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ENC2022-0020
4 Qwkra GEM ofibe DE';FWr — ENCROACHMENT PERMIT PUBLIC WORKS CONSTRUCTION See below for Finance Revenue Codes 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. DATE: 3/21/2022 LOCATION OF CONSTRUCTION (Street address or Description): JEFFERSON AT DEREK ALAN DR PURPOSE OF CONSTRUCTION: FOR CITRUS PLAZA IN INDIO; TRAFFIC CONTROL ONLY WITHIN LA QUINTA DESCRIPTION OF CONSTRUCTION: FRONTIER 70058-5282409 PLACE PULL BOX, HANDHOLE, & PVC DIMENSION OF INSTALLATION OR REMOVAL:SEE ATTACHED TRAFFIC CONTROL PLAN APPROXIMATE TIME WHEN WORK WILL BEGIN:2/28/2022 TIME OF COMPLETION: 3/28/2022 ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS: TRAFFIC CONTROL ONLY WITHIN CITY OF LA QUINTA; WORK IS WITHIN CITY OF INDIO NO WORK DURING COACHELLA MUSIC AND STAGECOACH FESTIVALS APRIL 14-18, 21-2S, AND APRIL 28 - MAY 2, 2022. 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 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 applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the result of this work. FRONTIER CALIFORNIA - HANNAH PADON Name of Applicant (please print) FRONTIER CALIFORNIA 1177 IDAHO ST REDLANDS, CA 92374 Business Address 9 S. 4TH ST REDLANDS, CA 92374 Name of Contractor and Job Foreman Business Address 488385 Contractor's License No. STEADFAST INSURANCE COMPANY Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION TRAFFIC CONTROL $673.00 TRAFFIC CONTROL PLAN REVIEW $83.00 TECHNOLOGY ENHANCEMENT FEE $5.00 TOTAL: $0.00 NA City Business License No. GLO 0285992-04 Policy Number PERMIT NO: ENC2022-0020 DATE ISSUED: 3-21-2022 EXPIRATION DATE: 3-21-2023 BY: WORK INSPECTED BY*: PERMIT COMPLETION DATE*: ;�Z1V Signature of Applicant or Agent (951)992-1659 Telephone No. (760)342-1240 Telephone No. *If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. FRONTIER PROJECT #70058-5292409 Tw�v 4 4a" PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT Date: 2/3/2022 Tract No: Project Name: 70058-5282409 Vicinity Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.),WORK CREW TO� PLACE ADVANCED WARNING SIGNS IN THE CITIES ROW � Description of Construction i.e.: See Plan Set No. 01234 `NO WORK BEING DONE . IN CITY. ALL WORK IN INDIO Dimension of Installation or Removal: Approximate Construction Start Date: 2/17/2022 Approximate Construction Completion Date: 3/17/2022 Estimated Construction Cost: $M 12L 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: FRONTIER COMMUNICATIONS Phone Number:951-992-1659 Name of Applicant/Owner: HANNAH PADON/ DYNAMIC TELCO (AGENT FOR FRONTIER) Applicant Address: n 177 IDAHO ST, REDLANDS, CA 92374 Applicant Telephone Number: 951-992-1659 Applicant E-mail Address: DTPERMITS@DYNAMICTELCO.COM Name of Contractor: FRONTIER COMMUNICATIONS Contractor Address: 9 S. 4TH ST, REDLANDS, CA 92374 Contractor Telephone Number: MIKE REDDING: 760-342-1240 Contractor State License Number: it Contractor City Business License Number: 488385 Contractor E-mail Address: MIKE.REDDING@FTR.COM ►A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 1plicant or Contractor General Liability Insurance Company: Applicant or Contractor General Office Use Only: Inspection Fee: Permit Fee: As -Built Deposit:_ Dust Control Deposit: Credit Amount: ilitv Insurance Policv Number: Office Use Only: Assigned Permit Number: Approval Date: Expiration Date: Issue Date: Administrative Authority 'Application for Permit pose - TOTAL FEE DUE: DIMENSION "E" DIMENSION DIMENSION BUFFER SPACE SPEED "A/B/C" DIMENSION DIMENSION "L/3" (4-A) and MAXIMUM MXIMUM MAXIMUM JEFFERSON ST LIMIT ADVANCE MINIMUM "L" "L/2" FLAGGER CHANNELIZER CHANNELIZER CHANNELIZER MERGING SHIFTING STATION TAPER TANGENT CONFLICT 55 MPH (2) WARNING SIGN TAPER TAPER SHOULDER STOPPING SIGHT SPACING (3) SPACING (3) SPACING (6) END SPACING (5) TAPER DISTANCE (4-B) CA MUTCD WATCHBOOK (page 34): ROADWORK o 0 0 Mid Block Bike Lane Closure. oZM G20 2 (0%) (-3/0) (-6/0) (optional) MPH FT FT FT FT FT FT FT FT &b H 55 500 660 330 220 (495) (520) (555) 50 100 25 avow z = z J 04 U Q 2 YO N C OYC¢¢] z 3 O O Q a Y Lo 0pW Cn wN A.' �Q z SIGN SPACING 0 LLI C 0 4. re MEDIAN 1` y "A" "A" "L/3" \ SIGN SPACING SIGN SPACING SHOULDER TAPER D�� 0 a m In C� m00 m0" j �0 m 0� A Dmm Em--o m p m O O W W m rn DRIVEWAY TYPICAL 0 0 0 0 0 0 0 0 0 0 ALL DRIVEWAYS TO REMAIN OPEN (WHENEVER POSSIBLE) THROUGHOUT TRAFFIC CONTROL ZONE. LEGEND 0 TRAFFIC CONE �� TYPE III BARICADE WITH SIGN TEMPORARY SIGN O SIGNALIZED INTERSECTION y DIRECTION OF TRAVEL FLAGGER ® WORK AREA HIGH LEVEL WARNING DEVICE (HLWD) FLASHING ARROW SIGN (FAS) F UCKCI� HUi114 UK (25MPH)�, r M rn ` N' 3 AVENUE 50 50 MPH LOCATION 1 NTS WORK CREW TO UTILIZE THIS TYPICAL TO PLACE (1) PULL BOX AND (1) HH LOCATED ON THE E/S/O JEFFERSON ST @ N OF AVENUE 50 TO PLACE NEW SUBSTRUCTURE. 4-- ro MEDIAN TCP NOTE: 1) FRONTIER HAS APPLIED FOR AN ENCROACHMENT PERMIT TO THE CITY OF INDIO. Q�OFESS rL w-- :3 . 