Form TR-0106 "Chain Installer Permit Application/Release of Liability" - California

What Is Form TR-0106?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2018;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form TR-0106 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

ADVERTISEMENT
ADVERTISEMENT

Download Form TR-0106 "Chain Installer Permit Application/Release of Liability" - California

Download PDF

Fill PDF online

Rate (4.5 / 5) 28 votes
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CHAIN INSTALLER PERMIT APPLICATION/RELEASE OF LIABILITY
Page 1 of 3
TR-0106 (REV 12/2018)
PERMIT NUMBER
The applicant hereby applies for permit to install and remove tire chains on motor vehicles
during the snow season on assigned State Routes.
Name
Mailing Address
VEST NUMBER
Business Telephone No.
FOR OFFICIAL USE ONLY
Driver's License/ CA I.D.
Birthday
Fee:
$164.00
DATE:
Business License No(s).
County
Vest:
$
COLLECTED BY:
Total fee
Chaining Area
paid:
$
If you have an existing permit or have submitted an application in another District provide
Any dishonored checks will be considered as a
the following:
violation of the permit and will be an automatic
one year suspension.
District
Permit #
Pending
I have read, understand and agree to the CHAIN INSTALLER’S CONDUCT AND WORKMANSHIP CONDITIONS contained herein, and
I agree to comply with all provisions and conditions of this Chain Installer Permit Application/Release of Liability and the Chain Installer
Permit issued to me. Any failure to do so will result in suspension or revocation of my chain installer’s permit. I have also read, understand
and agree to the INDEMNIFICATION and ASSUMPTION OF RISK AND RELEASE OF LIABILITY provisions contained herein.
INDEMNIFICATION: I hereby agree to indemnify and save harmless the State of California, its officers, directors, agents,
employees, contractors, subcontractors and each of them (STATE) from and against any and all claims, demands,
causes of action, damages, costs, expenses, actual attorney’s fees, judgments, losses and liabilities of every kind and
nature whatsoever (CLAIMS) arising out of or in connection with the issuance and/or use of this permit for: 1) bodily
injury and/or death to persons including but not limited to myself, STATE, and the public; and 2) damages to property of
anyone. Except as provided by law, the indemnification provisions stated above shall apply regardless of the existence
or degree of negligence or fault of STATE.
ASSUMPTION OF RISK AND RELEASE OF LIABILITY: I understand that working as a chain installer carries with it
certain risks including, but not limited to, serious bodily injury and/or death resulting from being struck by moving
motor vehicles. To the maximum extent allowed by law, and in consideration for permission to work as a chain installer,
I hereby knowingly and expressly assume all such risks, and I, on behalf of myself and my heirs and assigns, agree to,
and I do hereby, release and hold harmless STATE, and waive all CLAIMS against STATE, for: 1) any and all loss,
damages, injury and/or death arising out of or in connection with the issuance or use of this permit; and 2) any and all
loss, damages, injury and/ or death arising out of or related to my work as a chain installer. The assumption of risk and
release of liability provisions stated above shall apply only to STATE and, except as provided by law, shall apply
regardless of the existence or degree of negligence or fault of STATE.
I UNDERSTAND THAT THE INTENT AND EFFECT OF THIS DOCUMENT IS TO RELEASE STATE
FROM LIABILITY FOR ANY PERSONAL INJURIES OR DEATH THAT OCCUR TO ME WHILE
WORKING AS A CHAIN INSTALLER, EVEN IF CAUSED BY STATE’S OWN NEGLIGENCE OR FAULT.
APPLICANT'S SIGNATURE
DATE
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CHAIN INSTALLER PERMIT APPLICATION/RELEASE OF LIABILITY
Page 1 of 3
TR-0106 (REV 12/2018)
PERMIT NUMBER
The applicant hereby applies for permit to install and remove tire chains on motor vehicles
during the snow season on assigned State Routes.
Name
Mailing Address
VEST NUMBER
Business Telephone No.
FOR OFFICIAL USE ONLY
Driver's License/ CA I.D.
Birthday
Fee:
$164.00
DATE:
Business License No(s).
County
Vest:
$
COLLECTED BY:
Total fee
Chaining Area
paid:
$
If you have an existing permit or have submitted an application in another District provide
Any dishonored checks will be considered as a
the following:
violation of the permit and will be an automatic
one year suspension.
District
Permit #
Pending
I have read, understand and agree to the CHAIN INSTALLER’S CONDUCT AND WORKMANSHIP CONDITIONS contained herein, and
I agree to comply with all provisions and conditions of this Chain Installer Permit Application/Release of Liability and the Chain Installer
Permit issued to me. Any failure to do so will result in suspension or revocation of my chain installer’s permit. I have also read, understand
and agree to the INDEMNIFICATION and ASSUMPTION OF RISK AND RELEASE OF LIABILITY provisions contained herein.
INDEMNIFICATION: I hereby agree to indemnify and save harmless the State of California, its officers, directors, agents,
employees, contractors, subcontractors and each of them (STATE) from and against any and all claims, demands,
causes of action, damages, costs, expenses, actual attorney’s fees, judgments, losses and liabilities of every kind and
nature whatsoever (CLAIMS) arising out of or in connection with the issuance and/or use of this permit for: 1) bodily
injury and/or death to persons including but not limited to myself, STATE, and the public; and 2) damages to property of
anyone. Except as provided by law, the indemnification provisions stated above shall apply regardless of the existence
or degree of negligence or fault of STATE.
ASSUMPTION OF RISK AND RELEASE OF LIABILITY: I understand that working as a chain installer carries with it
