Public Property Access Permit (Soil Boring near 2103 S. Ohio St) Revised 1/16/14
PUBLIC PROPERTY ACCESS PERMIT
Evergy (hereinafter referred to as "the Permittee") is hereby permitted by the
City of Salina (hereinafter referred to as "City") to access public property as shown on the attached
Evergy Soil Boring Map,near 2103 S Ohio St (the"Property").
The terms of this Permit are as follows:
1. The access to the Property granted by the City to the Permittee, its employees, agents, assigns, or
contractors is in consideration for the promises and assurances provided by the Permittee
regarding the performance of the work under the conditions set forth below.
2. The City grants the Permittee, its employees, agents, assigns, or contractors access to the Property
for the purpose of drilling soil borings and/or monitoring wells, as proposed on the drawing
Evergy Soil Boring Map . The Permittee shall drill the soil boring so that it does not
create any interference with the City's use of the Property, and shall take all reasonable efforts to
minimize interference with the City's use of the Property during the drilling.
3. The City grants the Permittee, its employees, agents, assigns or contractors access to the Property
for purpose of monitoring, repairing, removing, and maintaining any existing groundwater wells.
Provided, however, that the Permittee shall take all reasonable efforts to minimize interference
with the City's use of the Property during any such activities.
4. Use of the Right-of-Way shall in all matters be subordinate to the City's use of the Right-of-Way
for any public purpose. The Permittee shall coordinate the work in a manner which minimizes
adverse impact on public improvements,as reasonably determined by the City.
5. All earth, materials, sidewalks, driveway approaches, paving, crossings, utilities, public
improvements,or improvements of any kind injured or removed by the Permittee in their activities
under this Permit shall be fully repaired or replaced promptly by the Permittee at their expense and
to the reasonable satisfaction of the City and owner thereof,if privately owned or maintained.
6. The Permittee assures the City that prior to termination of this Permit,all materials and equipment
shall be removed from the Property and the Property restored to the condition it was in at the time
this Permit was executed. Once the monitoring wells are no longer needed, the Permittee will
properly abandon the wells in accordance with all regulatory requirements and return that portion
of the Property to match that of the property surrounding the wells to the extent possible.
7. The Permittee, its employees, agents, assigns, or contractors shall comply with all city, county,
state, and federal laws, statutes, regulations, and ordinances which may affect or pertain to the
environmental activities conducted on the Property (including notification of any relevant utilities
prior to drilling and compliance with drilling requirements), as well as commercially reasonable
standards of care.
8. Other than the activities specified in this access Permit, no further access to or use of the property
shall be permitted except upon written consent of the parties, which consent shall not be
unreasonably withheld.
9. The Permittee agrees to procure and maintain, during the term of this Permit and any extension
thereof for their use and operations on the Right-of-Way, commercial general liability insurance
with limits not less than $1,000,000 each occurrence bodily injury and/or property damage,
including the risk of explosion, collapse & underground; $500,000 personal and/or advertising
1
Revised 1/16/14
injury limit, $1,000,000 products and completed operations aggregate and $1,000,000 general
aggregate; $500,000 Auto Liability for all Owned, Hired and Non-Owned Autos; and Statutory
Worker's Compensation insurance. The Permittee is responsible to ensure their independent
contractors carry coverage equal or greater than that required of the Permittee. City shall be named
as an additional insured on the Permittee's general liability policy. The Permittee shall keep on file
with City a certificate of insurance that shows compliance with its obligations as set forth herein.
The Permittee agrees to obtain insurance coverage or self-insure itself for contents or owned
equipment associated with its own operation(s). The Permittee or its insurance representative shall
provide for at least (30) days prior written notice of cancellation or any changes of insurers to
City.
