ENC2021-0060 AY
10-18-2021
10-18-2022
10/20/2021 10/20/2021
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date: __________________________________
Tract No: _________________ Project Name: ________________________________
Vicinity:_______________________________________________________________
Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.)_________________
______________________________________________________________________
Description of Construction (i.e.: See Plan Set No. 01234) _______________________
Dimension of Installation or Removal: _______________________________________
Approximate Construction Start Date: _______________________________________
Approximate Construction Completion Date: _________________________________
Estimated Construction Cost: $ ____________________________________________
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-filling, compaction and
placing permanent resurfacing and or replacing improvements
Contact Name: _____________________________Phone Number: ________________
Name of Applicant/Owner: ________________________________________________
Applicant Address: ______________________________________________________
Applicant Telephone Number: _____________________________________________
Applicant E-mail Address: ________________________________________________
Name of Contractor: _____________________________________________________
Contractor Address: _____________________________________________________
Contractor Telephone Number: ____________________________________________
Contractor State License Number: __________________________________________
Contractor City Business License Number: ___________________________________
Contractor E-mail Address:
T Drive/Checklists – Forms & Applications/Application for Permit posted 8-26-09
Office Use Only:
Inspection Fee:
__________________________________________
Permit Fee:
__________________________________________
As-Built
Deposit:___________________________________
Dust Control
Deposit: ___________________________________
Credit
Amount: __________________________________
TOTAL FEE DUE:
ŹA COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDEDŻ
Applicant or Contractor General Liability Insurance Company:
______________________________________________________________________
Applicant or Contractor General Liability Insurance Policy Number:
______________________________________________________________________
Office Use Only:
Assigned Permit Number:
__________________________________________
Approval Date:
__________________________________________
Expiration
Date:______________________________________
Issue
Date: _____________________________________
Administrative Authority:
_________________________________________
LQHS Homecoming Parade
Old Town LQ, Main Street
Traffic Control for parade
Tops N' Barricades will block
traffic on Old Town to safely allow the annual Homecoming Parade to go down Main Street
Barricades and signage indication road closure
10/20/2021
10/20/2021
Josh Griswold 760-772-4150
La Quinta High School
79255 Blackhawk Way La Quinta, CA 92253
760-772-4150
joshua.griswold2@desertsands.us
Tops N' Barricades
44503 Jackson St Indio, CA 92201
760-347-2111
78495 Calle Tampico La Quinta, CA 92253 760.777.7000
RE: Encroachment Permits – Compliance with Insurance Requirements
Per Engineering Bulletin #97-04 please provide proof of the insurance items and
endorsement certificates below:
ޭ General Liability – $1M per occurrence / $2M general aggregate
ޭ General Liability – Additional Insured Endorsement (for ongoing and
completed operations)
ޭGeneral Liability – Primary / Non-contributory Endorsement
ޭAutomobile Liability – $1M combined single limit
ޭWorkers’ Compensation – Statutory Limits / Employer’s Liability $1M per
accident or disease
ޭWorkers’ Compensation – Waiver of Subrogation Endorsement
6+28/'७$1<७2)७7+(७$%29(७'(6&5,%('७32/,&,(6७%(७&$1&(//('७%()25(७
7+(७(;3,5$7,21७'$7(७7+(5(2)௵७127,&(७:,//७%(७'(/,9(5('७,1७
$&&25'$1&(७:,7+७7+(७32/,&<७3529,6,216
3 333
SCR 00101-35 7/1/2021
7/1/2022
1,000,00050,000
3333
3
SCR 00101-35 7/1/2021
7/1/2022
50,000 1,000,000
SCR 00101-35 7/1/2021
7/1/2022
250,250,00025,000
SCR 00101-35 7/1/2021
7/1/2022
50,000 Included
Keenan & Associates
4204 Riverwalk Parkway Suite 400
Riverside, CA 92505
mneades@keenan.com Southern California ReLiEF
A
A
10/15/2021
0451271
1,000,000
1,000,000
1,000,000
3
3
A
A
Southern California ReLiEF
WCE-0937813-21 7/1/2021
7/1/2022
500,0003C
Star Insurance Company
3
Marisa Neades
John Stephens
310-212-0363 x1187
La Quinta High School homecoming parade in the City of La Quinta on October 20, 2021.
