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PRINT_PERMIT_format_finance Page 1 of 4 State of New York rexsisn@%m Department of Transportation Highway Work Permit Ieswed: 08132014, Projet ID No. omDae:12/512014 Peas , CORSE TION MerLINE COMPANY, LLC ;DOUHLEP DRILLING WINE, 296 MORRIS ROAD. ND FLOOR 10 WILLIAMSTOWN PIKE SCHENDETADY, NY 12505, WILLIAMSTOWN, WY 25187 ‘Unk he proviso egy Lao Veh Trafic Law, pons ber panto penis: Nmkpaiy ——Stteliny = SeRove Dagan (WetioN eNO : Soe awommran — asne 4 th eel i abl pletion fhe treo rc ae ee ei gid ad i fewer Sevaidta eioeees EGE nee acter naan re repens Tis PERMITS ISSUED BASEDON ALL LOCAL STATE, AND FEDERAL REQUIREMENTS BEINGSATISEIE, toda! apbamionDatesignds——GUISOLE Commoner of Trapt By: Ton Signore DIORA rus pena, wrru 4PpLicaTioN AND DRAWING (OR COMES THEREOM ATTACHED, SHALL Be PLACED IN THEHANDS or nic Covinactow eront aN WORK ALOIS THE MIRWAY WORK FERMI SHALL GEAVAILANLE AT TESTE ue constNucHION unos coururios oF Wonk, siCOND 10 LAST PAGE, MUST BF COMPLETED SIGNED BY THE PERMITTE, NO http://prodas| .nysdot.private:7785/pls/apex30/f?p=227:2501:340839588498301::NO:RP,2... 8/13/2014 PRINT_PERMIT_format_finance Page 2 of 4 “Tae ising at eee te ih to pnd ook hi pot i Soo wiht hein the ace of hong ane site belo due Seep aud ‘te Ronee all ene on sppne yf aalio be alemantuched e lnrk te emi ice irvine mieten beatin i tg atl at ann pine ae 6 Ibe tate hgnyightotnay matory th work permit he pre, rm crpration ‘ent yer te earn or nent Ser rt reenter shal be eps re ees a PE ‘Wtwclnerk oe pref ses werk vet orien endian oe ek pea AevRecd |; $500 Ged Na) 01100 CekDae CLAUC-E Lor Ap Ne op? _¥0 Tasik he pen fe Now Oy We http://prodas| .nysdot.private:7785/pls/apex30/f%p=227:2501 :340839588498301-:NO:RP,2... 8/13/2014 PRINT_PERMIT_format_finance State of New York Tene) Department of Transportation Highway Work Permit PermitNes 20140964873 Date swed: 0V12014 Project ID No. Expiration Date 1231/2014 Return this page to: ‘Mike ale, Reset Engneer Fees CORSTTTION FIPELNE COMP, so, 12 295 MORRIS ROAD, 2N0 FLOOR eee SCHENECTADY ,NY_12305 DATE Fr “AUTHORIZED AGENT fan) od tine his oie ise cond elias 1 Reem of ind shred 1D nto hele eign rp 1 amantadine yo hn enter Grae Det subarzed bate ‘RESIDENT ENGINEER Mlingabben ofr eee eid ind edie fio te Dpeiton is pei i thse 1D art Garter Dope to NYSOOT http://prodasl nysdot private:7785/pls/apex30/f?p=227:250 :340839588498301::NO:RP,2. Page 3 of 4 8/13/2014 PRINT_PERMIT_format_finance Page 4 of 4 INSPECTION REPORT folowing rept mus be complete fr ah ste vis, tom tine eee how thn a FIN 12 >. Foreach Hiway Work ont ised iepctions wl be pefoned tora oa spec rapes he TION FOR DEPARTMENT SERVICES) f REQI INSPECTION REPORT LOG HOURS WORKED BY DATE HOURS espn Nane [Dae Tne Regan [Ovens quar [ovine faapecor Nave [Du ape Remar | Overime gale ovens aspecor Nene [Die nape Reg _[Overine egal vein (Gampite nour Trench dae pee ‘Add raul hour nombre arom os nd he overt hore aero on. ‘A4d bor colamns down for otal hur of permit peton ine CCOMMENTSIOUSERVATIONS: [I HERERY CERTIFY THAT THE INFORMATION CONTAINED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, SANE THE htp://prodas| nysdot.private:7785/pls/apex30/f?p~227:2501:340839588498301::NO:RP,2... 8/13/2014 PERM 39 NONATILITY (718) ‘SUBHAT THREE (3) COPIES ‘STATE OF NEW YORK DEPARTMENT OF TRANSPORTATION HIGHWAY WORK PERMIT APPLICATION FOR NON-UTILITY WORK ‘Application is hereby made fora highway work permit: Name_Constitution Pipeline Company, Uc Address _296 Morrie Rd., 2nd Floor City__Schenectads State__NY _zip_22303 Applicant Phone ( 516 ) 698-9083, ‘Applicant Email Address C®AIG. ADANS@HILLTANS COM Emergency Contact _CRATG_ ADAMS Emergency Contaét Phone (£28 ) 698-9083, For Joint application, name and address of Applicant 2 below: Name_Pouble J Drilling Ww tne ‘Address 1207 Wiliianstowm Pik, Stato City Bi Lanstown 2ip_26287 (To bo comploted by NYSDOT tecuing office) Project Identification No. Highway Work Permit No, RETURN PERMIT TO (if different than above): Nome SA¥8 AS vsRuArTRS Address city State zi 4) Estimated