MnDOT Contract No.

     

TEMPORARY BLOWING SNOW CONTROL AGREEMENT FORMWinter Season of Protection

     

Trunk Highway

     

Drift Identification #

     

Plow Route /Road Segment #

     

Control Section #

     

Reference Post      to      

County

     

Truck Station

     

Township Name

     

Section

     

Township

     

Range

     

Participant(s) agree(s) to provide blowing snow control on private property near the Right of Way line of the above Trunk Highway in the area indicated above and/or on the diagram on the reverse side of this form. Participant(s) agree(s) to leave the temporary blowing snow control practices in place until       (date). After this date the Participant(s) may remove the temporary blowing snow control practice(s) without notification from MnDOT.

In consideration for this service, the Minnesota Department of Transportation (MnDOT) agrees to pay Participant(s) according to Section 1 Payment Formula below providing that MnDOT certifies that the terms and conditions contained in the Contract have been met.

1.

2. PAYMENT FORMULA

(Round all numbers to the second decimal point)

Lineal feet (ft)

No of acres

Cost per acre or Lineal Foot ($)

Sub-Total ($)

Payment for Standing Corn Rows           

            

Payment for Temporary Snow Fence

                 

Payment for Bales                  

Total Payment      

Appropriate payment is to be made after final inspection on or before:

April 30,      .

3. LENGTH OF THIS AGREEMENT IS ONE WINTER SEASON.

Agreement period starts on the date on which all the necessary signatures for executing this Agreement have been obtained.

INSPECTED AND APPROVED FOR PAYMENT:Year Initial $

20                 

** See formula for $ amount above.

FOR MnDOT DISTRICTBLOWING SNOW CONTROL COORDINATORS USE

4. TRANSFER OF LANDA.Participant(s) must notify MnDOT within 30 days when a new owner or operator purchases or obtains the right and interest in, or right of occupancy to the land subject to this agreement. Any new owner(s) or operator(s), must be approved by MnDOT in order to become a participant to a new Snow Fence Agreement under the same terms and conditions of this Contract;

B.If any new owner(s) or operator(s) become an heir, successor, or assign to the existing Snow Fence Agreement the new owner(s) or operator(s) shall assume all obligations under such agreement of the previous participant;

C.If the new owner(s) or operator (s) becomes a successor to this Agreement with MnDOT; the annual rental payments paid in the fiscal year the land was transferred shall be divided equally, as determined by MnDOT.

5. TERMINATIONIn the event that the Minnesota Legislature does not appropriate to the Department of Transportation funds necessary for the continuation of this agreement, this agreement may be terminated by the Department of Transportation upon giving thirty (30) days written notice to the Participant(s).

temporary-blowing-snow-control-agreement (Rev 2-26-2018) 1

6. DATA PRACTICES Books, records, documents, and accounting procedures and practices of the participant(s) relevant to the agreement shall be subject to examination by the contracting department or agency and the legislative auditor.

temporary-blowing-snow-control-agreement (Rev 2-26-2018) 2

7. PARTICIPANTS – SIGNATURE(S)By signing below, Participant(s) agree(s) to the terms and conditions in this Contract and that the information I have provided is the amount on lines III, of the Payment Formula.

Participant(s) may receive a W-9 verification form requiring further information to register as a vendor with the State of Minnesota. Participant(s) will receive a 1099 form, which reports the amount received from the State of Minnesota from this Contract within the calendar year.

Participant(s) have read and understand the terms and conditions of the Contract and agree to its terms and conditions.

A(1). Participants Name: Phone #, Address (Zip Code)

     

(2) Share in %

     

(4) Signature

     

Date (mm-dd-yyyy)

     

B(1). Participants Name: Phone #, Address (Zip Code)

     

(2) Share in %

     

(4) Signature

     

Date (mm-dd-yyyy)

     

C(1). Participants Name: Phone #, Address (Zip Code)

     

(2) Share in %

     

(4) Signature

     

Date (mm-dd-yyyy)

     

Signature of Area Maintenance Engineer (with delegated authority)

     

Date (mm-dd-yyyy)

     

.................................................................................................................................................................................................................................................................

TO BE COMPLETED BY THE MNDOT DISTRICT BUSINESS OFFICE

Purchase Order No.       Vendor No. & Location No.       Category      

FUND:       FIN DEPT ID:       APPROP ID:      

ACCOUNT:       PROJECT ID:       SOURCE TYPE:      

TAXABLE: NO      

Note to Business Office: This signed form serves as the invoice Use the vendor number as the invoice number

temporary-blowing-snow-control-agreement (Rev 2-26-2018) 3