This coverage shall be primary to the certificate holder’s coverage as respects to the actions and activities of the Covered Party due to their sole
negligence.
Desert Sands Unified School District
Riverside Schools' Insurance Authority
47-950 Dune Palms Road
La Quinta CA 92253
City of La Quinta
78495 Calle Tampico
La Quinta CA 92553
La Quinta HS Homcoming Parade 10/20/021
$2,000,000 annual aggregate as requested by contract.
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ENDORSEMENT
ADDITIONAL COVERED PARTY
COVERED PARTY
COVERAGE DOCUMENT
ADMINISTRATOR
Subject to all its terms, conditions, exclusions, and endorsements, such additional
covered party as is afforded by the coverage document shall also apply to the following
entity but only as respects to liability arising directly from the actions and activities of the
covered party described under “as respects” below.
Additional Covered Party:
As Respects:
____________________________________________
Authorized Representative
Issue Date:
10/15/2021
Desert Sands Unified School District
Riverside Schools' Insurance Authority
SCR 00101-35 Keenan & Associates
La Quinta High School homecoming parade in the City of La Quinta on October 20, 2021. This coverage shall be
primary to the certificate holder’s coverage as respects to the actions and activities of the Covered Party due to
their sole negligence. $2,000,000 annual aggregate as requested by contract.
City of La Quinta
78495 Calle Tampico
La Quinta CA 92553
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EXCESS WORKERS’COMPENSATION AND EMPLOYER’S LIABILITY POLICY
Waiver of Our Right to Recover From Others Endorsement
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule.This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
Company No.
Insured:
Policy Number:
Endorsement Number:
Endorsement Effective:Printed on:
Form No.46 93 WC 0807
⁄Copyright 1983 National Council on Compensation Insurance,Inc.
Any third party who requires you to provide this waiver. This endorsement is effective until the next
Anniversary Rating date of 7/1/22.
Desert Sands Unified School District
WCE-0937813-21
8
7/01/2021 6/17/2021
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PERMIT NO. ENC2021-0060
Traffic Control for La Quinta High School Homecoming Parade / Main St East of
Desert Club Dr (Permit for City Streets Only)
Special Conditions Page 1 of 2
In addition to the standard permit conditions, the following shall apply:
1. The applicant shall be available during the event by phone at (760) 772-4150 x 25101.
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. Desert Sands Unified School District (Josh Griswold), 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 completion of the event on October 20, 2021.
6. The Permittee shall contact the City Traffic Signal Maintenance Division at (760) 777-7070 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 County jurisdictions 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), at
residential streets, advance warning signs and traffic control shall be installed and maintained in
accordance the latest edition of the California Manual of Uniform Traffic Control Devices (CA
MUTCD) or the latest edition of the Work Area Traffic Control Handbook (WATCH).
On Collectors to Arterial Streets, the permittee must submit a traffic control plan which shall be from or
prepared under the guidance of the latest edition of the California Manual of Uniform Traffic Control
Devices (CA MUTCD) or the latest edition of the Work Area Traffic Control Handbook (WATCH).
Traffic Control plans not from the CA MUTCD or the WATCH shall be signed and stamped by a civil
or traffic engineer registered in the State of California. 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 without Public Works Director approval.
10. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 811. 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.
PERMIT NO. ENC2021-0060
Traffic Control for La Quinta High School Homecoming Parade / Main St East of
Desert Club Dr (Permit for City Streets Only)
Special Conditions Page 2 of 2
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 minimum
amounts provided in the Engineering Bulletin for Indemnification & Insurance Requirements. Limits
are subject to review but in no event less than the following:
- General Liability – $1M per occurrence / $2M general aggregate
- General Liability – Additional Insured Endorsement (for ongoing and completed operations)
- General Liability – Primary / Non-contributory Endorsement
- Automobile Liability – $1M combined single limit
- Workers’ Compensation – Statutory Limits / Employer’s Liability $1M per accident or disease
- Workers’ Compensation – Waiver of Subrogation Endorsement
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 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, 5th 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, sidewalk, lighting, etc., shall be
replaced to its original condition.
16. Access and egress to all local properties shall be maintained at all times.
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. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time.
19. 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.