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MINNEAPOLIS PARK & RECREATION BOARD

PLANNING SERVICES

Construcon Permits: cpermits@minneapolisparks.org

Technical Assistance: 612.230.6463 or 612.230.6461

2117 West River Road, Minneapolis, Minnesota 55411-2227

APPLICATION FOR CONSTRUCTION PERMIT

NAME OF ORGANIZATION / UTILITY /OWNER CONTACT PERSON * All Permits will be E-mailed to Licensee

Project for (Name Private Owner / Ulity Co. / Municipal Enty)

Address

Contact

Title

Company/Organizaon

City State Zip

Work Phone Cell

Phone Project Manager

Email Address

Note: PERMIT IS NON-TRANSFERRABLE. EACH CONTRACTOR/ENGINEER/AGENCY WORKING ON SITE SHALL APPLY FOR ITS OWN PERMIT.

PROJECT LOCATION PROPOSE

D DATES OF PROJECT

Start Date Finish Date

Esmated Project Cost:

Crew Size:

Work Hours: Start

End:

PARKWAY ACCESS NOTE

To access a construcon site from the Minneapolis Parkway system all alternate possibilies and opons for accessing the construcon

site shall be exhausted, prior to requesng a Park Board Construcon Permit. Alternate Access Example: Adjacent streets or alley.

Parkway Access Statement: (Why is this your only alternave? What other alternaves were considered? Be Speciﬁc)

Park facilies to be aﬀected by this project (parkway, pathway, bouleva

rd, trees, etc):

Describe proposed construcon acvies:

List all vehicles & equipment including approximate weight or axle weight of each:

REQUIRED SUBMITTALSS WITH THIS COMPLETED APPLICATION (see also Permit Applicaon Checklist)

1. Permit Applicaon Fee (see Construcon Permit Categories & Fee Schedule)

2. Liability Insurance Cerﬁcate with Minneapolis Park and Recreaon Board Listed as Addionally Insured

3. Site Map or Construcon Drawings as necessary for Locaon/Usage Clariﬁcaon

(see “Permit Applicaon Checklist”, item 5, for Site Map or Construcon Drawings requirements)

4. If applicable, Restricted Permit

Category - Heavy Equipment, (see addional requirements for Type 3a & 3b)

APPLICANT ACKNOWLEDGES AND ACCEPTS WEIGHT RESTRICTIONS TERMS OF PERMIT CATEGORY LISTED WITHIN. (Inials)

Upon acceptance of the weight restricon terms by Applicant, Failure to comply with the Permit Category chosen by the

Applicant will result in immediate permit cancellaon and rejecon of future permit applicaons.

(Inials)

APPLICANT NAME (PRINTED) APPLICANT SIGNATURE

DATE__________________ TITLE_________________________________

COMPANY/ORGANIZATION

click to sign

signature

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THE SIGNED APPLICANT AGREES

1. that all alternate possibilities have been exhausted for accessing the construction site without using the Minneapolis Parkway;

2. to bear all costs of policing, cleaning and restoring park property and parkways including removal of erosion control measures after

stabilization is complete as associated to the Park Board permit;

3. to reimburse the Park Board for all such costs incurred by the Park Board;

4. that the Applicant is responsible for obtaining all necessary permits from other agencies in addition to this construction permit;

5. that if the information provided in this application is found to be misleading or inaccurate, especially vehicles and equipment weight, it

may result in suspension of permit, administrative action, imposition of fine(s), and the rejection of future right-of-entry;

6. that failure to abide by the terms of the permit or any other applicable permits laws, rules or city, county, and state regulations,

including truck idling restrictions, may result in revocation of the permit;

7. that the permit applicant shall be solely responsible for any and all fines, civil liability, and criminal prosecution arising from applicable

laws, rules or city, county, and state regulations;

8. Park Board permits are issued for six (6) weeks maximum. Permits can be extended one time at no charge for two (2) weeks due to

inclement weather or unforeseen circumstances. A new permit and fee will be required after this extended period has ended;

9. if a longer duration construction permit is initially sought (more than 6 weeks), the Applicant must obtain prior approval from Cliff

