HomeMy WebLinkAboutUtility Installation Request Form 401 F of This space reserved for office use.
(Revised 01/06)
z h7;n i4 'rni" �0,
Return in duplicate to: j�A
� •j
Secretary of State
P.O. Box 13697
Austin, TX 78711-3697 Statement of Change of
512 463-5555 Registered Office/Agent
FAX: 512/463-5709
Filing Fee: See instructions
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r s o > �`' e�r"''•r� `J'7�`r+ r . k fir' +� •
X36 1 a ,ka ,+ ` 11 `^a' ntiytnforma ion
��,��� rVecte. ,.,�L � � ,.
The name of the entity is:
Di arm owA C C-011/4) _L� I f'Ul.e±; ouo, -)- N e
State the name of the entity as currently shown in the records of the secretary of state.
The file number issued to the filing entity by the secretary of state is: /.--57? g,P) 0
The registered agent and registered office of the entity as currently shown on the records of the
secretary of state are: h ('t ►�h
I (�S '7 O <Sin:1-,e. . 5c w-c-P1
ez Siez e )1N.Ix. 7/1Pys
� �M � *e�S4�'Y' 9 r ,s
� ' ang ' e fisted en,. `s i't'0
it t m
The certificate of formation or registration is modified to change the registered agent and/or office of
the filing entity as follows:
Registered Agent Change
(Complete either A or B,but not both.Also complete C if the address has changed.)
❑ A. The new registered agent is an organization (cannot be entity named above)by the name of:
OR
yje B. The new registered agent is an individual resident of the state whose name is:
ok R1108 e--5
First Name M I. Last Name Suffix
Registered Office Change
❑ C. The business address of the registered agent and the registered office address is changed to:
14500 Car1'"er Cc rfer Cheek a03 rya TX 71‘26;---
Street Address(No P.O.Box) City 1 State Zip Code
The street address of the registered office as stated in this instrument is the same as the registered
Form 401 3
agent's business address.
a., t ,�.. ^.,c.a�, xr " ;t 'fi.,. ; ;�.`? ^."e;�,.vt ?;�,'. +'d ,l: '>�'u. .•.�;3a h§a. _ .. c's x>r ;"..t". 'f,''. .,..,;- ..
The change specified in this statement has been authorized by the entity in the manner required by the
BOC or in the manner required by the law governing the filing entity, as applicable.
, M Effect>< enessMof iieSelecte , �• ;5 ily 5314 73;.t,
A. [This document becomes effective when the document is filed by the secretary of state.
B. ❑ This document becomes effective at a later date, which is not more than ninety (90) days from
the date of signing. The delayed effective date is:
C. ❑ This document takes effect upon the occurrence of a future event or fact, other than the
passage of time. The 90th day after the date of signing is:
The following event or fact will cause the document to take effect in the manner described below:
The undersigned signs this document subject to the penalties imposed by law for the submission of a
materially false or fraudulent instrument.
Date: a S -
es tc et,.,+
Signature and title of authorized person(see instructions)
Form 401 4
Utility Installation Request Form 1082(Rev 11/2006)
(GSD-EPC)
r Page 1 of 2
pnrnunnt
of rrsnsportatrm
To theTexasTransportation Commission Date F)q-f?-_0 7
c/o District Engineer
Texas Department of Transportation w II+rpt -iU,--' exas
N.•
Formal notice is hereby given that 01-144 if Co.-, rr-c /,'�+ .�✓/C .
proposes to place a 0..--1.1 t'r Cel -
line within the right of way of H,,,, 30 , R to ' M County
Texas, MNT Sec. No. agfollows: ••cation, le •th, •-.--ra •: .-n, etc. Use additional sheet as needed)
lika Sh/,4-t
fr,r,-.., ;e,1- ivrh �-�-, is a y R`eJ ' 1- 6I1 �,fi.< / q/
-- Pe / op,tx;ell.,it' / 40 ,'
rt',7rr v� `_:,y L7h ,,f nn t
/-P7 .r. :, •
/v< , f,c, e.; .. ,t�,1A t ,)
//,/4
We will construct and main . th ine on the high right of way as shown on the attached drawing and in accordance
with the rules, regulations an cies of the Texas ►\, •artmen if Transportatitn (T .,,ST) and all governing laws,
including, but not limited to, th as Engineering P tic- ' t," "Federal Clean Wa TA 4, ,"the "National Endangered
Species Act," "Americans Disabilities Act," and t - ederal Historic Preserv— At ." Upon request by TxDOT, we will
submit to TxDOT proof if co . ce with all •l rni • aws, rules and regulatio \b- - e commencement of construction.