cost of work being performed in highway right-of-way: RETURN OF DEPOSITIBOND 70 (if diferont from Permittee): RRTORN DEPOSITS TO PERNITER/RBTURN BONDS TO = wruurans Address ATIW: RMID ONE WILLIAMS CRYTER Gity__ TULSA," ox» T4172 Name: $1,000.00 2). Anticipated duration of work: From 07/14/2024 to 12/31/2014 (applies to the operations indicated on the revere sido) 3) Insurance (check one}: XX General Lia! iy Ins. ___Undertaking ___ Insurance Fee (rosidential driveways ony) DESCRIPTION OF PROPOSED WORK: ‘Temporary access from NYSDOT RoW for Geotechnical soll investigations for a conventional bore feasibility study. Anticipated duration is one day per test bore site. 1 test bore proposed within NYSDOT RO# - cee attached "Boring Location Map" WILL OVERHEAD OR UNDERGROUND (6'+) OPERATIONS BE INVOLVED IN THE PROPOSED WORK? YES XX NO__ ATTACHED: Plans _XXX ‘Specifications _¥0 LOCATION: Stato Routo:_SH 206 City/Town Village of _BAINBRIDGE ‘SER REVIEW (soloct one) [1 Typetl 17ypet [ 1Untsted LEAD AGENGY: Between Reference Markers _206-9302-3233 and 208-302-1234 County of _ CHENANGO DATE OF DETERMINATION NOTE: PERMIT IS ISSUED CONTINGENT UPON ALL LOCAL REQUIREMENTS BEING SATISFIED ACKNOWLEDGMENT: OW BEHALF OF-THE APPLICANT, I HEREBY REQUEST A HIGHWAY WORK PERIAIT, AND DO ACKNOWLEDGE AND ‘XGREE TO THE RESPONSIBILITIES OF PERMITTEE AND THE OTHER OBLIGATIONS SET FORTH IN THIS PERMIT AND WARRANT COMPLIANCE THEREWITH ei guialzats oa? Jub Applicant 2 Signature an AG fa, AD Dato_ 2-1 4-/ 7 ST. at Approval recommended by Resident Engineer Resno_f-Z-_ pate S/4/14 Approved Se Roloal Trt tnginee reeno Si pate Ls . Ss i] sara Operational Type and Description ; ae DRIVEWAYS I ‘Sai | Residential Driveway 45 26 = a2__| Commorcial~ Minor 550 Baza _| Commercial = Minor (Home Business) 100 5a3__ | Commercial - Major (Less than 100K sq ft Gross Bullding Aroa) 7400 a4 | Commorcial~ Major (100K+ sqft) [Actual cost-$2,000 min) | 2,000 $85 | Subdivision strect 300 a6 | Tomporary avcoss road or streot 200 IMPROVEMENTS _ ‘sbt__| Residential _ 5b2a_| Commorcial- Sidewalk, curb paving, drainage, eto. ‘Sb2b ,2ed, improve land contour, clear brush ‘Bb26 isting road or driveway ‘Sb2d1_| Annual resurfacing of roadways and driveways - PER COUNTY Number of countios: ‘Annual resurfacing of roadways and driveways - PER REGION ‘Vegetation contral for advert Residential 6 Commercial rinoval or lant 25 Commercial pruning apalying chemicals to stumps 35 : signs ~ PER SIGN 10 Number of Signa [— MISCELLANEOUS CONSTRUCTION AND WORK OPERATIONS Sa1__| Booutify ROW (civic eroups only) 5d2a_ | Temporary signs, banners, décor (not-for-profit organizations) 5d2b__| Temporary signs, banners, décor (Other organizations) '5d3__| Traffic contro! signals ‘544 | Warning and entrance signs Nic. 3 | Nie 25 _ 500 - 25 400 25 ‘55 __| Miscellaneous ~ Requiring substantial review (describe below) '548__| Miscellaneous (describe below) OTHER TYPES OF HIGHWAY WORK PERMITS é Encroachment caused by DOT acquisition of property 25 7a1__ | Compulsory permit required for demolition requested by DOT Nic. 7a2__ | Compulsory permit required for moving requested by DOT Nic. 7b___ | Improvement to meet Department standards NIC. bel 8 Miscellaneous (describe below) 25 ‘Adopt-a-Highway Nic. WN Daseription of Miscellaneous Operation: ‘RST RORE FOR GEOTECHNICAL STUDIES PERFORMANCE SECURITY (Select one); Guarantee Doposit -Cash{ ] Guarantee Deposit Amount: Guarantee Deposit Check Number or Bond Number. rorformanee Bond] Lotter of Credit] PERM 33 (7/14) REVERSE PERM 33 Submission Package Requirements In addition to Forn PERM 33, the final submission package should include the following (check all that apply): Stamped Final Plans ~ Submitin POF fle format on CD, and paper copies (1* = 50') as requested Permit Fee (Including Insurance Fee for Residential Driveways) ACORD 25 - Certificate of Insurance, NYSDOT named as additional insured (See insurance Requirements below) ACORD 856 - New York Construction Certificate of Liability Insurance Addendum PERM 36 - Attachment to Highway Work Permit - Consultant Inspection, if