certain risks including, but not limited to, serious bodily injury and/or death resulting from being struck by moving
motor vehicles. To the maximum extent allowed by law, and in consideration for permission to work as a chain installer,
I hereby knowingly and expressly assume all such risks, and I, on behalf of myself and my heirs and assigns, agree to,
and I do hereby, release and hold harmless STATE, and waive all CLAIMS against STATE, for: 1) any and all loss,
damages, injury and/or death arising out of or in connection with the issuance or use of this permit; and 2) any and all
loss, damages, injury and/ or death arising out of or related to my work as a chain installer. The assumption of risk and
release of liability provisions stated above shall apply only to STATE and, except as provided by law, shall apply
regardless of the existence or degree of negligence or fault of STATE.
I UNDERSTAND THAT THE INTENT AND EFFECT OF THIS DOCUMENT IS TO RELEASE STATE
FROM LIABILITY FOR ANY PERSONAL INJURIES OR DEATH THAT OCCUR TO ME WHILE
WORKING AS A CHAIN INSTALLER, EVEN IF CAUSED BY STATE’S OWN NEGLIGENCE OR FAULT.
APPLICANT'S SIGNATURE
DATE
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CHAIN INSTALLER PERMIT APPLICATION/RELEASE OF LIABILITY
Page 2 of 3
TR-0106 (REV 12/2018)
DEPARTMENT OF TRANSPORTATION ENCROACHMENT PERMIT
CHAIN INSTALLER'S CONDUCT AND WORKMANSHIP CONDITIONS
In accordance with Section 670 of the Streets and Highways Code, permission is hereby granted to install and remove the chains for compensation
within the State's Highway rights-of-way when required by the Department, relating to the safe and orderly movement of traffic, for the safe
operation of the highways. The permittee shall operate in compliance with Section 670 of the Streets and Highways Code and all provisions of this
Encroachment Permit and the Chain Installer Permit Application/Release of Liability he/she executed including the Conduct and Workmanship
Conditions stated herein, and shall conform to all other applicable State and local laws. If the county or other political subdivision within which the
permittee intends to install chains requires the permittee to have a business license in order to collect fees for doing this work, such business
license shall be obtained by the permittee and the license must be presented before this Encroachment Permit will become valid for use. This
Permit may be suspended or revoked as provided in these Conduct and Workmanship Conditions, for non-compliance with any of the provisions
of this Encroachment Permit or the Chain Installer Permit Application/Release of Liability executed to obtain this permit, at any time by any
Departmental representative or the California Highway Patrol. The permittee shall surrender, upon demand by any Departmental representative
or the California Highway Patrol, their chain installer permit and chain installer identification vest. Failure to comply shall be cause for denial of
any future chain installer permits.
Prior to issuance of a permit, all chain installer applicants shall attend a mandatory chain installer orientation class, pass a written test, and
demonstrate knowledge of snow tire identification and proficiency in tire chain installation. Failure to attend the mandatory chain installer
orientation class, shall result in permanent revocation. The number of permits available for issuance is limited. First consideration shall be
given to prior applicants of the previous winter season, providing their permits were not suspended for more than 30 days or revoked during
the previous winter season.
Any permits suspended near the end of the winter season, and/or if the suspension if found to be ineffective at the time so ordered in the opinion
of the District Permit Engineer, may be applied to the next winter season if so stated in the letter of suspension to the permittee.
Appeals of any punitive action taken against a chain installer permittee, shall be submitted in writing within 5 business days to the District Permit
Engineer at:
A written decision shall be rendered within 10 business days from the receipt of the written appeal. The District Permit Engineer's written decision
may be appealed in writing within 5 business days, to the District Director in which the permit was issued. The District Director's decision shall be
rendered in writing within 10 working days from the receipt of the appeal, and this decision is final. (There are no further administrative rights of
appeal).
Penalties noted in this permit are minimums. Severe penalties may be imposed for any infraction of Permit Conditions if warranted by
the circumstances, or by the permittee's conduct.
All permit fees paid to the Department of Transportation are nonrefundable.
1. When installing, removing, repairing or modifying tire chains, the permittee shall display a sign (measuring a minimum of 12" x 24" up to a
maximum of 18" x 36") advising motorists in advance of their fee for providing these services, and their vest number. The letters shall be a
minimum of four inches high with a minimum brush stroke of 5/8". A permittee failing to display this sign, and/or display of any other type of
advertising sign other than this required sign will be issued a warning, and shall cease work until the unauthorized display is removed.
2. The permittee shall be in possession of a receipt book and shall issue one when requested by a motorist. The receipt shall show the
permittee's name, vest number, the type of work performed (installing, removing, repairing, modifying tire chains), and the fee charged for
the work. A permittee failing to issue a receipt for services provided when requested, shall be suspended for 7 days.
3. This Permit is non-transferable, only the person to whom it was issued is to perform the services authorized herein, and shall have it in their
possession at all times when performing said services. This Permit shall be presented for inspection upon demand by any departmental
