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ENC2023-0005
ta QaG fra GEM ofthe DESERT — — 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: 2/10/2023 LOCATION OF CONSTRUCTION(Street address or Description): WASHINGTON ST AT SEELEY DR PURPOSE OF CONSTRUCTION: TRAFFIC CONTROL AND CMS ON THE EAST SIDE OF WASHINGTON ST WITHIN THE CITY OF LA QUINTA DESCRIPTION OF CONSTRUCTION: DR. GEORGE CHARITY CAR SHOW; TRAFFIC CONTROL & ONE CMS SIGN DIMENSION OF INSTALLATION OR REMOVAL: SEE ATTACHED EXHIBIT APPROXIMATE TIME WHEN WORK WILL BEGIN: 2/11/2023 TIME OF COMPLETION: 2/11/2023 ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) MMENTS: NON-PROFIT 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. Signature of Applicant or Agent PALM SPRINGS CRUISIN ASSOCIATION - CRAIG KORTHASE P. 0. BOX 14063 PALM DESERT, CA 92255 Name of Applicant (please print) Business Address TOPS N BARRICADES INC 44-503 JACKSON STREET INDIO, CA 92201 Name of Contractor and Job Foreman Business Address 787664 Contractor's License No. ADMIRAL INSURANCE COMPANY Applicant's Insurance Company Finance Revenue Code TOTAL: $0.00 103875 City Business License No. WHO13816 Policy Number PERMIT NO: ENC2023-0005 DATE ISSUED: 2/10/2023 EXPIRATION DATE: 2/10/2024 BY: AMY YU WORK INSPECTED BY*: PERMIT COMPLETION DATE*: (425)501-2189 Telephone No. (760)347-2111 Telephone No. *If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: AUG 2 4 2004 PALM SPRINGS CRUISING ASSOCIATION C/O ROSS MCMULLIN PO BOX 12803 PALM SESERT, CA 92255 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 02-0641867 DLN: 604204028 Contact Person: CHAD R DAVIS ID# 31466 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: June 30 Public Charity Status: 509 (a) (2) Form 990 Required: Yes Effective Date of Exemption: July 30, 2002 Contribution Deductibility: Yes We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter. Please see enclosed Information for Exempt Organizations Under Section 501(c)(3) for some helpful information about your responsibilities as an exempt organization. If you distribute funds to other organizations, your records must show whether they are exempt under section 501(c)(3). In cases where the recipient organization is not exempt under section 501(c)(3), you must have evidence the funds will be used for section 501(c)(3) purposes. Letter 947 (DO/CG) -2- PALM SPRINGS CRUISING ASSOCIATION Sincerely, Lois G. Lerner Director, Exempt Organizations Rulings and Agreements Enclosures: Information for Organizations Exempt Under Section 501(c)(3) Letter 947 (DO/CG) r N W p E La NO SCALE FRED WARING ST. �S CMS 6 1 i SC5(CA) N Pending Z O Raft oosuPl.Arot Dr George Car Show caw Coachella Valley Crusing Assn Craig 425-501-2189 c� Z _ TO& C-MCAOWMby der rep a Tops N Barricades, Inc. Ron Fifield (800)852-TOPS 50 1/10/23 1 - — -- SOUTHWEST CHURCH SC5 (CA) Ty j. CMS i ` GATE 1. . . . . . . . . . . CMS 2 GATE 2 c FOR EXIT MESSAGES FOR CHANGEABLE MESSAGE SIGNS (CMS): CMS 1 CMS 2 CMS 3 CMS 4 CMS 5 CMS 6 TENNIS VENDOR CAR SHOW EVENT EVENT EVENT GATE 1 PARKING »»»» PARKING PARKING PARKING »»»> GATE 2 MILES AV «««« «««« »»»» CAR SHOW V I P SHOW CAR SHOW CAR SHOW CAR PARKING PARKING MILES AV GATE 5 GATE 5 STRAIGHT GATE 2 ««««< »»»»> ««««< 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 (Ca.A4,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 INDIAN WELLS AND/OR CITY OF LA QUINTA 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' (TYP. 12') TRAFFIC LANE WIDTH AT ALLTIMES, 5. ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED AT ALL TIMES. 6. THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING EVENT HOURS ONLY. AT END OF THE EVENT HOURS, THE TEMPORARY CROSSWALK SHALL BE REMOVED AND TRAFFIC RETURNED TO NORMAL. EVENT HOURS WILL BE 6 AM TO 4 PM. 7. A BARRICADE WITH A SIGN ON BOTH SIDES OF IT WILL PLACED ON THE MEDIAN AT APPROXIMATELY 150' INTERVAILE SIGNS WILL SAY "NO PED CROSSING" 8. ATEMPORARY CROSSWALK AND STOP BAR SHALL BE INSTALLED USING WHITE FOIL PAVEMENT MARKING TAPE, THE LINES SHALL BE 8" TO 12" WIDE. THIS CROSSWALK SHALL BE REMOVEDA,TTHE END OF THE EVENT. �vPAFES51p ( C24577 * 9.�.L--� sPA, CIVIL. FOF CAt1F�R sCs (Ck '. v 1QO' w ;5 k• 4 �- � CMS 4 ,s Z. � ftS.s ~SEELEY DR SCS ICAI fYRClA1,\l PV9Ei �r City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2023-0005 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 two inches (2") of SC-800 shall be placed immediately. A permanent patch of ( "" N/A "" ) inches of A.0 surfacing placed on a ( " N/A " ) inch (" N/A " ) aggregate base shall be placed no later than (" N/A ") 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. 1. 2. 3. 4. 5. 6. PERMIT NO. ENC2023-0005 Dr. George Charity Car Show / Traffic Control Signs and Changeable Message Sign / East Side of Washington Street and Seeley Drive (No asphalt or earthwork permitted) In addition to the standard permit conditions, the following shall apply: 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. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during the actual work performed. The applicant, Craig Korthase, shall be available during the event at (425) 501-2189. The permittee shall remove all signs immediately after the completion of the festival. Sign removal should be accomplished by the end of 5PM on February 11, 2023. The permittee must maintain proper stopping and sight distances for the vehicular traffic users using the public right of way. Also, existing pedestrian and bicycle traffic shall not be impeded in anyway. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 7. 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 1st 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) neither before 8:30 a.m. nor after 4:30 p.m. 8. 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. 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. Special Conditions Page 1 of 2 PERMIT NO. ENC2023-0005 Dr. George Charity Car Show / Traffic Control Signs and Changeable Message Sign / East Side of Washington Street and Seeley Drive (No asphalt or earthwork permitted) 10. 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. 11. Should additional work, materials, or modifications of the work be required in order to meet City standards, safety requirements, signage requirements, or to fit actual field conditions, the work shall be performed by the Permittee as directed by and to the satisfaction of the City Engineer at no cost to the City of La Quinta. 12. The 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. 13. 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. 14. All landscaping, irrigation, decorative rock, decorative concrete, sidewalk, lighting, etc., shall be replaced to its original condition. 15. Access and egress to all local properties shall be maintained at all times. 16. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 17. 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 2 of 2 ACCOR " CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DDNYYY) 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 NAME: PHONE FAX AIC No Ext : A/C No), E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURED INSURER B INSURER C 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/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR EACH OCCURRENCE $ ( a oDAMAGE TO Ncur RENTED PREMISES)$ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ❑ LOC JECT OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED x SCHEDULED AUTOS ONLY AUTOS HIRED x NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ x PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EACH OCCURRENCE $ x AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A x PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 78-495 CALLE TAMPICO ACCORDANCE WITH THE POLICY PROVISIONS. LA QUINTA, CA 92253 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY # CF1 CA00338221 COMMERCIAL AUTO ECA 04 504 02 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE )esignation Or Description Of "Leased Autos": Any "leased auto" that qualifies as a covered 'auto' at the ime of loss, but this additional insured status does not apply to a lessor of a "leased auto" that is leased )r rented with an operator. A. Coverage 1. Any "leased auto" designated or described in the Schedule will be considered a covered "au- to" you own and not a covered "auto" you hire or borrow. 2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. Any person, except the lessor or any "em- ployee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. 3. The coverages provided under this endorse- ment apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. C. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premi- ums. E. Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the les- sor. ECA 04 504 02 14 Copyright, Everest Reinsurance Company, 2014 Includes copyrighted material of Insurance Services Office, Inc. used with its permission. Page 1 of 1 ❑ INSURED COPY il•»ry-E:�rw:r•SK��r:� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NORTHFIELD XTEND ENDORSEMENT - CONTRACTORS (Excludes Products -Completed Operations) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Total General Aggregate Limit And Per Project General Aggregate Limit B. Property Of Others - Limited Care, Custody Or Control Coverage C. Lost Key Expenses Coverage D. Blanket Additional Insured (Contractors) (Excluding Products -Completed Operations) E. Blanket Waiver Of Subrogation PROVISIONS A. TOTAL GENERAL AGGREGATE LIMIT AND PER PROJECT GENERAL AGGREGATE LIMIT 1. The following is added to SECTION III - LIMITS OF INSURANCE: A Total General Aggregate Limit and a Per Project General Aggregate Limit applies. a. The Total General Aggregate Limit of $5,000,000 is the most we will pay for the sum of all: (1) Medical Expenses under Coverage C; (2) Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard"; and (3) Damages under Coverage B; regardless of the number of: (1) Insureds; (2) Claims made or "suits" brought; (3) Persons or organizations making claims or bringing "suits"; or (4) "Projects". b. A