applicable PERM 44 - Surety Bond ~ Performance bond in Applicant's name, or deposit (Bank cashier's check required) PERM 50 — Inspection/Supervision Payment Agreement, if applicable Proof of Worker's Compensation Insurance (Form C-105.2, U-26.3 or SI-12), or proof of exemption (Form CE-200) Proof of Disability Benefits Coverage (Form DB-120.1 or DB-156), or proof of exemption (Form CE-200) Undertaking Agreement, i applicable Insurance Requirements oO) 2) 3) 4) 5) 6) In most cases, Permittee must provide proof of Commercial General Liability insurance coverage with limits of lability not less than $1,000,000 per ciaim/occurrence, unless any ofthe following circumstances exist, in which case the limits of labilty shall not be less than $5,000,000 per claim/ocourrence: (a) The estimated value of permitted work in state right-of-way is $250,000 or more: {b) The permitted work requires or includes the construction, alteration or maintenance of underground features at any depth five feet or more below grade; (0) The permitted work requires or includes the construction, alteration or maintenance of overhead features that include, but are not limited to, traffic signals, overhead sign structures, retaining walls or other grade separation structures, Exceptions to the above liability limits include: (a) Annual maintenance permits require limits of lability not less than $5,000,000 per clainfoccurrence; (b) Permits for vegetation control activities require limits of lability not less tran $1,000,000 per claim/occurrence; (c) Residential driveway permits require limits of ibility not tess than $500,000 per claim/occurrence; and (d) Adopt-a-Highway permits are exempt. ACORD 26 with ACORD 855 (New York Construction Addendum) shall be submitted as acceptable proof of liability coverage, New York State Department of Transportation should be named as Additional Insured and as the Certificate Holder at the mailing address of the Regional Office who will be issuing the permit. Municipalities, public utilities, public authorities and railroads may elect to provide an executed Undertaking agreement as a substitute for providing the insurance coverage and other financial security otherwise required. Homeowners may pay a $25 Insurance Fee in lieu of providing proof of insurance. Any contractor performing on behalf of a homeowner and who is named on the permit must provide proof of insurance as outlined above. When the estimated cost of work being performed in the right-of-way equals or exceeds $250,000, Permittee must additionally provide proof of a Protective Liability (OCP) insurance policy with a minimum liabilty limit of $1,000,000 per occurrence, with New York State Department of Transportation as Named Insured. v-c11029,000 BRIANJ LEOPOLD POREDNTAL: UTM, MAD 9, zoe 18,5 Fo. Comal Mean 754 LEGEND: @ @ Proposed Boring Location PraeaassenoncADiPrmany Rowena Lasion Mans MP 48,1NP 481 cA Fle 2 oi 1, 208-1 en A wo : 7 +1. The locations of all features shown are approximate. — ——————— 2. This drawing Is for information purposes, tt is intended | ue assist Feet peesesta se necmsentee tate Geotngincers, Ine. can not guarantee the accuracy a CONSTITUTION PIPELINE Conca net curmin nena Cee une eoEnsingers and wl sre ashe tical eco of is TIP 48-1 HIGHWAY 206 CROSSING ‘3. GeoEngineers has not veried the flekd location of the existing BAINBRIDGE TOWNSHIP, ca ibsanco COUNTY Ren VOR Le ee peppermint GeoEnaineers 77 FIGURE 2 Races eek a: PEC ry RURAL HIGHWAY &- a Notes: 1. Short-term stationary is daytime work that occupies a location for more than 1 hour within a single daylight parod. 