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11010
_ See below for Finance Revenue Codes ENCROACHMENT PERMIT FT° PUBLIC WORKS CONSTRUCTION "Psi For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS. Subdivision Improvement Permit - Class I II Minor Improvement Permit - Class IV DATE: 1/26/2011 LOCATION OF CONSTRUCTION: La Quinta Chamber of Commerce Car Show; 77865 Avenida Montezuma; La Quinta Community Park PURPOSE OF CONSTRUCTION: Putting Up Temporary (10) Directional Signs for Event and Traffic Control Around Park DESCRIPTION OF CONSTRUCTION: See Attached Traffic Control Plan and Exhibit for Directional Sign Locations DIMENSION OF INSTALLATION OR REMOVAL: (10) Y x 2' Directional Signs and Other Signs shown on Traffic Control Plan APPROXIMATE TIME WHEN WORK WILL BEGIN: 1/30/2011 TIME OF COMPLETION: 1/30/2011 ESTIMATED CONSTRUCTION COST: NIA (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS%ONOT PUT DIRECTIONAL SIGNS IN MEDIAN In consideration of the granting of this permit, the applicant hereby agrees to: Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or occuring as a proximate result of any work undertaken under the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started at (760) 777- 7097. To submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at least twenty-four (24) hours prior to the anticipated inspection. Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the result of this work. Signa re ent La Quinta Chamber of Commerce = David Archer 78-275 Calle Tampico t/B, La Quinta, CA 92253 760-564-3199 Name of Applicant Business Address Telephone No Sign a Rama 41945 Boardwalk Suite L, Palm Desert, CA 92211 760-776-9907 Name of Contractor and Job Foreman Business Address Telephone No. 830131 4466 Contractor's License Number City Business License No Burns & Wilcox Insurance Services NBP1550164A Applicant's Insurance Company Policy Number FEES Subdivision Improvement Permit - Class I Minor Improvement Permit - Class I Finance Revenue Code Inspection Fee EE=1 $0.00 Permit Fee E_1 $0.00 As -Built Deposit E-A $0.00 Cash Deposit -Surety Bond, EE=6 0.00 if required TOTAL $0.00 Public Improvements: 3% of estimated construction costs Private Improvements: 3% of estimated construction costs PERMIT NUMBER: 11010 DATE ISSUED: / EXPIRATIO DATE: /L BY: WORK INSPE ED BY`: PERMIT COMPLETION DATE*: If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. F r .� `, F r `, �� f City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number 11010 The following shall always app/v: ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within the City of La Quinta's right of way ONLY. Whenever construction extends within private property, it is the responsibility of the permittee for his contractors to secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work. TRACK -LAYING CONSTRUCTION EQUIPMENT: Cleated track -laying construction equipment shall not be permitted to operate on any paved surface unless fitted with smoother -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect the paving during excavations. Rubber -tired equipment only shall be used in backfill operation in paved areas. If the existing pavement is scarred, spalled, or broken during the term of this contract or if the pavement is marred, City of La Quinta shall request that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2") of A.C. surfacing plus appropriate seal coat as specified above. PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City Engineer or City of La Quinta Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration of the project. The City shall be notified twenty-four hours (24) in advance of any traffic detours or delineation. CARE OF DRAINAGE STRUCTURES: Any drainage structure to include corrugated metal pipe, concrete pipe, steel culvert and concrete structures encountered during excavation which necessitate removal shall be replaced in kind. In the event it becomes necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work. Drainage structures and open drains shall be kept free of debris at all times for proper drainage. RIGHT-OF-WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill and compaction. Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used immediately after backfill. DE -WATER OPERTATIONS: If de -watering operations are required and pumps are forcing water on City of La Quinta roads, it shall be the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary. CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited access for the adjoining property owners and emergency vehicles. In the event it is felt by the permittee that he must close a street for any length of time, permittee shall contact this office to obtain the necessary permission. SPECIAL PROVISIONS The following shall apply when indicated: ® R1 NOTIFICATION: Permittee shall be notified the City at (760) 777 - 7097 at least forty-eight hours (48) in advance of starting construction. ® R2 UTILITY CLEARANCE: (Substructures) Prior to making any excavations within the City of La Quinta right-of-way authorized by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures. Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility of the perm ittee. ® R3 UTILITY CLEARANCE (Surface Structures) No work shall be done under this permit until all utilities are clear of the proposed work site. The permittee shall notify all concerned utility companies of the proposed work. ❑ R4 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced with ( ** N/A ** ) inches of A.C. paving placed on ( ** N/A'* ) inches of ( ** N/A ** ) aggregate sub -base course having an "R" value of not less than ( ** N/A ") and in conformance with the City of La Quinta Road Improvement Standards and Specifications, Ordinance #461. ® R5 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of one-fourth inch (W) to one foot (1'). ❑ R6 GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades as established by a licensed engineer. ❑ R7 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter (" N/A **) feet shall be removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207. ❑ R8 DRIVEWAYS: A.C. driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the property line and the existing road paving shall be two and a half inches (2 Yz") of A.C. paving on (** N/A **) of class (" N/A " ) aggregate base. ® R9 SIGHT CLEARANCE: Sight Clearance of six -hundred feet (600') in all directions shall be assured and maintained at all times. ❑ R10 SOIL STERILIZER: The area to be surfaced shall be treated with soil strerilizer. Rate of application shall comply with the manufacturer's specifications. City of La Quinta ® R11 COORDINATE WORK: The proposed work shall be subordinated to any operation, which the State of California or City of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects. ❑ R12 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the centerline of all streets or property lines when included shall be completely tied out so they may be readily and correctly, replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the ties to these monuments shall be fumished to the City Engineer prior to the removal of any monuments. This office shall be notified upon completion or replacement of all surrey monuments for proper clearance. ❑ R13 PAVEMENT CUTTING: Pavement will be mechanically saw cut to a straight edge prior to excavation. Method of pavement cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment be used to excavate prior to cutting or pavement.) Excavation material shall be placed in such a position as to best facilitate the general flow traffic. Prior to final paving operations, any damage to pavement straight edges shall be corrected. ❑ R14 LIMIT OF EXCAVATIONS: Excavations shall be limited to one -thousand feet (1000') of open trench before backfill operations must begin. All excavations shall be property barricaded with lights overnight, on weekends and holidays for the protection of the traveling public. The Public Works Inspector shall determine the suitability of excavation barricading in each case. No excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction material is actually on the work site. ❑ R15 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes of producing and adequately consolidated backfill. Ant material which the City of La Quinta deems unsuitable (spongy or saturated material) which is encountered during excavation shall not be used for backfill, but shall be supplemented or replaced by an approved sand or gravel. ❑ R16 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed on lifts not greater than three feet (3') and vibrated using vibrostamper or equivalent equipment. Alternate methods may be substituted, but in any case, a relative compaction of ninety-five percent (95%) shall be maintained with the structural section of the roadway. ❑ R17 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than fifty percent (50%) of the total depth of the trench before flooding or a maximum of five feet (6) lifts where trenches are of excessive depths. Care is to be exercised that the backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the resulting compaction shall not be less than ninety percent (90%) or equivalent to the surrounding ground, whichever is the greater compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water supply shall be continuos. ❑ R18 COMPACTION TESTS: If so required by the inspector, compaction test shall be made at intervals of not more than