Swenson, Director of the Minneapolis Park Board Design and Construction Management Division, before a longer duration permit can

be processed;

10. that the Applicant must adhere to MnDOT Spring Weight Restriction Requirements and verify restriction dates;

11. that the Applicant, its consultants, subcontractors, design professionals and agents hereby agree to hold harmless, defend and

indemnify the Minneapolis Park Board and its agents from and against any liability, loss, claims, suits, losses, costs, and legal fees caused

by, or damage arising out of and resulting from the work performed pursuant or occurring in connection with the work herein. This

indemnity is intended to allocate to the Applicant the responsibility for personal injury (including death) caused by the Applicant, its

subcontractors and design professionals/consultants during the course of the project encompassed in this permit;

12. it is further agreed by and between the parties that as a condition precedent to the Applicants obligations to indemnify the

Minneapolis Park Board, the Applicant shall: promptly notify the Minneapolis Park Board Design and Construction Management

Division in writing of any alleged claim, loss or damage for which indemnification is sought; within ten (10) days of receipt of notice to it

of such claim, loss or damage, forward to Cliff Swenson, Director of the Minneapolis Park Board Design and Construction Management

Division, the names and addresses of the claimants, the names and addresses of any witnesses, the damages alleged, the date of the

alleged occurrence, and any other information available to the Applicant regarding the claim/loss and to cooperate fully with the

Minneapolis.

MPRB PERMIT CATEGORIES & FEE SCHEDULE

Note: Typical construction permits are based solely on vehicle or equipment weight. Additional fees may apply.

STANDARD PERMIT CATAGORIES

1. TYPE 1 CONSTRUCTION (residential, commercial or institutional)…………..……………………………..……………..….... $210

Construction Vehicles or Equipment with a 7,000 GVW (Gross Vehicle Weight) or less

2. TYPE 2 CONSTRUCTION (residential, commercial or institutional)…………………….….……..……….…………...….…… $420

Construction Vehicles or Equipment with a 5 ton per axle maximum weight (weight verification required)

RESTRICTED PERMIT CATEGORY - HEAVY EQUIPMENT (see also Type 3 Construction Notes)

3a. TYPE 3 CONSTRUCTION - WINTER - HEAVY EQUIPMENT (residential, commercial or institutional)……….............…..... $525

Construction Vehicles or Equipment over 5 ton per axle maximum weight during winter from Mid-December to Mid-March

(Assuming the ground is still frozen before and after this time frame)

3b. TYPE 3 CONSTRUCTION - SEASONAL - HEAVY EQUIPMENT (residential, commercial or institutional)……….…….……. $525*

Construction Vehicles or Equipment over 5 ton per axle maximum weight during Spring, Summer and Fall after Mid-March thru Mid-

December (Assuming the ground is not frozen during this time frame)

* Type 3b Pavement Damage; if the Minneapolis Park Board parkway pavement is damaged by the applicant/licensee during access

to their construction site from a Minneapolis Park Board Parkway a minimum 2” pavement mill and 2” bituminous overlay will be

required from the Parkway Access point to the Parkway Exit point. Refer to Type 3 Construction Notes for added information.

This 2” Bituminous Mill and Overlay replacement shall meet MnDOT Specification 2360, SPWEB540L, Level 5, wearing surface and

Minneapolis Code of Ordinances 429 & 430. Minneapolis Paving Engineer, Larry Matsumoto, 612-919-1148

Applicant shall provide with this application one of the two (2) options listed below for a 2” mill & overlay, whichever is greater;

* 3b Permit Fee plus the amount of the 2” Mill & Overlay Price Quote or a 50,000 “Construction Bond” or “Letter of Credit”

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TYPE 3 CONSTRUCTION NOTES

1. There is no guarantee a permit will be issued for Type 3 Construction on the Minneapolis Parkway system. Each Type 3 Permit

application shall be reviewed on a “case-by-case” basis only. It is imperative that the Permit Access Statement is specific (page 1).

2. Cliff Swenson, Director of the Minneapolis Park Board Design and Construction Management Division, must approve and sign- off

on any Type 3 Construction request prior to permit issuance.

3. Minneapolis Public Works, Street Division approval may also be required due to traffic flow restrictions, pavement design loads and

weight of heavy equipment and/or cranes.

