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ENC2022-0082
owkra G F M ofibe 1)I.M-I I- — 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: 10/31/2022 LOCATION OF CONSTRUCTION (Street address or Description): AVE 60 WEST OF MADISON ST PURPOSE OF CONSTRUCTION: USE TRUCK MOUNTED AIR/VAC SYSTEM TO POTHOLE EX WATER / SEWER LINES FOR EXACT SIZE. LOCATION. & ELEVATION FOR BUILDER POINT OF CONNECTION DESCRIPTION OF CONSTRUCTION: POTHOLE EXISTING SEWER & WATER FOR BUILDER CONNECTION DIMENSION OF INSTALLATION OR REMOVAL: (3) 6"X 10" SAW CUT HOLES APPROXIMATE TIME WHEN WORK WILL BEGIN: 9/19/2022 TIME OF COMPLETION: 9/22/2022 ESTIMATED CONSTRUCTION COST: $2,500.00 (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 of the City of La Quinta and to pay for any additional replacement necessary as the result of this work. ULTRA ENGINEERING CONTRACTORS INC - LEAH WEST 36806 PEBLEY COURT WINCHESTER, CA 92596 Name of Applicant (please print) Business Address ULTRA ENGINEERING CONTRACTORS 36806 PEBLEY COURT WINCHESTER, CA 92596 Name of Contractor and Job Foreman Business Address 971768 LIC-770408 Contractor's License No. SCOTTSDALE INSURANCE COMPANY Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION CUT/BORE $750.00 TECHNOLOGY ENHANCEMENT FEE $5.00 TOTAL: $0.00 City Business License No. BCS0040000 Policy Number PERMIT NO: ENC2022-0082 DATE ISSUED: 9/16/2022 EXPIRATION DATE: 9/16/2023 BY: AMY YU A r WORK INSPECTED BY*: PERMIT COMPLETION DATE*: APPLIED ON ETRAKIT Signature of Applicant or Agent (951)223-3552 Telephone No. (951)223-3552 Telephone No. *If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. 0 JACK AND BORE N sZ N � p o in - p C in M CL d o zcqcn t.D 00 W 00 d OD W IE J m N W qp d Gp 00 w all J pq W p -� M � r'7 w - CV +p m + C + d- N3 tG Z 07 + Z _ U W Zp + T Lu 3 W m � N, �,X// 56 ` EX. HOUSE 766-180-023 M.B. 457/74-80 10+00.00 LINE A-16+45.00 PER CVWD DWG No. 33276-33278 CONTRACTOR TO REMOVE EXIST. 24'x24"x6" REDUCER AND 6" BLOW OFF ASSM., AND CONNECT TO EX. 24" DIP UNDER DIRECT DISTRICT INSPECTION. DEVELOPER TO MAINTAIN INSTALLATION AREA, INSTALL FINAL PAVING AND RAISE VALVES TO FINAL GRADE. EXIST 60" IRRIGATION LATERAL 123.45 PER CVWD DWG NO. 36629 60TH AVENUE 11+00 C&GJ �EX. P n 55 -- io EX. HOUSE 766-180-022 TRACT N0. 32201 M.B. 450/29-32 15+03.90 AVE. 60 EX. 24"x24"x8' TEE PER i CVWD DWG. No. 33278 w no 9+36.87 EX. LINE A 24° x2,C xT TEE PER f 0 u CVWD DWG. No. 41578 I I &Zzl_ll_�' ' 766-180-027 LOT H (LANDSCAPE) F_ EX. FH PROP. SIDETLK 9+00 i , EX. C&G W04 T 6 R. 0 PiTHOC6 W6S- 7-' SOUV 6c V4605, IF kV4r6,P,1-241A1 /s A'0(11V 601V7-1nrU6 Y-05 ST �50V �d ra EEO OF MK`( EXIST Er I SEWER MAIN PER CVWD D G. No. 33194-33195 EXISTII 24' WATER MAIN PER CVWDi DWG. No. 33276-3327E EXIST. RW 0 t0O -- 3I - -- 8+00 0° -+- FA if - STORM DRAIN 2010-0273187 .■ it 111rep 1 DWG. No. 41578 6(f IRRIGATION LATERAL • PER CVWD DWG. No. 36629. i LOT G ri )O�4w /Ns,A6�7- IV4NI-lot 4465 Mjkl&Z Ex r6r1-0 Td 7-&6 WeST.' /f So, EXIST 6(f IRRIGATION +. +o 0 JACK AND BORE LATERAL 123.45 PER a2 2 0 0 2 � CVWD DWG NO. 3669 d TRACT NO. 32201 u-is mr M.B. 450/29-32 a o. a 4J W Z j! I rr I {21 +79.54) v' I I w w j' f EXIST. MH N0. 22 ` PER CVWD DWG 33195 Lq i] t�O �i to I] m J oo s I J \ �°° d'bo C�V °r° r O MO \ Lo fn ^II �[ 1] Lo z 1] w jj + O I J 1 z cal �' N w N m� `�' �'' EXIST. RW EXIST. RV \ 1a l M EX \ JACK AND BORE — — — I - 2s+oo < \ \ _ 25 za+oo N89'31'0 E 255.49' 23+00 2 +oo I �EX. 8" VCP) 21+}° 3s oa � -- -°0- -- - 77 ° _ _—_ ° ao _ —_ _---- ---- --- N89'31'D6�E 1 49 97' NO0'28'S6"W CB AVENUE GO (PUBLIC (STREET) — —PROP. SIDEWALK — — LANS N \ I — EXIST. RW LINE C FURNISH AND INSTALL 817 VCP SEWER MAIN �ua NO. 4, \ • \ I VTOJ.JV LII11C 4- / \ 8+40.78 LINE B PER \ ONSITE SEWER IMP. PLANS 56 CB 25' CVWD SANCTATION ESIuIT. - - - - - -- PER DOC. # 2021-0044180, - - - RECORDED JAN. 22. 