one - thousand (1000') feet and a maximum of one (1) test on each road. One (1) copy of each test shall be forwarded tot the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ❑ R19 COMPACTION TESTS: If so required by the Inspector, compaction tests shall be made for each crossing or service line. One (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Sections 6.3.001 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ❑ R20 TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch consisting of two inches (2") of SC -800 shall be placed on a prepared sub -grade. The SC -800 temporary paving shall be placed after a maximum of three -thousand linear feet (3000') or trench has been excavated and backfill operations completed, but in no case shall the placement of the temporary pavement exceed a five (5) day limit. ❑ R21 PERMANENT PAVEMENT REPAIR: After backfill and compaction have been completed, a temporary patch consisting of two inches (2") of SC -800 shall be placed immediately. A permanent patch of ( " N/A " ) inches of A.0 surfacing placed on a ( ** N/A ** ) inch (" N/A " ) aggregate base shall be placed no later than ("" N/A "") days after completion of temporary road repair. ❑ R22 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as determined by the City Engineer. ❑ R23 STREET RESTRIPING: Where street striping is still visible on street to be excavated, such striping shall be replaced upon completion of permanent repairs. ❑ R24 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right-of-way shall be accomplished by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public. It shall be the responsibility of the permitte to maintain the tree in a vigorous growing condition at its new location. Trees to be removed shall be in sections, which can be handled safely without interference or hazard to highway traffic. The entire width of the tree stump, shall be removed and disposed of so that no debris remains in view of the highway. The stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of five -hundred feet (500') at any one time. Adequate signs, flagmen and or barricades shall be provided to protect the traveling public at all times. Large holes resulting from tree removal shall be backfilled and compacted to not less than ninety percent (90%) or equivalent tot the surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973. N .. i PERMIT NO. 11010 La Quinta Car Show / Traffic Control and 10 Directional Signs/ La Quinta Community Park In addition to the standard permit conditions, the following shall apply: 1. Anne Blalock with the Chamber of Commerce shall be available during the event by cellular phone at (760) 238-6186. 2. Pursuant to Section 14.16.320 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), all work shall be performed in accordance with the latest edition of the Standard Specifications For Public Works Construction (SSPWC) and as directed by and to the satisfaction of the City Engineer. 3. Chamber of Commerce (David Archer), hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. 4. Streets shall be kept clean. They shall -be completely cleaned at the end of each working day and more frequently, if required. 5. The permittee shall remove all signs immediately after the completion of the show. Sign removal should be accomplished by the end of 5PM on January 30, 2011. 6. Pursuant to Section 6.08.050 of the La Quinta Municipal Code (Ordinance 18 § 1, 1982), throughout the work site, the Permittee shall comply with City regulated work hours. Operation and maintenance of equipment within one-half mile of human occupancy shall be performed only during the following time periods: October 1st to April 30: Monday -Friday 7:00 a.m. to 5:30 p.m. Saturday 8:00 a.m. to 5:00 p.m. May 1st to September 30: Monday -Friday 6:00 a.m. to 7:00 p.m. Saturday 8:00 a.m. to 5:00 p.m. Work shall be prohibited on legal holidays and Sundays. Note: Construction work (including setting up traffic control devices) is not permitted on any Arterial street (ie any 4 lane street) before 8:00 a.m. 7. Work within 500 feet of a signalized intersection shall be performed between the hours of 9 a.m. - 3 p.m. Traffic control shall be set up after 9 a.m. and removed before 3 p.m. The Permittee shall contact the City Traffic Signal Maintenance Technician at (760) 250-0571 if signal operation at the intersection is to be altered in any way. 8. Pursuant to Section 14.16.110 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), Permittee shall assume responsibility for repair of any pavement damage to any public or private street and for any damage to other City streets or facilities as a result of work performed under this permit. Special ConditionsPage l of 3 . PERMIT NO. 11010 La Quints Car Show / Traffic Control and 10 Directional Signs/ La Quinta Community Park 9. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), on Collector to Major Arterial Streets, the permittee must submit a traffic control plan which shall be prepared under the guidance of the latest version of California Manual of Uniform Traffic Control Devices (MUTCD). It shall be the Permittee's responsibility to appropriately detour and barricade all construction sites. Pursuant to Section 14.16.290 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), street closures shall not be permitted. A minimum of two (2) travel lanes of paved surface shall be maintained at all times. 10. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts provided in the Engineering Bulletin for Indemnification & Insurance Requirements. This insurance shall be kept in full force and effect at all times by Applicant or Contractor during the prosecution of the permitted work and updated Certificate of Liability Insurance shall be submitted to the City. Each policy shall name the City as an additional insured. 11. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 1-800-422- 4133. It shall be the Permittee's responsibility to notify the Public Works Department of anticipated excavation which impact City facilities, including but not limited to traffic signal conduits and loops, irrigation lines, electrical conduits, and storm drain facilities. 12. Should additional work, materials, or modifications of the work be required in order to meet City standards, safety requirements, signage requirements, or to fit actual field conditions, the work shall be performed by the Permittee as directed by and to the satisfaction of the City Engineer at no cost to the City of La Quinta. 13. The City of La Quinta reserves the right to require modifications of the work be made at permittee's sole cost for proper sight distance requirements per guidelines in the AASHTO " A Policy on Geometric Design of Highways and Streets, 5a' Edition" or latest, in the installation of all appurtenances abutting and within the public street right-of-way. 14. Pursuant to Section 14.16.370 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), backfill compaction within street rights-of-way shall conform to Section 306-1.3 of the latest edition of the Standard Specifications for Public Works Construction (SSPWC), except as otherwise specified herein. No excavation or backfill will be required on this project. Reapply if excavation is required. 15. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its original condition. 16. Access and egress to all local properties shall be maintained at all times. Special ConditionsPage 2 of 3 PERMIT NO. 11010 La Quinta Car Show / Traffic Control and 10 Directional Signs/ La Quinta Community Park. 17. Pursuant to Section 14.16.375 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), permanent pavement replacement shall be completed no later than seven (7) days after the completion of the work. Permanent pavement replacement shall conform to the following conditions: No asphalt work will be required on this project. Reapply if excavation is required. 18. Permittee shall permanently stabilize any and all soil that was disturbed as a result of work performed under this permit with an approved dust control treatment. Soil stabilization shall be done immediately after completing the operation. 19. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 20. The permittee shall indemnify, hold harmless and assume the defense of the City from all damages, delay costs, costs or expenses in law or equity that may arise out of work under this permit. Special Conditions Page 3 of 3 10.�. F' , ,�^ L , � 4.• cif' t . 1 4 CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDlYYNn 01/2812011 PRODUCER BURNS & WILCOX INSURANCE SERVICES, INC. 9370 CHESAPEAKE DRIVE, SUITE 200 SAN DIEGO, CA 92123 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # LA QUINTA CHAMBER OF COMMERCE 78275 CALLE TAMPICO STE B LA QUINTA, CA 92253 INSURERA' UNITED STATES LIABILITY INS CO 114SLIRERB: INSURER C: INSURER D: INSURER E: IICATED. NOTWITHSTANDING TE MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH LIMITS $ 1,000,000 :e) $ 100,000 'n) $ 5,000 Ry $ $ AGG $ $ T $ $ $ $ =NT $ EA ACC $ AGG $ $ $ $ $ OTH- ER $ .OYEE $ IMIT $ 1,000,000 LAIBILITY. BE CANCELLED BEFORE THE OVERAGE WILL ENDEAVOR TO :ATE HOLDER NAMED TO THE ON OR LIABILITY OF ANY KIND IRD CORPORATION 1988 POLICY NUMBER: NBP1650164A BUSINESSOWNERS BP 04 02 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name of Person or Organization: Effective Date: 09/03/2010 The City of La Quinta P.O. Box 1504 La Quinta, CA 92247 Designation of Premises 78275 Calle Tampico Suite B La Quinta, CA 92253 *Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations A. The following is added to Paragraph C. WHO IS AN INSURED in Section II - Liability: 4. The person or organization shown in the Schedule is also an insured, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule. B. The following exclusions are added to Section II - Liability: This insurance does not apply to: 1. Any "occurrence" that takes place after you cease to be a tenant in the premises described in the Schedule. 