4. A pre-construction meeting is mandatory to provide documentation and/or pictures of the condition of existing pavements, curbs

and trials for comparison at the end of the construction project. This meeting should include the applicant’s representative, design

professionals or consultants, subcontractors, Minneapolis Park Board representative, Minneapolis Public Works representative and

any other agencies or persons/agents directly involved with this project.

5. Applicant must adhere to MnDOT Spring Weight Restriction Requirements and verify restriction dates.

6. The permit process for Type 3b Construction-Seasonal-Heavy Equipment can take up to three (3) weeks to process in some cases.

7. Please submit with the Construction Permit Application Packet your acknowledgement to the conditions listed for Type 3

Construction by including the Required Pavement Price Quote, or a $50,000 Payment Bond, or Letter of Credit.

PARKWAY CLOSURE NOTES

1. In most situations, complete closure of the Minneapolis Parkway is not acceptable to the Minneapolis Park and Recreation Board

(time of day and duration is critical to permit issuance).

2. COMPLETE PARKWAY CLOSURE can only occur between 9:00 am & 3:00 pm MONDAY thru FRIDAY. COMPLETE PARKWAY

CLOSURE on the WEEKEND is only allowed with written approval by the Minneapolis Park Board Commissioners or, if applicable,

the Director of Design & Construction Management, Cliff Swenson.

3. If a Parkway Closure is approved, the applicant shall include exact parkway closure duration dates. The applicant shall give the

Minneapolis Park Board two weeks’ notice as to the exact date(s) that the parkway will be completely closed. This notification will

be used to alert park users of the parkway closure.

4. It will be the applicant’s responsibility to coordinate all detours with Minneapolis Traffic Department and 911 Emergency

Services.

5. Applicant shall abide by all requirements of the Minneapolis Traffic Department and the Minneapolis Park & Recreation Board.

6. Minneapolis Traffic Department requirements for road closure and detours supersede all Minneapolis Park Board requirements.

PERMIT APPLICATION CHECKLIST

1. Completed application with all information filled in.

2. A check in the amount specified in the Minneapolis Park and Recreation Board Construction Permit Category Fee.

3. A copy of “Liability Insurance Certificate” naming the Minneapolis Park and Recreation Board as additionally insured. Include ISO

Endorsements CG 20 10 04 13 and CG 20-37 07 13, or their equivalent. A copy of the minimum insurance requirements is

included at the end of this application.

4. The names, addresses, phone numbers of; the Applicant, Owner, Engineer and Contact Person.

5. A site map (8.5 x 11 or 11 x 17) showing:

• Location or Address

• Adjacent Areas within 100 feet

• Location and indication of Property Lines, Existing Structures, Fences, Sidewalks, Pathways, Roadways, Railroads, Bridges,

Streams, Rivers, Ponds, Public Waters, Wetlands, Adjoining Roads & Cities, Underground & Overhead Utilities, Easements,

Right-of Way and other Landmarks.

• For all road, trail, pathway, or sidewalk closures, licensees are required to submit a signed Temporary Traffic Control (TTC) Plan

from a MnDOT & ATSSA certified traffic control professional in accordance with MN MUTCD Regulations for Temporary Traffic

Control in order for a permit to be issued. Safety in the work zone is the primary consideration to be addressed in a TTC. The

needs and control of all motorists, bicyclists, and pedestrians, park patrons, and workers affected by the area of work and all

state, federal and municipal law and ordinances shall be addressed in the TTC. In addition, at all times equipment is moving or

operating on MPRB property, a flag person/spot person shall be present to control the work area.

6. Schedule of Anticipated Starting and Completion Date. Park Board permits are issued for six (6) weeks maximum.

7. Any other information pertinent to this application the Applicant determines would be helpful or necessary for permit review.

PERMIT EXPIRATION NOTE

Park Board permits are issued for six (6) weeks maximum. Permits can be extended one (1) time at no charge for two (2) weeks due to

inclement weather or unforeseen circumstances. A new permit and fee will be required for after this extended period has ended.

