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2016-MDT-RIGHT-OF-WAY WHITEHALL-SOUTH STATE OF MONTANA DEPARTMENT OF TRANSPORTATION (hereinafter referred to as State, Department,Grantee, and/or MDT) RIGHT-OF-WAY AGREEMENT ROW\FORMS\ACQ\200 (Revised 2-8-2013) PE PROJECT ID: STPP 55-1(6)0 Whitehall -South R/W PROJECT ID: NH 55-3(16)7 DESIGNATION Jefferson UNIFORM PROJECT No.: 5801-016-000 COUNTY Parcel From Station To Station Subdivision Section Township Range 15 13+22± 16+05± SE1/4 SW1/4 18 1N 4W List Names &Addresses of the Grantors (Contract Purchaser, Contract Seller, Lessee, etc.) Jefferson County, Montana 210 W Centennial Boulder, Montana 59632 1. In consideration of the payments herein set forth and the specific agreements to be performed by the parties hereto and written in this agreement, the parties bind themselves to the terms and conditions stated herein. No verbal representations or agreements shall be binding upon either party. Grantor certifies that any encumbrances on the property are shown on this agreement. This agreement is effective upon execution by the Acquisition Manager or a designated representative, and possession of the property is granted to the Department when it sends the payment(s) agreed to below. Grantors contract that they will, on Departments request, execute a deed and/or easement required by Department for all real property agreed to be conveyed by this agreement. 2. COMPENSATION FOR LAND AND IMPROVEMENTS (List acreage and improvements to be acquired.) None $0 3. OTHER COMPENSATION: • None $0 4. TOTAL COMPENSATION (includes all damages to the remainder): $0.00. 5. IT IS UNDERSTOOD AND AGREED THE STATE SHALL MAKE PAYMENT AS FOLLOWS: A warrant in the amount of$0.00 to be made payable to Jefferson County, 210 W Centennial, Boulder MT 59632. 6. Permission is hereby granted the State to enter upon the Grantor's land, where necessary and for the purpose described as follows: A. Station 14+85 Public Approach (Forcella Ln) RT SOP It is understood and agreed by the parties hereto that the location of these approaches are subject to adjustment at the time of construction to achieve the best physical location for said approaches. Adjustments exceeding 15' from the specified location requires concurrence of the Grantors. Grantor shall maintain, at their sole expense, all approaches identified in this agreement. Grantor further agrees to conduct maintenance activities in a prudent manner providing for the safe and continued operation of thru traffic on the highway. Physical changes in size or location or the change in use of these approaches cannot be made without first obtaining an approved approach permit from the Montana Department of Transportation. All drainage facilities within the existing right—of—way/easement associated with these approaches, i.e., approach culverts, drainage ditches, will be maintained by Jefferson County. 7. This agreement, upon execution by an agent of the Department of Transportation and presentation to the owner so designated, constitutes a written offer of compensation in the full amount of the determined value, a summary of the property and property rights being acquired and agreement that possession of the property is granted to the Department when it sends the payment(s). F A TRUE COPY C,F .rir_ORIGINAL ?,-66 Page 1 of 2 �� 4-1 R/W Project ID: NH 55-3(16)7 Parcel No.: 15 (Continued from Previous Page) 8. It is understood and agreed that a private approach will be installed at the following location: B. Station 14+72 offset 96.6' Private Approach RT SOP It is understood and agreed by the parties hereto that the location of these approaches are subject to adjustment at the time of construction to achieve the best physical location for said approaches. Adjustments exceeding 15' from the specified location requires concurrence of the Grantors. THE PARTIES HERETO HAVE EXECUTED THIS AGREEMENT ON THE DATES SHOWN: Grantor's Statement: We understand that we are required by law to provide our correct taxpayer identification number(s) to the Montana Department of Transportation and that failing to comply may subject us to civil and criminal penalties. We agree to provide our correct taxpayer identification number(s) by submitting a completed and signed W-9 or W-8 form. We further agree and authorize MDT to process the payments outlined in this agreement by withholding a percentage of the payments as required by the IRS if we fail to submit the W-9 or W-8 forms within 30 days of signing this agreement. Signature: Distffct 1: Leonard Wortman (Date) Signature: (Date) Jefferson County Commissioner Jinni:2( 7-12•16 Signature: Di tract 2: Cory Kirsch (Date) Signature: (Date) J tfersor�yCount't Commissioner t Lc� C�� ,� , /2 L> Signature: District 3: Bob Mullen (Date) Signature: (Date) Jefferson County Commissioner Signature: (Date) Signature: (Date) RECOMMENDED FOR APPROVAL: APPROVED FOR AND ON BEHALF OF DEPARTMENT: t> Stephanie Marshall, Right-of-Way Agent (Date ' NSOP items approved, if applicable (Date) r'J37C'1 I. Consultant Project or R/W Manager, if applicable (Date) Therese fwaniak, R/W Supervisor (Date) Acquisition Manager (Date) Page 2 of 2