VAMC Revocable License for NonFederal Use of Real Property Water Pipline
REV~~~~LE LICENSE F;R ~ON-FE~~;;~:~ ll~[I~~~~~ --- .--1
_ USE OF REAL PROPERTY ,i ____________ ,__ J
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2 NAME OF LICENSEE -- 4, NAME ANDADDRESSQF INSTALLATION
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Ci.tyof Sh\<ridiln. Wyoming Nuni.clpaHty Utilitles !.'{!;:>~ Sher.d~n VA M~dicfll Center
1998 Fort R.oae
3_ ADDRESS OF LICENSEE Shcri<;l,~n. Wyo~,in9 Qt601
City of Sheridan Utilit'es O"partment
!>!> Grinnell t>lal'il
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Sheridan Wyoming 82801
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6_ CONSIDERATION
IAS Specified in Addendum!
7A. DESCRIPTION OF PROPERTY AFFECTED (..b :11011'11 OIl E.Tchibi/(s) tllIlIc!led "erelO IlIId IIIll<le 1/ pllrlltenlif.) ll::~ ~~~~:~,C:~ A=:~~I,~,~"
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, 8 PURPOSE OF LICENSE
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ho dll""" ._he Ci'y 01 Sh.-ril"n. 1'I',omin", to <:':'0"1I s'.,:;;,-j-.r. ':f~'1<" 1;:>P..,.t, ~;t,. LI s"!:r.",-/-.,,., 'o'.""J .;"-!,,.'.
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r By lllc "eCo.'punce lJlthl~ lr....rw.:_ tllc li.,',ISI."C nglcss \0 nbidc b)' und b.: l"'u[~d b~' lh... gcncrd and spec ,,,! ..."ndll11lOs md'':;!led hCl"un""d "tt;:i;.:u k~~.l;; ---
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9. SPECIAL CONDITIONS
As specifh:d in Addendu,n ! il.nd .'\ddendurn II
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VETERANS AFFAIRS LICENSOR LICENSEE
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; DATE OF LICENSE 1_lfumh. '/"1, "'WJ! ,;.~'-~'1' DATE AC'';EPTEC ,I(umil. .I,,,. "."r} ,03/1 :;/;
SIGNATURElSI OF llCENSOIf' - ----- - ='----------~-
SIGNAT .JRE:CS) AND TYP~D NAME 9F SIGN
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i ADDRESS OF LICENSOR TITLE Of' SIGNATORY
i Medical Cent"r Director IpUbliC Utilit,es :>1.-ector
, Shcrid,~n V"terans Affilirs I~edica 1 Center -
11890.f'Ort Road TELEPHONE NO OF LICENSEE (ll1d/l('mg ,r.',
Sht:r.dan :-Jyom~ng 82801 !307,G'!',42D
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CERTJFICA TE OF COPORA TF LICENSEE
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VA FORMj 0-6211
MAR 2004
ADDENDUM I
6. CONSIDERATION:
A, Licensee shall restDre and landscape all disrupted surface to original condition after initial
installation and after any subsequent Dr future work that may be necessary for repairs or
maintenance.
B. Licensee will locate all existing utility service lines and conveyances and be solely
responsible for any and all utility disruptions that may result from operations associated with
specified installation, and will immediately effect any needed repairs to the satisfaction of the
V A Medical Center's Chief of Facilities Management; work to be dDne at no cost to the
Government.
C. Licensee will install a hydrant in the city's treated water pipeline system to allow a redundant
connection to the system should the V A require it in an emergency. InstallatiDn to be done at no
cost to the Government. Use of water (when needed) to be metered and billed at normal out-of-
city rates without further connection fees.
D. Licensee will allow the V A an interim connection to the City Water Treatment Plant at the
metered rate of $1.50 per thousand gallons during the VA's Water Treatment Plant renovation
project. Estimated consumption is to be approximately 100,000 gallons per day during the
course of the renovation.
9. SPECIAL CONDITIONS:
A. This license may be terminated by either party upon 180 days' written notice, to be computed
from the day ofreeeipt.
