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ENC2022-0075
4 Q"fra ---- GEM ofrh, DESERT — ENCROACHMENT PERMIT PUBLIC WORKS CONSTRUCTION See below for Finance Revenue Code: 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: 9/13/2022 LOCATION OF CONSTRUCTION (Street address or Description): JEFFERSON ST NORTH OF AVE 50 PURPOSE OF CONSTRUCTION: DRY UTILITY INSTALLATION DESCRIPTION OF CONSTRUCTION: FOR CITRUS PLAZA; TRENCH FOR III) DRY UTILITY INSTALLATION DIMENSION OF INSTALLATION OR REMOVAL: SEE ATTACHED IID CONDUIT LAYOUT AND TRAFFIC CONTROL PLAN APPROXIMATE TIME WHEN WORK WILL BEGIN: ?j. 9J2QZ2 TIME OF COMPLETION: 9/3012022 ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS: 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 o City of La Quinta and to pay for any additional replacement necessary as the result of this work. Signature o Ap icant or Agent CAPITAL BUILDING SERVICES - BILL SANCHEZ Name of Applicant (please print) J H THOMPSON & SONS INC 72140 MAGNESIA FALLS STE 2 RANCHO MIRAGE, CA 92270 Business Address 79607 COUNTRY CLUB DR #2 BERMUDA DUNES, CA 92201 Name of Contractor and Job Foreman Business Address 734478 Contractor's License No. GREENWICH INS CO Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION EXCAVATION $917.00 TRAFFIC CONTROL $3,918.00 TOTAL: $0.00 LIC-0005205 City Business License No. NPC100187502 Policy Number PERMIT NO: ENC2022-0075 DATE ISSUED: _ %3 Zi7 'ZZ- EXPIRATION DATE: Se BY: WORK INSPECTED BY*: PERMIT COMPLETION DATE*: (760)485-5308 Telephone No. (760)345-6003 Telephone No. *If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT Date: AUGUST 8, 2022 Tract No: 602-090-006 Project Name: CANOPY CITRUS PLAZA Vicinity:JEFFERSON STAND 50TH AVENUE INDIO CA Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.) OFFSITES - STREET DRY I ITII ITV INSTAI I OTION Description of Construction (i.e.: See Plan Set No. 01234) SEE ATTACHED IID APPROVE "CONDUIT LAYOUT" - DATED APRIL 5 2022 Dimension of Installation or Remoyal• , TRENCH APPROX. 110 LF`EXCAVATE/ ASPHALT Approximate Construction Start Date: AUG 17, 2022 Approximate Construction Completion Date: SEPT 30, 2022 Estimated Construction Cost: $ APPROX. $60,000 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: BILL SANCHEZ Phone Number: 760-485-5308 Name of Applicant/Owner: CANOPY LP/ KERRIE L OZARSKI Applicant Address: 1620 FIFTH AVE #770 SAN DIEGO CA 92109 Applicant Telephone Number: 619-780-0101 Applicant E-mail Address: Kerriel@reefrealestate.com Name of Contractor: J H THOMPSON - GENERAL ENGINEERING CONTRACTORS Contractor Address: 79-607 COUNTRY CLUB DRIVE STE 2 BERMUDA DUNES CA 92203 Contractor Telephone Number: 760-345-6003 Contractor State License Number: 734478 Contractor City Business License Number: #000-5205 Contractor E-mail Address: JHTS.EST@GMAIL.COM ►A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED• Applicant or Contractor General Liability Insurance Company: GARCIA INSURANCE CO Applicant or Contractor General Liability Insurance Policy Number: CL 2271907471 Office Use Only: Inspection Fee: Permit Fee: As -Built Deposit:_ Dust Control Deposit: Credit Amount: Office Use Only: Assigned Permit Number: Approval Date: Expiration Date: Issue Date: Administrative Authority Application for Permit pose - - TOTAL FEE DUE: RE: Encroachment Permits - Compliance with Insurance Requirements Per Engineering Bulletin #97-04 please provide proof of the insurance items and endorsement certificates below: O General Liability - $1M per occurrence / $2M general aggregate O General Liability - Additional Insured Endorsement (for ongoing and completed operations) O General Liability - Primary / Non-contributory Endorsement O Automobile Liability - $1M combined single limit O Workers' Compensation - Statutory Limits / Employer's Liability $1M per accident or disease O Workers' Compensation - Waiver of Subrogation Endorsement 78495 Calle Tampico La Quinta, CA 92253 760.777.7000 ❑ CUSTOMER ❑ DISTRIBUTION SUPERVISOR ❑ ❑ DISTRIBUTION ❑ PROJECT MANAGER ❑ ❑ INSPECTOR ❑ ❑ PROJECT SITE >�wk 11D C__ A century of servica m m �. r� v' OROD!,i Bwger.elleac z +PP Cn CONTRACTOR NOTES c�nai� cal y.,cmn oeiar ,II ■6ou17 THIS WORK REQUIRES IID UNDERGROUND INSPECTION. a`.... AVE. 50TH Q FOR THE UNDERGROUND INSPECTION PROCESS, SEE DETAIL PAGES 7 THRU 11 FROM THE DEVELOPER ENERGY PLANNING GUIDE. ALL EQUIPMENT OR MATERIAL INSTALLED, COVERED, OR ENCLOSED BY THE CONTRACTOR PRIOR TO IID INSPECTION SHALL BE REMOVED OR UNCOVERED FOR INSPECTION, AND REINSTALLED, AT NO EXPENSE TO IID. IID WILL NOT INDIO ACCEPT OR ENERGIZE FACILITIES THAT FAIL TO MEET THE REQUIREMENTS OUTLINED IN THE PROCESS. LOCATION MAP IID NOT TO SCALE , DETAIL PAGES DETAIL PAGES REFER TO THE DEVELOPER ENERGY PROJECT NOTES: 49880 JEFFERSON ST PLANNING GUIDE (D.E.P.G.) REV. 5.0 2020, IT CAN BE OBTAINED ON THE IID WEBSITE INDIO, CA, 92201 WWW.I[D.COM/ENERGY/NEW-CONSTRUCTION 0 CAUTION: ENERGIZED STRUCTURES & CABLE DO NOT PERFORM ANY TYPE OF WORK ON OR AROUND CUSTOMER CONTACT: BILL SANCHEZ ENERGIZED STRUCTURES. A QUALIFIED IID ELECTRICAL PHONE NUMBER:760-485-5308 WORKER MUST BE PRESENT AT JOB SITE BEFORE ANY PROJECT MANAGER: IVAN LOPEZ CONDUIT OR ANY TYPE OF WORK IS PERFORMED. DISTRIBUTION ESTIMATOR:STEVEN SALADO PLEASE CONTACT IID INSPECTION DESK AT LA QUINTA @:(760) 398-5828 ; IMPERIAL @:(760) 482-3300. SERVICE NOTIFICATION-4029495 INSPECTION SCHEDULES ARE SUBJECT TO A MINIMUM SERVICE ORDER:60126803 48 HOUR ADVANCE NOTICE AND ARE BY APPOINTMENT ONLY. SHEET 1 OF 2 IMPERIAL IRRIGATION DISTRICT UNDERGROUND SERVICE ALERT IMPERIAL, CA 1-800-422-4133 IMPERIAL VALLEY ENERGY PROJECT CALL USA/SC Lo FOR UNDERGROUND LOCATING U.G. DISTRIBUTION 2 WORKING DAYS BEFORE YOU DIG LICHTER EQUITIES LP (CITRUS PLAZA) o INDIO � ui 2 Q z APPROVED: JL DATE:4/5/2022 CHECKED BY: ui E DESIGN'D:S.SALADO D E:04/05/2022 DESCRIPTION IIIVI 1 260' EXISTING 3 OVERHEAD P DISTRIBUTP CONDUCTC i / II Ira 0 EX. 3- STUBOUT: 0' ND 13 UN1243458P 150KVA, 30 600A, 30 120/208V 98H 400A, 30 120/208V I®i I• ®I Q� ■ 300KVA, 30 EXISTING RESTAURANT CLUDED REQUIRED JEFFERSON ST. CROSSING 0243464S - REFER TO EASEMENT NOTE QUIREMENTS. 