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2. 
5. Application for Permission to Place Dumpster in City R.O.W.
7. The Director of Public Works must approve all applications.
9. Conditions:
   1. Dumpster must not interfere with or restrict traffic flow, plowing, or street cleaning operations.
11. 2. Dumpster must not be located in the vicinity of any blind spots in the roadway.
13. 3. Applicant must furnish and place barricades and flashers at each end of the dumpster.
15. 4. Permission to place dumpster in R.O.W. will be revoked if any complaints are received.
17. 5. Applicant must furnish a Certificate of Insurance in the amount of $2,000,000 General Liability & the City of Bristol must be named as co-insured.
19. Upload your Certificate of Liability Insurance here:
    You may also send your Certificate of Liability Insurance via email (publicworks@bristolct.gov), or via fax (860-584-3838).
20. Your application is not complete until we receive your COI
22. 6. Placement of dumpster in R.O.W. must not exceed 7 calendar days.
24. 7. Applicant is responsible for cleaning up and restoring the area.
28. Name of Applicant (s):*
30. Applicant's Address:*
31. Apt/Unit
33. City*
34. State*
35. Zip*
37. Telephone #: *
38. Email address:*
40. Location of Dumpster:*
    (Street & Address)
42. Distance to Nearest Fixed Object:*
    (Pole, Driveway, Etc.)
44. Anticipated Date and Time of Dumpster Placement*
    Anticipated Date and Time of Dumpster Placement

    Anticipated Date and Time of Dumpster Placement
45. Anticipated Date of Dumpster Removal:*
    Anticipated Date of Dumpster Removal:
    Must not exceed 7 calendar days from the date of placement
47. Insurance Furnished:
49. Company:*
50. Policy #:*
51. Policy Effective Dates:*
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field