Application And Permit For Private Snowplowing Of County Roads Form - Teton County Road And Bridge Department
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1
2Permit No.______________________
APPLICATION AND PERMIT for PRIVATE SNOWPLOWING OF COUNTY ROADS
TETON COUNTY ROAD AND BRIDGE DEPARTMENT
PERMITTEE _____________________________________________Phone_________________________
Type or Print
Address
_______________________________________________________________________________
Street
PO Box
_______________________________________________________________________________
City
State
Zip
Email
______________________________
CONTRACTOR: _____________________________________________Phone______________________
Type or Print
Address
_______________________________________________________________________________
Street
PO Box
_______________________________________________________________________________
City
State
Zip
Email
______________________________
LOCATION/DESCRIPTION OF SNOW REMOVAL
:
County Road Name: ______________________
Map Included: YES NO
Starting Location:________________________
Ending Location:_________________________ Total Miles:____
Start Date ______________________________
Estimated Completion Date _______________________________
List of Equipment to be used: ________________________________________________________________________
Name of person(s) responsible for Snow Removal:_______________________________________________________
Reason Snow Plowing is needed:_____________________________________________________________________
________________________________________________________________________________________________
The undersigned Permittee agrees:
INDEMNIFICATION: To the fullest extent permitted by law, Permittee agrees to defend, hold harmless, and unconditionally indemnify TETON
COUNTY, and all of their respective officers, directors and employees, against and for all liabilities, costs and expenses including attorney’s
fees and expenses of investigation, claims and damages which TETON COUNTY may at any time suffer or sustain or become liable for by
reason of any accidents, damages or injuries (including injuries resulting in death) either to the persons or property, or to any other parties, in
any manner caused by or resulting from Permittee’s breach of this Permit or acts or failures to act by Permittee or its employees or agents in
the performance of the Permit; provided, however, that such indemnification and hold harmless shall not apply to claims for loss, damage,
injury, or death to the extent caused by the negligence of TETON COUNTY.
That the Permittee has read and understands all of the foregoing requirements, restrictions and conditions; That, for valuable and sufficient
consideration, the Permittee is contractually obligated to TETON COUNTY to fully and faithfully abide by and perform all of the foregoing
requirements, restrictions and conditions; and in its sole discretion TETON COUNTY reserves the right to terminate this permit at anytime
upon written notice to Permittee mailed regular mail, postage prepaid to Permittee at the address shown here in. Said notice shall be effective
upon mailing. TETON COUNTY may also serve said notice on Permittee personally or by leaving a copy of said notice at Permittee’s place of
business or home.
Permittee
Permittee
Signature __________________________________ ___ Printed Name _________________________________________ Date ___________
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