All encroachments on Park Board land or parkways resulting from construction work associated with this permit may be required to be

removed at the applicant’s expense upon expiration of the permit without the execution of an additional agreement regarding any longer

duration encroachments.

Sample Insurance Form with Insurance Requirements included at the end of this MPRB Permit Application.

MPRB INSURANCE REQUIREMENTS - EXHIBIT

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MPRB - 2018

This exhibit, along with MPRB Construction Permit serves as an agreement, or contract, under which the Licensee and its

sub-contractors or other professionals are permitted to work on parkland subject to the terms and conditions of their permit.

By entering into this agreement, the Licensee hereby agrees to obtain and maintain insurance, meeting all of the applicable

requirements herein.

Insurance secured by the Licensee shall be issued by insurance companies acceptable to the Minneapolis Park and Recreation

Board (MPRB) and admitted in Minnesota. The insurance specified may be in a policy or policies of insurance. MPRB Such

insurance shall be in force on the date of execution of the Contract and shall remain continuously in force for the duration of

the Contract. The Licensee’s shall pay for all deductibles, self-insured retention and/or self-insurance included hereunder.

Coverage shall be primary and non-contributory with any other insurance and self-insurance.

The Minneapolis Park and Recreation Board shall be added as an additional insured on your policy for General Liability and

Auto Liability, as applicable. The liability insurance coverage required for performance of the Contract shall include the

Minneapolis Park and Recreation Board, and its agents, divisions, officers and employees as Additional Insured’s on your

policy with respect to the Licensee’s work and activities to be performed under this Contract. Such coverage shall be

conveyed to MPRB via Endorsements acceptable to the MPRB for On-going and Completed Operations.

Self-Insured Municipalities pursuant to authority granted in Minnesota Statute 471.981, shall extend additional insured status

to the Minneapolis Park and Recreation Board meeting all of the coverage requirements herein, to the extent allowable by

law.

The Licensee and its sub-contractors shall secure (prior to co

mmencing work on parkland) and maintain the following

insurance:

Workers Compensation insurance that meets the statutory obligations with Coverage B- Employers Liabil

ity

mits of at least $100,000 each accident, $500,000 disease - policy limit and $100,000 disease each employee.

b) C

ommercial General Liability insurance with limits of at least $2,000,000 general aggregate, $2,000,000 products

- completed operations $2,000,000 personal and advertising injury, $100,000 each occurrence fire damage

and

$10

,000 medical expenses any one person. The policy shall be on an "occurrence" basis, and shall include

contractual liability coverage, and the MPRB shall be named an additional insured. The Minneapolis Park and

Recreation Board shall be Certificate Holder. Amount of coverage required may increase or types of coverage

may be added if the project involves potentially high risk activity.

c) C

ommercial Automobile Liability insurance covering all owned, non-owned and hired automobiles with limits of at

least $1,000,000 per accident and the MPRB shall be named an additional insured.

The Minneapolis Park and Recreation Board does not represent that the insurance requirements are sufficient to protect the

Licensee's interest or provide adequate coverage. Acceptance of the declarations and endorsements by the Minneapolis Park

and Recreation Board shall not relieve, limit, or decrease the liability of the Licensee. Any policy deductibles or retention shall

be the responsibility of the Licensee. Licensee shall control any special or unusual hazards and be responsible for any

damages that result from those hazards.

In the case that amenities are damaged and restored under this permit, such insurance shall extend for any restored work (such

as concrete work, etc…) for a corrective warranty period of one year past the date of the permit’s expiration. Additional

insurance and liability agreements in place as a result of an agency agreement, encroachment permit, or easements shall be

considered in force, complimentary, and in excess of the minimum requirements stated in this Exhibit.

A thirty (30) day written notice is required if the policy is canceled, not renewed or materially changed. The Licensee shall

require any of its sub-contractors, if sub- contracting is allowable under this Contract, to comply with these provisions.

Licensee acknowledges that failure to obtain, provide, or maintain such insurance on behalf of itself and Minneapolis Park

and Recreation Board required under this permit constitutes a material breach of contract. It is the Licensee’s responsibility

to notify the Owner of a lapse in coverage, and to provide updated policy and endorsements prior to the expiration date of

those provided with this permit.

