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3375III Eel With proper validation this form constitutes an encroachment permit CITY OF LA QUINTA APPLICATION FOR PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 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 DATE: 1/17/01 Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Approximately 685E/O intersection at Madison St. & Ave. 52 (Street address or Description of Location) PURPOSE OF CONSTRUCTION Install dry utilitien to feed well site DESCRIPTION OF CONSTRUCTION Exit 1ID vault west to crossine. Sweep un conduit to feed site DIMENSION OF INSTALLATION OR REMOVAL 2-5" & 1-2" conduit to feed well. site SIZE OF EXCAVATION, IF NEEDED G' dAen APPROXIMATE TIME WHEN WORK WILL BEGIN 1/22/01 APPROXIMATE TIME OF COMPLETION 1 25 01 ESTIMATED CONSTRUCTION COST $ 21500 (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) Sketch (attach construction plans if appropriate) In consideration of the granting of this permit, the applicant hereby agrees to: See Attached Special Conditinse 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 occurring 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. 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. Signature of Applicant or Agent GR Utlderaround, Inc. 77670 Sprinefield, ,#8, P.D., CA 250-1767 Name of Applicant (please print) Business Address Telephone No. Eddie Cobb Name of Contractor and Job Foreman Business Address Telephone No. 765654 Contractor's License No. 587 Citv Business License No. Applicant's Insurance Company Policy, Number FEES: Subdivision Improvement Permit — Class III' Public improvements: 3% of estimated construction costs �e, + Private improvements: 3% of estimated construction costs 1 Minor. Improvement Permit — Class IV: See attached schedule Inspection Fee' $ Permit Fee . — Penalty Cash Deposit -Surety Bond if required TOTAL: Receipt No. Received by Recorded by 75 100 $ 175 Date pNI. QV* 3375 PERMIT VALIDATION PERMIT NO. 3375 DATE APPROVED 1/23/01 EXPIRATION DATE 2/28/01 DATE ISSUED 1/23/01 By Administrative Autiority Telephone: (760) 777-7075 The following General and Special Provisions are attacbed to and made a pan of Permit No. GENERAL PROVISIONS The following shall always apply: . ENROACENENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within City of La Quints 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. TRACKLAYING CONSTRUCTION EQUIPMENT: Cleated tracklaying construction equipment shall not be permitted to operate on any paved surface unless fitted with smooth -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 operations 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 I.e Quints 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 sea! coat as specified above. PROTECTION OF TRAFFIC: An excavations and work areas shall be properly lighted and barricaded as deemed necessary b'y the City Engineer or La Quints City Public Works inspectors. Suitable detours and demur signs shall be placed and maintained for the duration of the project. The City shall be notified.24 hours in advance of any traffic detours or delineations. CARE OF DRAINAGE STRUCTURES: Any drainage structure including 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 Quints shall be notified prior to commencement of this work. Drainage structures and opendrains 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 shal be removed from the right Of way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backftll 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 OPERATIONS: 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 llowing shall apply when indicated: Rd NOTIFICATION: Permittee shall notify the City at (619)777-707S at least 48 hours in advance of starting construction. R2 ITTILM CLEARANCE: (Substructures) Prior to making any excavation within the City of La Quints right of way authorized by permit, the perminee 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 permittee. R3 UTILITY CLEARANCE: (Surface Structures) No work shall be done under this permit until all utilities are clear of the proposed work site. The permitter shall notify all concerned utility companies of the proposed work. M R4 PAVEENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced With inches of A.C. paving placed on inches of class _ aggregate subbase course having an 'R' value of not less than and in conformance with City of La Quints Road Improvement Standards and CR5 Specifications, Ordinance 0461. PARKWAY GRADING: Area between the property line and top of the proposed concrete, curb sball'be graded to a dope of 1/4 inch to one foot (I).. R6 GRADE. CHECKING: City of La Quints 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 (_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 Quints Standard 1207. R8 DRIVEWAYS: A.C. driveways shell be constructed as not to alter existing drainage pattern. Surfacing between the property line and the existing road paving shall be 2 1/2 inches of A.C. paving placed on ( ) of class aggregate base. Driveway construction shall conform to attached drawing. 