Plans shall include the •: ign proposed loc io erti.:l elevations, . hori ont. :lignments of the facility based on the
department's surve , e relationshi o e stir. highway faciliti_. a d t - right of way line, traffic safety and access
procedures, and lo ation • existing utilitie at may be affected by the , o•is:: utility facility. The location and description
of the propose e •d appurtenance 's m fully shown by a complet= 1 ' drawings attached to this notice.
O - •- io w e Best Mana ment Practices to minimize erosion a d sedimentation resulting from the proposed
installation, : • w 'II revegeta the 'e area as indicated under"Revegetation Special Provisions."
Our organi.:ti• ,. -nsure t , tra c trol measure! co '• Ike , applicable portions of the Texas Manual on
U •rm Tr ffic ontrol Device• be installed and maintai -• for e duration of this installation.
When in -fling our utilit • con o11=• ac - facilities, sh_ onform to the Texas Transportation Code, Title 6
Roadways, hapter 03, •cha• -r Contro if Acc 3.031 ( http://tlo2.tic.state.tx.us/statutes/statutes.html.). We
shall limit acc- s fo servici • this nstall_ in t. :cce (a)frontage roads where provided, (b) nearby or adjacent
public roads or str ts, (c)tt ong or near hr '.h ight of way lines, connecting only to an intersecting road; from
any one or all of w h entry may be made to th o er •ortion of the highway right of way for normal service and
maintenance operat . Our rights of access t• h- •h'.ugh traffic roadways and ramps shall be subject to the same rules
and regulations that app the general pu,•\ .
It is expressly understood that TxDO .•es t p pert, hereby, to grant any right, claim, title or easement in or upon this
highway; and it is further understoo• at TxD• ay require us to relocate this line, subject to the provisions of governing
laws, by giving thirty (30) days writt: notice
We will notify TxDOT prior to comm- ceme • any routine or periodic maintenance which requires pruning of trees within
the highway right of way, so that TxDOT - ovide specifications for the extent and methods to govern in, but not limited
to, trimming, topping, tree balance, type • uts, painting cuts and clean up. We understand that these specifications are
intended to preserve TxDOT's considerable investment in highway planting and beautification, by reducing damage due to
trimming and to protect known endangered species.
Our installation shall not damage any part of the roadway structure or associated appurtenances and we will make
adequate provisions to minimize inconveniences to the traveling public, and adjacent property owners. In the event we
fail to comply with any or all of the requirements as set forth herein, the State may take such action as it deems
appropriate to compel our compliance.
Following approval, we will begin construction on or after C /£ - 0 7
Month/Day/Year
Form 1082
(Rev.11/2006)
Page 2 of 2
Additional Provisions and Requirements (for TxDOT input only)
•General Special Provisions:
T Are attached.
• Are not attached.
.As-built Plans/Certifications of Construction:
• Are required and shall be certified as accurate by an authorized representative of the company.
(— Are required and shall be signed and sealed by a State ofTexas Licensed Professional Engineer.
• Are not required
• Certification that utility was installed as approved
• Re-vegetation Special Provisions: In order to minimize erosion and sedimentation resulting from the proposed
installation, the project area will be re-vegetated:
(� in accordance with TxDOT's Standard Specification Item 164 which specifies teh appropriate grass seed mix
to be used, or:
I— as indicated on the attachment.
TxDOT Representative to be notified 48 hours prior to beginning construction
If approved, we understand that we will assume all risks associated with this installation within the TXDOT right of way.
These risks include, but are not limited to, injuries to our workers, damage to contiguous utility lines that may be in the
area, injuries or damage resulting from our failure to properly install and maintain the line as shown on plans.
