The URL can be used to link to this page

ENC2023-0009ta (2ai�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: 3/8/2023 LOCATION OF CONSTRUCTION (Street address or Description): AVE 50 WEST OF JEFFERSON ST PURPOSE OF CONSTRUCTION: ACCESS EXISTING MH #210 AND TRENCH +/- 32' TO PLACE (1) HUB AND REMOVE/REPLACE 48 SO. FT OF ASPHALT (PLEASE ONLY REFER TO PAGE 2 OF THE CONDUIT DESIGN. THE REST IS INSIDE AN HOA) DESCRIPTION OF CONSTRUCTION: IN PALMILLA; FRONTIER 70063-5323156 TRENCH TO PLACE 1 HUB DIMENSION OF INSTALLATION OR REMOVAL: TBD APPROXIMATE TIME WHEN WORK WILL BEGIN: 5/1/2023 TIME OF COMPLETION: 5/31/2023 ESTIMATED CONSTRUCTION COST: $0.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS: THIS ENCROACHMENT PERMIT IS FOR WORK WITHIN THE CITY OF LA QUINTA LIMITS ONLY 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. DYNAMIC TELCO - ANDREA MAGANA 1177 IDAHO ST STE 102 REDLANDS, CA 92374 Name of Applicant (please print) GULBRANSON SERVICES INC-JOHN POMROY APPLIED ON ETRAKIT Signature of Applicant or Agent (951)992-1715 Business Address Telephone No. 15371 BONANZA ROAD UNIT A VICTORVILLE, CA 92392 (951)533-7325 Name of Contractor and Job Foreman Business Address 890841 Contractor's License No. VALLEY FORGE INSURANCE COMPANY Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION TRAFFIC CONTROL $707.00 TECHNOLOGY ENHANCEMENT FEE $8.00 TOTAL: $0.00 Telephone No. LIC-770365 City Business License No. 7034725207 Policy Number PERMIT NO: ENC2023-0009 DATE ISSUED: 3/8/2023 EXPIRATION DATE: 3/8/2024 BY: AMY YU WORK INSPECTED BY*: PERMIT COMPLETION DATE*: *If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. TCP NOTE: 1) WORK CREW TO USE THIS TCP TO ACCESS WORK ZONE, LOCATED ON THE S/S/O AVE 50 @ VIA PALMIA TO PLACE NEW HUB, TO BORE AND PLACE +/- 17' OF NEW CONDUIT TO TIE INTO EXISTING DUCT, AND TO SPLICE FIBER OPTIC CABLE IN MH 210 2) WORK CREW TO PLACE TEMPORARY NO PARKING SIGNS ALONG ENTIRE WORK AREA 72 HOURS PRIOR TO COMMENCING WORK. Q,�pF ESS/pH r,Y LfHpc��, La C 28043 m c EXP. 03/31/24 a �T\ 1� F�FC1CVAt�F 10 a CURB MEDIAN J LU Ln7- l-OZM Q l-OZM Otl3Htl END Otl3HV Otl Q ROAD WORKXdOM G20-2 Z I avow ll<^^ Q VJ 0 0 Q o z U N AVE 50 Q 50 MPH IDEWALK SIDEWALK PARK WAV E LANE BIKE LANE BIKE CURB MEDIAN J � CURB MEDIAN 0 0 0H o 0 0 0 0 0 0 0 0 0 0 0 0 C BIKE LANE PARK WAY PARKWAY BIKE LANE 0 � � I PARK WAV 500' 350' 4 N A 4 ENO W ROAD WORK G20-2 Q za_ 02 N C7 BIKE 425' BUFFER l-OZM 4 END Otl3HV � ROAD WORK 4tl0a G20-2 U = o a w� 2 Lo QN J 1S JOSS END ROAD WORK Q G20-2 Z = z a Q U) N LU �3a 500' BIKE LANE BIKE LANE SIDEWALK N go LO 4-� Q C\1 C Z-Ozo 0 NaoMON3 Q *W2.-I a flagman at every intersection /driveway to ensure drivers can see approaching vehicles when work is near intersection and equipment may be blocking clear view. 0 0 0 0 F KE LANE DWY 350' I 200' BIKE LANE TAPER E Z �m o m ti "z1 O C) ry a Z-DZ�J Na0 N0tl0a 4 WORK U�/ ry AHEAD W20-1 0 2 In G LO N PARK WAY PARK WAY 600' MERGING TAPER Af W W SCALE: 1 "=80' FRONTIER COMMUNICATION CONSTRUCTION SPECIFICATIONS 1. Contact Frontier Engineer DAVID DIEGUEZ (562) 666-7712 sixty (60) days prior to need of service in order to confirm compliance,order materials,and schedule work forces. 2. FRONTIER COMMUNICATIONS, INCORPORATED RESERVES THE RIGHT TO REFUSE ANY CONDUIT, PULL BOXES, MANHOLES, OR UTILITY BOXES THAT DEVIATE FROM PLANS AND SPECIFICATIONS. 3. CHANGES OR DEVIATIONS FROM THIS PLAN MUST BE APPROVED BY FRONTIER. 4. CONTACT THE FRONTIER INSPECTOR 48 HOURS BEFORE TRENCHING AND UPON COMPLETION OF YOUR SUBSTRUCTURES TO SCHEDULE THE FINAL INSPECTION. 5. FRONTIER INSPECTOR SHALL BE PRESENT ON SITE WHEN CONTRACTOR NEEDS TO ACCESS ANY EXISTING FRONTIER FACILITY. 6. All conduit risers bends to have a minimum thirty-six (36) inch radius. 7. All horizontal ninety degree bends (90e) shall have a radius of not less than 12.5 feet and all vertical ninety degree bends (90e) shall have a radius of not less than three feet. No more than two (2) ninety degree (90°) horizontal bends shall be placed in any single run unless otherwise specified. Contact Frontier engineer concerning any required deviations. 8. All conduit must be proven using a mandrel no less than a 1/2" smaller than the conduit to be accepted. Mule tape shall be placed in all conduits proven. Wall to wall measurements must be taken with a mule tape. 9. Accurate AS-BUILTS shall be provided to the Frontier inspector assigned to this project. AS-BUILTS shall include conduit section measurements, wall to wall footages, stations and offsets of AS -BUILT Frontier structures, and the cover to the top of the Frontier underground structure placed. Copy of the AS -BUILT conduit work order must be provided to the Frontier inspector assigned to your project. 10. Contact MIKE REDDING (760) 342-1240 at the inspection office for coordination of inspection dates. 11. Place weatherproof cap on end of all conduits terminated outside of a building. 12. Place temporary weatherproof cap on end of all conduits exposed during construction. 13. Rigid steel, approved plastic conduit (PVC Schedule #40,TYPE-C (4") or DB-120 (2") or Frontier provided or approved Roll Sheet sub duct, is specified for underground construction. Condulets, Flex, Transite, Plumbers fittings, Water and Gas Pipes must NOT be used. RIGID STEEL MUST BE USED WHEN CONDUIT CAN BE EXPOSED TO VEHICULAR TRAFFIC. 14. Conduit terminated on a pole must be PVC Schedule 80. If conduit will be exposed to traffic, rigid steel pipe and sweep is required to 48" above finished grade otherwise turned up 12" above finished grade. Location of riser on pole will be as shown on conduit plan and location can be modified by approval of Frontier engineer/inspector only. 15. Minimum separation from other utilities shall be a minimum of 12". Conduit placed in same trench with primary power conduit must be separated by no less than twelve inches(12") of well -packed sand or three inches(3") of concrete. Minimum cover shall be no less than thirty (30") inches measured from the final grade of the street flow line to the top of Frontier structure unless noted otherwise. Ducts placed in the driven portion of the roadway must have no less than 48 inches(48") of cover to top of pipe measured at flow line of roadway. 16. FRONTIER RECOMMENDATIONS: Provide a minimum 14" conduit home run from each suite location to the main terminal backboard in lieu of running cables over drop ceiling access. Frontier will not install cables not contained in conduit. 