2012 VPAH, LLC - Village Park Animal Hospital - Storm Water ManagementRECORDING REQUESTED BY
AND WHEN RECORDED RETURN TO:
City of La Quinta
City Clerk
P.O. Box 1504
78-495 Calle Tampico
La Quinta, CA 92253-1504
EXEMPT FROM RECORDERS FEES PURSUANT TO
GOVERNMENT CODE SECTIONS 6103 AND 27383.
DOC # 2013-0065014
02/06/2013 12:49P Fee:NC
Page 1 of 8
Recorded in Official Records
County of Riverside
Larry W. Ward
Assessor, County Clerk & Recorder
111111111111111111111111111111111111111111111111111111
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APN: 773-072-019 SPACE ABOVE THIS LINE FOR RECORDER'S USE
STORM WATER MANAGEMENTBMP M
FACILITIES AGREEMENT NO.2012-002
City of La Quinta, Riverside County, California
THIS AGREEMENT, is made and entered into this Zgttday ofAdUAKV , 2013, by
and between Kathryn Carlson, hereinafter called the "Landowner," and the City of La. Quinta,
California, hereinafter called the "City."
RECITALS
WHEREAS, the Landowner is the owner of certain real property describe as Lots 9, 10,
11, and 12 Block 128 of Santa Carmelita at Vale La Quinta No. 14 as recorded by deed in the
land records of Riverside County, California, Map Book 18 Page 82, hereinafter called the
"Property," and more particularly and legally described in Exhibit, "A" attached hereto and made
a part hereof by this reference; and
WHEREAS, the City is the owner of Eisenhower Drive, Avenida Montezuma, and
Avenida Martinez and its storm drains that are adjacent to the Property, and
.I
WHEREAS, the City is subject to the Riverside Countywide National Pollutant
Discharge Elimination System ("NPDES") Municipal Stormwater Permit issued by the State
Water Resources Control Board — Colorado River Region No. 7 (''NPDES Permit"): and
WHEREAS, pursuant to the NPDES Permit and the City's.Stormwater Management and
Discharge Controls Ordinance (codified as Chapter 8.70 of the La Quinta Municipal Code)
("Ordinance"). all new development must implement storm water treatment devices, fund the
perpetual maintenance of those devices, and enter into an agreement with the City stating that the
landowner, his successors, heirs, and assigns, will maintain the devices, grant a right of entry to
City staff for inspections, and agree to pay the cost of such City inspections; and
WHEREAS, the Landowner is proceeding to build on and develop the Property; and
2479/015610-0002
1015111. 03.03,27112
WITNESS the following signatures and seals:
40 L,ANDOWNE '
By:
Name: Kathryn J. Carlson
Please Print
Title: Owner
11
ATTEST:
By: �/��
Name: �^ moo` f
Please Print
Title: U Ofix 6I _ LA,/6) I C,
Notary must attach an "All -Purpose
Acknowledgement'
(Seal)
cow.aMW
NOTARYPUBLIC CAUFORNMI
RIVERSIDE COUNtY
E.Commission 6es JULY 22, t015
CITY qF LA QU p lf,A
..Frm—WJ. S v k, City Manager
ATTEST: PAPR VED S t7 FORM:
By:
Susan Maysels, City Clerk 1A. katherine
City Attorney, ' of La Quinta
All signatures on this Agreement on behalf of the Owner must be acknowledged before a Notary
Public. In the event that the Owner is a corporation, the President/Vice President and the
corporate secretary of the corporation must sign and the corporate seal must be affixed thereto.
1479 (115610-0002
10151I1 03 a01/27/12
5-
State of California )
County of Riverside 1
On January 24, 2013, before me, SUSAN MAYSELS, Notary Public,
personally appeared FRANK J. SPEVACEK who proved to me on the basis of
satisfactory evidence to be the person whose name is subscribed to the
within instrument, and acknowledged to me that he executed the same in his
authorized capacity, and that by his signature on the instrument the person,
or the entity upon behalf of which the person acted, executed the
instrument.
I certify under PENALTY OF PERJURY under the laws of the State of
California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal. 3-------Wfsecs
NOTARY PUBLIC • cAUFOMA
M R&M COUNTY
Signature i.giLf Q.( Canmuion ' APa13 2013 +
(seal)
DOCUMENT:
STORM WATER MANAGEMENT / BMP FACILITIES AGREEMENT NO. 2012-
002 between Kathryn Carlson (Landowner) and City of La Quinta dated
1 /24/2013 re: APN 773-072-019.
CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
l�j
County of
On �Il 2-before me, i'C.�I Ianda F"W i N*1O`4 �I I" 1lC
(Here insert nametand title of the officer)
personally appeared ��y,�=�—_ � V� �
who proved to me on the basis of satisfactory evidence to be the se (s) whosdCQ (snare subscribed to
the within instrument and ark r�owledged a that he/(i they executed the same in hiADheir authorized
wh�ci (les) and that by his/ heir=(s) on the instrument th (s), or the entity upon behalf of
he jjjrso ) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and of I seal.
Signature of Public
FERNAlIDA ----------------
No$
talon. aittI MI
WT&W Pl gM a C&FORWq
MVER X COUNTY
CWMWM t Itet,NtYY! P515
(Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOC NT
(Ti e or desion of ttac t)
(Title or description of attached document commue )
Number of Pages Document Date
(Additional information)
CAPACI CLAIMED BY THE SIGNER
vldu s)
❑
orporate Officer
Title)
❑
Partner(s)
❑
Attomey-in-Fact
❑
Trustee(s)
❑
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document The only exception is if a
document is to be recorded outside of California. In such instances, any alternative
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that is illegal for a notary in
California (i.e. certifying the authorized capacity of the signer). Please check the
document carefully for proper notarial wording and attach this form tf required.
L• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the names) of document signer(s) who personally appear at the time of
notarization.
• Indicate the correct singular or plural fors by crossing off incorrect forms (i.c.
he/shehhey, is /are ) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment for.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
J Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
f Indicate title or type of attached document, number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (ie. CEO, CFO, Secretary).
• Securely attach this document to the signed document
2008 Version CAPA v 12. 1 0.07 800-873-9865 "�N%.NotaryClasses.corn
At'oR' ® CERTIFICATE OF LIABILITY It
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must I
the terms and conditions of the policy, certain policies may require an endorsement. A at
certificate holder In lieu of such endorsement(s).
PRODUCER
Commercial Lines - (916) 589-8000
Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408
10940 White Rock Road, 2nd floor
Rancho Cordova, CA 95670-6076
CONTACT
NAME
PNO N
EMAIL
ADDRESS;
I
INSURER A: Her
INSURED
Village Park Animal Hospital
P.O. BOX 1711
La Quinta CA 92253
INSURER B
INSURER C:
INSURERD:
INSURER E
INSURE0. F
COVEKAGtS - -------
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LT
TYPEOF INSURANCE
DL
UBR
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
05/01/12
POLICY EXP
MM/DO/YYVV
LIMITS
05/01/13
EACH OCCURRENCE
$ 2,000,000
A
GENERAL LIABILITY
%t COMMERCIAL GENERAL LIABILITY
ODF905552400
PREMISES(Ea occurrence
$ 1,000.000
MED EXP (Any one person)
$ 10,000
CLAIMS -MADE X OCCUR
PERSONAL B ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 4,000,000
PRODUCTS - COMP/OP AGG
$ 2,000.000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
COMBINED SINGLE LIMIT
$
AUTOMOBILE LIABILITY
Ea awitlent
BODILY INJURY (Per Derson)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
-
BODILY INJURY (Per eccitlent)
$
PROPERTY DAMAGE
Pera«ident
$
E
X
UMBRELLA LIAB
EXCESSLIAB
OCCUR
CLAIMS -MADE
ODF9055524
5/1/2012
5/1/2013
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
WC STATU- OTH-
DE RETENTION
WORRERS COMPENSATION
E.L. EACH ACCIDENT
$
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN
E.L. DISEASE - EA EMPLOYE
$
EXCLUOEDI
OFFICERIMEMBER ❑
(Mandatory In NH)
NIA
llyes,desaibe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more a pace la required)
The City of La Quinta is named as Additional Insured with respect to General Liability
City of La Quinta
PO Box 1504
La Quinta, CA 92247
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010/05)
reserved.
POLICY NUMBER: ODF905552400
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
Name of Person or Organization:
SCHEDULE
City of La Ouinta
PO Box 1504
La Ouinta, CA 92247
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or
rented to you.
The City of La Ouinta is named as Additional Insured with respect to General Liability
CG 20 2611 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 0