0 I I! mFIA ITY41 n`_ 1 asoul�� 500KVA, 30 10101010 0�0 00 00 pp pip 0�0 0�0 000�0 0:00:0 c z a F14STUBOUT 0, - II I 2 130' 10' 4 I P O s ° I UN1243462P 0 ° 1600A, 30 500KVA, 30 ° 120/208V „ NU I t: "IID STRUCTURES ARE NOT TO SCALE" CONDUIT NOTES: INSTALL 2-4" CND SCH.40 PVC PER SHOWN LENGTH. r� 24 g (REFER TO SHEETS 10-11,104-105, 107-110, 112-115 OF THE D.E.P.G. REV. 5.0 2020) ' INSTALL 3-4" CND SCH.40 PVC PER SHOWN LENGTH. 3S (REFER TO SHEETS 10-11,104-105, 107-110, 112-115 OF THE D.E.P.G. REV. 5.0 2020) ® , INSTALL 7-4" CND SCH.40 PVC PER SHOWN LENGTH. s (REFER TO SHEETS 10-11,104-105, 107-110, 112-115 OF THE D.E.P.G. REV. 5.0 2020) INSTALL 1-4" CND SCH.40 PVC PER SHOWN LENGTH. 1P (REFER TO SHEETS 10-11,104-105, 107-110, 112-115 OF THE D.E.P.G. REV. 5.0 2020) STUBOUT �4y INSTALL 2-5" CND SCH.40 PVC PER SHOWN LENGTH. P (REFER TO SHEETS 10-11,104-105, 107-110, 112-115 OF THE D.E.P.G. REV. 5.0 2020) ar- A INSTALL 2-5" CND SCH.40 PVC PER SHOWN LENGTH. qa A•K P (REFER TO SHEETS 10-11,104-105, 107-110, 112-115 OF THE D.E.P.G. REV. 5.0 2020) STUBOUT '� ^-�r'e o•-•°TM' K�°�° a-'• -r° •° --- INSTALL 3-6" CND SCH.40 PVC PER SHOWN LENGTH. p6 (REFER TO SHEETS 10-11,104-105, 107-110, 112-115 OF THE D.E.P.G. REV. 5.0 2020 ��M•+P�M�aiY � '•"'xa u rws•rnewwe.�v t•+ R•w., INSTALL 3-6" CND SCH.40 PVC PER SHOWN LENGTH. � p6 (REFER TO SHEETS 10-11,104-105, 107-110, 112-115OFTHE D.E.P.G. REV. 5.02020 STUBOUT ,a IN UN106 517P l 300KV , 30 I CURVE DATA TABLE # RADIUS < LENGTH 25.0' 90° 39.26' ® 25.0' 45° 19.63' �p 25.0' 22.5° 9.82' I KtNUHING NV I t5: TYPICAL: CONTRACTOR SHALL INSTALL 2" LINE GUARD TAPE (RED) "CAUTION: BURIED ELECTRIC LINE BELOW." (REFER TO SHEET 115 OF THE D.E.P.G. REV. 5.0 2020) TYPICAL: 7' FROM FACE OF CURB TO CENTER OF TRENCH. EASEMENT NOTE: CONDUITS SHALL BE INSTALLED WITHIN 10' ULTIMATE ROAD RIGHT OF WAY, ADDITIONAL EASEMENTS REQUIRES AT LARGE SWITCH VAULT LOCATIONS FOR IID MAINTENANCE AND OPERATION. (REFER TO SHEET 106 AND 206 OF THE D.E.P.G. REV. 5.0 2020 DETAIL 202.9) TRENCH DETAILS SINGLE SEC.OR SERV.DUCT L REFER TO SHEETS 109 & 115 OF THE D.E.P.G. REV. 5.0 2020 i2-4 PRI. DUCT CONC. ENCASED pp REFER TO SHEETS 109 & 115 OF THE D.E.P.G. REV. 5.0 2020 5-9 PRI. DUCT CONC. ENCASED REFER TO SHEETS 109 & 115 OF THE D.E.P.G. REV. 5.0 2020 COMPACTION BACK FILL MULTI PRI. DUCT REFER TO SHEETS 109 & 115 OF THE D.E.P.G. REV. 5.0 2020 STRUCTURE DETAILS: z PRECAST PAD FOR SINGLE PHASE TRANSFORMER REFER TO SHEETS 151-152 & 167-168, 196-197, 200-201 OF THE D.E.P.G. REV. 5.0 2020 PRECAST PAD FOR THREE PHASE TRANSFORMER 45KVA TO 500KVA ® REFER TO SHEETS 155-156 & 169-170, 196-197, 200-201 OF THE D.E.P.G. REV. 5.0 2020 MEDIUM VAULT EQUIPMENT ENCLOSURE BSUBSTRUCTURE REFER TO SHEETS 171-172 OF THE D.E.P.G. REV. 5.0 2020 LARGE SWITCH PAD ❑ REFER TO SHEETS 179-180, 206-207 OF THE D.E.P.G. REV. 5.0 2020 T STUB OUT MARKER DETAIL REFER TO SHEETS 117 & 118 OF THE D.E.P.G. REV. 5.0 2020 LEAVE CONDUIT STUB -OUT WITH NO CONCRETE 4/ /5 2022 ENCASEMENT FOR FUTURE PICKUP. INSTALL TYPICAL BARRIER POST °® REFER TO SHEETS 164 & 165 OF THE D.E.P.G. REV. 5.0 2020 TYPICAL FOR ALL SECTOR AND TRANSFORMER LOCATIONS. IID JLG ' 4/5/2022 SCALE :1:40 T.5. R.7. SEC.33 NOTES: 1, ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH REVISION 6 OF THE 2014 CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIA M.U.T.C.D.) 2. TRAFFIC CONTROL SHOWN HEREIN IS THE MINIMUM REQUIRED. ADDITIONAL TRAFFIC CONTROL MAY BE REQUIRED TO FACILITATE PUBLIC SAFETY AND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LA QUINTAAND/OR CITY OF INDIC REPRESENTATIVE, 3. THROUGHOUT EACH WORK PERIOD, CONTRACTOR SHALL INSPECT TRAFFIC CONTROL (SIGNS, BARRICADES AND DELINEATORS)AND MAINTAIN SAME IN ACCORDANCE WITH TRAFFIC CONTROL PLANS. 4. CONTRACTOR SHALL MAINTAIN A MINIMUM 10' (12' TYR) TRAFFIC LANE WIDTH AT ALL TIMES. THERE SHALL BE A MINIMUM 2' BETWEEN THE EDGE OF CUT AND THE NEAREST TRAFFIC LANE. 5. ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED AT ALLTIMES. ALLAFFECTED RESIDENTS SHALL BE NOTIFIED IN ADVANCE OF THE WORK, 6. THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING WORK HOURS ONLY. THE WORK HOURS SHALL BE DETERMINED BY THE CONTRACTOR AND THE CITY OF LA QUINTA. AT THE END OF WORK HOURS, THE TRENCH SHALL BE BACKFILLED OR COVERED WITH STEEL TRAFFIC PLATES ("STEEL PLATES AHEAD" SIGNS ON BARRICADES WITH FLASHING LIGHTS SHALL BE POSTED), THE ROAD SHALL BE CLEAR OF DEBRIS AND TRAFFIC RETURNED TO NORI 7. ALL TRAFFIC CONTROL DEVICES USED DURING HOURS OF DARKNESS SHALL BE RETRO-REFLECTIVE AND ALL BARRICADES SHALL BE EQUIPPED WITH FLASHING LIGHTS, AVE 50 I tit sIUkVVALK sU I Mt sIUtVVALK SHOULD BE ABLE TO REMAIN OPEN IN THE EVENT THAT THE SIDEWALK NEEDS TO BE CLOSED, FOLLOW SIGNAGE ON SHEET 4 MOVED TO THE OTHER SIDE ,-- RoAmWed By Pate Nad � C245 Pending TreRa Cardml Plan for Install Electrical Conduit for New Retail Center Q� it RmeCanh dw� cw J HIThompson Construction Eric (764) 345-60 CAL E by Premed BY ChwkwBy Tops N Barricades, Inc. Ron Fifield Plwne $peed Limn Do Sheet Numbe (800)852-TOPS 55 5/18/22 1 NOTES: 1. ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE INACCORDANCE WITH REVISION 6 OF THE 2014 CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIA M.U,T.C,D.) 2. TRAFFIC CONTROL SHOWN HEREIN IS THE MINIMUM REQUIRED, ADDITIONAL TRAFFIC CONTROL MAY BE REQUIRED TO FACILITATE PUBLIC SAFETY AND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LA QUiNTAAND/OR CITY OF INDIO REPRESENTATIVE, 3. THROUGHOUT EACH WORK PERIOD, CONTRACTOR SHALL INSPECT TRAFFIC CONTROL (SIGNS, BARRICADES AND DELINEATORS)AND MAINTAIN SAME IN ACCORDANCE WITH TRAFFIC CONTROL PLANS, 4. CONTRACTOR SHALL MAINTAIN A MINIMUM 1U (IZ TYR) TRAFFIC LANE WIDTH AT ALL TIMES. THERE SHALL BE A MINIMUM Z BETWEEN THE EDGE OF CUT AND THE NEAREST TRAFFIC LANE. 5. ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED AT ALL TIMES. ALL AFFECTED RESIDENTS SHALL BE NOTIFIED IN ADVANCE OF THE WORK. 6. THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING WORK HOURS ONLY. THE WORK HOURS SHALL BE DETERMINED BY THE CONTRACTOR AND THE CITY OF LA QUINTA. ATTHE END OF WORK HOURS, THE TRENCH SHALL BE BACKFILLED OR COVERED WITH STEEL TRAFFIC PLATES ("STEEL PLATES AHEAD" SIGNS ON BARRICADES WITH FLASHING LIGHTS SHALL BE POSTED), THE ROAD SHALL BE CLEAR OF DEBRIS AND TRAFFIC RETURNED TO NORMAL. 7. ALL TRAFFIC CONTROL DEVICES USED DURING HOURS OF DARKNESS SHALL BE RETRO-REFLECTIVE AND ALL BARRICADES SHALL BE EQUIPPED WITH FLASHING LIGHTS, AVE 50 ve ■ e %FIt erg •Xvee. er. jCCL24Zj577 RNWMW By oats Pem Pending TreRlc Conhel Pten forInstall Electrical Conduit for New Retail Center Construction Eric (760) 345- C-12,g NO SCALE TJ�HThompson reaps by Pwow By and ed By Tops N Barricades, Inc. Ron Fifield Ai—v� speed unt 01 sheet») (800)852-TOPS 55 5/18/22 2 NO SCALE AVE 50 CITY OF INDIO �x0.2 END ROAD WORK Lu AVE 4 W20.9 Q 350 C20 (CA) (LT) / aaan C20 (CA) (LT) Yd20-1 / LEF[ZLl4kE�Y WORK A14EAD �� 2 5 LEFr r.AUE� -. �'✓ G20-2 C30 CAj W4- W7.g R3.7 CLOSED AREAS CLOSED RQpO WORK R3-7 LEFTEANE E,RTvm m m AHEAD a EAo C rum uEi r IE" " LIE"C� EFFERSON ST° -7 350' W2D-1 czo-2 a � W20-1 ,,.� E .,. m ;RDA W LID ROADC woRu „a, „ AHEAD p 350' W20.1 G20.2 CITY OF LA QUINTA ENJ DW R R4A0 W0R NOTES: 1, ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH REVISION 6 OF THE 2014 CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIA M.U.T.C.D.) 2. TRAFFIC CONTROL SHOWN HEREIN IS THE MINIMUM REQUIRED. ADDITIONAL TRAFFIC CONTROL MAY BE REQUIRED TO FACILITATE PUBLIC SAFETY AND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LA QUINTAANDIOR CITY OF INDIO REPRESENTATIVE. 3. THROUGHOUT EACH WORK PERIOD, CONTRACTOR SHALL INSPECT TRAFFIC CONTROL (SIGNS, BARRICADES AND DELINEATORS)AND MAINTAIN SAME IN ACCORDANCE -WITH TRAFFIC CONTROL PLANS. 4. CONTRACTOR SHALL MAINTAIN A MINIMUM 10' (12- TYR) TRAFFIC LANE WIDTH AT ALL TIMES. THERE SHALL BE A MINIMUM 2' BETWEEN THE EDGE OF CUTAND THE NEAREST TRAFFIC LANE 5, ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED ATALLTIMES. ALLAFFECTED RESIDENTS SHALL BE NOTIFIED IN ADVANCE OF THE WORK. 6. THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING WORK HOURS ONLY. THE WORK HOURS SHALL BE DETERMINED BY THE CONTRACTORAND THE CITY OF LA QUINTA. AT THE END OF WORK HOURS, THE TRENCH SHALL BE BACKFILLED OR COVERED WITH STEEL TRAFFIC PLATES ("STEEL PLATES AHEAD" SIGNS ON BARRICADES WITH FLASHING LIGHTS SHALL BE POSTED), THE ROAD SHALL BE CLEAR OF DEBRIS AND TRAFFIC RETURNED TO NORI 7, ALL TRAFFIC CONTROL DEVICES USED DURING HOURS OF DARKNESS SHALL BE RETRO-REFLECTIVE AND ALL BARRICADES SHALL BE EQUIPPED WITH FLASHING LIGHTS. y ti�� Fyn R%iffM By DO pm*Nu Pending Tmft C&*d Plan fa d'1 C�VtL Install Electrical Conduit for New Retail Center z H Prime CWkWbor ON CALW J H Thompson Construction Eric (760) 345-60 %) NO SCALE TmftOma by PmpsM By che*wBy Tops N Barricades, Inc. Ron Fifield Phone Speed Limn Dete Sheet NuR;i (800)852-TOPS 55 5119122 3 NOTE .1. ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH REVISION 6 OF THE 2014 CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIA M.U.T.C.D.) 2. TRAFFIC CONTROL SHOWN HEREIN IS THE MINIMUM REQUIRED. ADDITIONAL TRAFFIC CONTROL MAY BE REQUIRED TO FACILITATE PUBLIC SAFETY AND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LA QUINTAANDIOR CITY OF INDIO REPRESENTATIVE 3. THROUGHOUT EACH WORK PERIOD, CONTRACTOR SHALL INSPECT TRAFFIC CONTROL (SIGNS, BARRICADES AND DELINEATORS)AND MAINTAIN SAME IN ACCORDANCE WITH TRAFFIC CONTROL PLANS. 4. CONTRACTOR SHALL MAINTAIN A MINIMUM 10' (12' TYP.) TRAFFIC LANE WIDTH AT ALL TIMES, THERE SHALL BE A MINIMUM 2' BETWEEN THE EDGE OF CUT AND THE NEAREST TRAFFIC LANE. 5. ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED AT ALL TIMES. ALL AFFECTED RESIDENTS SHALL BE NOTIFIED IN ADVANCE OF THE WORK, 6, THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING WORK HOURS ONLY, THE WORK HOURS SHALL BE DETERMINED BY THE CONTRACTOR AND THE CITY OF LA QUINTA. AT THE END OF WORK HOURS, THE TRENCH SHALL BE BACKFILLED OR COVERED WITH STEEL TRAFFIC PLATES ("STEEL PLATES AHEAD" SIGNS ON BARRICADES WITH FLASHING LIGHTS SHALL BE POSTED), THE ROAD SHALL BE CLEAR OF DEBRIS AND TRAFFIC RETURNED TO NORMAL. 7. ALL TRAFFIC CONTROL DEVICES USED DURING HOURS OF DARKNESS SHALL BE RETRO-REFLECTIVE AND ALL BARRICADES SHALL BE EQUIPPED WITH FLASHING LIGHTS. AVE 50 y �u T, r r C24577 (� r} ReVta'wadey DaW PwQNumt Pending Tmft Cwhi Plan for Install Electrical Conduit for New Retail Center C106 1� z N Pdme Cw*aft corb J H Thompson Construction Eric (760) 345-600 f� C NO SCALE namtoama Dwp by PmWedBy owedsy Tops N Barricades, Inc. Ron Fifield Phm Speed L Uepe Sheet Number (800)852-TOPS 55 5/18/22 4 City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2022-0075 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 (5) 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. ENC2022-0075 For Citrus Plaza Project/ III) Dry Utility / Jefferson St North of Ave 50 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. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during the actual work performed. 3. The permittee is responsible for obtaining a valid separate permit from other City, or County jurisdictions if any of the work or traffic control devices extend into other City, or County right of way. 4. The permittee must compact any disturbed soil within the paved right of way back to its original condition or compact to a minimum density of 95% based on ASTM D1557 and be placed while the soil is at +/- 2% of optimum moisture, which ever compacting effort produces the greatest density. 