2844 (2)O,QT"=29-98 03:,19,PM LA. QUIN"TA CHAMBER�:OF- COM . 6'1.9564311 1 "f x P. 02
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'With proper velidapOh
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Y ;` i',. -• this foie: cDnititv;ti an
" b nnc oachment permit . CITY OF LA' QUINTA rt
s APPLICATION FOR PERMIT r Y , PUBLIC WORKS T
_ CONSTRUCTION (ENCROACI�MENT�P ;00jz—
tE- "
- f ..,, ,Ff"`. •` d -fs -7 t_r-t'� •• j •i •r For Ntr c0nlr'JctlOil of publ,r. or anvatr, ,Curb..^., rad lveweys, pavcmctits,'sidewJwks, perking lots, sewcr's;'water.mainta±d otlua like public works improvcmentsut Connectionwith MINOR IM.PROVEMEN'TSandAPPROVEDSUBOIVISIONS' Subdivisin+DATE.�2J/gg. _ o Imprpvt;mentPmm,it —Class illMinor Improvemern Permit Class IV
LOCATION OF CONSTRUCTION(Street addrvss ar Oe,WPtion of LucationlPURPOSE OF CONSTRUCTION Anr.u:�l 1OK/°SIC Rim Sketch (Atach conitruction plans if;spproF NSTRUCTION
sec. CMLA:� -
S DI CNSI r INSTALL TION R REMOVAL okek 1—.�S2EOF EXCAVATION, If NEEUfD
APPROXIMATE TIME WHEN WORK WILL BEGIN
APPROXIMATE TIME OF COMPLETION 1 U j�/kI.QESTIMATED CONSTRUCTION COSTS(Includiny removal of all obstruction, mate,ials, and debtis, L'ackfilling, com.
P+coon anU pldcinq petmanrnt resurlycinq aril/Or replacing improvements)In eonsideradon of the granting of lrtispermit, the applicant hereby agrees to:Indemroly, JrhndJr4 wvv the City, its400(;xad aponrs. ufficers, rooresentarivei and empluyars•-ha Mess from end agamtt anv and atIPenalties, Lan'iitirs ar toss .,rwlting f'.)m claims or. cuurt acUo„ end anainy outoranv accn.lrut. lou or Jarna96 s0 persons or property
y ork undertaken undo, the or occowrt� es a O,J iimitc result or an w pvrm,t y,enten punts t asnijs aPPlirylion. N
otA tt ,e Admin�t
v trot've 'Aurn�
uric at I v Part twenty•fow (2M1I hove m advanue of the time wnq.. work wAl. br atJRed.Comply with all apptlualde CrtO•dinancaa, the terms,and conn,tioor of she Permit anU ail a
PPhcable rutµ and. regulations of that Cityof
La buimrs and to Pap aw any additional reois"ment necemry as thr result of this vprti_ a
tjSignature of Applicant or Agent u flIt Choi i,cr of Connner.c� '7'$=371' Hw '111, 'LaUinta 760S(��+-3�gg . "Narnr of Applicant (plaair, printl.. _Susiiigm Address s Telephone No.Name of Coitryctor and Job Forernin9usine.s AddressTelephone No.
Comiavlor's License Nd.City Business Lit:cnse No,
Applicant's Insurance, CompanyPolicy Number
FEES: +Subdivisiun ImprovementPermit -CIJss illPublic irnpruvcments. 336 of estim aced cunstrucGuncost1 Ptivrte,:mprovcments: 3%Of estimated cor•:structiwt costsImprovement Permit — Class IV; See attached schedule74{ 0PERMIT VALIDATIONPcrmit F;r' fl' PERMIT NO. 28 pDATE APPROvU 3 Ig
` • • .xr ;r '..""'°�j� FCC Qr i,- ` +
TO'—TAI : g'� pv EXPIRATION GATE
' SSUEU
Receipt No. ,» r DATF. I y.
' t I Received Iry Date 9y '
,t;r+ern 1 A'dministrativ
II ¢Authority
r R Corded by
_ 9) 777 7075 Telephone: (B1
loo Af�
t4= Zo CAI = 23!5-
0410
, 11
08:24
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PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Diller & Associates
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 8517
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Ft. Wayne, IN 46808
(219) 482-5455
COMPANY
A ST. PAUL FIRE & MARINE INS..CO
INSURED
Y
OTRP
ROAD RUNNERS CLUB OF AMERICA
1150 S. WASHINGTON ST.
SUITE 250
Ccmp� Y C
ALEXANDRIA, VA. 22314
COMPANY
D
... .....
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.
LTA OF! INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY WIFLAT*u
DATE (MNV19DNY) DATE (MWDgNY) LIMITS
GENERAL UADILITY GENERAL AGGREGATE 1$2,000,000
A COMMERCIAL GENERAL LIABILITY CKO 1301918 01/01/98 01/01/99 PRODUCTS - COMPfO? AGG aOOOWO
CLAIMS MADE OCCUR
7
X PERSONAL & ADV INJURY s2,000,WC
OWNER'S 9 CONTRACTCAIS PROT EACH OCCURRENCE 52,000,O00
FIRE DAMAGE (A.IV
MED EXP (Amy one person) $ 5,000
AUTOMOSU
LIABIUTV
A
ANY AUM
CKO 1301918
()1/01/98
01/01/99
COMBINED SINGLE LIMIT
$1.000,000
ALL OWNED AUTOS
BODILY INJURY
SCMGOULED AUTOS
(Pg, pefwn)
X
MIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
accidunt)
PROPERTY DAMAGE
GARAGE, LIASILM
AUTO ONLY - EA ACCIOUIT
$
ANY AUTO
FOTHER �THAN AUTO ONLY:
. .. ......... ........
::1.::::."".''..1.1 .. ........ ..
........ ..
EACH ACCIDENT
S
p
I AGGREGATE
$
EXCESS LIANUIM
EACH OCCURRENCE_
$
UMBRELLA FORM
is
AGGREGATE
OTHER THAN UMBRELLA FORM
S
WORKERS COMPENSATION AND
STATUTORY LIMITS
DAPLOYERS, LIABRM
EACH ACCIDENT
$
THE PROPRIETOR/ INCL
PARTNERS)EXECUTIVE
DISEASE - POLICY.L IMiT
5
I
DISEASE - EACH EMPLOYEE
OFFICERS ARE: EXCL
S
OTHER
DESCRIPTION OF OPVtATIONS1=A'nONS'MICLE&%P=U1L MUG
CERTIFICATE HOLDER IS ADDITIONAL INSURED BUT ONLY WITH RESPECT TO
THE FOLLOWING EVENT:5K RUN/WALK 10K RUN/ KIDS 1/2 MI. RUN DATE OF
EVENT: 11/15/98_ ADDITIONAL INSURED: DESERT CITIES TRACK CLUB, ATT
NORM RAINES, POB 183, RANCHO MIRAGE,. CA. 92770
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 9E CANCIF11 BEFORE THE
EERRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR To MAIL
3
DAYS WRrrr" NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LIFT,
CITY OF LA QUINTA
ATT LIZ BUT FAMURIE TO MAIL SUCH NOTICE "ALL IMPOSE NO OBLIGATION OR LIABILTYY
OF AN COUPA6� E) QM OR REPREGINTATIM.
78-495 CALLE TAMPICO 4
AUTHO
LA QUI7A CA 53
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