17. Provide source of ground at the telephone backboard location: (1) #6 insulated copper wire (solid preferred) to power system ground. - (1) #6 insulated copper wire (solid preferred) to permanent metallic structure such as UFER ground or building steel. - (1) #6 insulated copper wire (solid preferred) to metallic water pipe bonded to previously described permanent metallic structure. Leave adequate wire to extend six feet beyond base of backboard. NOTE: THE FOLLOWING MUST NOT BE USED FOR GROUND SOURCES: ROOF TRUSSES, FLOOR JOINTS, BRACES, SPRINKLER SYSTEM PIPES, METAL ELECTRICAL DISTRIBUTION CONDUIT, AND HORIZONTAL STEEL MEMBERS LESS THAN 3/8" THICK. 18. Provide cable racking as described in attachment. Provide pulling irons as described in attachment. 19. Three to six weeks will be needed from the date of final inspection for Frontier to start placing facilities. All paperwork and easements must also be completed, if applicable. 20. Work crew to adjust manholes to final grade as shown on the approved grading plan. 21. Actual footages of conduit are needed to order materials. CONDUIT DESIGN H2O07 AVENUE 50 / VIA PALMILA LA QUINTA CA, 92253 Ral hs Pharmacy e�ug ga"lens cl p Y ----- %mho Santa Margarita71 he PROJECT LOCATION Coffee nousseY t Avenue 50 pumas 50 Avenue 50 0 '8 RANCHO DEL SDLQ g 3 e I e onver ers arina of La Quinta - pomNo P-1, Vern. Dr Pare 46 m m D Ve Psa 3 PICK UP POINT: VICINITY MAP NTS PATH LENGTH: MATERIALS: -FRONTIER MH210 2" BORE = 9381' 4" BORE = 2562' 5" BORE = 1532' TRENCH = 193' 19586' OF 1.25" SD 92' OF 4" PVC (81) FLOWER POT(S) (24) 17X30 HH(S) (7) 2X3 HH(S) (1) HUB TUB # H2O07 (1198) SQFT ASPHALT SHEETINDEX 1-COVER 2/13 - CONDUIT DESIGN 14 - DETAILS ABBREVIATIONS PROPOSED EXISTING BUILDING BLDG bldg CENTERLINE C/L c/I CONCRETE CONC cone SIDEWALK CSW csw DRIVEWAY DWY dwy EDGE OF PAVMENT EDP eop FACE OF CURB FOC foc HANDHOLE HH hh MANHOLE MH mh PEDESTAL PED ped POLYVINYL CHLORIDE PVC pvc SUB DUCT SO ad PROPERTY LINE P/L P/I RAILROAD RR rr RAILROAD R/W RR R/W rr r/w RIGHT OF WAY R/W r/w SOUTHERN CAL EDISON SCE sce WALL To BUILDING W-B WALL TO POLE W-P NOT TO SCALE NTS LEGEND CONDUIT Main line/Backbone Concuit or ,CBS Service Lateral Conduit JT Joint Trench T Sole Trench 1 Proposed Construction Cal O)_t UTILITIES Existing Proposed Gas G Water w — w Telephone — T San Sewer SS Electric -e E Storm Drain sd SD POLES Existing Proposed Frontier Owned O o Foreign owned X X Joint Owned CA/'`II ITICC Manhole 0 0 Handhole o O PullBOx m m Bore Pit ❑ Electrical Vent Fire Hydrant �o 5/8"-8' Copper Ground Rod Material provided by Frontier & Placed by Devclopc. �LA, Non -Reimbursable Material Provided & Placec r. • • • Fr'ont*ier COMMUNICATIONS JOB ID: 70063-5323156 DATE: 01/13/2023 TITLE: CONDUIT DESIGN STREET ADDRESS: HARVILL AVE / PLACENTIA AVE CITY/STATE: AVENUE 50 / VIA PALMILA 92253 FTR ENGINEER: DAVID DIEGUEZ (562) 666-7712 FTR INSPECTOR: MIKE REDDING (760) 342-1240 DRAWN BY: ;1 DYNAMIC TELCO 951-992-1472 C/ EST. #: SHEET#: DYNAMIC TELCO of �4 ,do,oquih,aDigA,eDevernment GENERAL NOTES: Code requires a Dig Alert Itlentifiwtion Number tobeisserea "Perm%lo Excavate"'will 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD will bbe valid. For your Dig AlertLD.Namnereall: DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD OBSERVATIONS. EXACT UTILITIES LOCATIONS TO BE VERIFIED BY USA MARKINGS PRIOR TO DIGGING. Call 1-800-227-2600 THE OPENING OF THE HUB WILL BE FACING THE SIDEWALK SIDE AND NOT THE STREET SIDE 3/5-16 UNC STAINLESS STEEL 1 HEX HEAD BOLT W/ WASHER (5) 1 1 25 x4 102 PULL SLOT W/ 01/4 PIN F ��Rr/FR Quin o Q-TonlT -R/W — — — — -FOC SEE DETAIL "A" — q�_ C/L �— -FOC = .R/W = TO VIA PALMILA C/L — R/W- FOC= C/L- AVENUE 50 FOC- — R/W- SIDEWALK PARKWAY Detail "A" SCALE: 1 "=20' TIE INTO EX. MH 210 � w GUTTER FOC- N R/W. B 2" BORE 0 LF B 4" BORE 0 LF B 5" BORE 0 LF T TRENCH 32 LF 17"x30" HANDHOLE(S) 0 EA 0 2'x3' HANDHOLE(S) 0 EA FP FLOWER POT(S) 0 EA ASPHALT R&R 48 SF CONCRETE R&R 0 SF O 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA Q 4'x4' BORE PITS 0 EA Q 4'x6' BORE PITS 1 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALER "=60' TYPICAL 3'X3'X3' HUB TUB DETAIL ,do,oquih,aDig",eDevernment GENERAL NOTES: Code requires a Dig Nert Itlentifiwtion Number tobeissued lbe valid. before, "Perm%lo Excavate" will b1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD For your Dig Alert l.D. Number call: DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD OBSERVATIONS. EXACT UTILITIES LOCATIONS TO BE VERIFIED BY USA MARKINGS PRIOR TO DIGGING. Call 1-800-227-2600 STA. NA 1 1 FP STA. NA 50155 1 FP 3 \50030 1 1.25" 50025 / \ B 151' — STA. NA 1 FP 5012 I I 1 1.25" \ 1 1.25" I B 172' B 145' I 5006 I 5009 \ \ 5007( 3 STA. NA CHC STA. NA 3 1 FP 3 J 1 17X30 3 STA. NA T 1 3" 501 B 1428 1 17X30 o Q 2 1.25" \ \ H B 75' \ Q B 94' 1 50105 \ £ \ STA. NA 3 1 FP y STA. NA 1 1.25' O 1 FP 3 2 4" B 107' T 9' y 2 4" 50145 1 1.25" 5002 T 21' B 122' 3 ; 0 STA. NA \ \ i 1 F P o w 3 3 2 1.25" 3 — 3 B 95' 501 5 25 50265 1 1 1.25" STA. NA 3 1.251, B 96 1 FP STA. NA B 194' 1 TA. NA 1 2X3 ISTING 1-4" PVC AND PLACE SPLIT WYE SEE SPLIT WYE DETAIL LOCATE AND INTERCEPT \S-7 1-4" PVC AND PLACE SPLIT WYE SEE SPLIT WYE DETAIL TO vs 91 e B 2" BORE 841 LF B 4" BORE 264 LF B 5" BORE 194 LF T TRENCH 143 LF 0 17"x30" HANDHOLE(S) 3 EA 0 2'x3' HANDHOLE(S) 1 EA FP FLOWER POT(S) 8 EA ASPHALT R&R 84 SF CONCRETE R&R 0 SF O 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA 02 4'x4' BORE PITS 0 EA Q3 4'x6' BORE PITS 17 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' seetiequihres 4z"or@eDevernment GENERAL NOTES: Code reoquia Dig Nert Itlentifiwtion Number tobei WwilbIbe valitl. beforea Perm%lo Excavate" w1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD " For your Dig Alert LD. N—bercall: DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF a 57 Q a 6- MATCHLINE "B" SEE SHEET 5 B 2" BORE 980 LF B 4" BORE 274 LF B 5" BORE 203 LF T TRENCH 0 LF 0 17"x30" HANDHOLE(S) 0 EA 0 2'x3' HANDHOLE(S) 1 EA (FPS FLOWER POT(S) 4 EA El ASPHALT R&R 168 SF n CONCRETE R&R 0 SF O 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA 02 4'xX BORE PITS 0 EA Q3 4'x6' BORE PITS 7 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' Code requires a Dig Alert Identification Number to be issued before a .P.