2. Structural alterations, new construction or demolition operations perfored by or for the person or organization designated in the Schedule. BP 04 02 07 02 ISO Properties, Inc., 2001 I roiicy iNumDer: NlSY10bU1b4A uaie r- merea: 1/L'// euii ACORO®CERTIFICATE OF LIABILITY INSURANCE 1 DATE /27//DD/Y2011 1/27/1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 'RODUCER CONTACT Douglas W. Motz Insurance Agency, Inc. AME PHONE 43-875 Washington St. Ste AAIL (760)200-0270 aCNO:(760)345-5126 ADDRESS: dougmotz@yahoo.com Palm Desert, Ca 92211 PRODUCER JSURED La Quinta Chamber of Commerce 78275 Calle Tampico Ste B La Quinta, CA 92253 INSURER A: Burns & INSURER B: INSURER C : AFFORDING COVERAGE NAIC # :OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 'HIS 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 IEOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED ► D&O Liability-Nonpro NBP1550164A 913/2oio 9/3/2011 each claim i,000,UUU 0 IESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) ertificate Holder is Listed as Additional Insured, Hired and Non -Owned Auto Included in General Liabiliti imit ne Day Event -Location -7-78,65 Avenida Montezuma, La Quinta, CA 92253. Date of event 01/30/2011 ;ERTIFICATE HOLDER CANCELLATION Desert Recrecation District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 45305 --Oasis Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. (Pia-Quinta, CA 92253 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. %CORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICIES DESCRIBED E E N IS SUBJECT TERMS, U ND CONE ITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE EDUC BY PAID CLAIMS, ISR TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP L M GENERAL LIABILITY EACH OCCURRENCE $1,000,000 ► COMMERCIAL GENERAL LIABILITY X PREMISES (Ea occurrence)$100,000 CLAIMS MADE ® OCCUR NBP1550164A 9/3/2010 9/3/2011 M ED EXP (Any oneperson)$5, 000 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS - COMP/OP AGG $ $ POLICY PRO -LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS . PROPERTY DAMAGE $ (Per accident) H & No Auto $INCLUDED ► NON -OWNED AUTOS $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION TN C STATLIMU- OTH- TS ER CRYFR AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ► D&O Liability-Nonpro NBP1550164A 913/2oio 9/3/2011 each claim i,000,UUU 0 IESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) ertificate Holder is Listed as Additional Insured, Hired and Non -Owned Auto Included in General Liabiliti imit ne Day Event -Location -7-78,65 Avenida Montezuma, La Quinta, CA 92253. Date of event 01/30/2011 ;ERTIFICATE HOLDER CANCELLATION Desert Recrecation District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 45305 --Oasis Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. (Pia-Quinta, CA 92253 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. %CORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD BUSINESSOWNERS GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy No. NBP1550164A Effective Date: 09/03/2010 12:01 AM STANDARD TIME Liability and Medical Expenses $1,000,000 Medical Expense (per person) $5,000 Damages To Premises Rented To You (Any One Premises) $100,000 Hired and Non -owned Auto Each Occurrence Included Hired and Non -owned Auto Aggregate Included An Aggregate Limit of Liability applies to this Coverage as defined in SECTION 11 - LIABILITY, paragraph DA. of the Businessowners Coverage Form. 71 Location Address Territory 1 78275 Calle Tampico, Suite B, La Quinta, CA 92253 012 PRE(�gtliVl; CtflMl?�U .Moo Rate Advance Premium Loc Classification Code No. Premium Basis PNCo AU Other Pr/Co AN Other 1 Non -Owned 8 Hired Automobile Liability - Non Profit 90099 Flat 0.000 225.000 $0 $225 Organization 1 Additional Insured - Designated Person 49950 1 Per Additional 0.000 50.000 So $50 Insured 1 Additional Insured - Managers or Lessors of 49950 1 Per Additional 0.000 50.000 $0 $50 Premises Insured 1 Additional Insured - Mortgagee, Assignee or Receiver 49950 1 Flat 0.000 0.000 Included Included 1 Chamber of Commerce - Not -For Profit only 41668 2.000 Per 1,000 Total 0.000 280.498 $0 $561 Area MINIMUM PREMIUM FOR GENERAL LIABILITY COVERAGE PART: $450 TOTAL PREMIUM FOR GENERAL LIABILITY COVERAGE PART: $886 (This Premium maybe subject to adjustment) MP -minimum premium Coverage Forms)/Part(s) and Endorsement(s) made a part of this policy at time of issue: See Form EOD (01/95) THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. ,ndwans copyngn[ea marenai or too "mmerciai KisK ,services, inc., wivi ns permission. BPL150 (02/091 Coavriaht. ISO Commercial Risk Services. Inc.. 1983. 