We understand TxDOT may place additional provisions and requirements as listed above, based upon, but not limited to,
the type of utility being installed, local site conditions, soil types and traffic.
We acknowledge that this Utility Installation Request approval expires on the 91st calendar day from the date of issuance,
unless otherwise approved, if we do not begin our installation by this date. If we do not begin our installation within this
time frame and still wish to continue, we will resubmit our request in accordance with the prevailing governing laws, rules,
regulations and policies at the time of resubmission.
By signing as/for the requestor below, I certify that I am authorized to represent the requestor, that I agree to the provisions
and requirements included in this Utility Installation Request, and our commencement of construction will further attest to
our review and acceptance of said additional provisions and requirements.
REQUESTOR APPROVED BY TxDOT
Date: /2 G 7 Date:
BY: J o lir) d<S By:
Signature: Signature:
Title: /' e Title:
Address: ADD � i f-f� (i { Address:
03
City g,y yn Stater( Zip Code77/v, City State Zip Code
( c17 ) ) 33(,- C,
Area Code Telephone Number Area Code Telephone Number
Privacy Statement
•
Utility Installation Request (Ra 112006)
(GSD-EPC)
itg. Page 1 of 2
pram root
W 7ransZtanm
To theTexasTransportation Commission Date 0g. -1?-0 7
do District Engineer
Texas Department of Transportation (VII t,t S , Texas
Formal notice is hereby given that �i �+vn o ✓t GA v s f'r_c/,'j3,3 x'✓��
proposes to place a wvi Ir
line within the right of way of H_ 30 , RM to RM in County
Texas, MNT Sec. No' aifollows: (give location, length, general design, etc. Use additional sheet as needed)
( a 7 . 6
(i.J�►l /t� lr1y salr' of vim-/ r71 eT # II S 4i 'p� /U!n / /!l J 63 i 1'.n.fJ //h)42l
We will construct and maintain the line on the highway right of way as shown on the attached drawing and in accordance
with the rules, regulations and policies of the Texas Department of Transportation (TxDOT), and all governing laws,
including, but not limited to, the"Texas Engineering Practice Act," "Federal Clean Water Act," the"National Endangered
Species Act," "Americans with Disabilities Act," and the"Federal Historic Preservation Act." Upon request by TxDOT, we will
submit to TxDOT proof of compliance with all governing laws, rules and regulations before commencement of construction.
Plans shall include the design, proposed location, vertical elevations, and horizontal alignments of the facility based on the
department's survey datum, the relationship to existing highway facilities and the right of way line, traffic safety and access
procedures, and location of existing utilities that may be affected by the proposed utility facility. The location and description
of the proposed line and appurtenances is more fully shown by a complete set of drawings attached to this notice.
Our organization will use Best Management Practices to minimize erosion and sedimentation resulting from the proposed
installation, and we will revegetate the project area as indicated under"Revegetation Special Provisions."
Our organization will ensure that traffic control measures complying with applicable portions of the Texas Manual on
Uniform Traffic Control Devices will be installed and maintained for the duration of this installation.
When installing our utility on controlled access facilities, we shall conform to the Texas Transportation Code, Title 6
Roadways, Chapter 203, Subchapter C, Control of Access, §203.031 ( http://tlo2.tic.state.tx.us/statutes/statutes.html.). We
shall limit access for servicing this installation to access via (a) frontage roads where provided, (b) nearby or adjacent
public roads or streets, (c)trails along or near the highway right of way lines, connecting only to an intersecting road; from
any one or all of which entry may be made to the outer portion of the highway right of way for normal service and
maintenance operations. Our rights of access to the through traffic roadways and ramps shall be subject to the same rules
and regulations that apply to the general public.
It is expressly understood that TxDOT does not purport, hereby, to grant any right, claim, title or easement in or upon this
highway; and it is further understood that TxDOT may require us to relocate this line, subject to the provisions of governing
laws, by giving thirty (30) days written notice.