separate Per Project General Aggregate Limit applies for all sums which the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" caused by an 'occurrence" under Coverage A, and for all medical expenses for "bodily injury" caused by an accident under Coverage C, that can be attributed only to operations at a single "project'. © 2020 The Travelers Indemnity Company. All rights reserved. S3073-CG (11/20) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7 The Per Project General Aggregate Limit is an amount equal to the amount of the General Aggregate Limit shown in the Declarations. Subject to the Total General Aggregate Limit, the Per Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Coverage C, regardless of the number of: (1) Insureds; (2) Claims made or "suits" brought; or (3) Persons or organizations making claims or bringing "suits". Any payments made under Coverage A for damages or under Coverage C for medical expenses will reduce both the Total General Aggregate Limit and the Per Project General Aggregate Limit for that "project'. Such payments will not reduce the General Aggregate Limit shown in the Declarations, nor will they reduce any other Per Project General Aggregate Limit for any other "project'. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply to each "project' subject to both the Total General Aggregate Limit and the applicable Per Project General Aggregate Limit for that "project'. c. For all sums which the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" caused by an 'occurrence" under Coverage A, and for medical expenses for "bodily injury" caused by an accident under Coverage C, that cannot be attributed only to operations at a single "project': (1) Any payments made under Coverage A for damages will reduce both the Total General Aggregate Limit and the General Aggregate Limit, or will reduce the Products -Completed Operations Aggregate Limit, whichever is applicable; (2) All payments made under Coverage C for medical expenses will reduce both the Total General Aggregate Limit and the General Aggregate Limit; (3) Such payments will not reduce the Per Project General Aggregate Limit for any "project'; and (4) The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. d. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Aggregate Limit and will not reduce the Total General Aggregate Limit, the General Aggregate Limit, or the Per Project General Aggregate Limit for any "project'. 2. The following replaces Paragraph 2. of SECTION III - LIMITS OF INSURANCE: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and b. Damages because of "bodily injury" or "property damage" caused by an 'occurrence" under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and for all medical expenses for "bodily injury" caused by an accident under Coverage C, that cannot be attributed only to operations at a single "project'. 3. The following is added to the DEFINITIONS Section: "Project" means an area away from premises owned by or rented to you at which you are performing operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project' that includes premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or waterway, or by a right-of-way of a railroad, will be considered a single "project'. © 2020 The Travelers Indemnity Company. All rights reserved. S3073-CG (11/20) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 B. PROPERTY OF OTHERS - LIMITED CARE, CUSTODY OR CONTROL COVERAGE 1. The following is added to Exclusion j., Damage To Property, in Paragraph 2. of SECTION 1 -COVERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Paragraphs (4) and (5) of this exclusion do not apply to "property damage" to "property of others" that arises out of your operations and is not caused by conversion or unauthorized taking or use. Separate limits of insurance apply to Property Of Others - Limited Care, Custody Or Control as described in SECTION III - LIMITS OF INSURANCE. 2. The following is added to SECTION III - LIMITS OF INSURANCE: Property Of Others Limits Of Insurance Subject to the General Aggregate Limit, the Property Of Others Aggregate Limit of $50,000 is the most we will pay for all damages because of "property damage" to "property of others". Subject to the Each Occurrence Limit, the Property Of Others Each Occurrence Limit of $25,000 is the most we will pay for all damages because of "property damage" to "property of others" arising out of any one "occurrence". 3. The following Section is added: PROPERTY OF OTHERS DEDUCTIBLE 1. Our obligation to pay damages on your behalf for "property damage" to "property of others" applies only to the amount of "property damage" to "property of others" in excess of the Property Of Others Deductible amount of $1,000. The Property Of Others Aggregate Limit will not be reduced by the application of such deductible. 2. The deductible amount applies to all "property damage" to "property of others" as a result of any one "occurrence" regardless of the number of persons or organizations who sustain "property damage" because of that "occurrence". 