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Jo ,(slap apnloaJd o1 9931oj galno eZ jo 4!0 Jo olMS ago glut pgeulpioo3 aq pegs 4ioM •1!mj2d Blgi 10 pouad aql gaunp eaJe qqi. at witao3 Som eia!no el Jo Alo Jo a!wojtte0 jo orals aqt golgm aonsiodo ,(as of pateu!piogre aq liege )p— posodoid aqj :H1iOM 3LVNI(I1L00 j y N SPECIAL CONDITIONS --PERMIT NO. 3375 --- G R Underground, Inc. --- In addition to the standard permit conditions, the following shall apply: 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 (SSP.WC) and as directed by and to the satisfaction of the City Engineer. 2. G R Underground, Inc., hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. 3. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently if required. 4. 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 1 st 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 1 st 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. Traffic control for this permit shall be set up after 8 a.m. and removed before 4 p.m. 5. Work performed within 500 feet of a signalized intersection is restricted between the hours of 9 a.m.- 3 p.m. Traffic control shall be setup after 9 a.m. and removed before 3 p.m. The Permittee shall contact the Riverside Country Traffic Signal Maintenance Department at (909) 955-6894 if signal operation at the intersection is to be altered in any way. 6. 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. 7. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), advance warning signs and traffic control shall be installed and maintained in accordance with Cal Trans Standards or the Work Area Traffic Control Handbook (WATCH Manual). A traffic control plan, if required, shall be prepared in accordance with the WATCH Manual and submitted to the City for review and approval one (1) week prior to starting any construction. It shall be the Permittee's responsibility to appropriately detour and barricade all construction sites. - Special Conditions - Permit No. 3375 Page 1 of 4 SPECIAL CONDITIONS --PERMIT NO.3375 --- G R Underground, Inc. --- 8. 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 one travel lane of paved surface shall be maintained with flagmen at all times. 9. 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. 10. 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.. 11. Installation of service lines, conduits or sleeves maybe by the "Trenching Method". 12. 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 with Section 306-1.3 of the latest edition of the Standard Specifications For Public Works Construction (SSPWC), except as otherwise specified herein. Native material may be used as backfill material provided that minimum compaction, achieved in the manner prescribed herein, is achieved. Backfill shall be performed by mechanical means; no water densified compaction via jetting or flooding or other means shall be allowed. It shall be the Permittee's responsibility to provide appropriate geotechnical supervision, testing, and inspection, onsite, at all times during backfill operations. Backfill compaction shall be achieved by the following conditions: A. When a firm foundation is not encountered due to soft, spongy or other unsuitable material, such material shall be removed to the limits directed by the Geotechnical Inspector and/or the City Inspector and the resulting excavation backfilled with pipe bedding material. B. Backfill materials shall be brought to or maintained at -an appropriate moisture content for compaction. The appropriate moisture content range shall be established at the onset of the project and ensured prior to use of the materials through progress testing on the stockpiles. C. The first length of trench backfilled shall be backfilled in the presence of the City Inspector. Compaction shall be tested at random depths at approximate three-foot vertical intervals as backfill is placed to ensure the effectiveness of the compaction methods and to establish the depth of lift that can be compacted. D. If lifts greater than one foot are attempted in this trial length of trench, compaction tests shall be taken within the lifts to ensure that the full depth of the lift is compacted. Upon satisfactory Special Conditions - Permit No. 3375 Page 2 of 4 SPECIAL CONDITIONS --PERMIT NO. 3375 --- G R Underground, Inc. -=- completion of this portion of trench, the City Inspector shall establish the maximum lift thickness to be compacted for the remainder of the project. E. In -subsequent lengths of trench, the frequency of compaction tests shall equal one per each lift of backfill, per 300 linear feet of open trench, at randomly selected locations within the open length of trench. F. The depth of the randomly selected compaction tests shall also be randomly selected except that where multiple tests are required in a given length of trench, the tests shall be no closer than three feet (vertically) from each other. G. If any compaction test fails, previously placed backfill (in the'same length of open trench or previous lengths of trench) which is represented by the failing test (as determined by the City Inspector), shall be tested for compliance with compaction requirements. H. All costs incurred due to the conditions above shall be borne by the Permittee. Copies of all test results shall be furnished -to the City Inspector. 13. All excavations within City of La Quinta right-of-way shall be backfilled, and temporarily paved if within the existing travel way, at the end of every workday as directed by and to the satisfaction of the City Engineer for the protection of the public. Lengths of open trench shall not greatly exceed that which can not be backfilled in the same day. Excavated trenches shall not be allowed open overnight, however, Permittee may leave a length of excavated trench, not to exceed twenty (20) feet in length, open overnight at a point where construction will begin the next day, provided that this length of trench is completely covered by steel plating. 14. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its original condition. 15. Access and egress to all local properties shall be maintained at all times. 16. 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: A. Existing asphalt concrete pavement shall be sawcut one (1) foot beyond trench edges. Edges shall be .straight and clean. B. Permanent pavement replacement structural section, within all trenches, shall be 1" thicker than existing of asphalt concrete over the same existing thickness of crushed aggregate base or crushed miscellaneous base, meeting the requirements of Sections 200-2.2 and 200-2.4 of the Standard Specifications for Public Works Construction. The replaced pavement and base material shall be compacted to 95% relative compaction and respectively tested, for each 300 Special Conditions - Permit No. 3375 Page 3 of 4 SPECIAL CONDITIONS --PERMIT NO. 3375 --- G R Underground, Inc. --- linear feet of trench. Verify exact structural replacement section thicknesses with the City. prior to installation. C. Permanent pavement replacement shall be installed using a City approved 1/4" max medium asphalt concrete as the base course lift and a City approved t/2" max medium finish course lift for capping: Asphalt concrete- mix design shall be approved by the City prior to its placement. D. Cold -Mill and Overlay - The existing pavement which was properly protected in place during the trenching operation located adjacent to the trench saw cut shall be cold -milled to a depth of 0.10 feet with butt joint created next to the existing unmilled pavement.surface. The cold - milled area and base asphalt concrete in the trench area shall be overlaid with a City approved C2-AR-4000 asphalt concrete mix. The width of the cold milling area shall be as follows: For longitudinal trenches located in a parking lane: two (2) feet outside the sawcut removal lines. For longitudinal trenches located in a traffic lane: two (2) feet outside the sawcut removal lines, or to the lane line striping, whichever is greater. • For transverse trenches across existing street: two (2) feet outside the sawcut removal lines. E. If grinding and capping operations are not performed in the same day as base paving operations, the base course lift of max medium asphalt concrete shall be installed from saw -cut edge to saw -cut edge flush with the existing street surface. The base course lift of paving shall not be left 0.10' low in anticipation of grinding and capping. F. Any existing lane striping affected by this resurfacing .shall be replaced in kind by the Permittee, as directed by and to the satisfaction of the City Engineer. Affected traffic signal loops shall be removed and replaced in kind. The finished pavement surface shall be smooth, consistent, and shall conform to the surrounding grades. 17. 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. 