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Minnesota Department of Transportation Adopt -a -Highway Permit (check one) 0 Adopt -a -Highway. The group agrees to pickup litter at least three times a year for a minimum of two years. - 1' ❑ Pick -a -Highway. The group agrees to pick up litter one time only. We request percussion to pick up litter on between and for a total of miles. The Minnesota Department of Transportation reserves the right to refuse, cancel or revise this agreement if in its sole judg- ment the nature of the group or its sign is political, controversial or in questionable taste, or if the group is not meeting the terms and conditions of this agreement. By signing this agreement, the group acknowledges the hazardous nature of the work and agrees to comply with the terms and conditions herewith to the satisfaction of the Minnesota Department of Transportation. Except for the negligent acts of the State, its agents and employees, the volunteers or their agents shall assume all liability for, and save the State, its agents and employees, harmless from, any and all claims for damages, actions or causes of action arising -out of the work to be done herein. Any and all volunteers of the group or other persons while engaged in the performance of any work or service performed under this agreement shall not be considered employees of the State, and any and all claims that may or might arise under . the Worker's Compensation Act of Minnesota on behalf of said employees or other persons while so engaged, and any and all claims made by any third party of the group's volunteers or other persons while so engaged on any of the work or . services to be rendered shall in no way be the obligation or responsibility of the State. Name of group (please print) Name of group representative Signature _ Phone (home) (work) Name to appear on sign .Special provisions Area Maintenance Engineer Date