We will notify TxDOT prior to commencement of any routine or periodic maintenance which requires pruning of trees within
the highway right of way, so that TxDOT may provide specifications for the extent and methods to govern in, but not limited
to, trimming, topping, tree balance, type of cuts, painting cuts and clean up. We understand that these specifications are
intended to preserve TxDOT's considerable investment in highway planting and beautification, by reducing damage due to
trimming and to protect known endangered species.
Our installation shall not damage any part of the roadway structure or associated appurtenances and we will make
adequate provisions to minimize inconveniences to the traveling public, and adjacent property owners. In the event we
fail to comply with any or all of the requirements as set forth herein, the State may take such action as it deems
appropriate to compel our compliance.
Following approval, we will begin construction on or after q /1,— O 7
Month/Day/Year
Form 1082
(Rev.11/2006)
Page 2 of 2
Additional Provisions and Requirements (for TxDOT input only)
.General Special Provisions:
r' Are attached.
(" Are not attached.
•As-built Plans/Certifications of Construction:
✓ Are required and shall be certified as accurate by an authorized representative of the company.
✓ Are required and shall be signed and sealed by a State ofTexas Licensed Professional Engineer.
✓ Are not required
✓ Certification that utility was installed as approved
• Re-vegetation Special Provisions: In order to minimize erosion and sedimentation resulting from the proposed
installation, the project area will be re-vegetated:
(- in accordance with TxDOT's Standard Specification Item 164 which specifies teh appropriate grass seed mix
to be used, or:
r as indicated on the attachment.
TxDOT Representative to be notified 48 hours prior to beginning construction
If approved, we understand that we will assume all risks associated with this installation within the TXDOT right of way.
These risks include, but are not limited to, injuries to our workers, damage to contiguous utility lines that may be in the
area, injuries or damage resulting from our failure to properly install and maintain the line as shown on plans.
We understand TxDOT may place additional provisions and requirements as listed above, based upon, but not limited to,
the type of utility being installed, local site conditions, soil types and traffic.
We acknowledge that this Utility Installation Request approval expires on the 91st calendar day from the date of issuance,
unless otherwise approved, if we do not begin our installation by this date. If we do not begin our installation within this
time frame and still wish to continue, we will resubmit our request in accordance with the prevailing governing laws, rules,
regulations and policies at the time of resubmission.
By signing as/for the requestor below, I certify that I am authorized to represent the requestor, that I agree to the provisions
and requirements included in this Utility Installation Request, and our commencement of construction will further attest to
our review and acceptance of said additional provisions and requirements.
REQUESTOR APPROVED BY TxDOT
Date: g— /2 p 7 / Date:
By: J v Yt r �t rS By:
Signature: Signature:
Title: p esi14/(ri i- Title:
Address: 4 -,OD f-t - C, - t/( Address:
City b,y yam, Stater( Zip Code77b1? City State Zip Code
( ) x`76- 336 ( >
Area Code Telephone Number Area Code Telephone Number
Privacy Statement
Form
Utilit Installation Request (Rev 1111/2/2
Y Rev.
Q ( 006)
limnsg(GSD-EPC)
fleneroMnr Pagee 1 off 2
2
of nxi.porh am,
To theTexasTransportation Commission Date 0c? —1?-07
do District Engineer
Texas Department of Transportation 6)Il t c S�1 LiLrN , Texas
Formal notice is hereby given that P1'u vvi o v G Co.-1 s ti,c/,'��
proposes to place a 0,-1,1 IY/
line within the right of way of 1- 3O , RM to RM in County
Texas, MNT Sec. No, aifollows: (give location, length, general design, etc. Use additional sheet as needed)
(c ll y1SJ E.tv-t
Pr.);«J for, i'5 a i c6/I Narv<y (lc,aA PeAc,s i �!pp -�x;eh / 4O' "e)
t_w y 07,-, .,"`/l r� r t g /� s/y, loch / .velc r i'�s� //<,}447
We will construct and maintain the line on the highway right of way as shown on the attached drawing and in accordance
with the rules, regulations and policies of the Texas Department of Transportation (TxDOT), and all governing laws,
including, but not limited to, the"Texas Engineering Practice Act,""Federal Clean Water Act,"the"National Endangered
Species Act," "Americans with Disabilities Act," and the"Federal Historic Preservation Act." Upon request by TxDOT, we will
submit to TxDOT proof of compliance with all governing laws, rules and regulations before commencement of construction.