18. Pursuant to Chapter 12.56 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982) the City has designated certain city streets as Truck Routes. The weight limit for restricted streets (i.e., streets not part of the Truck Route network) is three (3) tons; trucks exceeding the weight limit may use a restricted street if making a delivery or pickup on the subject street, or if this permit specifically grants permission to use the street to deliver street construction materials and/or equipment. 19. This permit allows for the installation of 2-five inch and 2- two inch conduits crossing Ave 52, at approximately 685 feet east of the intersection of Madison and Avenue 52, per the attached plans. 20. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. Special Conditions - Permit No. 3375 Page 4 of 4 NOTE: With proper validation this form constitutes an CITY OF LA OUINTA encroachment permit s: APPLICATION FOR. PERMIT PUBLIC WORKS CONSTRUCTION (ENCROACHMENT) 0F 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 17 January 2001 Subdivision Improvement Permit —Class I I I DATE:- Minor Improvement Permit Class IV LOCATION OF CONSTRUCTION Approx., 685 feet east of intersection at Madison Street and Avenue 52nd. (Street address or Description of Location) PURPO E OF CON T UCTION Install dry utilities Sketch (attach construction plans if appropriate) to DESCRIPTION QF CONST UCTION EXit LLD vault west Sweepi:�IID Plan attached to ossing. u conduit Tract No., 29347 D MENSIONtwo ,OF INSTALL TIQN OR REnch cWQ11 OVAL 17 lve 1 ervice ror ana lime warnerAUL. SIZE OF EXCAVATION, IF NEEDED p SI L2 IMA1�IM KIWI L BEGIN APPROXIMATE TIME OF COMPLETION,_% 2001 ESTIMATED CONSTRUCTION COST $ _�—,l�l1Pl nn (Including removal of all obstruction, materials, and debris, backfilling, com- paction and placing permanent resurfacing and/or replacing improvements) 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 occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Notify the Administrative Authority at lean twenty-four 124) hours in advance of the time when work will be started. Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of La Quints and to pay for any additional replacement necessary as the result of this work. gna reof Ap r Ant ._dries .._ an, Business'MR-r. Name of Applicant (please print) Business Address Telephone No. Eddie Cobb office 760-360-7994 mobile 760-250-1767 Name of Contractor and Job Foreman Business Address Telephone No. 765654 00587 exp. 5.28.01 Contractor's. License No. City Business License No. (GL) CAIC 10020666 St. Paul Fire and 'Marine Insurance Applicant's Insurance Company cent, attached Policy Number FEES: Subdivision Improvement Permit —Class III Public improvements: 3% of estimated construction costs Private improvements: 3% of estimated construction costs Minor Improvement Permit — Class IV: See attached schedule Inspection Fee $ 1-5-' Permit Fee 1610 Penalty Cash Deposit -Surety Bond if required TOTAL Receipt No. Received by $ / 7�5'_ Date 2774 PERMIT VALIDATION PERMIT NO. 33 75�_ DATE APPROVED EXPIRATION DATE - DATE ISSUEDBy— �� Z Administrative Authority Recorded by 11 Telephone: (619) 777-7075 WORKERS' COMPENSATION DECLARATION I hereby affirm, under penalty of perjury, one of the following declarations: I have and will maintain a certificate of consent to self -insure for worker's compensation, as provided by Section 3700, for the duration of any business activities conducted for which this license is issued. I have and will maintain worker's compensation insurance, as required by Section 3700, for the duration of any business activities conducted for which this.license is issued. My workers' compensation insurance carrier and policy number are: Cartier California Indemnity Inmrance SP109860B (cert. attached) Policy Number I certify that in the performance of any business activities for which this license is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions of Section 3700. Name GR Underground, Inc. Date 17 January 2001 Address 77670 Springfield Lane, #8 Signature t Palm Desert, Ca.92211. E. Dries Mallants, Busienss Manager WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO $100,000, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CERTIFICATE GOF Iie►BILITY INS`URANCEx°£` � Y t DATE(MMIDD/YY) s r �� s�'r[, 06woo ..d. .. _. ... -...- �.4R:wC.sw.:'3 r�:....., r .. '1. �]R !.w' ��)t PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HRH Ins Sery of So California HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR License Number 0694503 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 77-564 Country Club Dr. #401 COMPANIES AFFORDING COVERAGE Palm Desert CA 92211 COMPANY A St Paul Fire 8 Marine In INSURED COMPANY G R Underground Inc 8 INSCORP C X R Badchoe Service 77-670 Springfield #8 Palm Desert CA 92211 COMPANY C CaliforniaIndemnity Ins COMPANY D COVERAGES#' �Jt .Y,Y..�,.„s7iPo.Lw.a },:r4...v.siusAw,}wA'..d.."t.'vW:A.4 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. Lp TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE DATE (MWDD/YY) POLICY EXPIRATION DATE (MMIDD/YY) UM�S B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR CAIC 10020666 06/10/00 06/10/01 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 PERSONAL 6 ADV INJURY $ 1,000,000 OWNER'S 6 CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any one fire) $ 100,000 MED EXP (Any one person) $ 5,000 A AUTOMOBILE LIABILITY ANY AUTO KA08300078 12/17/99 12/17/00 COMBINED SINGLE LIMIT $ 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS X BODILY INJURY (Per accIdeni) $ X PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: Ax EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERSIEXECUTNE INCL SP109860B 07/06/00 07/06/01 X TWC STA - OTR s EL EACH ACCIDENT $ 1,000,000 EL DISEASE -POLICY LIMIT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 OFFICERS ARE: EXCL OTHER DESCAFI TION OFOPERATION,%OCATIONSNEHICLESISPECIAL ITEMS All Operations t 777-7155 tW'Fax `CERTIFIC s� K��.. _ t a ...,..ATE MOLDER_ �s�„.•Y�.�..,��`:....� � :„..x s'�.�.�.�"��::��:.�MCANCELLATION>� ,.`��,r� � ��'`.�"��.�:�F�,�v:��x7:��::'� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of La Quinta Public Works Dept P Q BOX 1504 La Quinta CA EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY =53 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Sal Sandoval 45 ., ,03 ri ,t : R ORPO J .19 w • ® r � � kix � � t� '� s� DATE (MMIDDIYY) CER` I(FICATE OF h, = IRBILITY INSURANCE , � � ` 01/04/01 , ... _ .. .R_......,,.nv...,_,.,u.ds.,.N�...,....,.....,zn"tc ::r•'cc, t�k..r s._l..r� _,q•.�.K,t .,� .., .,_a wx, _. e_.,i... ,. T �` .'5;as,»:k..• ,�a ., & :•Y.> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. HRH Ins Sery of So California License Number 0684503 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 77-564 Country Club Dr. #401 Palm Desert CA 9M11 COMPANIES AFFORDING COVERAGE COMPANY A INSCORP INSURED COMPANY G R Underground Inc B C & R Backhoe Service 77-670 Springfield #8 Palm Desert CA 9W1 COMPANY C COMPANY D COVERAGES c`� :1c£�, a..,� �� -d gr '.0 zZ .., +"k�.FL..is:5 .._�i �li3a..+..id .u3lwSeu?5�2:`.ai�' • .bw d 3x��`a. i'".4...4Y w3 A,,....,sr T ; THIS IS TO CERTIFY THAT THE €POLICIak.ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOi:VE FOR THE POLICY PERIOD n 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. CID TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POLICY EXPIRATIONLTR DATE (MM/DD/YY) �� GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY =?' CLAIMS MADE .D OCCUR PRODUCTS • COMP/OP AGG $ PERSONAL & ADV INJURY $ OWNER'S & CONTRACTOR'S.PROT EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ A AUTOMOBILE LIABILITY ANY AUTO CAIC10020666 12/17/00 06/10I01 . COMBINED SINGLE LIMIT $ 1 , 000,000 X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per �enA $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY • EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: :, TAM EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $. OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 0 Y IM"a EL EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERSIEXECUTIVE EL DISEASE • POLICY LIMB ' $ EL DISEASE • EA EMPLOYEE $ OFFICERS ARE: EXCL OTHER DESCRIPTION OFOPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS All Operations Fax # 777-7155 ;€ GERIIFICAIE HOLCANCELLATI :a SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of La Quinta EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL . Public Works Dept O BOX 1504 La Quinta CA 92253 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Sal Sandoval � � ,a^,{�:�.�� u�r QrL3 s�nssu�ssu�su�u�su��nsu��nu�ssu�ssu�u��nssssL3nu�ssuLfflPr ��nu�sssu��nu-�nu"�nur s�nssssL3nuasLnu�L3n� BUSINESS LICENSE CERTIFICATE NON TRANSFERABLE CITY OF, LA QUINTA The Licensee named herein having paid to the City of La Ouinta all fees required, license is hereby granted said Licensee.to.lransact the business herein set forth, for the period stated, in comformity with the Provisions of Ordinance No. 2 of this city. This License is issued without verification that the licensee is subject to or exempt from licensing by the State of California. NUMBER LOC: 77670 SPRINGFIELD LANE, SUITE #8 00587 PALM DESERT,CA 92211- BUSINESS LICENSE ID TYPE GR UNDERGROUND INC 1500 GENERAL CONTRACTOR LICENSEE: GR UNDERGROUND INC 77670 SPRINGFIELD LANE, SUITE 48 PALM DESERT, CA 92211- ISSUED EXPIRES 04/20/00 05/28/01 PLEASE POST IN A CONSPICUOUS PLACE CONTROL NO. 08358