5. Any asphalt removed during potholing shall be replaced with City approved mix asphalt or equivalent. Temporary (Cold Patch) is not acceptable as an approved asphalt mix. The asphalt shall have a thickness equivalent or greater than the removed asphalt thickness and shall obtain a density of 95% or greater based on maximum density obtained by the ASTM Marshall Mix Design Method. 6. Capital Building Services (Bill Sanchez) and/or J H Thompson & Sons, Inc., hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. 7. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 8. 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. 9. 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. 10. The permittee shall block off the work area to prevent access and provide alternate pathways if applicable. Special Conditions Page 1 of 4 PERMIT NO. ENC2022-0075 For Citrus Plaza Project/ III) Dry Utility / Jefferson St North of Ave 50 11. 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. 12. 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. 13. 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. 14. 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. 15. 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. 16. 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. 17. The permittee shall be responsible for calling the city inspector to arrange the city inspector to observe random pothole backfill compaction and testing if requested by the inspector. 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. Special Conditions Page 2 of 4 PERMIT NO. ENC2022-0075 For Citrus Plaza Project/ III) Dry Utility / Jefferson St North of Ave 50 18. 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. 19. 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 20. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts provided in 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. 21. 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. 22. 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. 23. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its original condition. 24. Access and egress to all local properties shall be maintained at all times. 25. 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 Special Conditions Page 3 of 4 PERMIT NO. ENC2022-0075 For Citrus Plaza Project/ III) Dry Utility / Jefferson St North of Ave 50 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. 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. 26. 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. 27. 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. 28. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 29. 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. 30. If it is the intent of the permittee to cut the pavement and have it restored by a third party, the permittee shall postpone cutting the pavement until the intended third party has acquired a permit from the City to perform the required restoration work. Special Conditions Page 4 of 4 /�cova®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 08/08/2022 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 CONTACT Quetha Rodriguez NAME: Garcia Insurance Inc aHC No Ext : (760) 320-1111 FgIC, No : (760) 320-1115 ADDAIL 2099 E. Tahquitz Canyon Way INSURER(S)AFFORDING COVERAGE NAIC N INSURER A : Mt. Hawley Palm Springs CA 92262 INSURED INSURER B : Infinity Commercial Auto 20260 Capital Building Services, Inc. INSURERC: State Fund Insurance 35076 INSURER D : Indian Harbor 72140 Magnesia Falls INSURER E : Ste. 2 INSURERF: Rancho Mirage CA 92270 rr)VFRArFS CERTIFICATE NUMBER: CL2271907471 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. I LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDYfYEYYY EXP MM/DDY/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000.000 �/ CLAIMS -MADE OCCUR DAMA ET R NT D PREMISES Ea occurrence 100,000 $ MED EXP (Any one person) S 5,000 PERSONAL BADVINJURY $ 1,000,000 A Y Y MGLO196150 07/22/2022 07/22/2023 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO POLICY PRO ❑ LOC PRODUCTS -COMP/OPAGG $ 2,000,000 S OTHER: I AUTOMOBILE LIABILITY COM BINED S INGLE LIMIT Ea accident S 1,000.000 BODILY INJURY (Per person) $ X ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED �/ NON -OWNED X AUTOS ONLY AUTOS ONLY(Per. 504-61016-0466-001 07/22/2022 07/22/2023 BODILY INJURY (Per accident) s PROPERTY DAMAGE Per accident $ Underinsured motorist $ 1,000,000 X UMBRELLA LIAB OCCUR `v"'y"' , WE` """. EACH OCCURRENCE $ 5.000,000 HCLAIMS-MADE AGGREGATE $ 5,000.000 A EXCESS LIAR MXL0437364 07/22/2022 07/22/2023 DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (Mandatory In NH) NIA Y 9247728-22 03/2112022 03/21/2D23 X1 STATUTE I I OERH E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000.000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1.000.000 $1, 000, 000 D Pollution Professional Liability PECO05933201 06/23/2022 06/23/2023 $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of La Quinta is named as additional insured. This insurance is primary and non-contributory. Waiver of subrogation applies on the GL. *10 day notice of cancellation may be issued for nonpayment of premium CERTIFICATE HOLDER L;ANUt:LLAI IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of La Quinta ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico AUTHORIZED REPRESENTATIVE C, La Quinta CA 92253 O�L� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: MGLO196150 Mt. Hawley Insurance Company 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 All persons or organizations where required by written All "Commercial Construction Projects". For the purpose contract executed prior to the commencement of your of this Endorsement, "Commercial Construction work. Projects" are defined as buildings or structures constructed for commercial use and also include apartments, hotels, homes for the aged, dormitories or barracks. However, "Commercial Construction Projects" shall not include any building or structure which, in whole or in part,contains individual owner occupied units or dwellings. 