2, The barter vehicle shal be en unoccupied large dump tuck, withthe parking brake set and withthe front wheels turned ‘away from the employees in the work area. 3. There shall be no workers, equioment, or other vehicles in the buffer space othe roll ahead distance, 4, Any butfordstance provided in advance ofthe barrier vehicle ‘setup will add tothe safety ofthe work area. The butfer space is from the end of the lane taper tothe beginning ofthe work area, 5. State Law signs (NYR9-11 or NYR9-12) are optional ifthe anticipated work duration is ess than 4 hours. fused, State Law sign to be placed 300-500 FT. In advance of initial ¥ & warning sign 500FT. (Min) Ti Reference Marker) Cone spacing not to exceed 40 FT. 4100 FT. Min, (25 Skip Lines) Spotter Z Recommended Ii Barter Vehicle Set-up is used: Barrier Vehicle is Required and TMIA Recommended. Roll Ahead Buffer Space Distance 30__[200" (5 Skip Lines) | 40° (1 Skip Line) 35_| 250° (-6 Skip Lines) | 40" (1Skip Line) 40__| 305° (-8 Skip Lines) [40° (1 Skip Line) 45 _| 3607 (@ Skip Lines) [80° (2 Skip Lines) 50 [425° (-11 Skip Linos)| 80° (2 Skip Lines) 35 [495° (-13 Skip Linos)] 80° (2 Skip Lines) Buffer Space (See Table) OR Barrer Vehicle Setup Required, This sign shall be located a Maximum 6202 y ‘See Note 4 distance of 500'(12 Skip Lines) past BR sin erent Eee we0-1 wats 200 FT. 36x36 in, 3636 in, (6 Skip Lines) & Work Avea ‘Aron Panel 500 FT. (Min.) (Caution Mode) (1 Reference Marker) DBE barre: vehicle win TMA nysboT Ge WORK ZONE TRAFFIC CONTROL SHORT-TERM STATIONARY ‘OPERATION INVOLVING SHOULDER CLOSURE (PAVED SHOULDER 8 FT. OR WIDER) ON RURAL ‘TWO-LANE CONVENTIONAL HIGHWAY 500 FT. (Min.) (1 Reference Marker) FEBRUARY 2009 TAST.CaR b NOT TO SCALE PERM 50 (10/10) New York State Department of Transportation Highway Work Permit Application Agreements Inspection and/or Supervision Payment Agreement Asa condition of the attached permit application and in consideration of the issuance of the attached permit, Constitution Pipeline Company, LLC _as permittee, hereby agrees as follows: ‘The permittee will reimburse the New York State Department of Transportation for inspection and/or supervision of the permit work by Department employees which exceeds four wark hours If the Department determines that the proposed work on a specific permit project will exceed five (5) workdays of inspection, the permittee will be required to secure the services of @ reputable consulting engineering firm. This firm, upon approval by the Department, will be responsible for all inspection and/or supervision of the permit work. Its estimated that_ —O— Work Days of inspection time will be required and that the cost per Work Day to be reimbursed, will be $370,00. These estimates are not intended to be final and the permittee agrees to pay reimbursement for all reasonable expenses incurred by the Department of Transportation in necessary inspection and/or supervision of work performed pursuant to this permit, including supervising work inspected by consultants, The Department of Transportation shall be the sole judge of whether such inspection and/or supervision are necessary. ‘The permitice will be billed on a monthly basis and the permittee agrees to pay the charges as billed within thirty days of the date of billing, Failure to pay as billed within the specified time limit may result in the revocation of this permit Indemnity Agreement In addition to the protection afforded to NYSDOT under any available insurance, NYSDOT shall not be liable for any damage or injury to the Permittee, its agents, employees, or to any other person, or to any property, ‘occurring on the site or in any way associated with Permittee’s activities or operations; whether undertaken by Permittee’s own forces or by contractors ot other agents working on Permittee’s behalf. To the fullest extent permitted by law, the Permittee agrees to defend, indemnify and hold harmless the State of New York, NYSDOT, and their agents from and against all claims, damages, losses and expenses, including but not limited to attorneys" fees, arising out of any claim, including but not limited to claims for personal injuries, property damage or wrongful death and/or environmental claims, in any way associated with the Penmittee’s, activities or operations, no matter how caused By signing you have read and agree to abide by the above requirements and conditions. ‘of Permittee or Authorized Representative Cody Bhaus , Eurgi'e Print name, if a corporation or business include positionititie

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