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11016See below for Finance Revenue Codes c'� 5�� ENCROACHMENT PERMIT COPV nroF n PUBLIC WORKS CONSTRUCTION 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 III Minor Improvement Permit - Class IV DATE: 2/8/2011 LOCATION OF CONSTRUCTION: Avenida Bermudas in La Quinta PURPOSE OF CONSTRUCTION: Soap Box Derby; Street Closure to Hold Soap Box Derby DESCRIPTION OF CONSTRUCTION: See Attached Traffic Control Plan DIMENSION OF INSTALLATION OR REMOVAL: APPROXIMATE TIME WHEN WORK WILL BEGIN: 3/19/2011 TIME OF COMPLETION: 3119/2011 . ESTIMATED CONSTRUCTION COST: N/A (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS In consideration of the granting of this permit, the applicant hereby agrees to: i 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. r 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 anall ap ieable rules and regulations of the City his of La Quinta and to pay for any additional replacement necessary as the result of tork. 1 of Applicant or Agent Desert Recreation District - Tatiana Hinkle 45-305 Oasis Street, Indio, CA 92201 760-347-4263 Name of Applicant Business Address Telephone No Desert Recreation District 45-305 Oasis Street, Indio, CA 92201 760-347-4263 Name of Contractor and Job Foreman Business Address Telephone No. N/A N/A Contractor's License Number City Business License No Philadelphia Indemnity Ins Co PHPK546304 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, E_B $0.00 if required TOTAL 0.00 Public Improvements: 3% of estimated construction costs Private Improvements: 3% of estimated construction costs PERMIT NUMBER: 11016 DATE ISSUED: MhpC# I �1 .2 p l EXPIRATION ATE: /4 7,011, BY: WORK INSPECTED 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. Date:' cedf 4 so a" PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT Tract No: 'Project Name: '�9a -RaX DP_ -b vicinity: ?OWkUda er�,..,16t5 `lel QitNr�� Purpose of Construction (i.e.: Rough ding, Offite Street, etc.) e,olL,2!"- iption of Construction (i.e.: See Plan Set No. 01234) 5e.e. G44tc�4 Dimension of Installation or Removal: Approximate Construction Start Date: Ale -e; 1. I R' Approximate Construction Completion Date: 'AH tC 6 1 19 t .10 .� Estimated Construction Cost: $ 43 1AEstimated Construction Cost shall include the removal of all ob'stru'•:f�ns, materials, and debris, back -filling, compaction and placing permanent resurfacing and or replacing improvements Contact Nalrie Tit ti 6►;.:u N; a lslt Phone Number: w,Y2 63 Name of Applicant/Owner: Qt�c� Applicant Address:_a" Applicant Telephone: Number: 7�0 4 3 Y? Applicant E-mail Address: Ia fijuna`Q AR 1) -VS'. c an Name of Contractor: ���y . .b �' A L .t Q�� f ew.d�rF ?4ecr Contractor Address: solvh , Contractor Telephone Number: Contractor State License Number: / F1 Contractor City Business License Number: Contractor E-mail Address: ►A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED -4 Applicant or Contractor General Liability Insurance Company: Applicant or Contractor General Liability Insurance Policy Number: Office Use Only: G (t= Inspection Fee: `• Permit tce: As -Built "Deposit Dust Control Deposit: 'Credit n( Amount: TOTAL FEE DUE: $ 10 Office Use Otilys Assigned Permit Number: V' Approval Date: V Expiration Date: Issue Date: Administrative Authority: ACORDTM CERTIFICATE OF LIABILITY INSURANCE RATE(MWDD/YY) 02/14/2011 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BRUNER GOODHUE COOKE CRANZ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1168 TALLMADGE RD. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CUYAHOGA FALLS, OH 44221-5158 INSURERS AFFORDING COVERAGE NAIC # INSURED INTERNATIONAL SOAP BOX DERBY, INC. ENSURER A: PHILADELPHIA INDEMNITY INS CO 18058 PO BOX 7225 INSURER B THE HARTFORD AKRON, OH 44306-0225 INSURER C. INSURER 0: INSUP.ER E nnVFRAnFS 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY.PAID CLAIMS. NSR LTR DD'POLICY NS D- P NUMBER EFFECTIVE DA POLICYE M,1DD POLICY EXPIRATION DATE IDD LIMITS A X GENERAL LIABILITY PHPK546304 5/18/2010 5/18/2011 EACH OCCURRENCE _ a 1,000,000 PREMISES (E rence) S �XTCO GENERAL LIABILITY FMMERCIAL 111------ CLAIMS MADE © OCCUR MED EXP (Any one person) a PERSONAL & ADV INJURY S GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMP/OP AGG a 3,000,000 I i POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a ANY AUTO (Ea accident) BODILY INJURY a ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY a HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE: S (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT a OTHER THAN EA ACC a ANY AUTO AUTO ONLY AGG a __j_F A EXCESSIUMBRELLA LIABILITY PHUB302051 .05/18/2010 05/18/2011 EACH OCCURRENCE a 2,000,000 AGGREGATE a 2,000,000 I X1 OCCUR CLAIMS MADE a S DEDUCTIBLE S X RETENTION a 10,000 WC STATU- OTH- WORKERS COMPENSATION AND Y E.L EACH ACCIDENT S EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE OFFICEERiM-EMBER EXCLUCc0' E L DISEASE - EA EMOLnYFE S Ir es, descnbe under SPECIAL PROVISIONS below E L. DISEASE -POLICY LIMIT a B OTHER 45SR750381 12/01/2010 12/01/2011 $250 Dental Limit, $5,000 Accidental Death SPECIAL RISK ACCIDENT $15,000 Excess Accidental Medical 45SR750382 12/01/2010 12/01/2011 )ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS :,ertificate Holder(s) named below shall be an additional insured as pertains to the licensee, sponsorship or running of your All 4merican Soap Box Derby Event to be run on the following date(s): TRIAL RUN DATE(S) March 19, 2011 RACE DATE(S) March 19, 2011 RAIN DATE(S ERTIFICATE HOLDER Soap Box Derby of the Desert Desert Recreation District, City of LaQuinta, City of Palm Desert, Coachella Valley Community Recreationa Foundation 45305 Oasis St Indio, CA 92201 kCORD 25 (2001/08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF /1NY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. I 1 I © ACORD CORPORATION 1988 03/11/2011: `12:36 330928,3800 ,DRYARCADE PC dCY NUMBER: 2546304 COMMERCIAL GeNERAL UABILI Y 'CG 20 28 07 OA THISMDORSEMENT CHANGI`S THE POLICY. PLEASE,RA13 IT CAREI`ULLY. ADDMONAL INSURED .— DtSIGNATED PERSON OR ORGANIZATION This endorsement mbdlRoa Insurance provided udder the followlnq: t OMMERCIAL GENMAL L(AellU7Y COVERAGE PART • 94HRt7ULE .0. AF:)PJD ReglOnal. Dizectors, Local pt.r�c,tOrG, I,1CCn_ed Or..idniidtlony/FY2nchj;c�„ officials and members but Only With rF,,Spert to AP :8D nailonaJ:, req.ional arta lor,al. event:., in.cludi,ng ra:l.ly cars. cven�s an pr �cr.i.ce^ in, epnjunction with th64e aforementioned evenly, PASI3D cl na.Cs ,nd. AP �.rwed Fundraiser s . :404n 11- Whole,, An; Insured :is amdAdisd..to.�•in= duan' Is an :addltfonel: insured: the penwnI(e} or-cr- pa m lon(ry shaWh,;n the 3ch8dul6, .but only;"'ll, "'spec: to 114WIY for "bodily injury", "property dam- ege" c "pensonat. end advedlsing injury' caused, In whole. w In pad, by your acts or.omlaslons cr the:acts or, omll etons.Of those acting on your.ps tf:. A.. lh t a pelformanbe of your ongolnq.cpemudh6 :or' ,11.4n oimcotlon, with your premises nwned .by :lir rgn: rd to you. PAGE 02/02 GO 20.2 07 04 04SO PMOe dad, Inc., ?004 Page 1 oP 7 O GENERAL CONDITIONS --PERMIT NO. 11016 --GREATER COACHELLA VALLEY SOAP BOX DERBY -- This permit authorizes special event activities to be accomplished within City of La Quinta right-of-way ONLY. Whenever the special event activities extend into private property, it is the responsibility of the applicant, or their agents, to secure permission from abutting property owners. Such authorization must be secured by the applicant prior to starting the special event activities. 1. The: applicant, Tatiana Hinkle — Desert Recreation District, shall be available during the event by cellular phone at (760) 701-1005 or a message can be left at (760) 347-3484 ext 105 or (760) 347-4263. 