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 dam- age" 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 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 re- quired 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 shown in the Declarations; whichever is less. 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- This endorsement shall not increase the applicable ante afforded to such additional insured will not Limits of Insurance shown in the Declarations. not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Policy Number: MGLO196150 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations: All persons or organizations where required All Locations by written contract executed prior to the commencement of your work. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or re- pairs) to be performed by or on behalf of the addi- tional insured(s) at the location of the covered operations has been completed; or 1. The insurance afforded to such additional insured 2. That portion of "your work" out of which the injury only applies to the extent permitted by law; and or damage arises has been put to its intended use by any person or organization other than another 2. If coverage provided to the additional insured is contractor or subcontractor engaged in performing required by a contract or agreement, the in- operations for a principal as a part of the same surance afforded to such additional insured will project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 Insured C. 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 Insured Policy Number: MGLO196150 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition (2) You have agreed in writing in a contract or agree - and supersedes any provision to the contrary: ment that this insurance would be primary and would not seek contribution from any other in - Primary And Noncontributory Insurance surance available to the additional insured. This insurance is primary to and will not seek con- tribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Policy Number: MGLO196150 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART 0191111;K1111t Name of Person or Organization: All persons or organizations where required by written contract executed prior to the commencement of your work. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Insured ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9247728- 22 RENEWAL SP 3-42-88-59 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE March 21, 2022 AT 12,01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING March 21, 2023 AT 12.01 A,M, AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME Capital Building Services, Inc. 72140 Magnesia Falls, Ste 2 Rancho Mirage, CA 92270 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, City of La Quinta. WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, Capital Building Services, Inc. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, AL TEA, WAIVE OR EXTEND ANY OF THE TEAMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED, NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT, COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: November 1, 2020 AUTHORIZED REPRESENT IVF PRESIDENT AND CEO G011' FORM 10217 IREV.4-2010) 2570 OLD OP 217 / A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/19/2021 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 CONTACT Cindy Hullender CISR NAME: James G Parker Insurance Associates ACC Ext : (559) 222-7722 A/XC, No): (559) 222-1724 E-MAIL clhullender@jgparker.com ADDRESS: License #0554959 INSURER(S) AFFORDING COVERAGE NAIC # P O Box 3947 INSURERA: Greenwich Ins Cc 22322 Fresno CA 93650 INSURED INSURER B : XL Specialty Insurance Company 37885 INSURER C : NIP GROUP INC 00005 J H Thompson & Sons Inc INSURER D : 79-607 Country Club Dr INSURER E : Suite 2 INSURER F : Bermuda Dunes CA 92203 COVERAGES CERTIFICATE NUMBER: 21-22 GL BA UMB 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 INSURANCEADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �X OCCUR DAMAGE TO PREM SES Ea oNcRETE ante $ 100,000 _7CLAIMS-MADE IVIED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 A NPC100187502 10/14/2021 10/14/2022 LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO ❑ LOC JECT: MOTHER PRODUCTS-COMP/OP AGG $ 2,000,000 Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS NBA100187702 10/14/2021 10/14/2022 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accidHent $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Medical payments $ 5,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X AGGREGATE $ 2,000,000 C EXCESS LAB CLAIMS -MADE NEC600665200 10/14/2021 10/14/2022 DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Job: Citrus Plaza, Jefferson St and Ave 5, Indio, Ca 92201 Certificate Holder is included as additional insured as required by written contract per the attached forms CG2010 1219 & CG2037 1219, Primary & NonContributory CG2001 12/19, Waiver of Subrogation applies per form XLPlus Endorsement attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of La Quinta ACCORDANCE WITH THE POLICY PROVISIONS. 