29570 m Exp. 03/31 /23 * 2/27/2022 J� C / v \ \Q qTF OF CAL CONSTRUCTION NOTES: 1) WORK CREW TO UTILIZE THIS TYPICAL FOR THE WORK LOCATION(S) DEFINED TO THE LEFT. 2) WORK CREW TO UTILIZE STEEL PLATES FOR VEHICLE INGRESS AND EGRESS FOR DRIVEWAYS. 3) WORK CREW TO PLACE TEMPORARY NO PARKING ANY TIME SIGNS ALONG ENTIRE WORK AREA 72 HOURS BEFORE CONSTRUCTION. 4) WORK CREW TO COMBINE TYPICALS AS NEEDED TO ACHIEVE ADEQUATE TRAFFIC CONTROL. 5) WORK CREW TO ROTATE TYPICALS AS NEEDED TO MATCH STREET CONDITIONS. Frontier COMMUNICATIONS JOB ID: 70058-5282409 DATE: 02/25/2022 TITLE: TRAFFIC CONTROL PLAN STREET ADDRESS: 100 JEFFERSON ST CITY/STATE: INDIO, CA 92201 FTR ENGINEER: AL FASANO (661) 949-8604 FTR INSPECTOR: MIKE REDDING (760) 342-1240 DRAWN BY: SCALE: N.T.S 00f DYNAMIC TELCO 951-992-1472 EST. #: SHEET#: DYNAMIC TELCO 9 OF 7 3. 4. 5. 6. 7. 8 9 10. 11. 12. 13. 14. 15. 16. 17 18. 19 20 21 FRONTIER COMMUNICATION CONSTRUCTION SPECIFICATIONS Contact Frontier Engineer CHOOSE ENGINEER sixty (60) days prior to need of service in order to confirm compliance,order materials,and schedule work forces. FRONTIER COMMUNICATIONS,INCORPORATED RESERVES THE RIGHT TO REFUSE ANY CONDUIT, PULL BOXES, MANHOLES, OR UTILITY BOXES THAT DEVIATE FROM PLANS AND SPECIFICATIONS. CHANGES OR DEVIATIONS FROM THIS PLAN MUST BE APPROVED BY FRONTIER. CONTACT THE FRONTIER INSPECTOR 48 HOURS BEFORE TRENCHING AND UPON COMPLETION OF YOUR SUBSTRUCTURES TO SCHEDULE THE FINAL INSPECTION. FRONTIER INSPECTOR SHALL BE PRESENT ON SITE WHEN CONTRACTOR NEEDS TO ACCESS ANY EXISTING FRONTIER FACILITY. All conduit risers bends to have a minimum thirty-six (36) inch radius. All horizontal ninety degree bends (90°) shall have a radius of not less than 12.5 feet and all vertical ninety degree bends (90°) shall have a radius of not less than three feet. No more than two (2) ninety degree (90°) horizontal bends shall be placed in any single run unless otherwise specified. Contact Frontier engineer concerning any required deviations. All conduit must be proven using a mandrel no less than a 1/2" smaller than the conduit to be accepted. Mule tape shall be placed in all conduits proven. Wall to wall measurements must be taken with a mule tape. Accurate AS-BUILTS shall be provided to the Frontier inspector assigned to this project. AS-BUILTS shall include conduit section measurements, wall to wall footages, stations and offsets of AS -BUILT Frontier structures, and the cover to the top of the Fronter underground structurre placed. Copy of the AS -BUILT conduit work order must be provided to the Frontier inspector assigned to your project. Contact CHOOSE INSPECTOR at the inspection office for coordination of inspection dates. Place weatherproof cap on end of all conduits terminated outside of a building. Place temporary weatherproof cap on end of all conduits exposed during construction. Rigid steel, approved plastic conduit (PVC Schedule #40,TYPE-C (4") or DB-120 (2") or Frontier provided or approved Roll Sheet sub duct, is specified for underground construction. Condulets, Flex, Transite, Plumbers fittings, Water and Gas Pipes must NOT be used. RIGID STEEL MUST BE USED WHEN CONDUIT CAN BE EXPOSED TO VEHICULAR TRAFFIC. Conduit terminated on a pole must be PVC Schedule 80. If conduit will be exposed to traffic, rigid steel pipe and sweep is required to 48" above finished grade otherwise turned up 12" above finished grade. Location of riser on pole will be as shown on conduit plan and location can be modified by approval of Frontier engineer/inspector only. Miminum separation from other utilites shall be a minimum of 12". Conduit placed in same trench with primary power conduit must be separated by no less than twelve inches(12") of well -packed sand or three inches(3") of concrete. Minimum cover shall be no less than thirty (30") inchs measured from the final grade of the street flow line to the top of Frontier structure unless noted otherwise. Ducts placed in the driven portion of the roadway must have no less than 48 inches(48") of cover to top of pipe measured at flow line of roadway. FRONTIER RECOMMENDATIONS: Provide a minimum 1-4" conduit home run from each suite location to the main terminal backboard in lieu of running cables over drop ceiling access. Frontier will not install cables not contained in conduit. Provide source of ground at the telephone backboard location: (1) #6 insulated copper wire (solid preferred) to power system ground. - (1) #6 insulated copper wire (solid preferred) to permanent metallic structure such as LIFER ground or building steel. - (1) #6 insulated copper wire (solid preferred) to metallic water pipe bonded to previously described permanent metallic structure. Leave adequate wire to extend six feet beyond base of backboard. NOTE: THE FOLLOWING MUST NOT BE USED FOR GROUND SOURCES: ROOF TRUSSES, FLOOR JOINTS, BRACES, SPRINKLER SYSTEM PIPES, METAL ELECTRICAL DISTRIBUTION