2021 1 �p JACK AND BORE 9sFQ NJ �� r TRACT NO. 33597 M.B. riCB EXIST. PL HONOREES [oII■■■■■ ■■■■■■■I ■■�■n■■■ ■(III■■■■I [!II[f■■ :1.:..:: 1■■■■■■■1 1WIII011101011 J 457/74—&—l', SEX. 36" STORM DRAIN EX. 60" IRRIGATION LATERAL Work Area Traffic Control Handbook Mid Block Narrowing of Lane 35 i� W20-1 ❑VEHV AUDM ovctu (optional,)k 4L.y G20-2 1� EHU ROAN Yfi}Rlt vvo (optional) v a ' a 0 a n P a a e� (optional) a If used, operate in E caution mode only 4 .' Min o (J3 u c P P G20-2 A .NARROW C12 xgDM ©rox (� LANE (optional) va; j (optional) l A 9" i ROAD WORK W20-1 AHEAD SPEED MPH (2) Dimension A/B/C ADVANCE WARNING SIGN SPACING (5) TEMPORARY TRAFFIC CONTROL PLAN DIMENSION GUIDELINES Dimension Dimension Dimension Dimension MAXIMUM L U2 L/3 "E" CHANNELIZER MERGING SHIFTING MINIMUM BUFFER SPACE (4-A) TAPER SPACING TAPER TAPER LENGTH SHOULDER and (3) LENGTH- TAPER FLAGGER STATION STOPPING SIGHT DISTANCE (4-B) (D%) (-3%) (-6%) MAXIMUM CHANNELIZER TANGENT SPACING (3) MAXIMUM CHANNELIZER CONFLICT SPACING (6) MPH Ft ft ft ft ft ft ft ft 25 100 125 65 45 (155) (160) (165) 25 50 12 30 250 180 90 60 (200) (205) (215) 30 60 15 35 250 245 125 85 (250) (260) (275) 35 70 17 40 250 320 160 110 (305) (315) (335) 40 80 20 45 350 540 270 180 (360) (380) (400) 45 90 22 50 350 600 300 200 (425) 450 (475) 50 100 25 55 500 660 -330 220 (495) (520) (555) 50 100 25 60 500 500 720 1 780 : ,. 360 240 (570) (600) (640) 50 100 25 65 390 260 (645) (685) (730) 50 100 25 (1) Work on Freeways and eerssawaykliffoo meet the caltrans Standard Plans and Standard Specification requirements. Posted Speed or observed operating speed (whichever is greater) Channelizer spacing shall be reduced.I ! half at areas where work Is taking place on curves or areas of head-on conflict (2) (3) (4-A) Buffer space may be inserted in low -speed urban areas and should be inserted in high-speed urban and rural areas The slopping Sight Distance should enable Road Users to see the Primary Flagger Station and safely slop Sign spacing in rural areas should be 500 ft "Table OF-101(CA) T (4-S) (5) Y (6) 4. www.invarion.com # + ' •+ { . fit .S•.-' F jr Mir. T � db A v + " dF 4 t. ROAD - WORK AHEAD ti• , f ', " W20-1 M ilk #lb* f �'• r ; �• ':, • .. . h . � #• ��..- Legend Cone * . ! ♦♦ 'ir 3 + r ',! J � ��ll -� Work Area 4. do IL Y f dk IP -L k. J • ` * i ROAD WORK NARROWS AHEAD At RIGHT ." y'-� ~-k. S '.i�'4i► #-=i* 7+- . •'. . • i� s R4-7A-- ��__ W5-1 W2� ROAD NARROWS + W5 1 r - Ilk ll- ° 'T SHOULDER � CLOSED .+ � s Agency: City of La Quinta �1®�� Temporary Traffic Control Plan for 2 Water Main Potholes. ENGINESRING 2 hour max duration (Shoulder Closure) 2 Ultra Engineering Contractors, Inc. Project Manager: Jeremy Marginson +` a . 36806 Peble Court i"1... e yourMobile: (858) 414-4134 Winchester, CA 92596 Email: jeremy@UltraEngineering.comc , (951) 223-3552 -,. `1 • www.DigWithAir.com IL il& www.invarion.com 4L oil " • * �.. r ! ' '* � •. �! � r` � �•. ..;, • .. }. � , � . �#• `� � x :,..- Legend 410. i;* Cone • r ir Mir. Work Area do 40 # a a• ; �� .y . + # * +' . " % Ik ' +ter * . r. , %Ir r i y � y �' •� � ' �•.. ' �• -. y ft �{ kid � r • -i - _ �� � �i 41 T A v ' #+ • # ' r . ��. . i i ,. . ti ` * yr: + du k•+ IP ■ ti ■ y Or *' e t •L k. 7 1 ROAD Fi +. • # ROAD WORK - ''i - '- # �.' . '# y NARROWS AHEAD Fi N SHOULDER r CLOSED • n}:. flD Il�pDfl T W5-1 W2 a 02B ��flDuu;;66�6Gou ROAD ROAD - WORK NARROWS .. AHEAD 4. W20-1 W5-1 �r ' � ROAD RK F � + ` Y 4 . HEAD {Mir . Ir . W r * •' r Agency: City of La Quinta ^ # #+ Temporary Traffic Control Plan for quick Sewer Manhole Inspection. ENGINESRING (Shoulder Closure) N ' Ultra Engineering Contractors, Inc. Project Manager: Jeremy Marginson 36806 Pebley Court i Winch, Mobile: (858) 414-4134 ester, CA 92596 , (951) ester, 52 Email: jeremy@UltraEngineering.com � c www.DigWithAir.com r.I City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2022-0082 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. ENC2022-0082 Potholing for Existing Sewer and Water Lines / Ave 60 West of Madison St 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. Ultra Engineering Contractors, 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. Special Conditions Page 1 of 4 PERMIT NO. ENC2022-0082 Potholing for Existing Sewer and Water Lines / Ave 60 West of Madison St 10. The permittee shall block off the work area to prevent access and provide alternate pathways if applicable. 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. Special Conditions Page 2 of 4 PERMIT NO. ENC2022-0082 Potholing for Existing Sewer and Water Lines / Ave 60 West of Madison St 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. 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. Special Conditions Page 3 of 4 PERMIT NO. ENC2022-0082 Potholing for Existing Sewer and Water Lines / Ave 60 West of Madison St 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 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 ULTRENG-01 WAIJE1 ,4coR0 CERTIFICATE OF LIABILITY INSURANCE7 DATE(MMIDDIYYYY) 9/15/2022 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 License # OL48969 C3 Risk 8r Insurance Services 404 Camino Del Rio S. STE 410 San Diego, CA 92108 CONTACT Jessica Waite NAME: PHONE Ext): FAX (A/C, No): E-MAIL Jessica@c3insurance.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Scottsdale Insurance Company 41297 INSURED INSURER B : State Compensation Ins Fund of CA 35076 INSURER C : Argonaut Insurance Company 19801 Ultra Engineering Contractors, Inc. INSURER D : The Ohio Casualty Insurance Company 24074 36806 Pebley Court Winchester, CA 92596 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 YYY POLICY EXP MM DD YYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X X BCS0040000 5/30/2022 5/30/2023 DAMAGE TO RENTED PREMISES Ea occurrence 100,000 $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PECOT- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Abuse/Sex Moles $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ HIRED L NON -OWNED AUTOS ONLY AUTOS ONLY $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE XLS0125248 5/30/2022 5/30/2023 DED X RETENTION $ 0 $ B WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A X 9013876 5/30/2022 5/30/2023 X PER OTH- 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 $ C Professional Liab. 121AE019126202 5/30/2022 5/30/2023 Occur/Agg Ded: $15k 1,000,000 D Equipment Floater BM059534194 3/5/2022 3/5/2023 Leased/Rented Equip. 60,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional insureds are included as/where required by written contract as respects to General Liability, General waiver of subrogation, General Liability Primary Non -Contributory wording, and Workers Compensation waiver of subrogation, but limited to the operations of the Insured under said contract, and always subject to all the policy terms, conditions and exclusions per endorsements attached. Commercial Excess Liability policy is follow form to the General Liability and Workers Compensation policy and all endorsements. General Liability includes 30 days notice of cancellation, except 10 days for non-payment of premium as required by written contract. *THIS CERTIFICATE CANCELS AND SUPERSEDES ANY CERTIFICATE PREVIOUSLY ISSUED* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico La Quinta, CA 92253 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD '`` a CERTIFICATE OF LIABILITY INSURANCE ATE 1 