Plans shall include the design, proposed location, vertical elevations, and horizontal alignments of the facility based on the
department's survey datum, the relationship to existing highway facilities and the right of way line, traffic safety and access
procedures, and location of existing utilities that may be affected by the proposed utility facility. The location and description
of the proposed line and appurtenances is more fully shown by a complete set of drawings attached to this notice.
Our organization will use Best Management Practices to minimize erosion and sedimentation resulting from the proposed
installation, and we will revegetate the project area as indicated under"Revegetation Special Provisions."
Our organization will ensure that traffic control measures complying with applicable portions of the Texas Manual on
Uniform Traffic Control Devices will be installed and maintained for the duration of this installation.
When installing our utility on controlled access facilities, we shall conform to the Texas Transportation Code, Title 6
Roadways, Chapter 203, Subchapter C, Control of Access, §203.031 ( http://tlo2_.tic.state.tx.us/statutes/statutes.html.). We
shall limit access for servicing this installation to access via (a) frontage roads where provided, (b) nearby or adjacent
public roads or streets, (c)trails along or near the highway right of way lines, connecting only to an intersecting road; from
any one or all of which entry may be made to the outer portion of the highway right of way for normal service and
maintenance operations. Our rights of access to the through traffic roadways and ramps shall be subject to the same rules
and regulations that apply to the general public.
It is expressly understood that TxDOT does not purport, hereby, to grant any right, claim, title or easement in or upon this
highway; and it is further understood that TxDOT may require us to relocate this line, subject to the provisions of governing
laws, by giving thirty(30)days written notice.
We will notify TxDOT prior to commencement of any routine or periodic maintenance which requires pruning of trees within
the highway right of way, so that TxDOT may provide specifications for the extent and methods to govern in, but not limited
to, trimming, topping, tree balance, type of cuts, painting cuts and clean up. We understand that these specifications are
intended to preserve TxDOT's considerable investment in highway planting and beautification, by reducing damage due to
trimming and to protect known endangered species.
Our installation shall not damage any part of the roadway structure or associated appurtenances and we will make
adequate provisions to minimize inconveniences to the traveling public, and adjacent property owners. In the event we
fail to comply with any or all of the requirements as set forth herein, the State may take such action as it deems
appropriate to compel our compliance.
Following approval, we will begin construction on or after 7
Month/Day/Year
Form 1082
(Rev.11/2006)
Page 2 of 2
Additional Provisions and Requirements (for TxDOT input only)
.General Special Provisions:
r Are attached.
f Are not attached.
•As-built Plans/Certifications of Construction:
✓ Are required and shall be certified as accurate by an authorized representative of the company.
• Are required and shall be signed and sealed by a State ofTexas Licensed Professional Engineer.
fl Are not required
E Certification that utility was installed as approved
• Re-vegetation Special Provisions: In order to minimize erosion and sedimentation resulting from the proposed
installation,the project area will be re-vegetated:
(— in accordance with TxDOT's Standard Specification Item 164 which specifies teh appropriate grass seed mix
to be used, or:
(- as indicated on the attachment.
TxDOT Representative to be notified 48 hours prior to beginning construction
If approved, we understand that we will assume all risks associated with this installation within the TXDOT right of way.
These risks include, but are not limited to, injuries to our workers, damage to contiguous utility lines that may be in the
area, injuries or damage resulting from our failure to properly install and maintain the line as shown on plans.
We understand TxDOT may place additional provisions and requirements as listed above, based upon, but not limited to,
the type of utility being installed, local site conditions, soil types and traffic.
We acknowledge that this Utility Installation Request approval expires on the 91st calendar day from the date of issuance,
unless otherwise approved, if we do not begin our installation by this date. If we do not begin our installation within this
time frame and still wish to continue, we will resubmit our request in accordance with the prevailing governing laws, rules,
regulations and policies at the time of resubmission.
