ENC2023-0003CQC4.1 VWCV
ENCROACHMENT PERMIT
PUBLIC WORK5 CONSTRUCTION
For the Construction of public cr private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other IIke public works
Improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE, 1/1012023
LOCATION OF CONSTRUCTtON(Street address or Descrlption): SILVERROCK WAY WEST OF JEFFERSON 5T
PURPOSE OF CONSTRUCTION: TEM F Oft ARY.ENTRAN CE- FOR TOUR-NAMENT PARKING_—_-..
DESCRIPTION OF CON STRLCTION. AMEX., TEMPORABY ENTRANCE IMPROYEMENTS TO TOURNAMENT PARKING
DIMENSION OF INSTALLATION OR REMOVAL. BUILD ROADWAY WITH NEW CLASS l! RQ6D F?Mgl 24' WIDE X 140' LONG
APPROXIMATE TIME WHEN WORK WILL BEGIN; 111212023 TIME OPCC) MPLERCN; 1/1212028
ESTIMATED CONSTRUCTION COST- . (Including removaI of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMAAENTS:
In can side ration 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, IIahIIitles cr loss resulting from clahns or court action and arisir}g out of any accident, I=or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursvant to this app[[cation.
Notify the Administrative Authorlty at least twenty-four (241 hours in advance of the time when work will he started at (760) 777-7097. To
submit an inspection request, leave a message un the InspMlon Request Hotllne at (760) 777-7097 prlar to 1.30 P,M. at least twenty-four (24;
hours prior to the anticipated inspittion.
'amply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and r ul oils of the City of La
:tuInta and to pay for any additional replacement necessary as the resufk of this work, r
re
EMERY LAN DCLEARING AND GRADING
- JIAMES EMERY P 0 BOX 1QU9 THERMAL, CA 92274
Name of Applicant please print) Buslncss Address
EMERY LAN DCLF-AR I N G & GRAI)ING P 0 BOX 1009 TPERNIAL, CA 92271
Name of Contractor and Job Foreman Business Address
600283
Contractor's L[cense No.
FINANCIAL PACIFIC INSURANCE COMPANY
AppIIcant's Insurance Company
FInance Revenue Cade
TOTAL :S0.010
LIC-OODD019
City Buslness License No.
60465347
Policy Number
PERMIT ND: ENC2023-ON3
DATE. 15SU t= t1: 1-10 -2023
EXPIRATION DATE: 1-10-2024
RY:-�-z
WORK INSPECfEO BY9,
1PJ~RMIT COMPLE nON DATE*;
(750)774-9493
Telephone No.
(760)345-4746
Telephone No.
*If the work Is covered by a SuWtv1sion Improvement Agreement,
Subdivider shall request final aemptance of Improvements from the
City Council.
TAf 4 4 aakm
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date:
Tract No: Pro'ect Name: (��Y1}Zar1
Vicini
ty'
Purpose of CQnStrLlCtlb (i.e.: Rough Grading, Offsite Street eta.)
` c�
Description of Construction (i.e.: See Plan Set No, O1 ) 1 Aact "4
bw (Ar1s S
Dimension of Installation or Removal: 3L4 ' tN - 140 t Ib
Approximate Construction Start Date: t I ID, AD D3
Approximate Construction Completion Date:
Estimated Construction Cost: $ , no
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: OCIMP— C- - -(Y7-Q_Y^c4 Phone Number: /1 tO 7-7 .9453
Name of Applicant/Owner: [ _ c
Applicant Address: D Cap �
Applicant Telephone Number: -7b S
Applicant E-mail Address: 0- ML, Lo iv,
Name of Contractor: tiv; cx c
Contractor Address: �h�Do 9
Contractor Telephone Number: a -7
Contractor State License Number: (c(50 a 2
Contractor City Business License Number: 00
Contractor E-mail Address: <-VI\C
■A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED■
)pligor Contract General Liability Insurance Company: c3A} 6 �z hV
teem(\ t&.1 ' Fit- Cc,
Applicant or Contractor General Liability I
(0D 4663,4 `7 -Qx f .2;
Office use Only:
Inspection Fee:
As -Built
Deposit:
Dust Control
Deposit
Credit
Amount:
TOTAL FEE. DUE:
rIVA P1' IC C — nrmc
Policy Number:
Office Use Only:
Assigned Permit Number:
Approval hate:
Expiration
_ Date:
Issue
Date:
for
Administrative Authority:
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2555p t EVENT LEGEND
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307
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(3,900) 13>20 pill#KING gPOTS I
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TAXI ; DROP Opf +PICK UP
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City of La Quinta
The following General and Special Provisions are attached to and made a part of
Permit Number ENC2023-0003
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 be notified 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
two inches (2") of SC-800 shall be placed immediately. A permanent patch of Asphalt Concrete surfacing per City of La
Quinta Standard 600 shall be placed on 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. ENC2023-0003
For AMEX Golf Tournament / Temporary Entrance Improvements to
Tournament Parking / SilverRock Way West of Jefferson 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. Emery Landclearing and Grading — James Emery, hereinafter referred to as "Pennittee", shall be
responsible for providing continuous dust and erosion control.
4. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more
frequently, if required.
5. 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 8:30 a.m. nor after 4:30 p.m.
6. 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.
7. The permittee and/or contractor placing engineered fill must provide adequate time and safety for the
Geotechnical Engineer of Record to perform soils testing during engineered fill placement. The testing
frequency shall be determined by the Geotechnical Engineer of Record such that the fill can be
determined to be placed according to the city approved plans.
Special Conditions Page 1 of 4
PERMIT NO. ENC2023-0003
For AMEX Golf Tournament / Temporary Entrance Improvements to
Tournament Parking / SilverRock Way West of Jefferson St
8. The permittee and/or contractor shall provide surveyor staking information adequate for the City
Inspector to determine horizontal and vertical locations relative to the approved city plans. The
minimum required wood lath type stakes shall be placed at all proposed building corners, and they shall
state the horizontal location relative to building corner and the elevation of the top of hub next to the
lath.
9. 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.
10. This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to
start of construction, a letter from any owners of the driveways/access ways that will be closed down
due to the construction. The letter must be approved by the city and at minimum state from the owner
the following:
A. Approval of the construction
B. Plan identification
C. Time Frame of Closure
D. Alternative Routes
11. 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.
12. 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.
13. 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.
Special Conditions Page 2 of 4
PERMIT NO. ENC2023-0003
For AMEX Golf Tournament / Temporary Entrance Improvements to
Tournament Parking / SilverRock Way West of Jefferson St
14. 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.
15. The permittee shall be responsible for calling the city inspector to arrange the city inspector to observe
random compaction testing performed by a city approved material testing firm. If the inspector's phone
number is unknown, the permittee shall call the Public Works front counter phone at 777-7075 or the
Associate Engineer at 777-7047 to determine the city inspector's phone number. The inspector shall
determine the number and location of the test location/s. The above testing does not relieve the
permittee's responsibility for future repairs due to settlement at and near the locations of the work area.
Materials testing must be performed under direct supervision of a California Registered Civil Engineer.
16. 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.
17. 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
18. Work within 500 feet of any designated School Zone shall be performed between the hours of 8 a.m. —
1:30 p.m. Traffic control shall be set up after 8 a.m. and removed before 1:30 p.m.
19. The permittee shall not encroach upon private property without prior written approval (submit to the
Public Works Department, attention to the Associate Engineer) of the private land owner whom is being
encroached upon.
20. Prior to performing construction work and closing any lanes in the Public Right of Way, the permittee
shall call the City at (760) 777-7097 at least 48hrs prior to work and request a City Inspection.
21. The permittee shall haul all offsite debris to a certified landfill. Prior to hauling debris, the permittee
shall inform the City (Inspection staff or 777-7089) of the name and location of the certified dump site.
22. 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.
Special Conditions Page 3 of 4
PERMIT NO. ENC2023-0003
For AMEX Golf Tournament / Temporary Entrance Improvements to
Tournament Parking / SilverRock Way West of Jefferson St
23. The permittee is required to provide an informative message board (approved by the City Engineer)
informing the commuters using the affected roadways of possible traffic delays, time of construction,
and if possible alternate routes. The message board shall be provided for the commuters 48 hours prior
to the start of traffic delays.
24. Pursuant to Section 14.16.370 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
backfill compaction within street rights -of -way shall conform with Section 306-1.3 of the latest
edition of the Standard Specifications For Public Works Construction (SSPWC), except as otherwise
specified herein.
Native material may be used as backfill material provided that minimum compaction, achieved in the
manner prescribed herein, is achieved. Backfill shall be performed by mechanical means; no water
densified compaction via jetting or flooding or other means shall be allowed. It shall be the
Permittee's responsibility to provide appropriate geotechnical supervision, testing, and inspection,
onsite, at all times during backfill operations.
25. 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.
26. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its
original condition.
27. Access and egress to all local properties shall be maintained at all times.
28. 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.
29. 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.
30. 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.
31. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time.
32. 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.