CONDUIT, AND HORIZONTAL STEEL MEMBERS LESS THAN 3/8" THICK. Provide cable racking as described in attachment. Provide pulling irons as described in attachment. Three to six weeks will be needed from the date of final inspection for Frontier to start placing facilities. All paperwork and easements must also be completed, if applicable. Work crew to adjust manholes to final grade as shown on the approved grading plan. Actual footages of conduit are needed to order materials. CONDUIT DESIGN PICK UP POINT: 70058-5282409 49906 JEFFERSON ST INDIO, CA 92201 VICINITY MAP NTS PATH LENGTH: MATERIALS -EX FRONTIER MH - 2" TRENCH = 564' -743' OF 2" PVC 33.687194,-116.267988 -(1) 2'x3' HANDHOLE(S) -(1) PULLBOX(ES) SHEETINDEX 1-COVER 2 - CONDUIT DESIGN 3 - CONDUIT DESIGN 4 - DETAILS ABBREVIATIONS PROPOSED EXISTING BUILDING BLDG bldg CENTERLINE C/L c/I CONCRETE CONC cone SIDEWALK CSW csw DRIVEWAY DWY dwy EDGE OFPAVMENT EOP eop FACE OF CURB FOC foc HANDHOLE HH hh MANHOLE MH mh PEDESTAL PED ped POLYVINYL CHLORIDE PVC pvc SUB DUCT SD sd PROPERTY LINE P/L p/I RAILROAD RR rr RAILROAD R/W RR R/W rr r/w RIGHT OF WAY R/W r/w SOUTHERN CAL EDISON SCE sce WALL TO BUILDING W-B WALL TO POLE W-P NOT TO SCALE NTS LEGEND CONDUIT Mainline/Backbone Conduit or ARS Service Lateral Conduit JT Joint Trench T Sole Trench 0— Iroposed Construction Call Cu: UTILITIES Fx h- Gas Water w Telephone San Sewer Electric Storm Drain POLES _xis-. rig 'ropas=:. Frontier Owned O Foreign Cwrcd X Joint Owned FACILITIES Manhole 0 Handhole o PullBox m Bore Pit 5/8"-8' Copper Ground Rod /11 Material provided by Frontier & Placed by Developer. ALA Non— Reimbursable Material Provided & Placed Frontier COMMUNICATIONS JOB ID: 70058-5282409 DATE: 01/31/2022 TITLE: CONDUIT DESIGN STREET ADDRESS: 49906 JEFFERSON ST CITY/STATE: INDIO, CA 92201 FTR ENGINEER: AL FASANO (661) 949-8604 FTR INSPECTOR: MIKE REDDING (760) 342-1240 DRAWN BY: 4;1 DYNAMIC TELCO 951-992-1472 C/ EST. #: SHEET#: DYNAMIC TELCO 9 OF 4 Imeodanl Nobca Section 4216/421 ] of the Government Code requires a Dig All Identification Number to be Issued before a "Permit to Excavate" will be valid. For your Dig Aled I . Number call: Untlerground Service Alert F G � O� Pv 9c�o S6R�\F. Ca11 1ND-800-227-2600 21 GENERAL NOTES: 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD OBSERVATIONS. WORK CREW TO VERIFY LOCATION OF ALL EXISTING UTILITIES PRIOR TO CONSTRUCTION. U L c U. a LL LL LL LL B 2" BORE 0 LF B 4" BORE 0 LF T j TRENCH 259 LF COMBO PED 0 EA 1700" HANDHOLE(S) 0 EA 0 2'x3' HANDHOLE(S) 1 EA F FLOWER POT(S) 0 EA CONCRETE R&R 0 SF ASPHALT R&R 0 SF Q 3'x3' BORE PITS 0 EA 02 4'x4' BORE PITS 0 EA Q 4'x6' BORE PITS 0 EA CURVE DATA Q R L T 0 90°00'00" 12.5' 19.6' 12.5' ® 45-00-00" 12.5' 9.8' 5.18' 0 22e30'00" 12.5' 4.9' 2.49' O J O \ a' 1L U 0 o_' • EXACT UTILITIES LOCATIONS TO BE VERIFIED BY USA MARKINGS PRIOR TO DIGGING. CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS & SIDEWALKS SCALE: 1 "=60' Important Nobca Section 42161421 ] of the Government Cotle requires a Dig Alert Itlentifcatipn Number to be Issued before a "Permit tp Excavate" will be valid. For your Dig Alert I . Number call: Untlerground Service Alert F G � O� Pv 9c�o S6R�\F. ca11 1ND-800-227-2600 GENERAL NOTES: 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD OBSERVATIONS. WORK CREW TO VERIFY LOCATION OF ALL EXISTING UTILITIES PRIOR TO CONSTRUCTION. EXACT UTILITIES LOCATIONS TO BE VERIFIED BY USA MARKINGS PRIOR TO DIGGING. CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS & SIDEWALKS SCALE: 1 "=60' B 2" BORE 0 LF B 4" BORE 0 LF T j TRENCH 305 LF COMBO PED 0 EA 1700" HANDHOLE(S) 0 EA 0 2'x3' HANDHOLE(S) 0 EA F FLOWER POT(S) 0 EA CONCRETE R&R 0 SF ASPHALT R&R 0 SF Q 3'x3' BORE PITS 0 EA 02 4'x4' BORE PITS 0 EA Q 4'x6' BORE PITS 0 EA CURVE DATA Q R L T 0 90°00'00" 12.5' 19.6' 12.5' ® 45-00-00" 12.5' 9.8' 5.18' 0 22e30'00" 12.5' 4.9' 2.49' K to"XI8" KNOCKOUT 2 EACH SIDE APPROX. WEIGHT: 2480 LBS. 111111�����` yHT1jF1T1FTITITIT'I_'ITIyfT il_ I Illk%i i QI �....... RISERS MODEL NO. I T RS304806 6" 283 LBS. RS304812 12" 567 LBS. FOR COMPLETE DESIGN AND PRODUCT INFORMATION, CONTACT JENSEN PRECAST. 18" X 18" KNOCKOUT 1 EACH END WALL PULLING IRON 1 EACH END STANDARD NON ADJUSTABLE COVERS MODEL NO. A DESIGN LOAD WEIGHT CA3048C61 6" INCIDENTAL H-20 560 LBS. CA3048C61C 1 13"1 PEDESTRIAN 1 490 LBS. 3048 PULLBOX MODEL PB3048 2'-6" x 4'-0" x 2'-6" I.D. 1-X 4" PULL SLOT W/ CENTER PIN 2 PLACES SKID RESISTANT 18 UNC LG SURFACE M3-66 SSSS HEM O 2 PLACES OUAZITE LOGO .."FLAT WASHER ® 2 P ACES ..."PAL NUT O 2 PLACES HANDHOLE -24" X 36" X 24' 20K RATING - BOX 8 2 Pc SPLIT COVER ITEM SWEEP DETAIL HANDHOLE DETAIL-2'x3' 1 3 PARKWAY ROADWAY CURB AND GUTTER FLOW LINE w z O M cr J LL O� O O O z 1211 z 12" �a ry N Q w U) PUBLIC R/W TRENCH DETAIL N.T.S. City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2022-0020 The following shall always apply: ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within