-it to Excavate" will be valid. For your Dig Alert I.D. Number call: Call 1-800-227-2600 GENERAL NOTES: 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD OBSERVATIONS. EXACT UTILITIES LOCATIONS TO BE VERIFIED BY USA MARKINGS PRIOR TO DIGGING. B 2" BORE 734 LF B 4" BORE 278 LF B 5" BORE 164 LF T TRENCH 9 LF 0 11 17"x30" HANDHOLE(S) 3 EA 0 2'x3' HANDHOLE(S) 0 EA FP FLOWER POT(S) 10 EA ASPHALT R&R 126 SF CONCRETE R&R 0 SF O 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA Q 4'x4' BORE PITS 0 EA Q 4'x6' BORE PITS 15 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' ,do,o uih6 2"°""eGevernment GENERAL NOTES: Code requiresa Dig Nert before, STA. NA STA. Number tobeias'will berea 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD 1 FP 1 1 "Perm%lo Excavate" will be valid. For your Dig Ale"D. Number call: DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 4 1.25" 3 1.25" 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD B 45' B 79' OBSERVATIONS. STA. NA 2 1 FP 0210 B — 50220 EXACT UTILITIES LOCATIONS TO BE VERIFIED 5 00 3 BY USA MARKINGS PRIOR TO DIGGING. 3 Call 1-800-227-2600 0180 / \ i 3 O 3 1.25" ss B 1 77 5 / Q� 50225 STA. NA �� STA. NA 1 FP 3 1 FP 2 1 1.25" 5019 3 B 1 59' NA - Innr_ NA 50255 \1 1 1.25" \ j^ B 136' �� 7 5 \ _ \ 3 w- 3 79935 7 975 79955 STA. NA NA 502 3 = � I 023 \ 3 II 50245 C/L- FOC i R/W. / — I 5 B 2" BORE 276 LF B 4" BORE 419 LF B 5" BORE 589 LF T TRENCH 13 LF 1:1 17"x30" HANDHOLE(S) 4 EA 0 2'x3' HANDHOLE(S) 0 EA FP FLOWER POT(S) 12 EA ASPHALT R&R 84 SF CONCRETE R&R 0 SF O 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA 02 4'x4' BORE PITS 0 EA Q3 4'x6' BORE PITS 16 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' Code requires a Dig Alert Identification Number to be issued before a .P.-it to Excavate" will be valid. For your Dig Alert I.D. Number call: Call 1-800-227-2600 GENERAL NOTES: 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD OBSERVATIONS. EXACT UTILITIES LOCATIONS TO BE VERIFIED BY USA MARKINGS PRIOR TO DIGGING. 1 n yo B 2" BORE 914 LF B 4" BORE 150 LF B 5" BORE 149 LF T TRENCH 43 LF 13 17"x30" HANDHOLE(S) 2 EA 0 2'x3' HANDHOLE(S) 1 EA (FPS FLOWER POT(S) 9 EA El ASPHALT R&R 126 SF n CONCRETE R&R 0 SF O 17130" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA 02 4'x4' BORE PITS 0 EA Q3 4'x6' BORE PITS 15 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' Code requires a Dig Alert Identification Number to be issued before a .P.-it to Excavate" will be valid. For your Dig Alert I.D. Number call: Call 1-800-227-2600 GENERAL NOTES: 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD OBSERVATIONS. EXACT UTILITIES LOCATIONS TO BE VERIFIED BY USA MARKINGS PRIOR TO DIGGING. D,-- B 2" BORE 636 LF B 4" BORE 196 LF B 5" BORE 0 LF T TRENCH 0 LF 1:1 17"x30" HANDHOLE(S) 2 EA 0 2'x3' HANDHOLE(S) 0 EA FP FLOWER POT(S) 5 EA ASPHALT R&R 84 SF CONCRETE R&R 0 SF O 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA 02 4'x4' BORE PITS 0 EA Q3 4'x6' BORE PITS 7 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' moortant Notice Section io Government C216/res GENERAL NOTES: Code requiDig Itlentifiwtion a Alert,ft a Number tobeisW,eill before a 'Permit to Excavate" will be valid. 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD For your Dig Alert l D. Number call: DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF Underground S.M. Alert WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD Q OBSERVATIONS. EXACT UTILITIES LOCATIONS TO BE VERIFIED ° N° 1BY USA MARKINGS PRIOR TO DIGGING. OO Coll 1-600-227-2600 SZN B 2" BORE 848 LF B 4" BORE 383 LF B 5" BORE 44 LF T TRENCH 11 LF 1:1 17"x30" HANDHOLE(S) 2 EA 0 2'x3' HANDHOLE(S) 1 EA FP FLOWER POT(S) 7 EA ASPHALT R&R 142 SF CONCRETE R&R 0 SF M 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA Q 4'x4' BORE PITS 0 EA Q 4'x6' BORE PITS 12 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' s,doeGilhoea"°""eDevernment GENERAL NOTES: Code requires a Dig Nert Itlentifiwtion Number tobeiss°ederea "Perm%lo Excavate" willll be valid. 1. RIGHT OF WAY SHOWN BASED ON AVAILA For your Dig Alert l.D. Number call: DATA. WORK CREW TO VERIFY LOCATIO WAY PRIOR TO CONSTRUCTION. 11 2. UTILITIES SHOWN LOCATED BY RECORD N OBSERVATIONS. II EXACT UTILITIES LOCATIONS TO BE' BY USA MARKINGS PRIOR TO DIG Coll 1-800-227-2600 B 11 2" BORE 1079 LF B 4" BORE 166 LF B 5" BORE 189 LF T TRENCH 8 LF 13 17"x30" HANDHOLE(S) 2 EA 0 2'x3' HANDHOLE(S) 2 EA FP FLOWER POT(S) 9 EA ASPHALT R&R 84 SF CONCRETE R&R 0 SF M 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA 02 XxX BORE PITS 0 EA Q3 XxG BORE PITS 8 EA 1.25" 106' CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' s,doeGilhoea"°""eDevernment GENERAL NOTES: Code requires a Dig Nert Itlentifiwtion Number tobeiss°ederea "Perm%lo Excavate" willll be valid. 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD For your Dig Alert l.D. Number call: DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 11 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD OBSERVATIONS. II EXACT UTILITIES LOCATIONS TO BE VERIFIED BY USA MARKINGS PRIOR TO DIGGING. Coll 1-800-227-2600 ESN SINE „�, E SMP�GN o s� NA FP 3 79 5 \ \� 79645 EX. HH STA. NA 1 1 pp, 79665 79680 _ O 79685 S 13„ SEE SN\A A 11 to o o \o 50135 I I I I 5014C STA. / 1 / 1 3 5 / 50180 B 3 / / 3 / 50220 EX. HH t /I / / 1 1 1.25" r^OO B 269' ` 0 \W Raw i _ M AIL `), Foc �l VIA SIN CUIDq p Raw = o O U YI„SE HEET 121„ B 2" BORE 1197 LF B 4" BORE 236 LF B 5" BORE 0 LF T TRENCH 34 LF 1:1 17"x30" HANDHOLE(S) 2 EA 0 2'x3' HANDHOLE(S) 1 EA FP FLOWER POT(S) 4 EA ASPHALT R&R 84 SF CONCRETE R&R 0 SF O 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA 02 4'x4' BORE PITS 0 EA Q3 4'x6' BORE PITS 10 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' ,do,oquih 4z"°""eDevernment GENERAL NOTES Code requires a Dig Nert Itlentifiwtion Number tobeissued beflbe valid. before "Perm%lo Excavate" will b1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD For your Dig Alert l.D. Number call: DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD OBSERVATIONS. EXACT UTILITIES LOCATIONS TO BE VERIFIED SEE Sc"LINE BY USA MARKINGS PRIOR TO DIGGING. „I' MATCHLIJ I3;)0250 Coll 1-800-227-2600 � UO U � a a I I I i 1 1.25" / B 134' 3 / / 3 STA. NA 1 17X30 50290 2 1.25" 3 B 1 55' 5029 / 3 3 TIE INTO 1 1.25" I I I EX. HH B 228' I 50330 1 B 50335 - STA. 1 3 LU 50375 z 50370 B W STA. NA 1 17X30 H / 3 \� 3 0410 415 _ 1 1.25" B 110, 50455 I STA. NA I NA B 2" BORE 764 LF B 4" BORE 55 LF B 5" BORE 0 LF T TRENCH 0 LF 1:1 17"x30" HANDHOLE(S) 2 EA 0 2'x3' HANDHOLE(S) 0 EA FP FLOWER POT(S) 3 EA ASPHALT R&R 42 SF CONCRETE R&R 0 SF M 17"X30" COMBO PED(S) 0 EA O 2'x3' COMBO PED(S) 0 EA 02 4'x4' BORE PITS 0 EA Q3 4'x6' BORE PITS 8 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' i i 3 NA )50 2 1.25" 215' ' 7954 I I ly f 3 � I I 79565 NA 3 FP �I.25" 94' I I I I 79555 3 EX. HH \ coc, CIO, 7960:1 �CNL1� jl ` NA 1.25" O 44' Q A. NA Q� FP J Q Important Notice secemqui GENERAL NOTES: eaDig(e,,,ee'nme"` Code requires a Dig Alert Itlentifiwtion NumberE be issued bbe-li 'Permit to Ezcavale" will be valid. 