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Anoka County Highway Department <br />Adopt-a-Highway Permit A091 <br />(Check One) <br />X Adopt-a-Highway. The group agrees to pick up litter at least two times a year for a minimum of two years. <br />Pick-a-Highway. The group agrees to pick up litter one time only. <br />We request permission to pick up litter on <br />between <br />and <br />for a total of#miles. <br />Anyandallvolunteersofthegrouporotherpersonswhileengagedintheperformanceofanyworkorserviceperformedunder <br />thisagreementshallnotbeconsideredemployeesoftheCounty,andanyandallclaimsthatmayormightariseunderthe <br />Worker'sCompensationActofMinnesotaonbehalfofsaidemployeesorotherpersonswhilesoengaged,andanyandall <br />claimsmadebyanythirdpartyofthegroup'svolunteersorotherpersonswhilesoengagedonanyoftheworkorservicesto <br />berenderedshallinnowaybetheobligationorresponsibilityoftheCounty. <br />ExceptforthenegligentactsoftheCounty,itsagentsandemployees,thevolunteersortheiragentsshallassumeallliability <br />for,andsavetheCounty,itsagentsandemployees,harmlessfrom,anyandallclaimsfordamages,actionsorcausesof <br />actionarisingoutoftheworktobedoneherein. <br />TheAnokaCountyHighwayreservestherighttorefuse,cancelorrevisethisagreementifinitssolejudgementthenatureof <br />thegrouporitssignispolitical,controversialorinquestionabletaste,orifthegroupisnotmeetingthetermsandconditionsof <br />this <br />agreement.Bysigningthisagreement,thegroupacknowledgesthehazardousnatureoftheworkandagreestocomplywith <br />thetermsandconditionsherewithtothesatisfactionoftheAnokaCountyHighwayDepartment. <br />Name of group <br />Responsible person <br />Signature <br />Address <br />Phone (home)(work) <br />Name to appear on sign <br />Special provisions <br />County EngineerDate <br /> <br />