If the Licensee maintains higher limits than the minimums shown above, the Minneapolis Park and Recreation Board

requires and shall be entitled to coverage for the higher limits maintained by the Licensee. Any available insurance proceeds

in excess of the specified minimum limits of insurance and coverage shall be available to the Minneapolis Park and

Recreation Board.

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

Month/Date/Year

PRODUCER

Insurnce Agent/Broker Name

Insurnce Agent/Broker Street Address or P.O. Box

Insurnce Agent/Broker City, State & Zip Code

Contact & Phone Number

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY

AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE

COVERAGE AFFORDED BY THE POLICIES BELOW.

INSURERS AFFORDING COVERAGE

NAIC #

INSURED

Vendor Name

Vendor Street Address or P.O. Box

Vendor City, State & Zip Code

INSURER A:

Name of Insurance Company

Enter NAIC#

INSURER B:

Name of Insurance Company (if applicable)

Enter NAIC#

INSURER C:

Name of Insurance Company (if applicable)

Enter NAIC#

INSURER D:

Name of Insurance Company (if applicable)

Enter NAIC#

INSURER E:

Name of Insurance Company (if applicable)

Enter NAIC#

COVERAGES

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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

TYPE OF INSURANCE POLICY NUMBER

POLICY EFFECTIVE

DATE (MM/DD/YY)

POLICY EXPIRATION

DATE (MM/DD/YY)

LIMITS

GENERAL LIABILITY

COMMERICAL GENERAL LIABILITY

CLAIMS MADE OCCUR

GEN’L AGGREGATE LIMIT APPLIES PER:

POLICY PROJECT LOC

Enter Policy # Enter Effective

Date

Enter Expiration

Date

EACH OCCURENCE

$500,000

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

10,000

PERSONAL & ADV INJURY

2,000,000

GENERAL AGGREGATE

$2,000,000

PRODUCTS - COMP/OP AGG

2,000,000

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS

Enter Policy # Enter Effective

Date

Enter Expiration

Date

COMBINED SINGLE LIMIT

(Each Occurrence)

$1,000,000

BODILY INJURY

(Per person)

BODILY INJURY

(Per accident)

PROPERTY DAMAGE

(Per accident)

GARAGE LIABILITY

ANY AUTO

Enter Policy # (if

required)

Enter Effective

Date

Enter Expiration

Date

AUTO ONLY - EA ACCIDENT

OTHER THAN

AUTO ONLY:

EA ACC

AGG

EXCESS/UMBRELLA LIABILITY

OCCUR CLAIMS MADE

DEDUCTIBLE

RETENTION $Enter Amount

Enter Policy # (if

required)

Enter Effective

Date

Enter Expiration

Date

EACH OCCURRENCE

Enter Limit

AGGREGATE

$Enter Limit

WORKERS COMPENSATION AND

EMPLOYERS’ LIABILITY

ANY PROPRIETOR/PARTNER/EXECU-

TIVE OFFICER/MEMBER EXCLUDED?

If yes, describe under

SPECIAL PROVISIONS below

Enter Policy # Enter Effective

Date

Enter Expiration

Date

WC STATU-

TORY LIMITS

OTH-

E.L. EACH ACCIDENT

500,000

E.L. DISEASE - EA EMPLOYEE

$500,000

E.L. DISEASE - POLICY LIMIT

500,000

OTHER

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS

[NAME OF PROJECT] The Minneapolis Park and Recreation Board, its officers, directors, employees, agents and representatives are included as an additional insured in

respect to Commercial General Liability, Automobile Liability and Excess/Umbrella Liability coverage "for ongoing and completed operations" using ISO forms CG 20 10

04 13 and CG 20-37 07 13, or their equivalent. See the attached endorsements naming the Minneapolis Park and Recreation Board on each schedule. (Insert Contract Job

Decscription, if Applicable)

CERTIFICATE HOLDER

CANCELLATION

Minneapolis Park and Recreation Board

2117 West River Rd.

Minneapolis, MN 55411

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE

EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO

MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT

FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE

INSURER, ITS AGENTS OR REPRESENTATIVES.

AUTHORIZED REPRESENTATIVE

INSR

LTR

ADD’L

INSRD

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