By signing as/for the requestor below, I certify that I am authorized to represent the requestor, that I agree to the provisions
and requirements included in this Utility Installation Request, and our commencement of construction will further attest to
our review and acceptance of said additional provisions and requirements.
REQUESTOR APPROVED BY TxDOT
Date: — /Z p 7 Date:
By: J o I1 r o G{ is By:
Signature: /A - -- Signature:
Title: p esi'7((r Title:
Address: 45—DO ftp ('-f Address:
03
City bty 0,1 Stater-X Zip Code77eyi, City State Zip Code
( 'i7') ) e 6- 336
Area Code Telephone Number Area Code Telephone Number
Privacy Statement
Utility Installation Request Form
10/006)
Anus (GSD-EPC)
if Anus nt Page 1 of 2
ul7hnspwtatwn
To theTexasTransportation Commission Date U g —/ '-—O 7
do District Engineer
Texas Department of Transportation 6)/l CSC , Texas
Formal notice is hereby given that 01-61 yr-Po ✓t &I Co s fry c I,'r;,i„ .�✓]C ,
proposes to place a wry f Y1 l in
line within the right of way of i-i,v 30 , RM to RM in County
Texas, MNT Sec. No' aifollows: (give location, length, general design, etc. Use additional sheet as needed)
]� L 1 '7 / (dl/cccSi*f�ta-t /
PrJ)\)r(.1" �Ulc,l-ison I'S 0. 1' d b/I H(IP ?( (LouA / Te Acts G�f Iri7,emAle lyJ, 40 /4,)
i9II /J'- l_Ky nh pf w,‘1/ /rl tCJ �� S +f/fit loch / �!�Hf , i �'ilS/`� /s,A4-
We will construct and maintain the line on the highway right of way as shown on the attached drawing and in accordance
with the rules, regulations and policies of the Texas Department of Transportation (TxDOT), and all governing laws,
including, but not limited to, the"Texas Engineering Practice Act," "Federal Clean Water Act,"the"National Endangered
Species Act," "Americans with Disabilities Act,"and the"Federal Historic Preservation Act." Upon request by TxDOT, we will
submit to TxDOT proof of compliance with all governing laws, rules and regulations before commencement of construction.
Plans shall include the design, proposed location, vertical elevations, and horizontal alignments of the facility based on the
department's survey datum, the relationship to existing highway facilities and the right of way line, traffic safety and access
procedures, and location of existing utilities that may be affected by the proposed utility facility. The location and description
of the proposed line and appurtenances is more fully shown by a complete set of drawings attached to this notice.
Our organization will use Best Management Practices to minimize erosion and sedimentation resulting from the proposed
installation, and we will revegetate the project area as indicated under"Revegetation Special Provisions."
Our organization will ensure that traffic control measures complying with applicable portions of the Texas Manual on
Uniform Traffic Control Devices will be installed and maintained for the duration of this installation.
When installing our utility on controlled access facilities, we shall conform to the Texas Transportation Code, Title 6
Roadways, Chapter 203, Subchapter C, Control of Access, §203.031 ( http://tlo2.tic.state.tx.us/statutes/statutes.html.). We
shall limit access for servicing this installation to access via (a)frontage roads where provided, (b) nearby or adjacent
public roads or streets, (c)trails along or near the highway right of way lines, connecting only to an intersecting road; from
any one or all of which entry may be made to the outer portion of the highway right of way for normal service and
maintenance operations. Our rights of access to the through traffic roadways and ramps shall be subject to the same rules
and regulations that apply to the general public.
It is expressly understood that TxDOT does not purport, hereby, to grant any right, claim, title or easement in or upon this
highway; and it is further understood that TxDOT may require us to relocate this line, subject to the provisions of governing
laws, by giving thirty(30) days written notice.
We will notify TxDOT prior to commencement of any routine or periodic maintenance which requires pruning of trees within
the highway right of way, so that TxDOT may provide specifications for the extent and methods to govern in, but not limited
to, trimming, topping, tree balance, type of cuts, painting cuts and clean up. We understand that these specifications are
intended to preserve TxDOT's considerable investment in highway planting and beautification, by reducing damage due to
trimming and to protect known endangered species.