1. RIGHT OF WAY SHOWN BASED ON AVAILABLE RECORD F.,Y-1Dig Alertl.D.Number oall: DATA. WORK CREW TO VERIFY LOCATION OF RIGHT OF J,,dergmundServi-Alert WAY PRIOR TO CONSTRUCTION. 2. UTILITIES SHOWN LOCATED BY RECORD MAPS/FIELD Q OBSERVATIONS. EXACT UTILITIES LOCATIONS TO BE VERIFIED v O SER�\� - call 1-800-227-26"g BY USA MARKINGS PRIOR TO DIGGING. i 50015 3 50055 3 NA 095 NA B 2" BORE 1112 LF B 4" BORE 141 LF B 5" BORE 0 LF T TRENCH 0 LF 1:1 17"x30" HANDHOLE(S) 2 EA 0 2'x3' HANDHOLE(S) 0 EA FP FLOWER POT(S) 10 EA ASPHALT R&R 126 SF CONCRETE R&R 0 SF 13 17"X30" COMBO PED(S) 0 EA 13 2'x3' COMBO PED(S) 0 EA 02 4'x4' BORE PITS 0 EA Q3 4'x6' BORE PITS 16 EA CONSTRUCTION NOTE: WORK CREW TO PUNCH UNDER GUTTERS, SIDEWALKS, & DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PROTECT IN PLACE DRIVEWAYS CONSTRUCTION NOTE: WORK CREW TO PLACE FACILITIES AS CLOSE TO PROPERTY LINE AS POSSIBLE SCALE:1 "=60' W/, "CENTER PIN 2 P ACES SKID RESISTANT ."-18UNCLG SURFACEM366 O SS HEX HEAD BOLT 2 PLACES WASHER ®O � 2 PLACES F� ® DU—TE LOGO .."PAL NUT O 22 Pao UNC S.S. INSERT ` 2 PLACES 1- X 4' PULL SLOT W/ CENTER PIN 2 PLACES SKID RESISTANT 18 UNC LG SURFACE M3 6 SSSSHBOLT O 2 PLACES ODA2ITE LOGO FLAT WASHER ® 2PLACES ..."PAL NUT O 2 PLACES FLOWER POT DETAIL FLOWER POT TO BE PLACED WITH LID AT GRADE. MISSILE BORE DETAIL )A, o (CENTERED ONE END) (CENTERED ONE END) / (2 EACH SIDE AND HANDHOLE - iT' X 30" X 24" 2 EACH END) 20K RATING -BOX 8 2 Pc SPLIT COVER ITEM ID 911691 lylvinfti>\lnh if"ll HANDHOLE DETAIL-17"x30" 1 4'X4' BORE PIT REMOVE 16 SF OF EXISTING MATERIAL REPLACE WITH 16SF OF NEW MATERIAL TO MATCH EXISTING CONDITIONS O1' TRENCH WIDTH REMOVE 20LF OF EXISTING MATERIAL. REPLACE WITH 2OLF OF NEW MATERIAL TO MATCH EXISTING CONDITIONS V / 1 HANDHOLE -24" X 36' X 24- 20K RATING - BOX 8 2 Pc SPLIT COVER ITEM CIA/CCU M=AII HANDHOLE DETAIL-2'x3' TRENCHING TO CONTINUE ON DESIGN PLAN 900 DELTA-12.5' RADIUS SINGLE BORE PIT TRENCH DETAIL CiLti1111 L-Bolt Cover Top Inside Dimensions: 11.0" Width X 11.0" Length (279.4mm X 279.4mm ) Depth: 16.0" (406.4mm) O4k4' BORE PIT REMOVE 16 SF OF EXISTING MATERIAL. REPLACE WITH 16SF OF NEW MATERIAL TO MATCH EXISTING CONDITIONS O1'TRENCH WIDTH L7 F- REMOVE 20LF OF EXISTING MATERIAL. / I REPLACE WITH 2OLF OF NEW MATERIAL TO MATCH EXISTING CONDITIONS 12.5'R / 1 900 DELTA-125RADIUS DOUBLE BORE PIT TRENCH DETAIL O10'X4' TRENCH REMOVE 40SF OF EXISTING MATERIAL. REPLACE WITH 40SF OF NEW MATERIAL TO MATCH EXISTING CONDITIONS AIMING SIGHT CID — Z M PIERCING TOOL BORE PIT LAUNCH CRADLE PARKWAY ROADWAY PROPOSED CURB AND GUTTER FLOW 450 DELTA-12.5' RADIUS TRENCH DETAIL C 45° WYE PVC SCHEDULE 40 AND 80 ELECTRICAL CONDUIT NOTE: *DIMENSIONS LISTED HERE ARE NOMINAL, AND EACH PRODUCT MAY VARY SLIGHTLY IN SIZE AND WEIGHT.' 1 ^I W z J CD C M a O Ll J LL O O z E 0 z L 12" 12" 2 C N 0- Lu PUBLIC R/W TRENCH DETAIL N.T.S. COMMUNICATIONS JOB ID: 70063-5323156 DATE: 01/13/2023 TITLE: CONDUIT DESIGN STREET ADDRESS: HARVILL AVE / PLACENTIA AVE CITY/STATE: AVENUE 50 / VIA PALMILA 92253 FTR ENGINEER: DAVID DIEGUEZ (562) 666-7712 FTR INSPECTOR: MIKE REDDING (760) 342-1240 DRAWN BY: ;1 DYNAMIC TELCO 951-992-1472 C/ EST. #: SHEET#: DYNAMIC TELCO 14 OF 14 City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2023-0009 The following shall always apply: ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within the City of La Quinta's right of way ONLY. Whenever construction extends within private property, it is the responsibility of the permittee for his contractors to secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work. TRACK -LAYING CONSTRUCTION EQUIPMENT: Cleated track -laying construction equipment shall not be permitted to operate on any paved surface unless fitted with smoother -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect the paving during excavations. Rubber -tired equipment only shall be used in backfill operation in paved areas. If the existing pavement is scarred, spalled, or broken during the term of this contract or if the pavement is marred, City of La Quinta shall request that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2") of A.C. surfacing plus appropriate seal coat as specified above. PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City Engineer or City of La Quinta Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration of the project. The City shall be notified twenty-four hours (24) in advance of any traffic detours or delineation. CARE OF DRAINAGE STRUCTURES: Any drainage structure to include corrugated metal pipe, concrete pipe, steel culvert and concrete structures encountered during excavation which necessitate removal shall be replaced in kind. In the event it becomes necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work. Drainage structures and open drains shall be kept free of debris at all times for proper drainage. RIGHT-OF-WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill and compaction. Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used immediately after backfill. DE -WATER OPERTATIONS: If de -watering operations are required and pumps are forcing water on City of La Quinta roads, it shall be the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary. CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited access for the adjoining property owners and emergency vehicles. In the event it is felt by the permittee that he must close a street for any length of time, permittee shall contact this office to obtain the necessary permission. SPECIAL PROVISIONS The following shall apply when indicated: ® R1 NOTIFICATION: Permittee shall notify the City at (760) 777 - 7097 at least forty-eight hours (48) in advance of starting construction. ® R2 UTILITY CLEARANCE: (Substructures) Prior to making any excavations within the City of La Quinta right-of-way authorized by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures. Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility of the permittee. ® R3 UTILITY CLEARANCE (Surface Structures) No work shall be done under this permit until all utilities are clear of the proposed work site. The permittee shall notify all concerned utility companies of the proposed work. ❑ R4 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced with ( ** N/A ** ) inches of A.C. paving placed on ( ** N/A ** ) inches of ( ** N/A ** ) aggregate sub -base course having an "R" value of not less than ( ** N/A **) and in conformance with the City of La Quinta Road Improvement Standards and Specifications, Ordinance #461. ❑ R5 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of one-fourth inch ('/d') to one foot (1'). ❑ R6 GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades as established by a licensed engineer. ❑ R7 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter (** N/A **) feet shall be removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207. ❑ R8 DRIVEWAYS: A.C. driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the property line and the existing road paving shall be two and a half inches (2 ''/2") of A.C. paving on (** N/A **) of class (** N/A ** ) aggregate base. ® R9 SIGHT CLEARANCE: Sight Clearance of six -hundred feet (600') in all directions shall be assured and maintained at all times. ❑ R10 SOIL STERILIZER: The area to be surfaced shall be treated with soil strerilizer. Rate of application shall comply with the manufacturer's specifications. City of La Quinta ® R11 COORDINATE WORK: The proposed work shall be subordinated to any operation, which the State of California or City of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects. ® R12 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the centerline of all streets or property lines when included shall be completely tied out so they may be readily and correctly, replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall be notified upon completion or replacement of all survey monuments for proper clearance. ® R13 PAVEMENT CUTTING: Pavement will be mechanically saw cut to a straight edge prior to excavation. Method of pavement cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment be used to excavate prior to cutting or pavement.) Excavation material shall be placed in such a position as to best facilitate the general flow traffic. Prior to final paving operations, any damage to pavement straight edges shall be corrected. ❑ R14 LIMIT OF EXCAVATIONS: Excavations shall be limited to one -thousand feet (1000') of open trench before backfill operations must begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays for the protection of the traveling public. The Public Works Inspector shall determine the suitability of excavation barricading in each case. No excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction material is actually on the work site. ® R15 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes of producing and adequately consolidated backfill. Ant material which the City of La Quinta deems unsuitable (spongy or saturated material) which is encountered during excavation shall not be used for backfill but shall be supplemented or replaced by an approved sand or gravel. ❑ R16 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed on lifts not greater than three feet (3') and vibrated using vibrostamper or equivalent equipment. Alternate methods may be substituted, but in any case, a relative compaction of ninety-five percent (95%) shall be maintained with the structural section of the roadway. ❑ R17 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than fifty percent (50%) of the total depth of the trench before flooding or a maximum of five feet (6) lifts where trenches are of excessive depths. Care is to be exercised that the backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the resulting compaction shall not be less than ninety percent (90%) or equivalent to the surrounding ground, whichever is the greater compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water supply shall be continuos. ❑ R18 COMPACTION TESTS: If so required by the inspector, compaction test shall be made at intervals of not more than one - thousand (1000') feet and a maximum of one (1) test on each road. One (1) copy of each test shall be forwarded tot the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ® R19 COMPACTION TESTS: If so required by the Inspector, compaction tests shall be made for each crossing or service line. One (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Sections 6.3.001 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ® R20 TEMPORARY PAVEMENT REPAIRS: After completion of Backfill and compaction operations, a temporary patch consisting of two inches (2") of SC-800 shall be placed on a prepared sub -grade. The SC-800 temporary paving shall be placed after a maximum of three -thousand linear feet (3000') or trench has been excavated and backfill operations completed, but in no case shall the placement of the temporary pavement exceed a five (5) day limit. ® R21 PERMANENT PAVEMENT REPAIR: After backfill and compaction have been completed, a temporary patch consisting of three inches (Y) of SC-800 shall be placed immediately. A permanent patch of Asphalt Concrete surfacing per City of La Quinta Standard 600 shall be placed no later than ( 5 ) days after completion of temporary road repair. ❑ R22 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as determined by the City Engineer. ❑ R23 STREET RESTRIPING: Where street striping is still visible on street to be excavated, such striping shall be replaced upon completion of permanent repairs. ❑ R24 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right-of-way shall be accomplished by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public. It shall be the responsibility of the permitte to maintain the tree in a vigorous growing condition at its new location. Trees to be removed shall be in sections, which can be handled safely without interference or hazard to highway traffic. The entire width of the tree stump, shall be removed and disposed of so that no debris remains in view of the highway. The stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of five -hundred feet (500') at any one time. Adequate signs, flagmen and or barricades shall be provided to protect the traveling public at all times. Large holes resulting from tree removal shall be backfilled and compacted to not less than ninety percent (90%) or equivalent tot the surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973. PERMIT NO. ENC2023-0009 Frontier 70063-5323156/ Trench to Place 1 Hub/ Ave 50 West of Jefferson St (See Traffic Control Plan) In addition to the standard permit conditions, the following shall apply: 1. Pursuant to Section 14.16.320 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), all work shall be performed in accordance with the latest edition of the Standard Specifications For Public Works Construction (SSPWC) and as directed by and to the satisfaction of the City Engineer. 