B. All affixed improvements constructed on V AMC property by the licensee shall become the
property of the U. S. Government upon expiration or termination of this license.
C. All maintenance operations on the licensee's water lines will be coordinated with the VA
Security Police and the V A Chief of Facilities Management Service.
D. Licensee will absolve/hold harmless the Sheridan V AMC for any damage to the licensee's
communications line system that may result from maintenance operations on V AMC property.
ADDENDUM II
852.228-71. INDEMNIFICATION AND INSURANCE (JAN 2008)
(a) Indemnification, The licensee expressly agrees to indemnify and save the Government, its
officers, agents. servants, and employees harmless from and against any and all claims, loss,
damage, injury, and liability, however caused, resulting from, arising out of, or in any way
connected with the performance of work under this agreement. Further, it is agreed that any
negligence or alleged negligence of the Government, its officers, agents, servants, and
employees, shall not be a bartc a claim for indemnification unless the act or omission of the
Government, its officers, agents, servants, and employees is the sole, competent, and producing
cause Dfsuch claims, IDSS, damage, injury, and liability. At the option of the licensee, and
subject to the approval by the contracting officer of the sources, insurance coverage may be
employed as guaranty of indemnification.
(b) Insurance. Satisfactory insurance coverage is a condition precedent to award ofa contract.
In general, the licensee must present satisfactory evidence Dffull compliance with State and local
requirements, or those below stipulated, whichever are the greater. More specifically, workers'
compensation and employer's liability coverage will conform to applicable State law
requirements for the service contemplated, whereas general liability and automobile liability of
comprehensive type shall, in the absence of higher statutory minimums, be required in the
amounts per vehicle used of not less than $200,000 per person and $500,000 per occurrence for
bodily injury and $20,000 per Dccurrence for property damage. State-approved sources of
insurance coverage ordinarily will be deemed acceptable to the Department of Veterans Affairs
installation, subject to timely certifications by such sources of the types and limits of the
coverages afforded by the sources to the licensee.
(End of Clause)
852.237-70" LICENSEE RESPONSIBILlTffiS (APR 1984)
The licensee shall obtain all necessary licenses and/or permits required to perform this work.
The licensee shall take all reasonable precautions necessary to protect persDns and property from
injury or damage during the performance of this contract. The licensee shall be responsible for
any injury to himselflherself, hislher employees, as well as for any damage to personal or public
property that occurs during the performance of this contract that is caused by his/her employees
fault or negligence, and shall maintain personal liability and property damage insurance having
coverage for a limit as required by the laws of the State of Wyoming. Further, it is agreed that
any negligence of the Government, its officers, agents, servants and employees, shall not be the
responsibility of the licensee hereunder with the regard to any claims, loss, damage. injury, and
liability resulting there from,
(End of Clause)
52.236-9. Protection of Existing Vegetation, Structures, Equipment, Utilities, and
Improvements (Apr 1984)
(a) The Licensee shall preserve and protect all structures, equipment, and vegetation (such as
trees, shrubs, and grass) on or adjacent to the work sites, which are not to be removed and which
do not unreasonably interfere with the work required under this contract. The Licensee shall
only remove trees when specifically authorized to do so, and shall avoid damaging vegetation
that will remain in place, If any limbs or branches of trees are broken during contract
performance, or by the careless operatiDn of equipment, or by workmen, the Licensee shall trim
those limbs or branches with a clean cut and paint the cut with a tree-pruning compound as
directed by the Contracting Officer.
(b) The Licensee shall protect from damage all existing improvements and utilities
(1) at or near the work site, and
(2) on adjacent property of a third party, the locations of which are made known to or
should be known by the Licensee.
The Licensee shall repair any damage to those facilities, including those that are
the property of a third party, resulting from failure to cDmply with the
requirements of this contract or failure to exercise reasonable care in performing
the work. If the Licensee fails or refuses to repair the damage promptly, the
Contracting Officer may have the necessary work performed and charge the cost
to the Licensee.
(End of Clause)
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