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PUBLICATION DISPENSER PERMIT
County of Hawai‘i
DEPARTMENT OF PUBLIC WORKS ENGINEERING DIVISION
DPW Form-35(1)
1/10/2012
PERMITTEE: PHONE NO.:
MAILING ADDRESS: EMAIL:
LOCATION OF PUBLICATION DISPENSER – ATTACH LOCATION MAP:
TAX MAP KEY: Name of County Road/Street
DURATION (dates): From: to (Not to exceed 1 year)
DIMENSIONS OF PUBLICATION DISPENSER AND SIDEWALK
(OR ATTACH SKETCH SHOWING DIMENSIONS):
1. WIDTH OF SIDEWALK (curb face to back edge of sidewalk): ft
2. WIDTH OF PUBLICATION DISPENSER (at widest point): ft
3. CLEAR WIDTH OF SIDEWALK (width of sidewalk – width of publication dispenser): ft (3 ft min)
4. HEIGHT OF PUBLICATION DISPENSER: ft (4 ft max)
REQUIRED ATTACHMENTS:
1. Location map showing the County Street, the publication dispenser, the sidewalk and all other objects in the area
including utility poles, signs, etc. [Hawai‘i County Code Section 22-3.5.(2)]
2. Statements of consent from all property owners and lessees directly fronting the publication dispenser. [Hawai‘i County Code Section 22-3.5. (6)]
3. Provide a certificate of insurance and proof of a public liability insurance policy naming as an additional insured, the county, its officers, representatives, employees, and agents covering any claim or liability for damages, injuries or death resulting from any of the uses permitted hereunder. The minimum amount of coverage under such policy shall be $1,000,000 per occurrence. The policy and coverage shall be kept in force until the banner, including all anchors, supports and other appurtenances are removed from the county right-of-way. [Hawai‘i County Code Section 22-3.5.(8)]
IN CONSIDERATION OF GRANTING THIS PERMIT, THE PERMITTEE UNDERSTANDS AND AGREES TO:
Hold harmless, indemnify and defend the County of Hawai‘i, its officers, employees and agents thereof, from all claims, demands, suits, actions, or proceedings of every name, character, and description which may be brought against the County of Hawai‘i for or
on account of any injuries or damages to any person or property received or sustained by any person by or in consequence of any act or acts of the holder of this permit for actions done under this permit. [Hawai‘i County Code Section 22-3.5.(7)]; and
Comply with all conditions as printed on the back of this permit. [Hawai‘i County Code Section 22-3.9].
By signing below, the Permittee certifies that the Permittee has legal authority to sign in the capacity stated, and the Permittee understands and agrees that the terms and conditions of this permit are a legally binding contract.
By:
Permitee’s Signature Date
Its:
APPROVED:
Director, Department of Public Works Date
AGENCY USE ONLY
* Pay by Check payable ONLY to: County Director of Finance
PERMIT NO: FEE: $25
County of Hawai‘i is an equal opportunity provider and employer
1/10/2012 DPW Form-35(2)
PUBLICATION DISPENSER PERMIT
CONDITIONS OF APPROVAL
(Hawai‘i County Code Section 22-3.9)
In addition to any other conditions imposed by Chapter 22 of the Hawai‘i County Code, all permits issued
pursuant to this article shall be subject to the following conditions:
1. All permitted items shall be removed from the county street during all periods outside of the permitted
times and days.
2. Permittees shall comply with all laws, ordinances and regulations of the federal, state and county
governments relating to the installation, operation and maintenance of their permitted items or uses.
3. Permittees shall be wholly responsible for the repair and maintenance of all permitted items, including
any associated utility improvements.
4. Only the use described on the permit shall be deemed to be authorized by the director. Any additional uses shall require additional authorization from the director.
5. Should the permitted use, activity or improvement interfere with or obstruct any county facility or other
authorized improvements, the permittee shall, at their own expense either:
(A) Terminate the use and remove the activity or improvement; or
(B) Move the use to a location acceptable to the director of public works.
6. Should the permitted use, activity or improvement impede or obstruct any emergency repairs to a
county facility or public utility, the permittee authorizes use of all necessary action to immediately
relocate the permitted activity, use or improvement and shall make no claim for any damages that may
result from the relocation action.
7. Any construction work associated with the permits of this article shall also be subject to the construction requirements of this chapter.
8. Upon termination of all permits, the permittee shall be responsible for the restoration of the county
street used or occupied by the permittee to a condition equal to or better than its original condition.
County of Hawai‘i is an Equal Opportunity Provider and Employer