Highway Use Permit

THIS FORM MUST BE SUBMITTED TEN (10) WORKING DAYS PRIOR TO THE INTENDED START DATE.

Section 1:

Mininum requirements:

• Prime Contractor Designation
• Payment of Fees
• Certificate of Insurance
  The certificate of insurance needs to state the City of Port Moody as the certificate holder and as the additional insurer at a minimum of $5,000,000
• Public Notification
• Traffic Management Plan
• Coordination with CMBC

Applicant Acknowledgement:

I am the owner of the property.

I am the Prime Contractor:

I/we acknowledge, in accordance with the Worker’s Compensation Act (RSBC 1996) Chapter 492, Part 3, Division 3, Section 118 and 119 that I/we are the “Prime Contractor” and are qualified to act as the “Prime Contractor”. I/we accept the duties and responsibilities for coordinator of health and safety in accordance with the Workers Compensation Act. And Further that I/we will do everything that is reasonably practicable to establish and maintain a system or process that will ensure compliance with the Workers Compensation Act and the Occupational Health and Safety Regulations

I hereby agree to the terms stipulated herein and further agree to indemnify and save harmless the City against any and all claims, actions or expenses whatsoever or by whomsoever brought against the City by the reason of the City granting us this Highway Use Permit. I further agree to accept responsibility to ensure proper siltation control and street cleaning for the duration of the road obstruction.