2. The permittee may only work at night if approved by the City Manager. If approved by the city manager, night work may be halted if the city receives complaints about the night work. 3. Prior to commencing the excavation of a trench 5 feet in depth or greater and into which a person will be required to descend, the Contractor shall first obtain a permit to do so from the Division of Industrial Safety pursuant to 7-10.4.1. 4. This permit is for work within the R/W. The permittee shall not encroach upon private property without prior written approval (submit to the Public Works Department, attention to the Associate Engineer) of the private land owner whom is being encroached upon. 5. The City of La Quinta reserves the right to require modifications of the work be made at permittee's sole cost for further modifications as it relates to any sight distance concerns and/or improvement plan requirements as required by the City Engineer. 6. "The permittee shall not construct an improvement that reduces vehicular sight distances. If such improvement is found to reduce the vehicular sight distance, then the permittee shall relocate the improvement prior to sign off of their encroachment permit." 7. The permittee shall not install improvements with the intention of providing video transmission services unless the permittee obtains a valid Franchise Agreement. The permittee shall remove any underground utility markings that are no longer being used for this project. The permittee shall remove markings on paved areas using high pressure wash or a method equivalent and at the discretion of the City Engineer. 9. Any asphaltic or concrete repairs shall closely match the existing paved areas in color at the discretion of the City Engineer. A finish product with a checkerboard appearance will not be accepted. 10. The permittee shall maintain the existing pedestrian path of travel and must maintain accessible compliant pathways leading to areas for use of public transportation systems. 11. No stockpiling of any materials will be allowed within the City R/W without an approved permit explicitly stating the use for stockpiling and/or storage. 12. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during the actual work performed. Special Conditions Page 1 of 6 PERMIT NO. ENC2023-0009 Frontier 70063-5323156/ Trench to Place 1 Hub/ Ave 50 West of Jefferson St (See Traffic Control Plan) 13. Frontier California Inc. and/or Gulbranson Services Inc (John Pomroy), hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. 14. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 15. The permittee shall submit inspection requests by calling the City Inspection Hotline at (760) 777-7097 before 1:30 p.m. and at least twenty-four (24) hours prior to the anticipated inspection. 16. The permittee is required to provide a changeable message board informing the commuters using the affected Major and Primary Arterial roads of major construction and possible traffic delays, time of construction, and if possible alternate routes. The message board shall be provided for the commuters 48 hours prior to the start of traffic delays. 17. Pursuant to Section 6.08.050 of the La Quinta Municipal Code (Ordinance 18 § 1, 1982), throughout the work site, the Permittee shall comply with City regulated work hours. Operation and maintenance of equipment within one-half mile of human occupancy shall be performed only during the following time periods: October 1 st to April 30: Monday -Friday 7:00 a.m. to 5:30 p.m. Saturday 8:00 a.m. to 5:00 p.m. May 1 st to September 30: Monday -Friday 6:00 a.m. to 7:00 p.m. Saturday 8:00 a.m. to 5:00 p.m. Work shall be prohibited on legal holidays and Sundays. Note: Construction work (including setting up traffic control devices) is not permitted on any Arterial street (ie any 4 lane street) before 8:00 a.m. 18. Work within 500 feet of a signalized intersection shall be performed between the hours of 9 a.m. - 3 p.m. Traffic control shall be set up after 9 a.m. and removed before 3 p.m. The Permittee shall contact the City Traffic Signal Maintenance Division at (760) 777-7070 if signal operation at the intersection is to be altered in any way. 19. Pursuant to Section 14.16.110 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), Permittee shall assume responsibility for repair of any pavement damage to any public or private street and for any damage to other City streets or facilities as a result of work performed under this permit. 20. The permittee shall place temporary no parking signs along the parking area affected by the construction. The signs shall be placed along the area 48hrs prior to the start of closing the area, and removed immediately after the construction completion date. Special Conditions Page 2 of 6 PERMIT NO. ENC2023-0009 Frontier 70063-5323156/ Trench to Place 1 Hub/ Ave 50 West of Jefferson St (See Traffic Control Plan) 21. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 811. It shall be the Permittee's responsibility to notify the Public Works Department of anticipated excavation which impact City facilities, including but not limited to traffic signal conduits and loops, irrigation lines, electrical conduits, and storm drain facilities. This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to start of construction, a letter from any owners of the driveways/access ways that will be closed down due to the construction. The letter must be approved by the city and at minimum state from the owner the following: A. Approval of the construction B. Plan identification C. Time Frame of Closure D. Alternative Routes 22. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), at residential streets, advance warning signs and traffic control shall be installed and maintained in accordance the latest edition of the California Manual of Uniform Traffic Control Devices (CA MUTCD) or the latest edition of the Work Area Traffic Control Handbook (WATCH). On Collectors to Arterial Streets, the permittee must submit a traffic control plan which shall be from or prepared under the guidance of the latest edition of the California Manual of Uniform Traffic Control Devices (CA MUTCD) or the latest edition of the Work Area Traffic Control Handbook (WATCH). Traffic Control plans not from the CA MUTCD or the WATCH shall be signed and stamped by a civil or traffic engineer registered in the State of California. It shall be the Permittee's responsibility to appropriately detour and barricade all construction sites. Pursuant to Section 14.16.290 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), street closures shall not be permitted. A minimum of two (2) travel lanes of paved surface shall be maintained at all times. 23. Should additional work, materials, or modifications of the work be required in order to meet City standards, safety requirements, signage requirements, or to fit actual field conditions, the work shall be performed by the Permittee as directed by and to the satisfaction of the City Engineer at no cost to the City of La Quinta. 24. The City of La Quinta reserves the right to require modifications of the work be made at permittee's sole cost for proper sight distance requirements per guidelines in the AASHTO "A Policy on Geometric Design of Highways and Streets, 5th Edition" or latest, in the installation of all appurtenances abutting and within the public street right-of-way. Special Conditions Page 3 of 6 PERMIT NO. ENC2023-0009 Frontier 70063-5323156/ Trench to Place 1 Hub/ Ave 50 West of Jefferson St (See Traffic Control Plan) 25. The permittee shall be responsible for calling the city inspector to arrange the city inspector to observe random trench compaction testing performed by a city approved material testing firm. If the inspector's phone number is unknown, the permittee shall call the Public Works front counter phone at 777-7075 or the Associate Engineer at 777-7047 to determine the city inspector's phone number. The inspector shall determine the number and location of the test location/s. The above testing does not relieve the permittee's responsibility for future repairs due to settlement at and near the locations of the work area. Materials testing must be performed under direct supervision of a California Registered Civil Engineer. 26. The issuance of this permit and the City approval of the related construction improvement plans do not provide a vested entitlement for all design parameters that may have been utilized for the plans. As such, plans approved for this permit may be "at risk" for further modifications as it relates to any follow up improvement plan requirements as required by the city or existing errors & omissions by the architect or engineer of record. 27. This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to start of construction, the name of the City approved contractor, who shall submit to the City the following items: a. General Liability Insurance Company and Policy Number b. City Business License c. Contractors State License Number 28. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts provided in the Engineering Bulletin for Indemnification & Insurance Requirements. This insurance shall be kept in full force and effect at all times by Applicant or Contractor during the prosecution of the permitted work and updated Certificate of Liability Insurance shall be submitted to the City. Each policy shall name the City as an additional insured. 29. The permittee shall not encroach upon private property without prior written approval (submit to the Public Works Department, attention to the Associate Engineer) of the private land owner whom is being encroached upon. 30. The permittee shall haul all offsite debris to a certified landfill. Prior to hauling debris, the permittee shall inform the City (Inspection staff or 777-7047) of the name and location of the certified dump site. 31. If public traffic lanes are required to be closed, this permit is not valid until the permittee submits, to the Public Works Department, a traffic control plan for review and approval prior to start of construction or parking on the paved R/W. 32. The permittee is required to provide an informative message board (approved by the City Engineer) informing the commuters using the affected Primary Arterial roads or heavier traffic of possible traffic delays, time of construction, and if possible alternate routes. The message board shall be provided for the commuters 48 hours prior to the start of traffic delays. Special Conditions Page 4 of 6 PERMIT NO. ENC2023-0009 Frontier 70063-5323156/ Trench to Place 1 Hub/ Ave 50 West of Jefferson St (See Traffic Control Plan) 33. All excavations within City of La Quinta right-of-way shall be backfilled, and temporarily paved if within the existing travel way, at the end of every workday as directed by and to the satisfaction of the City Engineer for the protection of the public. Lengths of open trench shall not greatly exceed that which can not be backfilled in the same day. Excavated trenches shall not be allowed open overnight, however, Permittee may leave a length of excavated trench, not to exceed twenty (20) feet in length, open overnight at a point where construction will begin the next day, provided that this length of trench is completely covered by steel plating. 34. Access and egress to all local properties shall be maintained at all times. 35. Pursuant to Section 14.16.375 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), permanent pavement replacement shall be completed no later than seven (7) days after the completion of the work. Permanent pavement replacement shall conform to the following conditions: A. Existing asphalt concrete pavement shall be sawcut one (1) foot beyond trench edges. Edges shall be straight and clean. B. Permanent pavement replacement structural section, within all trenches, shall be 1" thicker than existing of asphalt concrete over the same existing thickness of crushed aggregate base or crushed miscellaneous base, meeting the requirements of Sections 200-2.2 and 200-2.4 of the Standard Specifications for Public Works Construction. The replaced pavement and base material shall be compacted to 95% relative compaction and respectively tested, for each 300 linear feet of trench. Verify exact structural replacement section thicknesses with the City prior to installation. C. Permanent pavement replacement shall be installed using a City approved 3/4" max medium asphalt concrete as the base course lift and a City approved 1/2" max medium finish