57190 ¶270 • • - - - 1100 Y'1•W I400 2100 3+00 - • f..11li� - Ct.*•• 9+p�y la AL Mint* 0 0•- 7O Er o r• �• • • v • . 1 S.Tl4 201 A BURNS LMSDONNELL • TALLGRASS N-. ENERGY COOTINf3 PLAN a PROFILE (MP 37.0) -4 i ` - -+— r - - • 1 tSSAD TOIL mod Aa. 5,K:. 8455;3 o �a um. Mr'r •a , *II ~ - - at NOR POIYI! Or on �t y a est MAST. or - �m w.en .o 44 e . Nr7 M� �M M.�s 315,5,-1 W Vr.I{ o oe iO� o , ~ r a i�tr•1 APPNOA'LO ION 1A/�µC \:,-F C P ■� Y �+ SIM SD ti wAl� �� w4..r,��..,,.�.•i� - lt1A51a&ti• cons RUCTION REFERENCE mffila LS _ 3/19/2019 Cheyenne Connector Pipeline_HWY 85 Utility_Special Use Capture 3.18.19.PNG LIS- Gil Net- CZ 1 oti Mme, zap https://mai Ie.com/maillu/0/#inbox/QgrcJHsbhNtgmHZZfjjGmdvxGgxbrntnnHvG?projector=1 &mi ►Partld=0.1 1/2 02/22/2019 Quality Control Plan - Inadvertent Fluid Release Conventional Bore Cheyenne Connector — Pipeline Installation RE: CDOT Crossings — 36" Conventional Bore Hanging H is working with Tallgrass Energy to build the Cheyenne Connector Pipeline which crosses several Colorado state highways. As currently designed, these highways will be crossed by means of conventional bore, a method that does not utilize drilling fluids. Being that this method requires no drilling fluids, the threat of an inadvertent fluid release is non-existent. Below is a step-by-step explanation of our proposed installation method. 1. Before any excavation takes place, all locates will be called in and all utilities within the work zone will be potholed and their depths verified. 2. All environmental BMPs will then be installed in accordance with the approved environmental drawings provided by Tallgrass. 3. Should groundwater be present at any of the CDOT crossing work sites, Hanging H would install dewatering wells prior to performing any excavations. Hanging H would activate the wells prior to performing any excavations so that the groundwater is drawn down by the time the bore pits are ready to be excavated. 4. Crew will then excavate the bore pits on each side of the crossing using an excavator (CAT 336 size or equivalent). Hanging H will use trench boxes for shoring the excavation. 5. Hanging H will use a tracked boring machine to complete the crossing. The entry pit will be dug to specific grade and the tracks will be set up at the bottom of the pit. Before lowering the boring machine into the pit, the plumbness of the track system is checked to ensure that the trajectory of the bore is correct. Once the designed trajectory is confirmed, the boring machine is lowered onto the track system. 6. The boring machine auger will then be inserted into a piece of 36" sacrificial pipe. The sacrificial pipe will then be lowered into the pit using a pipelayer (CAT 583 or equivalent) and the auger will be connected to the boring machine. The pipelayer will support the sacrificial pipe, further ensuring the crossing will be completed at the designed trajectory. 7. After activating the auger, the boring machine will track forward, pushing the sacrificial pipe into the headwall of the entry pit. The auger will cut into the headwall and convey the bore cuttings through the sacrificial pipe and into the bore pit. Hanging H Companies 11912 S. Burlington Blvd, Ste 100, Burlington, WA 98233 1360.726.2334 info@hanginghco.com I www.hanginghco.com 8. On longer crossings, the boring machine will disconnect from the auger and track to the back of the entry pit. Another joint of sacrificial pipe with more auger will be lowered into the pit. The auger that was originally attached to the boring machine will be connected to the auger in the new piece of sacrificial pipe. The new piece of sacrificial pipe will be welded to the end of the sacrificial pipe that is sticking out of the headwall of the pit and then X-rayed to ensure a quality weld was made. Steps 7 & 8 would repeat until the crossing was completed. 9. Once the sacrificial pipe bores through the headwall of the exit pit, the auger is disconnected from the boring machine and removed from the sacrificial pipe. 10. The permanent pipe is then lowered into the entry pit and welded onto the sacrificial pipe. The boring machine then tracks ahead, pushing the permanent pipe into place while pushing the sacrificial pipe out into the exit pit. 11. The sacrificial pipe is then cut and removed from the exit pit. 12. On longer crossings, steps 10 and 11 may repeat. The welds made on the permanent pipe will be X-rayed and coated prior to being pushed into place. 13. After all permanent pipe is installed, the boring machine and track system is removed from the entry pit. 14. Prior to backfilling the bore pits, pipe that has engineered and bent to get the line from the depth of cover required for the crossing to the depth of cover required on each side of the crossing, is welded onto the crossing pipe in both the entry and exit pit. 15. The pits are then backfilled and compacted. As mentioned above, this method of installation does not require any drilling fluids. This method also does not leave any voids throughout the crossing like horizontal directional drills. The cutting head of the auger is sized to match the outside diameter of the pipe, leaving no voids or pockets that could result in future settlement issue. If at any time you require further information, please do not hesitate to contact me. Sincerely, Kasey Entrikin Project Manager Hanging H Companies 1912 S Burlington Blvd. Suite 100 Burlington, WA 98233 Cell: 360.661.0696 E-mail: Kentrlkin@hanginghco.com Website: http://hanginghco.corn Hanging H Companies 11912 S. Burlington Blvd, Ste 100, Burlington, WA 98233 1360.726.2334 info@hanginghco.com www.hanginghco.com Hello