3. Our right and duty to defend, and your duties in the event of an "occurrence", claim or "suit" under this insurance, apply irrespective of the application of the deductible amount. 4. We may pay any part or all of the deductible amount to settle any claim or "suit" for "property damage" to "property of others" and, upon notification of the settlement action, you must promptly reimburse us for the part of the deductible amount paid by us. 4. The following is added to the DEFINITIONS Section: "Property of others" means tools or equipment of others while being used by the insured in performing the insured's operations. C. LOST KEY EXPENSES COVERAGE 1. The following is added to SECTION I - COVERAGES: COVERAGE - LOST KEY EXPENSES 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as "lost key expenses" because of "property damage" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking "lost key expenses". However, we will have no duty to defend the insured against any "suit" seeking "lost key expenses" because of "property damage" to which this insurance does not apply. We may, at our discretion, investigate any "occurrence" or claim and settle any claim or "suit". But: (1) The amount we will pay for "lost key expenses" is limited as described in SECTION III - LIMITS OF INSURANCE; and © 2020 The Travelers Indemnity Company. All rights reserved. S3073-CG (11/20) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 7 (2) Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A, Coverage B, medical expenses under Coverage C or Coverage - Lost Key Expenses. We will have no other obligation or liability to pay sums or perform acts or services unless explicitly provided for under Supplementary Payments. b. This insurance applies to "property damage" only if: (1) The "property damage" is caused by an 'occurrence" of a 'lost key event' that takes place in the "coverage territory"; (2) The "property damage" occurs during the policy period; and (3) Prior to the policy period, no insured listed under Paragraph 1. of SECTION 11 - WHO IS AN INSURED and no "employee" authorized by you to give or receive notice of an 'occurrence" of a 'lost key event' or claim knew that the "property damage" had occurred, in whole or in part. If such a listed insured or authorized "employee" knew, prior to the policy period, that the "property damage" had occurred in whole or in part, then any continuation, change or resumption of such "property damage" during or after the policy period will be deemed to have been known prior to the policy period. c. "Property damage" which occurs during the policy period and was not, prior to the policy period, known to have occurred by any insured listed under Paragraph 1. of SECTION II - WHO IS AN INSURED or any "employee" authorized by you to give or receive notice of an 'occurrence" of a 'lost key event' or claim, includes any continuation, change or resumption of that "property damage" after the end of the policy period. d. "Property damage" will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph 1. of SECTION II - WHO IS AN INSURED or any "employee" authorized by you to give or receive notice of an 'occurrence" of a "lost key event' or claim: (1) Reports all, or any part, of the "property damage", including any claim or "suit' involving or alleging it, to us or any provider of other insurance; (2) Receives a written or verbal demand or claim for 'lost key expenses" because of "property damage"; or (3) Becomes aware by any other means that "property damage" has occurred, has begun to occur, or is alleged to have occurred or begun to occur. 2. The following replaces Paragraph 1.a.(2), and the last sentence of Paragraph 1.a., of SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY and of SECTION I - COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY: (2) Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverage - Lost Key Expenses, Coverage A, Coverage B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments. 3. The following replaces the title SUPPLEMENTARY PAYMENTS - COVERAGES A AND B of SECTION I - COVERAGES: SUPPLEMENTARY PAYMENTS 4. The following is added to Paragraph 2. of SECTION III - LIMITS OF INSURANCE as a subparagraph identifying another coverage to which the General Aggregate Limit applies: "Lost key expenses" under Coverage - Lost Key Expenses. © 2020 The Travelers Indemnity Company. All rights reserved. S3073-CG (11/20) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 7 5. The following provisions are added to SECTION III -LIMITS OF INSURANCE: Lost Key Expenses Limit Of Insurance And Deductible An Each Lost Key Event Limit and a deductible apply to 'lost key expenses" because of "property damage". a. Subject to the General Aggregate Limit, the Each Lost Key Event Limit of $2,500 is the most we will pay under Coverage - Lost Key Expenses for the sum of all 'lost key expenses" because of "property damage" arising out of an 'occurrence" of