1984. 1988 Page 1 Of 1 POLICY NUMBER: NBP1550164A BUSINESSOWNERS BP 04 02 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies Insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name of Person or Organization: Effective Date: 09/032010 The City of La Quinta P.O. Box 1504 La Quinta, CA 92247 Designation of Premises 78275 Calle Tampico Suite B La Quinta, CA 92253 *Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations A. The following is added to Paragraph C. WHO IS B. The following exclusions are added to Section Il - AN INSURED in Section II - Liability: Liability: 4. The person or organization shown in the Schedule This insurance does not apply to: is also an insured, but only with respect to liability 1 • Any "occurrence" that takes place after you cease to arising out of the ownership, maintenance or use be a tenant in the premises described in the of that part of the premises leased to you and Schedule. shown in the Schedule. 2. Structural alterations, new construction or demolition operations perfored by or for the person or organization designated in the Schedule. BP 04 02 07 02 ISO Properties, Inc., 2001 1'O 5e -7N5 44" Date: of Construction (i.e.: Rough Grading, Offsite Street, Description of Construction (i.e.: See Plan Set No. 01234) ETO —_ _,� — i s Dimension of Installation or Removal:✓ XZ by✓Ovf7ata.P Approximate Construction Start Date: jJanuary 30, 2011 Approximate Construction Completion Date: January 30, 2011 Estimated Construction Cost: $1 M / A Estimated Construction Cost shall include the removal df all obstructions, materials, and debris, back -filling, compaction and placing permanent resurfacing and or replacing improvements Contact Name: David Archer _ _ _ hone Number: 1760.564.3199 Name of Applicant/Owner: La Quinta Chamber of Commerce Applicant Address: 78-275 Calle Tampico -#B Applicant Telephone Number: 760.564.3199 Applicant E-mail Address: david(-giI_gchamber.com Name of Contractor: L�t►h.w• ��w►�, _ _ _ _ _ _ _ Contractor Address: M L(l kK� W��IG S�tl- L- •n Cl%�.L L Contractor Telephone Number: ZCot� Contractor State License Number: K3 C) 1 1 Contractor City Business License Number: Contractor E-mail Address: Q� 4 y1Gr1F�_c✓�i ►A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED -4 ADDlicant or Contractor General Liabilitv Insurance Comoanv: Applicant or Contractor General Liability Insurance Policy Number: Office Use Only: Inspection Fee: Permit Fee: As -Built D Deposposit:t: �Q Dust Control Deposit: Credit Amount: TOTAL FEE DUE: rives _ or ice — nrmc nn ire Jnr Office Use Only: Assigned Permit Number: I I O f D Approval Date: Expiration Date: Issue Date: Administrative Authority Ah n �� (17 .map y 0-3dx 4 CALLE CALLE HIDALGO M 4 W Ci Ci L _ALLEY a VENDOR AREA C rwilt BAND 4 T CLOSED STAGING AREA IR RANCES HACK KIDs AREA PARKS CLOSED ji it i4 LL:1UU ROAD I�� VETERINARIAN CLOSED OFFICE EY BACK GATE -� 13 _ O O �W2M a LU >i � ii SSS] l l 1T � HAACE RDWARE,— h I OLDTOW �. _-N PUBLIC-PARKING' UBLIC-PARKINI i LA QUINTA G CO I , i l r y I GAS STATION y SC6 (CA) 1� (p4 CALLE ESTADO ry TEDDY'S ,. All NOTES: 1. ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH THE 2006 CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROLS (M.U.T.C.D.) 2. TRAFFIC CONTROL SHOWN HEREIN IS THE MINIMUM REQUIRED. ADDITIONAL TRAFFIC CONTROL MAY BE REQUIRED TO FACILITATE PUBLIC SAFETYAND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LAQUINTA REPRESENTATIVE. 3. THROUGHOUT EACH WORK PERIOD, CONTRACTOR SHALL INSPECT TRAFFIC CONTROL (SIGNS, BARRICADES AND DELINEATORS) AND MAINTAIN SAME IN ACCORDANCE WITH TRAFFIC CONTROL PLANS. 4. THE LA QUINTA CHAMBER OF COMMERCE SHALL CONTACT THE NEWS MEDIA FOR PUBLIC SERVICE ANNOUNCEMENTS ABOUT THE CAR SHOW AND THE CLOSURE OF THE STREETS AROUND THE PARK AN ANNOUNCEMENT SEVERAL DAYS BEFORE THE EVENT WOULD BE HELPFUL FOR NONEVENT TRAFFIC TO AVOID THE AREA. 5. THE LA QUINTA CHAMBER OF COMMERCE SHALL CONTACTALL BUSINESSES & RESIDENTS AFFECTED BY THE PARADE ROUTE. THE CHAMBER & THE BUSINESSES WILL NEED TO COME TO AN AGREEMENT ABOUT ACCESS TO THEIR LOCATIONS OR LACK OF. 6. THIS TRAFFIC CONTROL SHALL BE IN PLACE SUNDAY 3129 FROM 7:30 AM TO 5 PM, N W�E NO SCALE 25 3rd Annual Hot Rod & Custom Car Show La Quinta Chamber of Commerce Tops N Barricades, Inc. (800)852 -TOPS Ron Fifield Date Permi umber 1 3/6/09 To Be Issued on Approval