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11024See below for Finance Revenue Codes FILE COP ENCROACHMENT PERMIT �F OF PUBLIC WORKS CONSTRUCTION Tom' 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: 2/22/2011 LOCATION OF CONSTRUCTION: La Cahuilla, Madison St, Ave 58 and Monroe St PURPOSE OF CONSTRUCTION: Desert Triathlon; Temporary Traffic Control -Bike Portion (Within the City of La Quinta Limits ONLY) DESCRIPTION OF CONSTRUCTION: See Attached Traffic Control Plan DIMENSION OF INSTALLATION OR REMOVAL: See Attached. Traffic Control Plan APPROXIMATE TIME WHEN WORK WILL BEGIN: 3/5/2011 TIME OF COMPLETION: 3/6/2011 ESTIMATED CONSTRUCTION COST: N/A (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS This Permit is Only for Traffic Control Setup Within the City of La Quinta Limits 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 of La Quinta and to pay for any additional replacement necessary as the result of this w AP UCANT NVEk 614NED , Tt}tiiZORee, C.PX As M4N'r W A -S Nor I56 v Ery . Greg Klein - Klein & Clark Sports 80 Via Del Mercato, Rancho Mirage, CA 92270 760-324-7069_ Name of Applicant Business Address Telephone No Tops N Barricade 44-631 Jackson St, Indio, CA 92201 760-347-2111 Name of Contractor and Job Foreman Business Address. Telephone No. 787664 $0.00 103875 Contractor's License Number City Business License No Lexington Insurance Company 9471952 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 EE=1 $0.00 As -Built Deposit E-A $0.00 Cash Deposit -Surety Bond, E_B $0.00 if required TOTAL $0.00 Public Improvements: 3% of estimated construction costs Private Improvements: 3% of estimated construction costs PERMIT NUMBER: 11024 DATE ISSUED: EXPIRATION DAT BY: WORK INSPECTED BY*: PERMIT COMPLETION DATE*: * If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. Traci 1VU, 1Vdme . Vicinity ` l�.;f;•'£ i' Ck Vis/; Purpose of Constxuction:(i a Rough Grading, Offs T?escri tion' of Co stru tion i e eelPlan-,S v _ Dimension of. Installation or Removal ! . , Approximate Construction Start Date' Approximate Construction Completions Estimated Construction Cost:$ Estimated Construction Cost, shall include the removal of ul l f bl_ teiions, mi placing permanent resurfacing and or replacing improvements .... Cantact Name �'22, . Name of Applicant/Owner Applicant Address rtr Applicant Telephone Number: Applicant E-mail Address:,, Name of Contractor . Contractor Address:., Contractor Telephone Number: Contractor. State License Numl: C..ontractor`City:_Bus riess Licen :Co ntractor:E mail` Address ►A COPY OF THE CURRENT INSUIF Applicant`or Contractor General l.iat>i Applicant or Contractor General Liabi Office Use Only. Inspection tee: ......:. Permd Nec As auill Deposit: Dust Control !: Deposli .:..._ :.: Credit Amount: O Number 0M 7� E MUST BE PROVIDED - any: Administrative Authority AC40 CERTIFICATE OF LIABILITY INSURANCE ;26; 0 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(les) must be endorsed. n SUBROGATION IS WANED, sibject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this dRlfleatl doss not e6nfer rlg•mts to the certificate holder in lieu of such endorsement(s). PRODUCER NOOAMeACT Hog Carruthers PHONE(641j842-2135 FAx Isaimsas-saa3 McKay Insurance Agency, Inc. No EX* 106 East Main Street ".slcarrnthersemckayinsagency.con PRooucTim P O Box 151 0008163 INSURED EINNSURER Silent Sports Association - Triathlon Klein Clark Sports, LLC 80 Via Dei Mercato Rancho Mirage CA 92270 INsuRERF COVERAGES CERTIFICATENUMBER:CL1112622632 REVI$ION NUMBER. �.. .d.V .L�IA,I THIS IS TO CERTIFY THAT THE POLICIES REQUIREMENT, OF INSURANCE LIS IW tstww nhvt aCCn waucu 1w I"Q •�.�.,..�........... r.. -.� • .-•- •••— • ___.. _ _.__ TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY WI MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIE TERMS, CERTIFICATE MAY BE ISSUED OR CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EXCLUSIONS AND 0 S EFF PO Y EXP LIMITS INSRPOLICY 7YPEOFINSURANCE POLKVNUMBER M 1.i 000, 00,0 GENERAL LIABILITY EACH OCCURRENCE S R ,1 'rru+i S 100;000 % COMMERCIALGENERALUABILITY I $ 491952 l4%2011 !7!2011 MED EXP. .