78-495 Calle Tampico AUTHORIZED REPRESENTATIVE La Quinta CA 92253 A� eo" @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) Acct#: 2530204 10/28/2021 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 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 CONTACT Lockton Companies PHONE FAX A/C No Ext : 844-290-4908 A/C No), 444 W 47th Street, Suite 900 ADDRESS: BBSlcerts@locktonaffinity.com Kansas City, MO 64112-1906 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Ace American Insurance Co. 22667 INSURED Barrett Business Services, Inc. INSURER B : L/C/F J.H. THOMPSON & SONS, INC. INSURER C 79-607 COUNTRY CLUB DRIVE SUITE 2 INDIO, CA 92203 INSURER D INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1:1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A X C69985543 12/1/2021 12/1/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy State = CA Waiver of Subrogation in favor of certificate holder when required by written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 78495 Calle Tampico IN ACCORDANCE WITH THE POLICY PROVISIONS. La Quinta , CA 92253 AUTHORIZED REPRESENTATIVE A,, , @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Barrett Business Services, Inc. Policy Number L/C/F J.H. THOMPSON & SONS, INC. 79-607 COUNTRY CLUB DRIVE SUITE 2 Symbol: Number: C69985543 INDIO, CA 92203 Policy Period Effective Date of Endorsement 12/1/2021 TO12/1/2022 12/1/2021 Issued By (Name of the Insurance Company) Ace American Insurance Co. Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: (x) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: INCLUDED Authorized Agent WC 99 03 22 POLICY NUMBER: NPC-1001875-02 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Blanket as required by written contract. Blanket as required by written contract. 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", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 C. 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 applicable limits of insurance. not increase the Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: NPC-1001875-02 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 Blanket as required by written contract. Blanket as required by written contract. 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 ENDORSEMENT# This endorsement, effective 12:01 a.m. , forms a part of Policy No. issued to by THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY XL Plus Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read this endorsement carefully to determine rights, duties, and what is and is not covered. A. Reasonable Force — Bodily Injury or Property Damage B. Damage To Premises Rented To You Extension • Perils of fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage • Limit increased to $300,000 C. Aircraft Chartered with Crew D. Non -Owned Watercraft E. Personal and Advertising Injury — Assumed by Insured Contract F. Increased Supplementary Payments • Cost for bail bonds increased to $5,000 • Loss of earnings increased to $1,000 per day G. Broadened Named Insured H. Blanket Additional Insured — Managers or Lessors of Premises I. Blanket Additional Insured — Lessor of Leased Equipment J. Injury to Co -Employees and Co -Volunteer Workers K. Knowledge and Notice of Occurrence or Offense L. Unintentional Omission M. Liberalization N. Blanket Waiver of Subrogation O. Incidental Medical Malpractice Injury P. Extension of Coverage — Bodily Injury Q. Coverage Territory Form XIL 436 1208 © 2008, XL America, Inc. Page 1 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. A. REASONABLE FORCE — BODILY INJURY OR PROPERTY DAMAGE Exclusion a. Expected Or Intended Injury of Part 2., Exclusions of Coverage A. Bodily Injury And Property Damage Liability of Section I — Coverages is deleted in its entirety and replaced by the following: [This insurance does not apply to:) Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. B. DAMAGE TO PREMISES RENTED TO YOU EXTENSION 1. The last paragraph of 2. Exclusions of Coverage A. Bodily Injury And Property Damage Liability of Section I - Coverages is deleted in its entirety and replaced by the following: Exclusions c. through In. do not apply to damages to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage. A separate limit of insurance applies to this coverage as described in Section III- Limits of Insurance. 2. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pressure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; or c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Paragraph 6. of Section III- Limits of Insurance is deleted in its entirety and replaced by the following: 6.a. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire, explosion, lightning, smoke, aircraft or vehicle, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire, explosion, lightning, smoke, aircraft or vehicle or riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage or any combination of any of these. b. The Damage to Premises Rented to You Limit will be the higher of: (1) $300,000; or (2) The amount shown on the Declarations for Damage to Premises Rented to You Limit. Form XIL 436 1208 © 2008, XL America, Inc. Page 2 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 4. Paragraph 9.a. of the definition of "insured contract' under Section V- Definitions, is deleted in its entirety and replaced by the following: ["Insured contract' means:] a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, aircraft or vehicle, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage to premises while rented to you, or temporarily occupied by you with the permission of the owner is not an "insured contract'. 5. This Article B. does not apply if coverage for Damage to Premises Rented to You of Coverage A. Bodily Injury And Property Damage Liability of Section I — Coverages is excluded by endorsement. C. AIRCRAFT CHARTERED WITH CREW 1. The following is added to the exceptions contained in Exclusion g., Aircraft, Auto or Watercraft in Part 2., Exclusions of Coverage A. Bodily Injury And Property Damage of Section I — Coverages: [This exclusion does not apply to:) Aircraft chartered with crew to any insured. 2. This Article C. does not apply if the chartered aircraft is owned by any insured. 3. The insurance provided by this Article C. shall be excess over any valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. D. NON -OWNED WATERCRAFT 1. The exception contained in Subparagraph (2) of Exclusion g. Aircraft. Auto or Watercraft in Part 2., Exclusions of Coverage A. Bodily Injury And Property Damage Liability of Section I — Coverages is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) 50 feet long or less; and (b) Not being used to carry persons or property for a charge; This Article D. applies to any person who, with your expressed or implied consent, either uses or is responsible for the use of the watercraft. 