the City of La Quinta's 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. TRACK -LAYING CONSTRUCTION EQUIPMENT: Cleated track -laying construction equipment shall not be permitted to operate on any paved surface unless fitted with smoother -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 operation 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 La Quinta 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 seal coat as specified above. PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City Engineer or City of La Quinta Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration of the project. The City shall be notified twenty-four hours (24) in advance of any traffic detours or delineation. CARE OF DRAINAGE STRUCTURES: Any drainage structure to include 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 Quinta shall be notified prior to commencement of this work. Drainage structures and open drains 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 shall be removed from the right of way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill 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 OPERTATIONS: 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 The following shall apply when indicated: ® R1 NOTIFICATION: Permittee shall notify the City at (760) 777 - 7097 at least forty-eight hours (48) in advance of starting construction. ® R2 UTILITY CLEARANCE: (Substructures) Prior to making any excavations within the City of La Quinta right-of-way authorized by permit, the permittee 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 permittee shall notify all concerned utility companies of the proposed work. ❑ R4 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced with ( ** N/A ** ) inches of A.C. paving placed on ( ** N/A ** ) inches of ( ** N/A ** ) aggregate sub -base course having an "R" value of not less than ( ** N/A **) and in conformance with the City of La Quinta Road Improvement Standards and Specifications, Ordinance #461. ❑ R5 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of one-fourth inch ('/d') to one foot (1'). ❑ R6 GRADE CHECKING: City of La Quinta 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 (** N/A **) 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 Quinta Standard #207. ❑ R8 DRIVEWAYS: A.C. driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the property line and the existing road paving shall be two and a half inches (2 ''/2") of A.C. paving on (** N/A **) of class (** N/A ** ) aggregate base. ® R9 SIGHT CLEARANCE: Sight Clearance of six -hundred feet (600') in all directions shall be assured and maintained at all times. ❑ R10 SOIL STERILIZER: The area to be surfaced shall be treated with soil strerilizer. Rate of application shall comply with the manufacturer's specifications. City of La Quinta ® R11 COORDINATE WORK: The proposed work shall be subordinated to any operation, which the State of California or City of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects. ® R12 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the centerline of all streets or property lines when included shall be completely tied out so they may be readily and correctly, replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall be notified upon completion or replacement of all survey monuments for proper clearance. ® R13 PAVEMENT CUTTING: Pavement will be mechanically saw cut to a straight edge prior to excavation. Method of pavement cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment be used to excavate prior to cutting or pavement.) Excavation material shall be placed in such a position as to best facilitate the general flow traffic. Prior to final paving operations, any damage to pavement straight edges shall be corrected. ❑ R14 LIMIT OF EXCAVATIONS: Excavations shall be limited to one -thousand feet (1000') of open trench before backfill operations must begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays for the protection of the traveling public. The Public Works Inspector shall determine the suitability of excavation barricading in each case. No excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction material is actually on the work site. ® R15 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes of producing and adequately consolidated backfill. Ant material which the City of La Quinta deems unsuitable (spongy or saturated material) which is encountered during excavation shall not be used for backfill but shall be supplemented or replaced by an approved sand or gravel. ❑ R16 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed on lifts not greater than three feet (3') and vibrated using vibrostamper or equivalent equipment. Alternate methods may be substituted, but in any case, a relative compaction of ninety-five percent (95%) shall be maintained with the structural section of the roadway. ❑ R17 