Special Conditions Page 4 of 4
ACOR" CERTIFICATE OF LIABILITY INSURANCE
DATE Y)
022
08/0303//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 Albert Zamora
NAME:
RISI dba Pan American Insurance Services
o Ext : (559) 222-0300 (AICC, No): (559) 222-9960
A/C No,
7673 N. Ingram Avenue
E-MAIL abert.zamora@relationinsurance.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
Suite 103
INSURERA: Financial Pacific Insurance Company
31453
Fresno CA 93711
INSURED
INSURER B : StarNet Insurance Company
INSURER C :
Emery Landclearing and Grading Inc
INSURER D :
PO Box 1009
INSURER E :
INSURER F :
Thermal CA 92274-9267
COVERAGES CERTIFICATE NUMBER: 2022-23All Lines 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.
ILTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
(MM/DDIYYYY)
POLICY EXP
(MM/DDIYYYY)
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE F OCCUR
PREMISES DAMAGE O(Ea occurrence)
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
60465347
08/05/2022
08/05/2023
LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY ❑ PRO ❑ LOC
JECT
MOTHER
PRODUCTS-COMP/OPAGG
$ 2,000,000
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANYAUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
60465347
08/05/2022
08/05/2023
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
Uninsured motorist
$ 1,000,000
UMBRELLA LIAB
OCCUR
v`""z6E' ' WE'"" """`
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N/A
Y
BNUWC0156525
04/10/2022
04/10/2023
SPER TATUTE ERH
X1
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
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of La Quinta is Additional Insured and Primary & Non -Contributory for General Liability per Form CG201OR 1221 attached. Workers Compensation
Waiver of Subrogation applies per Form WC040306 04/84 attached. Project: Amex Traffic Driveway Improvements at Silverrock.
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-Public Works
ACCORDANCE WITH THE POLICY PROVISIONS.
78495 Calle Tampico
AUTHORIZED REPRESENTATIVE
La Quinta CA 92253
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: CG 20 10R 12 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS
(WITH LIMITED COMPLETED OPERATIONS COVERAGE)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
BUSINESSOWNERS COVERAGE FORM
SCHEDULE
NAME OF PERSON OR ORGANIZATION
Any person or organization to whom or to which
the named insured is obligated by a virtue of a
written contract to provide insurance that is
afforded by this policy. Where required by
contract, the officers, officials, employees,
directors, subsidiaries, partners, successors,
parents, divisions, architects, surveyors and
engineers are included as additional insureds.
All other entities, including but not limited to
agents, volunteers, servants, members and
partnerships are included as additional insureds,
if required by contract, only when acting within
the course and scope of their duties controlled
and supervised by the primary (first) additional
insured. If an Owner Controlled Insurance
Program is involved, the coverage applies to off -
site operations only. If the purpose of this
endorsement is for bid purposes only, then no
coverage applies.
WHO IS AN INSURED: (Section II)
This section is amended to include as an
insured the person or organization within the
scope of the qualifying language above, but only
to the extent that the person or organization is
held liable for your acts or omissions in the
course of "your work" for that person or
organization by or for you. The "products -
completed operations hazard" portion of the
policy coverage as respects the additional
insured does not apply to any work involving or
related to properties intended for residential or
habitational occupancy (other than apartments).
This clause does not affect the "products -
completed operations" coverage provided to the
named insured(s).
WAIVER OF SUBROGATION:
We waive any right of recovery, when required
by written contract, that we may have against
the person or organization within the scope of
the qualifying language above because of
payments we make for injury.
LOCATION OF JOB:
The job location must be within the State of
domicile of the named insured, or within any
contiguous State thereto.
DESCRIPTION OF WORK:
The type of work performed must be that as
described under classifications in the CGL
Coverage Part Declarations.
PRIMARY CLAUSE:
When this endorsement applies and when
required by written contract, such insurance as
is afforded by the general liability policy is
primary insurance and other insurance shall be
excess and shall not contribute to the insurance
afforded by this endorsement.
EXCLUSION
This insurance provided to the additional insured
does not apply to "bodily injury", "property
damage" or "personal and advertising injury"
arising out of an architect's, engineer's or
surveyor's rendering or failure to render any
professional services, including:
1. The preparing, approving, or failing to
prepare or approve, maps, designs,
shop drawings, opinions, reports,
surveys, field orders, change orders, or
drawings and specifications; and
2. Supervisory, inspection, architectural or
engineering activities.
Endorsement EFFECTIVE DATE: SEE DEC
Endorsement EXPIRATION DATE: SEE DEC
CG 20 10R 12 11 Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission
POLICY NUMBER: BNUWC0156525
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 04 03 06
(Ed. 04-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA (Blanket)
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.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 0.020000 % of the California workers' compensation premium otherwise
due on such remuneration.
Schedule
State Description
CA Any party with whom the insured agrees to waive subrogation in a written contract.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Date:
Policy Number: BNUWC0156525 Endorsement No.:
Insured Name: Emery Landclearing And Grading, Inc.
Insurance Company: StarNet Insurance Company
Countersigned By