3. This insurance provided by this Article D. shall be excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. E. PERSONAL AND ADVERTISING INJURY —ASSUMED BY INSURED CONTRACT 1. Exclusion e. Contractual Liability in Part 2., Exclusions of Coverage B. Personal And Advertising Injury Liability of Section I — Coverages is deleted in its entirety and replaced by the following: Form XIL 436 1208 © 2008, XL America, Inc. Page 3 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. [This insurance does not apply to:) e. Contractual Liability "Personal and Advertising Injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages: 1. That the insured would have in the absence of the contract or agreement; or 2. Assumed in a written contract or agreement that is an "insured contract"; provided the "personal and advertising injury" is caused by an offense which occurs subsequent to the execution of the contract or agreement. 2. Subparagraph f. of the definition of "insured contract" Section V.- Definitions is deleted in its entirety and replaced by the following: If. That part of any other contract or agreement pertaining to your business, including an indemnification of a municipality in connection for work performed for a municipality, under which you assume the tort liability of anther party to pay for "bodily injury", "property damage" or "personal and advertising injury" to a third party or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. 2. This Article E. does not apply if Coverage B. Personal And Advertising Injury Liability is excluded by endorsement. F. INCREASED SUPPLEMENTARY PAYMENTS Subparagraphs 1. b. and d. of Supplementary Payments — Coverages A And B of Section I - Coverages are amended as follows: 1. In Subparagraph b., the amount we will pay for the cost of bail bonds is increased up to $5,000. 2. In Subparagraph d., the amount we will pay for a loss of earnings is increased up to $1,000 a day. G. BROADENED NAMED INSURED 1. The Named Insured in Item 1. of the Declarations is as follows: The person or organizations named in Item 1. of the Declarations and any organization, other than a partnership or joint venture, over which you maintain ownership or majority interest on the effective date of the policy. However, coverage for any such organization will cease as of the date that you no longer maintain ownership of, or majority interest in, such organization. 2. This Article G. does not apply to any person or organization for which coverage is excluded by endorsement. Form XIL 436 1208 © 2008, XL America, Inc. Page 4 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. H. BLANKET ADDITIONAL INSURED —MANAGERS OR LESSORS OF PREMISES 1. Section II -Who Is An Insured is amended to include as an insured any person or organization with whom you have agreed in a written contract executed prior to loss (an "additional insured"), but only with respect to liability arising out of the ownership, maintenance or use of that part of any premises leased to you, subject to the following provisions: a. Limits of Insurance. The Limits of Insurance afforded to the "additional insured" shall be the limits you agreed to provide, or the limits shown on the Declarations, whichever is less. b. The insurance afforded to the "additional insured" does not apply to: (1) Any "occurrence" that takes place after you cease to be a tenant in that premises; (2) Any premises for which coverage is excluded by endorsement; or (3) Structural alterations, new construction or demolition operations performed by or on behalf of such "additional insured". 2. The insurance afforded to the "additional insured" is excess over any valid and collectible insurance available to such "additional insured", unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. I. BLANKET ADDITIONAL INSURED —LESSOR OF LEASED EQUIPMENT 1. Section II -Who Is An Insured is amended to include an "additional insured" (as defined in Article H. above), but only with respect to their liability arising out of maintenance, operation or use by you of equipment leased to you by such "additional insured", subject to the following provisions: a. Limits of Insurance. The Limits of Insurance afforded to the "additional insured" shall be the limits which you agreed to provide, or the limits shown on the Declarations, whichever is less. b. The insurance afforded to the "additional insured" does not apply to: (1) Any "occurrence" that takes place after the equipment lease expires; or (2) "Bodily injury" or "property damage" arising out of the sole negligence of such additional insured. 2. The insurance provided to the "additional insured" is excess over any valid and collectible insurance available to such "additional insured", unless you have a written contract for this insurance to apply on a primary or contributory basis. J. INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS 1. Section II- Who Is An Insured is amended to include your "employees" as insureds with respect to "bodily injury" to a co -"employee" in the course of the co -"employee's" employment by you, or to your "volunteer workers" while performing duties related to the conduct of your business, provided that this coverage for your "employees" does not apply to acts outside the scope of their employment by you or while performing duties unrelated to the conduct of your business. Form XIL 436 1208 © 2008, XL America, Inc. Page 5 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. Section II — Who Is An Insured is amended to include your "volunteer workers" as insureds with respect to "bodily injury" to a co -"volunteer worker" while performing duties related to the conduct of your business, or to your "employees" employment