Get Adopt A Highway Mississippi

County Application Number Mississippi Transportation Commission ADOPT-A-HIGHWAY PROGRAM RENEWAL / CANCELLATION NOTICE WHEREAS the after completing Adopt-A-Highway Program requirements for the previously agreed upon period of time DOES wish to renew DOES NOT wish to renew the contract for the responsibility of litter pick up on the previously adopted section of Highway between and for the and period beginning and ending WHEREAS the Applicant accepts the responsibility of picking up litter on the entire adopted section of Highway a minimum of four 4 times January-March April-June July-September and October-December during a calendar year and promoting a litter-free environment in the community. NOW THEREFORE in consideration of the above Premises this agreement with the abovenamed applicant is RENEWED TERMINATED on the day of. Company/Organization/Participant By APPROVED Chief Engineer MDOT District Anti-Litter Coordinator The applicant specifically agrees to coordinate with the local MDOT District to ensure all rules of safety are followed specifically but not limited to compliance with 23 CFR Part 634 the Federal Highway Administration s requirement for the use of high-visibility safety apparel* American National Standards Institute ANSI Class Two 2 safety apparel shall be worn at all times by participants in the program* Also participants shall work only when traffic control signs are in place. If renewing please update contact person information* Name Title Address City State Telephone No* s Home Fax Zip Code Office. NOW THEREFORE in consideration of the above Premises this agreement with the abovenamed applicant is RENEWED TERMINATED on the day of. Company/Organization/Participant By APPROVED Chief Engineer MDOT District Anti-Litter Coordinator The applicant specifically agrees to coordinate with the local MDOT District to ensure all rules of safety are followed specifically but not limited to compliance with 23 CFR Part 634 the Federal Highway Administration s requirement for the use of high-visibility safety apparel* American National Standards Institute ANSI Class Two 2 safety apparel shall be worn at all times by participants in the program* Also participants shall work only when traffic control signs are in place. Company/Organization/Participant By APPROVED Chief Engineer MDOT District Anti-Litter Coordinator The applicant specifically agrees to coordinate with the local MDOT District to ensure all rules of safety are followed specifically but not limited to compliance with 23 CFR Part 634 the Federal Highway Administration s requirement for the use of high-visibility safety apparel* American National Standards Institute ANSI Class Two 2 safety apparel shall be worn at all times by participants in the program* Also participants shall work only when traffic control signs are in place. If renewing please update contact person information* Name Title Address City State Telephone No* s Home Fax Zip Code Office. NOW THEREFORE in consideration of the above Premises this agreement with the abovenamed applicant is RENEWED TERMINATED on the day of. Company/Organization/Participant By APPROVED Chief Engineer MDOT District Anti-Litter Coordinator The applicant specifically agrees to coordinate with the local MDOT District to ensure all rules of safety are followed specifically but not limited to compliance with 23 CFR Part 634 the Federal Highway Administration s requirement for the use of high-visibility safety apparel* American National Standards Institute ANSI Class Two 2 safety apparel shall be worn at all times by participants in the program* Also participants shall work only when traffic control signs are in place. If renewing please update contact person information* Name Title Address City State Telephone No* s Home Fax Zip Code Office.