10. The insurance limits outlined above represent the minimum coverage limit and do not infer or
place a limit of liability on the Permittee nor has the City assessed the risk that may be applicable
to the Permittee. The Permittee's liability program will be primary and any insurance maintained
by the City (including self-insurance) will not contribute with the coverage maintained by the
Permittee. Coverage limits outlined above may be met by a combination of primary and excess
liability insurance programs. The City will only accept coverage from an insurance carrier who
offer proof that it is licensed to do business in the State of Kansas, and carries a Best's rating of
"A:X"or better;or is a company mutually agreed upon by the City and the Permittee.
11. The Permittee agrees to be responsible for proper disposal of waste generated from drilling on the
Property relative to Permittee's investigative and remedial activities.
12. During the term of Permit, the Permittee and its successors and assigns shall hold harmless and
indemnify the City, its officers, agents, employees and authorized contractors, against all liability,
loss damage,expense,and judgment,including attorney's fees so incurred, arising from or relating
to its installation,use or maintenance of the Line in the public right-of-way pursuant to this Permit
by the Permittee,their agents,contractors,or employees.
13. The Permittee shall notify the City not less than three (3) working days in advance of any work
which would require any street closure which reduces traffic flow to less than two (2) lanes of
moving traffic. The City shall follow its policies in the granting or denial of such street closure,
which shall not be unreasonably delayed or withheld. In addition, all work performed in the
traveled way or which in any way impacts vehicular or pedestrian traffic shall be properly signed,
barricaded, and otherwise protected. Such signing shall be in conformance with the latest edition
of the Federal Highway Administration's Standards and Guideline for Work Zone Traffic Control.
14. The Permit shall commence upon execution of this document and shall continue until the
Permittee's authorized use of the Right-of-Way has been completed.
15. The parties signing below warrant that they have authority to enter into this Permit.
The City of Salina
By: A 'ODate: /0—/3-2
Daniel R. Stack,City Engineer
Evergy
By: Gk.-A--teA Date: October 9,2020
2
ACCORD DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 10/08/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
MCGRIFF,SEIBELS&WILLIAMS,INC. PHOS:
P.O.Box 10265 (NCNNo,Ext);E 800-4M-2211 FAX
No):
Birmingham,AL 35202 E-MAIL
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Assoc.Elec.&Gas Ins.Serv.Ltd.(AEGIS)AA-3190004
INSURED INSURER B:Self-Insured
Evergy Inc.including Westar Energy,Inc.
1200 Main St. INSURER C:
Kansas City,MO 64105-2122
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:JVAT3ZYP REVISION NUMBER:
THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL'SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE ,INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
B X COMMERCIAL GENERAL LIABILITY SELF-INSURED UP TO$3M 10/19/2019 10/19/2020 EACH OCCURRENCE $ 3,000,000
DAMAGE-10 RENTED included
CLAIMS-MADE 0OCCUR PREMISES(Ea occurrence) $ _
MED EXP(Any one person) $ included
PERSONAL&ADV INJURY $ included
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ included
R POLICY n PRO
JECT ❑LOC PRODUCTS-COMP/OP AGG $ included
OTHER: $
B AUTOMOBILE LIABILITY SELF-INSURED UP TO$3M 10/19/2019 10/19/2020 COMBINED SINGLE LIMIT 3,000,000
(Ea accident) _ $
X ANY AUTO BODILY INJURY(Per person) $ n/a
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS n/a
HIRED NON-OWNED PROPERTY DAMAGE
_ AUTOS ONLY AUTOS ONLY (Per accident) $ n/a
A UMBRELLA LIAB OCCUR XL5761502P 10/19/2019 10/19/2020 EACH OCCURRENCE $ 5,000,000
X EXCESS LIAB X CLAIMS-MADE X AGGREGATE $ 5,000,000
DED X RETENTION$3,000,000 $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE nN/A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
$
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
Certificate Holder is included as Additional Insured if required by written contract,subject to policy terms,conditions and exclusions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CITY OF SALINA
ATTN: JUDY LONG AUTHORIZED REPRESENTATIVE
P.O..O.BOX 736
lvfitifj
SALINA,KS 67402-0736
Page 1 of 1 0 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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