2. The necessary traffic control signage, barricades, and cones identified on the approved traffic control plans will be provided and set up- by the City. The applicant shall notify the City immediately if replacement equipment is needed. 3. The applicant shall be responsible to have volunteers at the intersection of Bermudas & Nogales at all times during the event to allow residents living on Avenida Bermudas within the event area, their guests, mail carriers, and companies delivering to them,. access to the southbound one-way fire lane provided on the traffic control plans. 4. The applicant shall also assign volunteers to regularly monitor the intersections of. 1) Bermudas & Chihuahua, 2) Bermudas & Monterey, 3) Bermudas & Colima, and 4) Bermudas & Arroba. 5. The permittee is responsible for making sure that temporary no. parking signs along the parking area affected by the special event are existing. The signs shall be placed along the area 48 hours prior to the start of closing the area and removed immediately after the construction completion date. 6. The Applicant or Contractor shall furnish.the City satisfactory evidence of insurance in the amounts provided in 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. 7. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 8. 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. y�z NO SCALE 0 0 �`SO- apo CVENT R-1 W20-3 R CLOSED AD W20-2 DE AHEAD Ma10 (LT) D R EISENHOWER D ILn Maf0 (LT) 0 W20-3-- geT�sp ROAD (� 1 CLOSED �J (Rn ® Ma un 500, R11-2 ROAD CLOSED i t CLOSED AHEAD .-RU-4 ROAD CLOSED TO THRU TRAFFIC RS -1 Rye 1R,~ H RS•1 Rye wU av[En 1�5 ONL I 1\ / I 11"5"1 ONLY W C co Z z C o W20=3— W J ROAD J J CLOSED Ma1o(Ln J Q AH EA,roll R V Ma (LT) AVC\111%A RAAnVIAIC7 WLLI QQC m sca cA G O ♦ DETOUR J � TCAJ♦ O � Q W O J Q � v J 500, R11-2 ROAD CLOSED i t CLOSED AHEAD .-RU-4 ROAD CLOSED TO THRU TRAFFIC RS -1 Rye 1R,~ H RS•1 Rye wU av[En 1�5 ONL I 1\ / I 11"5"1 ONLY W C co Z z C o W20=3— W J ROAD J J CLOSED Ma1o(Ln J Q AH EA,roll R V Ma (LT) AVC\111%A RAAnVIAIC7 WLLI Q V sca cA y ♦ DETOUR WSC3 TCAJ♦ Q O = O J J W 141 J C� J v W20-3 �C� CLOSED \�� AHEAD \ "' IDA MEND J MV L11 1JN IVINI%11 V sca cA y ♦ DETOUR WSC3 TCAJ♦ O Z "' IDA MEND J AVEN w V sca cA ♦ DETOUR AVC\11r%A ILP 1 A —.1% /NVCIYIUN VILLN r-1% R11-0 yl ♦ DETOUR ROAD CLOSED ro TNRU TRAFFIC SC3 CA ""' ♦ DETOUR ` KEEP - �, RIG, AVENIDA NAV, (LT) ROAD LErr EVENT Rye Nn R5-1 vV Ma10 RT CLOSED CLOSED AMEAD DETOURS aHEAD sv�o ante ONLY AHEAD AHEAD / �eR 15 15 \ONLY 1� V Q 500' \ 350' \ 350' � 1. 350' a 6 4"a 8 t -4..I 1 JL V-4CZ 8 8-r1 -& X�� EVENT AREA EVENT ARE Gp0 �C=OC�C�O F�C� L'�7C=QQq �Q44 i C O O R&1 RT ® RB® POST NO PARKING AT 100' INTERVALS ON WEST SIDE OF AVE BERMUDAS 72 HOURS IN ADVANCE OF EVENT (EAST SIDE IS PERMANENTLY POSTED) NOTES: 1. ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH THE 2010 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 SAFETY AND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LA QUINTA 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. CONTRACTOR SHALL MAINTAIN A MINIMUM 10' (12' TYP.) TRAFFIC LANE WIDTH AT ALL TIMES. THERE SHALL BEA MINIMUM 2' BETWEEN THE EDGE OF CUT AND THE NEAREST TRAFFIC LANE. 5. ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED AT ALL TIMES. 6. THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING WORK HOURS ONLY, AT END OF THE WORK HOURS, THE ROAD SHALL BE CLEAR OF DEBRIS AND RETURNED TO NORMAL., 7. CITY OF LAQUINTA OR THE DESERT RECREATION DIST. WILL NOTIFY ALLAFFECTED RESIDENTS IN ADVANCE OF THE EVENT AND HOW TO ACCESS THEIR HOMES. Jl�a naa. KEEP �i RIGHT R114 ROAD CLOSED rHRu rroRAFFIc 0D4 0� o< \� dc��GCr Oo�d o C30 (CA) \AVENIDA BERMUDAS #ONLY/ 45 Soap Box Derby Prime ConVador uaseo on bmnaarD City of La Quinta N/A Tops N Barricades, Inc. (800)852 -TOPS Ron Fifield 1 REV 03/07/11 To Be Issued on Approval