representative, the California Highway Patrol, or any local law enforcement personnel. A warning will be issued to any permittee found to be
working without their permit in their possession, they shall cease work immediately, and surrender their identifying vest, until their permit
can be produced to regain their identifying vest.
4. Any person found working under a permit not issued to them, and any permittee allowing such use, shall immediately surrender the permit.
And, neither individual will be eligible for issuance of a chain installer permit for a minimum of one year.
5. A colored vest containing the permittee's identifying number will be issued along with this permit. THIS VEST IS THE PROPERTY OF THE
DEPARTMENT. The vest shall be worn in plain sight in a legible manner at all times by the permittee while performing the services specified
herein. A permittee found to be working without their vest being clearly legible, shall be issued a warning, and shall cease all work until their
vest and identifying number are made clearly visible.
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CHAIN INSTALLER PERMIT APPLICATION/RELEASE OF LIABILITY
Page 3 of 3
TR-0106 (REV 12/2018)
6. Loss of a permittee's permit or identification vest shall be immediately be reported to the Department's district office that issued the permit.
Application for a duplicate permit or identification vest may be made during normal business hours. A duplicate permit will be issued upon
payment of the administrative fee (equal to one hour multiplied by the Standard Hourly Rate). A replacement vest will be issued upon
payment of the administrative fee plus the cost of the vest itself.
7. A permittee may only park a single vehicle within the State's highway rights-of-way in the area designated by the Department of the California
Highway Patrol, and only during the time the permittee is engaged in activities authorized by this permit. Parking on State conventional
highways in similarly designated areas shall conform with the applicable provision of the Vehicle Code. If a permittee's vehicle is parked in a
location or manner that interferes or impedes with highway traffic, snow removal equipment, or parked on any freeway ramp or taper, the
permittee shall be suspended for 7 days.
8. Permittees are not allowed in the lanes maintained for through traffic. A permittee shall remain in the area designated for installation or
removal of tire chains. Any interference, stopping, or controlling of traffic by flagging, signs, arm movements, the waving of signs or lights,
etc., impeding the orderly movement of traffic caused by a permittee shall result in a suspension of 7 days.
9. Vending or renting of tire chain accessories, or other items or products upon any State highway rights-of-way by a permittee is strictly
prohibited. A permittee offering to sell or rent tire chains or other items, or who accepts money for the sale or rental of tire chains or other
items, shall immediately surrender his/her permit and identification vest and shall be ineligible for issuance of a chain installer permit for a
minimum of one year. Such a permittee may be subject to prosecution for violation of the law (Streets and Highways Code Section 731)
prohibiting vending on State highways.
10. Permittees shall conduct their business in a professional and courteous manner. A permittee found to display poor workmanship in installing
chains, giving misleading statements concerning the necessity for altering chains, misrepresenting any conditions or requirements regarding
chain regulations, or causing complaints relative to his/her conduct shall be issued a warning. These violations may result in suspension or
revocation of permit privileges, depending on the circumstances of the incident and the conduct of the permittee. A permittee presenting any
form of threat or violence toward any person or property while involved in the activities related to this permit shall immediately surrender his/
her permit and identification vest and he/she shall be permanently ineligible for issuance of a chain installer permit.
11. Permittees shall wear yellow, orange or lime colored raingear (rain suit or jacket and class E pants). Personal protective safety clothing shall
meet the ANSI/ISEA
Performance Class 3 requirements of the
"American National Standard for High Visibility Safety Apparel and Accessories". A permittee found working without proper rain gear will be
issued a warning, and shall immediately cease work, surrender his/her permit, and identification vest. Work may resume when the permittee
is equipped with the proper rain gear and has regained their permit and identification vest.
12. Permittees shall only work in established chain installing areas. A permittee found working in an area other than the established area will be
suspended for the winter season and shall immediately surrender his/her permit and identification vest.
13. Permittees shall be 18 years of age or older. A permittee found to have obtained his/her permit by falsifying their age shall immediately
surrender their permit and identification vest. And, shall not be eligible for issuance of a chain installer permit for a period of one-year
extending beyond the date they attain 18 years of age.
14. A permittee maintaining an open fire or littering on the highway right of way shall be issued a warning.
15. A permittee may apply for a second chain installer permit in another district, provided there is no waiting list.
16. Unless surrendered, suspended or revoked as provided in the Permit package conditions, a permit shall expire on June 30 in the year
following its issuance.
17. A permittee shall not use any work lights in a manner that would impact motorists on the highway or the snow clearing equipment operators.
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Page of 3