Our installation shall not damage any part of the roadway structure or associated appurtenances and we will make
adequate provisions to minimize inconveniences to the traveling public, and adjacent property owners. In the event we
fail to comply with any or all of the requirements as set forth herein, the State may take such action as it deems
appropriate to compel our compliance.
Following approval, we will begin construction on or after q" JO- C) 7
Month/Day/Year
Form 1082
(Rev.11/2006)
Page 2 of 2
Additional Provisions and Requirements (for TxDOT input only)
•General Special Provisions:
(" Are attached.
n Are not attached.
•As-built Plans/Certifications of Construction,:
fi Are required and shall be certified as accurate by an authorized representative of the company.
r Are required and shall be signed and sealed by a State ofTexas Licensed Professional Engineer.
(— Are not required
f! Certification that utility was installed as approved
• Re-vegetation Special Provisions: In order to minimize erosion and sedimentation resulting from the proposed
installation, the project area will be re-vegetated:
r in accordance with TxDOT's Standard Specification Item 164 which specifies teh appropriate grass seed mix
to be used, or:
(— as indicated on the attachment.
TxDOT Representative to be notified 48 hours prior to beginning construction
If approved, we understand that we will assume all risks associated with this installation within the TXDOT right of way.
These risks include, but are not limited to, injuries to our workers, damage to contiguous utility lines that may be in the
area, injuries or damage resulting from our failure to properly install and maintain the line as shown on plans.
We understand TxDOT may place additional provisions and requirements as listed above, based upon, but not limited to,
the type of utility being installed, local site conditions, soil types and traffic.
We acknowledge that this Utility Installation Request approval expires on the 91st calendar day from the date of issuance,
unless otherwise approved, if we do not begin our installation by this date. If we do not begin our installation within this
time frame and still wish to continue, we will resubmit our request in accordance with the prevailing governing laws, rules,
regulations and policies at the time of resubmission.
By signing as/for the requestor below, I certify that I am authorized to represent the requestor, that I agree to the provisions
and requirements included in this Utility Installation Request, and our commencement of construction will further attest to
our review and acceptance of said additional provisions and requirements.
REQUESTOR APPROVED BY TxDOT
Date: Q— /.2-07 Date:
By: jovi d<S By:
Signature: ` fri Signature:
Title: p e5,'%-i Title:
Address: G-00 Ch ht- (, e dC. Address:
l'YoZ 03
City sty yh Stater( Zip Code77(591), City State Zip Code
( c1 7 ) ) ect6 - 3366 (
Area Code Telephone Number Area Code Telephone Number
Privacy Statement
Utility Installation Request (Ra 112006)
(GSD-EPC)
Page 1 of 2
,nM,r nop"ePa'tora4an
To theTexasTransportation Commission Date al—1?—G 7
c/o District Engineer
Texas Department of Transportation (u II 9c S /7L,-- , Texas
Formal notice is hereby given that 01-41 o ✓l L{ C Co s krt.c
proposes to place a i—i 1Y! I r i7 t
line within the right of way of (-j,y 30 , RM to RM in County
Texas, MNT Sec. Nor aifollows: (give location, length, general design, etc. Use additional sheet as needed)
L �d Il ejah/,(a-)
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We will construct and maintain the line on the highway right of way as shown on the attached drawing and in accordance
with the rules, regulations and policies of the Texas Department of Transportation (TxDOT), and all governing laws,
including, but not limited to, the"Texas Engineering Practice Act,""Federal Clean Water Act,"the"National Endangered
Species Act,""Americans with Disabilities Act," and the"Federal Historic Preservation Act." Upon request by TxDOT, we will
submit to TxDOT proof of compliance with all governing laws, rules and regulations before commencement of construction.
Plans shall include the design, proposed location, vertical elevations, and horizontal alignments of the facility based on the
department's survey datum, the relationship to existing highway facilities and the right of way line, traffic safety and access
procedures, and location of existing utilities that may be affected by the proposed utility facility. The location and description
of the proposed line and appurtenances is more fully shown by a complete set of drawings attached to this notice.
