TVA Construction Authorization

TETON VILLAGE ASSOCIATION ISD PO Box 866, Teton Village, WY 83025 * 307-733-5898

CONSTRUCTION, PARKING, AND ROAD CUTS APPLICATION, AUTHORIZATION, AND COMPLIANCE FORM ADMINISTRATION The Teton Village Association (TVA) promotes the safety and welfare of TVA District members, employees, invitees, and visitors by acting to ensure that all streets, access roadways, mall and common areas, parking lots, and landscaping within the boundaries of the District or on property outside the District but under the jurisdiction and control of the District are maintained in a repaired, orderly, and safe condition and in accordance with all applicable statutes, rules, and regulations. To these ends, TVA has adopted rules and regulations that require prior authorization by TVA of all construction, construction-related parking or storage, and street, roadway, walkway or pathway cuts activities within the boundaries of the District or on property outside the District but under the jurisdiction and control of the District. By the language incorporated in the adopted rules and regulations, TVA shall review applications for such activities, charge an administrative fee, as set forth on Schedule A, for performing the review, establish surety amounts that guarantee compliance by applicants with the adopted rules and regulations, issue authorizations, and impose penalties for violations of the rules and regulations during the course of the authorized activities.

PROJECT DESCRIPTION Project Address: ___________________________________________________________________________ Project Description, including timeline and any impacts to common roads, parking lots, pathways, landscaping or the Village Commons: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ ACKNOWLEDGEMENT AND INDEMNIFICATION □ □

I have been provided with a copy of, read, and understand the rules and regulations adopted by TVA regarding construction, parking, and road cuts authorization and I indemnify and hold TVA harmless for any liability or damages resulting from TVA's enforcement of its rules and regulations, particularly Sections 1.3 and 1.4 of those rules and regulations.

Applicant Name (Print): ________________________________________________________________ Applicant Phone: ______________________ Applicant Email: _______________________________ Applicant Signature: ______________________________________________ Page 1 of 4

Date: ____________

Please provide the following, in order to calculate the bond amount: 1. Estimated Construction Cost 2. Professional Engineers Estimate of Surface Restoration for replacement of concrete, asphalt and landscaping within the public right of way (if applicable)

APPLICATION TYPE Check

Type

Rules/Regulations Compliance Guarantee Formula

Amount

1. This is a guarantee that the owner/contractor will abide by the TVA-adopted rules and regulations that govern construction activities within the TVA District boundaries or on property outside of the TVA District boundaries under the control and jurisdiction of TVA. 2. This is a guarantee that the owner/contractor will abide by the TVA-adopted rules and regulations and ensure the reconstruction of damaged existing surfaces (e.g., roadways, walks, and landscaping) and existing and required public improvements.

ADMINISTRATIVE FEE/COMPLIANCE SURETY CHECKLIST □ □ □ □ □ □ □

□

TVA Administrative Fee Received TVAC Authorization Received TVW&SD Authorization Received Surety Amount (same as the total amount in the table above) Surety Type (Cash or Letter of Credit) Date Surety Received Date Surety Released Date Long-term Performance Guarantee Released

AUTHORIZATION Authorization of the described project is hereby issued. The signature by an authorized representative of TVA below serves as a letter of authorization for the described project.

________________________________________________________________

On Behalf of the Teton Village Association Improvement and Service District, a Wyoming improvement and service district

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Date

PENATIES Penalties for violations of the rules and regulations adopted by TVA regarding construction, parking, and road cuts authorization, noise abatement, and refuse and construction debris control, collection, and disposal shall nominally be $1,000 (construction-related) and $500 (parking-related or street, roadway, walkway or pathway cut-related). However, TVA expressly reserves the right to deduct a sum greater or less than these amounts from the compliance surety, dependent upon the severity of the violation. Funds deducted from a cash surety shall be "made current" by the applicant within ten (10) days of the imposition of the penalty.

Date

Violation

Penalty

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Date Pd.

Schedule A Administrative Fee Schedule as referenced in this Construction, Parking and Road Cuts Application, Authorization and Compliance Form ("Form") An administrative fee of $100.00 shall be charged per application submitted pursuant to this Form.

The Board of Directors of Teton Village Association, a Wyoming improvement and service district, reserves the right to amend this Schedule A from time to time in its sole discretion.

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