by you, provided that this coverage for your "volunteer workers" does not apply while performing duties unrelated to the conduct of your business. K. KNOWLEDGE AND NOTICE OF OCCURRENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit of the Section IV - Commercial General Liability Conditions: Notice of an `occurrence" or of an offense which may result in a claim under this insurance shall be given as soon as practicable after knowledge of the "occurrence" or offense has been reported to any insured listed under Paragraph 1. of Section II -Who Is An Insured or any "employee" (such as insurance, loss control, risk manager or administrator) designated by you to give such notice. Knowledge of any other "employee(s)" of an "occurrence" or of an offense does not imply that you also have such knowledge. Notice shall be deemed prompt if given in good faith as soon as practicable to your workers compensation insurer. This applies only if you subsequently give notice to us as soon as practicable after any insured listed under Paragraph 1. of Section II — Who Is An Insured or an "employee" (such as an insurance, loss control, or risk manager or administrator) designated by you to give such notice discovers that the "occurrence", offense or claim may involve this policy. L. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Representations, of Section IV- Commercial General Liability Conditions: The unintentional omission of, or unintentional error in, any information provided by you shall not prejudice your rights under this insurance. However, this Article L. does not affect our right to collect additional premium or to exercise our right of cancellation or nonrenewal in accordance with applicable state insurance laws or regulations. M. LIBERALIZATION The following is added to Section IV -Commercial General Liability Conditions: Liberalization After the issuance of this policy, if we adopt a change in our forms or rules which would broaden the coverage provided by any form that is a part of this policy without a premium charge, the broader coverage will apply to this policy. This extension is effective upon the approval of such broader coverage in your state. Form XIL 436 1208 © 2008, XL America, Inc. Page 6 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. N. BLANKET WAIVER OF SUBROGATION The following is added to Section IV -Commercial General Liability Conditions: Waiver of Subrogation We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. O. INCIDENTAL MEDICAL MALPRACTICE INJURY 1. For insurance applicable to this Article O, the definition of "bodily injury" in Section V - Definitions is amended to include, "Incidental Medical Malpractice Injury". 2. The following definition is added to Section V- Definitions: "Incidental medical malpractice injury" means "bodily injury", mental anguish, sickness or disease sustained by a person, including death resulting from any of these at any time, arising out of the rendering of, or failure to render, the following services: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances; c. First aid; or d. "Good Samaritan Services". As used in this Article O., "Good Samaritan Services" are those medical services rendered or provided in an emergency and for which no remuneration is demanded or received. 3. Paragraph 2.a.(1)(d) of Section II -Who Is An Insured does not apply to any registered nurse, licensed practical nurse, emergency medical technician or paramedic employed by you, but only while performing the services described in Paragraph 2. above and while acting within the scope of their employment by you. Any "employees" rendering "Good Samaritan Services" will be deemed to be acting within the scope of their employment by you. 4. The following exclusion is added to Paragraph 2. Exclusions of Coverage A. — Bodily Injury And Property Damage Liability of Section I — Coverages: [This insurance does not apply to:) Willful Violation of Penal Statute Liability arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals by or with the knowledge or consent of the insured. 5. For the purposes of determining the applicable Limits of Insurance, any act or omission, together with all related acts or omissions in the furnishing of services described in Paragraph 2.a. through 2.d. above to any one person, will be considered one "occurrence". 6. This Article O. does not apply if you are in the business or occupation of providing any of the services described in Paragraph 2. above. Form XIL 436 1208 © 2008, XL America, Inc. Page 7 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 7. The insurance provided by this Article O. shall be excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. P. EXTENSION OF COVERAGE — BODILY INJURY The definition of "bodily injury" Section V- Definitions is deleted in its entirety and replaced by the following: 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. Q. COVERAGE TERRITORY The definition of "coverage territory" Section V- Definitions is deleted in its entirety and replaced by the following: 4. "Coverage territory" means anywhere in the world. This insurance does not apply to: a. "bodily injury" or "property damage" that takes place; or b. "personal and advertising injury" caused by an offense committed outside the United States of America (including its possessions and territories), Canada and Puerto Rico, unless a "suit" on the merits (to determine the insured's responsibility to pay damages to which this insurance applies) is brought in the United States of America (including its possessions and territories), Canada or Puerto Rico. This insurance does not apply to damage, loss, cost or expenses in connection with any "suit" brought outside the United States of America (including its possessions and territories), Canada or Puerto Rico. Form XIL 436 1208 © 2008, XL America, Inc. Page 8 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission.