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FIELD DOCUMENTS_FILE 2
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545028
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FIELD DOCUMENTS_FILE 2
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Last modified
12/6/2019 5:08:09 PM
Creation date
12/6/2019 2:54:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 2
RECORD_ID
PR0545028
PE
3528
FACILITY_ID
FA0003919
FACILITY_NAME
VAN DE POL ENTERPRISES
STREET_NUMBER
5491
STREET_NAME
F
STREET_TYPE
ST
City
BANTA
Zip
95304
CURRENT_STATUS
02
SITE_LOCATION
5491 F ST
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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V <br /> II <br /> CONTRACTOR'S ENDORSEMENT <br /> Folder No. 02324-65 <br /> A. As a condition to entering upon Licensor's right-of-way to perform work pursuant to this <br /> Agreement, Licensee's contractor(Fill in): <br /> 1 J d` `` r''� d f• <br /> Ole <br /> ��� �° , ,) <br /> (hereinafter "Contractor") agrees to comply with all the terms and provisions of this Agreement relating <br /> to the work to be performed and the insurance requirements set forth in Exhibit A-1. <br /> B. Before the Contractor commences any work, the Contractor will pay the Licensor a <br /> nonrefundable payment of $500 upon execution and return of this Contractor's Endorsement, and will <br /> provide the Licensor with a certificate issued by its insurance carrier providing the insurance coverage <br /> required pursuant to Exhibit A-1 in a policy which contains the following type endorsement: <br /> UNION PACIFIC RAILROAD COMPANY is named as an additional insured <br /> with respect to all liabilities arising out of Insured's performance of work on behalf of the <br /> Licensee. <br /> All insurance correspondence shall be directed to: Jon E. Devish - Folder No. 02324-65, Union Pacific <br /> Railroad Company, 1400 Douglas Street STOP 1690, Omaha,Nebraska 68179-1690. <br /> 1, <br /> (Please print Contractor's Name above) <br /> X fJ <br /> Title: i <br />
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