a 'lost key event'. b. A Lost Key Expenses Deductible of $250 applies. Our obligation under Coverage - Lost Key Expenses to pay 'lost key expenses" on your behalf applies only to the amount of 'lost key expenses" in excess of the deductible. The Each Lost Key Event Limit will be reduced by the amount of such deductible. The $250 deductible applies towards handling, investigation, adjustment, and legal expenses, even when no payment is made to the claimant, when a compromise settlement is reached, or when the claim is denied. The $250 deductible applies to all 'lost key expenses" because of "property damage" as a result of any one "occurrence" of a 'lost key event' regardless of the number of persons or organizations who sustain "lost key expenses" because of that 'occurrence" of a 'lost key event'. The terms of this insurance, including those with respect to: (1) Our right and duty to defend the insured against any "suits" seeking those 'lost key expenses"; and (2) Your duties in the event of an "occurrence" of a 'lost key event', claim or "suit', apply irrespective of the application of the deductible amount. We may pay any part or all of the deductible amount to effect settlement of any claim or "suit' and, upon notification of the action taken, you shall promptly reimburse us for the part of the deductible amount paid by us. 6. The following is added to SECTION V - DEFINITIONS: "Lost key event" means the loss or mysterious disappearance of keys of others in the care, custody or control of the insured. "Lost key expenses" means the reasonable cost of: a. Replacement keys; b. The adjustment of locks to accept replacement keys; or c. New locks and keys, including the cost of installation of such new locks. D. BLANKET ADDITIONAL INSUREDS (CONTRACTORS) (EXCLUDING PRODUCTS -COMPLETED OPERATIONS) The following is added to SECTION II - WHO IS AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization; and © 2020 The Travelers Indemnity Company. All rights reserved. S3073-CG (11/20) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 7 c. Subject to the following limitations and conditions on the insurance provided to such additional insured: (1) If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in SECTION III - LIMITS OF INSURANCE. (2) The insurance provided to such additional insured does not apply to "bodily injury" or "property damage" arising out of the providing, or failure to provide, 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 or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (3) The insurance provided to such additional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed operations hazard". (4) The insurance provided to such additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if the written contract or agreement requires that the insurance provided under this Coverage Part apply on a primary basis, or a primary and non-contributory basis, then this insurance is primary to other insurance available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance. But, the insurance provided to the additional insured still is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under such other insurance. (5) The additional insured must comply with the following duties: (a) Give us written notice as soon as practicable of an "occurrence" which may result in a claim. To the extent possible, such notice should include: (1) How, when and where the 'occurrence" took place; (ii) The names and addresses of any injured persons and witnesses; and (III) The nature and location of any injury or damage arising out of the 'occurrence". (b) If a claim is made or "suit' is brought against the additional insured: (i) Immediately record the specifics of the claim or "suit' and the date received; and (ii) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit' as soon as practicable. (c) Immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. (d) Tender the defense and indemnity of any claim or "suit' to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to the additional insured is primary to other insurance available to the additional insured which covers that person or organization as a named insured. © 2020 The Travelers Indemnity Company. All rights reserved. S3073-CG (11/20) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 7 E. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph S., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a written contact or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" caused by an "occurrence" that takes place; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the written contract or agreement. © 2020 The Travelers Indemnity Company. All rights reserved. S3073-CG (11/20) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 POLICY NUMBER: BNUWC0158375 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. State Schedule 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: BNUWC0158375 Endorsement No.: Insured Name: Insurance Company: StarNet Insurance Company Countersigned By