Our organization will use Best Management Practices to minimize erosion and sedimentation resulting from the proposed
installation, and we will revegetate the project area as indicated under"Revegetation Special Provisions."
Our organization will ensure that traffic control measures complying with applicable portions of the Texas Manual on
Uniform Traffic Control Devices will be installed and maintained for the duration of this installation.
When installing our utility on controlled access facilities, we shall conform to the Texas Transportation Code, Title 6
Roadways, Chapter 203, Subchapter C, Control of Access, §203.031 ( http://tlo2.tic.state.tx.us/statutes/statutes.html.). We
shall limit access for servicing this installation to access via (a) frontage roads where provided, (b) nearby or adjacent
public roads or streets, (c)trails along or near the highway right of way lines, connecting only to an intersecting road; from
any one or all of which entry may be made to the outer portion of the highway right of way for normal service and
maintenance operations. Our rights of access to the through traffic roadways and ramps shall be subject to the same rules
and regulations that apply to the general public.
It is expressly understood that TxDOT does not purport, hereby, to grant any right, claim, title or easement in or upon this
highway; and it is further understood that TxDOT may require us to relocate this line, subject to the provisions of governing
laws, by giving thirty(30) days written notice.
We will notify TxDOT prior to commencement of any routine or periodic maintenance which requires pruning of trees within
the highway right of way, so that TxDOT may provide specifications for the extent and methods to govern in, but not limited
to, trimming, topping, tree balance, type of cuts, painting cuts and clean up. We understand that these specifications are
intended to preserve TxDOT's considerable investment in highway planting and beautification, by reducing damage due to
trimming and to protect known endangered species.
Our installation shall not damage any part of the roadway structure or associated appurtenances and we will make
adequate provisions to minimize inconveniences to the traveling public, and adjacent property owners. In the event we
fail to comply with any or all of the requirements as set forth herein, the State may take such action as it deems
appropriate to compel our compliance.
Following approval, we will begin construction on or after l" /!7 7
Month/Day/Year
Form 1082
(Rev.11/2006)
Page 2 of 2
Additional Provisions and Requirements (for TxDOT input only)
•General Special Provisions:
r
Are attached.
r Are not attached.
.As-built Plans/Certifications of Construction,:
E Are required and shall be certified as accurate by an authorized representative of the company.
✓ Are required and shall be signed and sealed by a State ofTexas Licensed Professional Engineer.
✓ Are not required
E Certification that utility was installed as approved
• Re-vegetation Special Provisions: In order to minimize erosion and sedimentation resulting from the proposed
installation, the project area will be re-vegetated:
✓ in accordance with TxDOT's Standard Specification Item 164 which specifies teh appropriate grass seed mix
to be used, or:
n as indicated on the attachment.
TxDOT Representative to be notified 48 hours prior to beginning construction
If approved, we understand that we will assume all risks associated with this installation within the TXDOT right of way.
These risks include, but are not limited to, injuries to our workers, damage to contiguous utility lines that may be in the
area, injuries or damage resulting from our failure to properly install and maintain the line as shown on plans.
We understand TxDOT may place additional provisions and requirements as listed above, based upon, but not limited to,
the type of utility being installed, local site conditions, soil types and traffic.
We acknowledge that this Utility Installation Request approval expires on the 91st calendar day from the date of issuance,
unless otherwise approved, if we do not begin our installation by this date. If we do not begin our installation within this
time frame and still wish to continue, we will resubmit our request in accordance with the prevailing governing laws, rules,
regulations and policies at the time of resubmission.
By signing as/for the requestor below, I certify that I am authorized to represent the requestor, that I agree to the provisions
and requirements included in this Utility Installation Request, and our commencement of construction will further attest to
our review and acceptance of said additional provisions and requirements.
REQUESTOR APPROVED BY TxDOT
Date: g- /Z p 7 / Date:
By: J c� h n �t is By:
Signature: Signature:
Title: p esi1�ln Title:
Address: 4G-DO i ftp C, f •'/(. Address:
'„,Z03
City bry y,,, State j-)( Zip Code77eyo, City State Zip Code
( c 7�1 ) e'746- 336
Area Code Telephone Number Area Code Telephone Number
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