• .ono rano S' Exclude A CLAIMS MAGE OCCUR PERSONAL it ADV INJURY S L,000,000 $ Iaaludes Athletic t'L4�-RALAGGREGATE 1 $ a'60 '000 Partici a�.ts „__• PRODUCTS'- COMP/OP AGG S 2#000400 $ GEN L AGGREGATE.UMIT'APPLIES PER POLICY PR R LOC COMBINEI;SINGLEUMM $ AUTOMOBILE LIABILITY (Es acctianl) ANY AUTO BOOILY INJURY (Perpomm) S ALL OWNED AUTOS BODILY INJURY (Per accident) S SCHEDULED AUTOS PROPERTY DAMAGE S (Per accident) HIRED AUTOS S NO"MED AUTOS S UMBRELLALUlB OCCUR eACHOCGUR.R['NCE S EXCESS LIAR CLAIMS•MADE AGGREGATE S S DEDUCTIBLE 6 RETENTION S WORKERS COMPENSATION STATU- OTH MIC IEB- AND EMPLOYERS' LIABILITY YIN E.L, EACH ACCIDENT S ANY PROPRIETORMARTNER/EXECUTIVEa OFFICER/M InrER EXCLUDED? N/A EL: DISEASE-EA;EMPLOYE E.L. DISEASE- POLICY LOAT.1 S fW�orS It yy�s dcisaibo under. DESf WPTION OF OPERATIONS below DESCRIPTTIONS I LOCATIONS I VEHICLES (Attach ACORD 101. A4dttfawl Remarks Schedule, it more apace requl+ed) ION OF OPERA It Sprint Triathlon a Duathlon: March 5 i 6, 2011. Certifieste holder Swim clinic: arch 4, 2011. Desert International M respect to liability arising out of the operations of the above name -3 insured. is an additional insured but only with to Iowa Code section 515.147, by a nonadmitted company in Iowa and as such is not "This policy is issued, pursuant covered by the Iowa Insurance Guaranty Association." CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXpIRAT(ON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of La Quinta 78495 Calle Temp1C0 AUTHORIZED REPRESENTATIVE La Quinta, CA 92253 Dan McKay/MEG�� a IQM9009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD fNS025 (200009) PERMIT NO. 11024 Desert International and Sprint Triathlon / Temporary Traffic Control — Bike Portion / Lake Cahuilla, Madison St, Avenue 58, and Monroe St In addition to the standard permit conditions, the following shall apply: The applicant, Greg Klein, shall be available during the event by phone at (760) 324-7069. 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. Klein and Clark Sports, LLC (Greg Klein), 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 event. Sign removal should be accomplished by the end of 5PM on March 6, 2011. 6. 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. 7. The permittee is responsible for obtaining a valid separate permit from the California Department of Transportation Department (CalTrans), other City, or Countyjurisdictions if any of the work or traffic control devices extend into the CalTrans, other City, or County right of 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. 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 the 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. 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. Special Conditions Page 1 of 2 PERMIT NO. 11024 Desert International and Sprint Triathlon / Temporary Traffic Control — Bike Portion / Lake Cahuilla, Madison St, Avenue 58, and Monroe St 11. 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. 12. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts provided in the Engineering Bulletin on 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. 13. The applicant shall provide informative message board(s) informing the commuters using the affected roadways of possible traffic delays due to the street closures and time of the event. The message board shall be provided for the commuters 48 hours prior to the start of event. 14. The City of La Quinta reserves the right to requite 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, 5t' Edition" or latest, in the installation of all appurtenances abutting and within the public street right-of-way. 15. 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. 16. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its original condition. 17. Access and egress to all local properties shall be maintained at all times. 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 2 of 2 NO SCALE LAKE CAHUIUA GATE THE QUARRY -41 Desert Triathlon Bike Portion F"ecantam Klein & Clark Sports Tops N Barricades, Inc- (80t1)852 -TOPS Ron FWm!lc DM -1 I of 2 1/18/11 To Be lsstxed on Approval, CALHOUN ST. VAN SURE! ST. HARRISON ST. MADISON ST, MONROE ST. mm' JACKSON ST. =2" 19 alz AIRPORTBLI AD ®r 0, 1 12� 'oaf V F RRII Lm SUP WT Lm CLMIC 1. cin VEA=1 11 sL M-1 SPRMT COURSE SAT 315 5 AM TO 9:30 AU BIKE 14 CMIES FiiTm �a=w AVE, 58 35W�lIr rVIn F�hnLall AVE.60 x=uc=j, I emt� F1X,6" mil -AVE.62 "I 093610 Li 117FERNAMML COURSE SUU 316 5 AW TO 10:301 AM BEE 24 MM (2 LOOPS) TRAFFIC DIRECTIM! PC= it OFFICER FiiTm �a=w AVE, 58 35W�lIr rVIn F�hnLall AVE.60 x=uc=j, I emt� F1X,6" mil -AVE.62 "I 093610 Li