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than fifty percent (50%) of the total depth of the trench before flooding or a maximum of five feet (6) lifts where trenches are of excessive depths. Care is to be exercised that the backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the resulting compaction shall not be less than ninety percent (90%) or equivalent to the surrounding ground, whichever is the greater compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water supply shall be continuos. ❑ R18 COMPACTION TESTS: If so required by the inspector, compaction test shall be made at intervals of not more than one - thousand (1000') feet and a maximum of one (1) test on each road. One (1) copy of each test shall be forwarded tot the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ® R19 COMPACTION TESTS: If so required by the Inspector, compaction tests shall be made for each crossing or service line. One (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Sections 6.3.001 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ® R20 TEMPORARY PAVEMENT REPAIRS: After completion of Backfill and compaction operations, a temporary patch consisting of two inches (2") of SC-800 shall be placed on a prepared sub -grade. The SC-800 temporary paving shall be placed after a maximum of three -thousand linear feet (3000') or trench has been excavated and backfill operations completed, but in no case shall the placement of the temporary pavement exceed a five (5) day limit. ® R21 PERMANENT PAVEMENT REPAIR: After backfill and compaction have been completed, a temporary patch consisting of three inches (Y) of SC-800 shall be placed immediately. A permanent patch of Asphalt Concrete surfacing per City of La Quinta Standard 600 shall be placed no later than ( 5 ) days after completion of temporary road repair. ❑ R22 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as determined by the City Engineer. ❑ R23 STREET RESTRIPING: Where street striping is still visible on street to be excavated, such striping shall be replaced upon completion of permanent repairs. ❑ R24 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right-of-way shall be accomplished by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public. It shall be the responsibility of the permitte to maintain the tree in a vigorous growing condition at its new location. Trees to be removed shall be in sections, which can be handled safely without interference or hazard to highway traffic. The entire width of the tree stump, shall be removed and disposed of so that no debris remains in view of the highway. The stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of five -hundred feet (500') at any one time. Adequate signs, flagmen and or barricades shall be provided to protect the traveling public at all times. Large holes resulting from tree removal shall be backfilled and compacted to not less than ninety percent (90%) or equivalent tot the surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973. PERMIT NO. ENC2022-0020 Frontier 70058-5282409/ Place Pull Box, Handhole, and PVC; Traffic Control Only Within La Quinta / Jefferson St at Derek Alan Dr In addition to the standard permit conditions, the following shall apply: 1. 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. 2. The permittee may only work at night if approved by the City Manager. If approved by the city manager, night work may be halted if the city receives complaints about the night work. 3. Prior to commencing the excavation of a trench 5 feet in depth or greater and into which a person will be required to descend, the Contractor shall first obtain a permit to do so from the Division of Industrial Safety pursuant to 7-10.4.1. 4. This permit is for work within the R/W. The permittee shall not encroach upon private property without prior written approval (submit to the Public Works Department, attention to the Associate Engineer) of the private land owner whom is being encroached upon. 5. The City of La Quinta reserves the right to require modifications of the work be made at permittee's sole cost for further modifications as it relates to any sight distance concerns and/or improvement plan requirements as required by the City Engineer. 6. "The permittee shall not construct an improvement that reduces vehicular sight distances. If such improvement is found to reduce the vehicular sight distance, then the permittee shall relocate the improvement prior to sign off of their encroachment permit." 7. The permittee shall not install improvements with the intention of providing video transmission services unless the permittee obtains a valid Franchise Agreement. The permittee shall remove any underground utility markings that are no longer being used for this project. The permittee shall remove markings on paved areas using high pressure wash or a method equivalent and at the discretion of the City Engineer. 