D09/08/2022Y) 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 ROBERT E FRANCY NT NAME: CT Morgan Phillips STATE FARM INSURANCE a/CC N Ext:858-451-1915 A//C No:858-451-8421 E-MAIL ADDREss: morgan@bobfrancy.com 12605 POWAY ROAD SUITE A POWAY CA 92064 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: State Farm Mutual Automobile Insurance Company 25178 ® INSURED ULTRA ENGINEERING CONTRACTORS INC INSURERB: INSURERC: 36806 PEBLEY CT INSURERD: WINCHESTER, CA 92596-8928 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY ❑ ❑ EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO JECT LOC $ A AUTOMOBILE LIABILITY ❑ El443 7364-F15-55 05/02/2022 05/02/2023 acciden INGLE LIMIT Ea S $ 2,000,000 X ANY AUTO 414 7369-EO2-55B 05/02/2022 05/02/2023 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED X AUTOS X AUTOS X HIRED AUTOS X NON -OWNED AUTOS 418 7630-E02-55C 05/0212022 05/02/2023 PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR ❑ ❑ EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DIED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? F7 N / A ❑ WC STATU- OTH- TORY LIMITS I ER E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ yes, describe under DESCRIPTION DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) JOB: Encroachment Permit - ENC2022-0082 CERTIFICATE HOLDER CANCELLATION City of La Quinta SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 78495 Calle Tampico ACCORDANCE WITH THE POLICY PROVISIONS. La Quinta, CA 92253 AUTHORIZED REPRESENTATIVE Awz&el� ©1988-201"CORD CORPORATION. Allifights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.6 11-15-2010 POLICY NO. BCS0040000 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 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 LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution 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 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS REP 02 9013876-22 RENEWAL SP 5-68-39-42 HOME OFFICE SAN FRANCISCO EFFECTIVE MAY 30, 2022 AT 12.01 A.M. PAGE ALL EFFECTIVE DATES ARE AND EXPIRING MAY 30, 2023 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ULTRA ENGINEERING CONTRACTORS IN 36806 PEBLEY CT WINCHESTER, CA 92596 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, 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: MAY 27, 2022 001, AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) 1 OF 1 2572 OLD DP 217 POLICY NUMBER: BCS0040000 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 ANY PERSON OR ORGANIZATION WHEN ALL LOCATIONS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT, EXECUTED PRIOR TO THE OCCURRENCE TO WHICH THIS INSURANCE APPLIES, THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY 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. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 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. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 37 12 19 Policy #BCS0040000 COMMERCIAL GENERAL LIABILITY CG20381219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured: 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured described in Paragraph 1. or 2. above. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 2. "Bodily injury" or "property damage" occurring after: a. 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 CG 20 38 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 b. 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1.; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 38 12 19 POLICY NUMBER: BCS 0 0 4 0 0 0 0 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM THE INSURED HAS AGREED TO WAIVE RIGHTS OF RECOVERY, PROVIDED SUCH AGREEMENT IS MADE IN WRITING AND PRIOR TO THE LOSS 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1