9. Any asphaltic or concrete repairs shall closely match the existing paved areas in color at the discretion of the City Engineer. A finish product with a checkerboard appearance will not be accepted. 10. The permittee shall maintain the existing pedestrian path of travel and must maintain accessible compliant pathways leading to areas for use of public transportation systems. 11. No stockpiling of any materials will be allowed within the City R/W without an approved permit explicitly stating the use for stockpiling and/or storage. 12. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during the actual work performed. Special Conditions Page 1 of 6 PERMIT NO. ENC2022-0020 Frontier 70058-5282409/ Place Pull Box, Handhole, and PVC; Traffic Control Only Within La Quinta / Jefferson St at Derek Alan Dr 13. Frontier California Inc. (Mike Redding), hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. 14. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 15. The permittee shall submit inspection requests by calling the City Inspection Hotline at (760) 777-7097 before 1:30 p.m. and at least twenty-four (24) hours prior to the anticipated inspection. 16. The permittee is required to provide a changeable message board informing the commuters using the affected Major and Primary Arterial roads of major construction and possible traffic delays, time of construction, and if possible alternate routes. The message board shall be provided for the commuters 48 hours prior to the start of traffic delays. 17. 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. Note: Construction work (including setting up traffic control devices) is not permitted on any Arterial street (ie any 4 lane street) before 8:00 a.m. 18. Work within 500 feet of a signalized intersection shall be performed between the hours of 9 a.m. - 3 p.m. Traffic control shall be set up after 9 a.m. and removed before 3 p.m. 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. 19. 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. 20. The permittee shall place temporary no parking signs along the parking area affected by the construction. The signs shall be placed along the area 48hrs prior to the start of closing the area, and removed immediately after the construction completion date. Special Conditions Page 2 of 6 PERMIT NO. ENC2022-0020 Frontier 70058-5282409/ Place Pull Box, Handhole, and PVC; Traffic Control Only Within La Quinta / Jefferson St at Derek Alan Dr 21. 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. This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to start of construction, a letter from any owners of the driveways/access ways that will be closed down due to the construction. The letter must be approved by the city and at minimum state from the owner the following: A. Approval of the construction B. Plan identification C. Time Frame of Closure D. Alternative Routes 22. 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. A minimum of two (2) travel lanes of paved surface shall be maintained at all times. 23. 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. 24. 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. Special Conditions Page 3 of 6 PERMIT NO. ENC2022-0020 Frontier 70058-5282409/ Place Pull Box, Handhole, and PVC; Traffic Control Only Within La Quinta / Jefferson St at Derek Alan Dr 25. The permittee shall be responsible for calling the city inspector to arrange the city inspector to observe random trench compaction testing performed by a city approved material testing firm. If the inspector's phone number is unknown, the permittee shall call the Public Works front counter phone at 777-7075 or the Associate Engineer at 777-7047 to determine the city inspector's phone number. The inspector shall determine the number and location of the test location/s. The above testing does not relieve the permittee's responsibility for future repairs due to settlement at and near the locations of the work area. Materials testing must be performed under direct supervision of a California Registered Civil Engineer. 26. The issuance of this permit and the City approval of the related construction improvement plans do not provide a vested entitlement for all design parameters that may have been utilized for the plans. As such, plans approved for this permit may be "at risk" for further modifications as it relates to any follow up improvement plan requirements as required by the city or existing errors & omissions by the architect or engineer of record. 27. This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to start of construction, the name of the City approved contractor, who shall submit to the City the following items: a. General Liability Insurance Company and Policy Number b. City Business License c. Contractors State License Number 28. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts provided in the 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. 29. The permittee shall not encroach upon private property without prior written approval (submit to the Public Works Department, attention to the Associate Engineer) of the private land owner whom is being encroached upon. 30. The permittee shall haul all offsite debris to a certified landfill. Prior to hauling debris, the permittee shall inform the City (Inspection staff or 777-7047) of the name and location of the certified dump site. 31. If public traffic lanes are required to be closed, this permit is not valid until the permittee submits, to the Public Works Department, a traffic control plan for review and approval prior to start of construction or parking on the paved R/W. 32. The permittee is required to provide an informative message board (approved by the City Engineer) informing the commuters using the affected Primary Arterial roads or heavier traffic of possible traffic delays, time of construction, and if possible alternate routes. The message board shall be provided for the commuters 48 hours prior to the start of traffic delays. Special Conditions Page 4 of 6 PERMIT NO. ENC2022-0020 Frontier 70058-5282409/ Place Pull Box, Handhole, and PVC; Traffic Control Only Within La Quinta / Jefferson St at Derek Alan Dr 33. 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. 34. Access and egress to all local properties shall be maintained at all times. 35. 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 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 3/4" max medium asphalt concrete as the base course lift and a City approved 1/2" 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: three (3) feet outside the sawcut removal lines. • For longitudinal trenches located in a traffic lane: three (3) 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. Special Conditions Page 5 of 6 PERMIT NO. ENC2022-0020 Frontier 70058-5282409/ Place Pull Box, Handhole, and PVC; Traffic Control Only Within La Quinta / Jefferson St at Derek Alan Dr E. If grinding and capping operations are not performed in the same day as base paving operations, the base course lift of 3/4" 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 or any existing detour 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. 36. All landscaping, irrigation, decorative rock, decorative concrete, lighting, sidewalk, etc., shall be replaced to its original condition. 37. 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. 38. 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. 39. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 40. 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. 41. If it is the intent of the permittee to cut the pavement and have it restored by a third parry, the permittee shall postpone cutting the pavement until the intended third parry has acquired a permit from the City to perform the required restoration work. Special Conditions Page 6 of 6 Page 1 of 2 A �J �O CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ 2021Y) o6/11�2021 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis Towers Watson Southeast, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-995-7378 FAX 1-888-467-2378 A/C No Ext : A X No ADDRESS: certificates@willis.com INSURER(S) AFFORDING COVERAGE NAIC # Nashville, TN 372305191 USA INSURERA: Steadfast Insurance Company 26387 INSURED Frontier Communications Parent, Inc. and its Subsidiaries 401 Merritt 7 INSURERB: Zurich American Insurance Company 16535 INSURERC: Associated Electric & Gas Insurance Servic B1164 INSURERD: American Zurich Insurance Company 40142 Norwalk, CT 06851 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W21243804 REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR a RDAMAGE TO ENTED PREMISES('a )$ 500,000 MED EXP (Any one person) $ 10,000 A Y Y GLO 0285992-04 06/01/2021 06/01/2022 PERSONAL & ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY ❑ JECT PRO- ❑ LOC X PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X BODILY INJURY (Per person) $ ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS Y Y BAP 0285990-04 06/01/2021 06/01/2022 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY C UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 X X AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE XL5943201P 06/01/2021 06/01/2022 DED RETENTION$ See Below RETENTION $ See Attached D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? No (Mandatory in NH) NIA Y WC 0285988-04 (AOS) 06/O1/2021 06/O1/2022 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ B Workers Compensation (WI) Y WC 0285989-04 (RETRO) 06/01/2021 06/01/2022 EL Each Accident $1,000,000 Per Statute EL Disease -Ea Empl. $1,000,000 and Employers Liab. EL Disease-Pol. Limi $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Frontier California Inc.'s applications for public works permits. The City of La Quinta is included as an Additional Insured as respects to General Liability and Auto Liability where required by written contract. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of LA Quinta 78495 Calle Tampico I�I LA Quinta, CA 92253 UV/ ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 21213929 BATCH: 2127693 AGENCY CUSTOMER ID: LOC #: ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Southeast, Inc. Frontier Communications Parent, Inc. and its Subsidiaries 401 Merritt 7 POLICY NUMBER Norwalk, CT 06851 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance purchased by Additional Insured where required by written contract. Waiver of Subrogation applies in favor of The City of La Quinta with respects to General Liability, Auto Liability and Workers Compensation as permitted by law, where required by written contract. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 21213929 BATCH:2127693 CERT: W21243804 POLICY No.: XL5943201P NAMED INSURED: Frontier Communications Parent, Inc. and its Subsidiaries 4;-4AEGIS ASSOCIATED ELECTRIC & GAS INSURANCE SERVICES LIMITED UNDERLYING LIMITS SCHEDULE SCHEDULE NO. 1 This schedule is attached to and forms a part of Item 6 of the Declarations of POLICY No. and lists all underlying insurance or self -insured retentions maintained by the NAMED INSURED effective this 1st day of June, 2021 at 12:01 A.M. Local Time at the address of the NAMED INSURED. Insured or Uninsured $1,000,000 any one OCCURRENCE - General Liability $1,000,000 any one OCCURRENCE - Pollution Liability $2,000,000 any one OCCURRENCE - Automobile Liability $ 500,000 any one OCCURRENCE - Emergency Assistance Agreement $1,000,000 any one OCCURRENCE - Employer's Liability $ 500,000 any one OCCURRENCE - Standards Board Activity $ 500,000 any one OCCURRENCE - Community Service Activity $5,000,000 any one OCCURRENCE - Non -Owned Aircraft Liability (Manned and Unmanned Aircraft) $1,000,000 any one OCCURRENCE - Watercraft Liability As per policy wording Signature of Authorized Representative 8300 (07/2011) Page 1 of 1 PRINT - 05/11/2021 18:17:48 POLICY NUMBER: GLO 0285992-04 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ONLY THOSE WHERE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT ALL LOCATIONS AND OPERATIONS Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Wolters Kluwer Financial Services, Inc. I Uniform Forms POLICY NUMBER: BAP 0285990-04 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: FRONTIER COMMUNICATIONS PARENT, INC. Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): Any person, organization, trustee, estate, governmental entity or entity of whatever form is an additional insured as required by contract, agreement or permit. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 2 Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 2 of 2 Other Insurance Amendment — Primary And Non - Contributory ZURICH; Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. AddT Prem Return Prem. GLO 0285992-04 06/01/2021 06/01/2022 18895000 INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Address (including ZIP Code): This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part 1. The following paragraph is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is primary insurance to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by a written contract or written agreement that this insurance would be primary and would not seek contribution from any any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit'. This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. All other terms and conditions of this policy remain unchanged. U-GL-1327-B CW (04/13) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Waiver Of Subrogation (Blanket) Endorsement Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add'1 Prem. Return Prem. GLO 0285992-04 06/01/2021 06/01/2022 18895000 $ INCL $ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-B Cw (12/01) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 04-84) 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 ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT, OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement 6/1/2021 Effective Policy No. WC 0285988-04 Endorsement No. Insured Frontier Communications Parent, Inc. Premium $ Insurance Company American Zurich Insurance Company Countersigned by WC124 (4-84) Page 1 of 1 WC 00 03 13 Copyright 1983 National Council on Compensation Insurance, Inc. Uniform FormsTI WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 04-84) 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 ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT, OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement 6/1/2021 Effective Policy No. WC 0285989-04 Endorsement No. Insured Frontier Communications Parent, Inc. Premium $ Insurance Company Zurich American Insurance Company Countersigned by WC124 (4-84) Page 1 of 1 WC 00 03 13 Copyright 1983 National Council on Compensation Insurance, Inc. Uniform FormsTI