course lift for capping. Asphalt concrete mix design shall be approved by the City prior to its placement. D. Cold -Mill and Overlay - The existing pavement which was properly protected in place during the trenching operation located adjacent to the trench saw cut shall be cold -milled to a depth of 0.10 feet with butt joint created next to the existing unmilled pavement surface. The cold -milled area and base asphalt concrete in the trench area shall be overlaid with a City approved C2-AR-4000 asphalt concrete mix. The width of the cold milling area shall be as follows: • For longitudinal trenches located in a parking lane: three (3) feet outside the sawcut removal lines. • For longitudinal trenches located in a traffic lane: three (3) feet outside the sawcut removal lines, or to the lane line striping, whichever is greater. • For transverse trenches across existing street: two (2) feet outside the sawcut removal lines. Special Conditions Page 5 of 6 PERMIT NO. ENC2023-0009 Frontier 70063-5323156/ Trench to Place 1 Hub/ Ave 50 West of Jefferson St (See Traffic Control Plan) E. If grinding and capping operations are not performed in the same day as base paving operations, the base course lift of 3/4" max medium asphalt concrete shall be installed from saw -cut edge to saw -cut edge flush with the existing street surface. The base course lift of paving shall not be left 0.10' low in anticipation of grinding and capping. F. Any existing lane striping or any existing detour lane striping affected by this resurfacing shall be replaced in kind by the Permittee, as directed by and to the satisfaction of the City Engineer. Affected traffic signal loops shall be removed and replaced in kind. The finished pavement surface shall be smooth, consistent, and shall conform to the surrounding grades. 36. All landscaping, irrigation, decorative rock, decorative concrete, lighting, sidewalk, etc., shall be replaced to its original condition. 37. Permittee shall permanently stabilize any and all soil that was disturbed as a result of work performed under this permit with an approved dust control treatment. Soil stabilization shall be done immediately after completing the operation. 38. Pursuant to Chapter 12.56 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982) the City has designated certain city streets as Truck Routes. The weight limit for restricted streets (i.e., streets not part of the Truck Route network) is three (3) tons; trucks exceeding the weight limit may use a restricted street if making a delivery or pickup on the subject street, or if this permit specifically grants permission to use the street to deliver street construction materials and/or equipment. 39. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 40. The permittee shall indemnify, hold harmless and assume the defense of the City from all damages, delay costs, costs or expenses in law or equity that may arise out of work under this permit. 41. If it is the intent of the permittee to cut the pavement and have it restored by a third party, the permittee shall postpone cutting the pavement until the intended third parry has acquired a permit from the City to perform the required restoration work. Special Conditions Page 6 of 6 GULBSER-01 CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YYYY) 2/23/2023 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 # OC36861 ERNTACT Brian Guzman San Diego-Alliant Insurance Services, Inc. PHONE FAX 701 B St 6th FI tA1Cq, No. Ext) (A/C, No): San Diego, CA 92101 AoDREss Brian-Guzman@alliant.com INSURED Gulbranson Services, Inc. 15371 Bonanza Rd Victorville. CA 92392 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Valley Forge Insurance Company 20508 INSURER B: Continental Insurance Company 35289 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. ILTR NSR TYPE OF INSURANCE _ INSD SWV0 POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000.01 CLAIMS -MADE X OCCUR X 7034725207 10/15/2022 10/15/2023 DAMAGE TO RENTED 100,01 REMISES (Ea occurrence) S MED EXP (Any one person)_ S 15.01 PERSONAL & ADV INJURY $ 1,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X 3EC7 LOC B AUTOMOBILE LIABILITY X ANY AUTO 7034725224 10/15/2022 10/15/2023 OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUUTOS ONLDY X UMBRELLA LIAR X OCCUR EXCESS LIAB CLAIMS -MADE 7034725210 DED X RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OOFFFiOER/ME NHR EXCLUDED? N / A tMendatary inj IFVes. describe under GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG _ EBLAGGREGATE s COMBINED SINGLE LIMIT (Ea BCcLdont) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ EACH OCCURRENCE $ 10/15/2022 10/15/2023 AGGREGATE c 5 PER OTW STATUTE ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLIGYLIMri S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AC:)Ri: 101, Add, i,Dnal Remarks Schedule, maybe attached if more space is r¢yuired) :ertifrcate Holder is named as Additional Insured with respect to General Liability and Auto Liability, when requires! by written contract per attached policy orm. Waiver of Subrogation applies to General Liability, when required by written contract, per attached policy form. General Liability Is 'rimarylNon-Contributory when required by written contract per attached policy form City of La Quinta is named as Additional Insured on Primary and Non -Contributory basis T.E. HOLDER City of La Quinta 78495 Calle Tampico, La Quinta, CA 92253 2,000, 2,000, 1,000, 1,000- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION All rights reserved. The ACORD name and logo are registered marks of ACORD ' CERTIFICATE OF LIABILITY INSURANCE Date (MM/DD/YYYY) 2/21/2023 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: Insurance Agency, Inc. 2739 U.S. Highway 19 North Holiday, FL 34691 CONTACT PHOPlymouth (Alr N 1-800-966-5562 FAC No INSURER(S) AFFORDING COVERAGE NAIC # Insurer A: State National Insurance Company, Inc. 12831 Insured: South East Employee Leasing Services, Inc. (LCF) Gulbranson Services, Inc. 2739 U.S. Highway 19 N. Holiday, FL 34691 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, CLI ISIO S I I ID CO DII IIO S OI I Si C OLICI S. LIMI S Si OI I I M I I II IV B I R D ICI ID B I ID CLI IMS. INSR I LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM DD POLICY EXP MM DD YYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC EACH OCCURENCE - - MED EXP (Any oneperson) - PERSONAL & ADV INJURY GENERAL AGGREGATE - PRODUCTS - COMP OP AGG - - AUTOMOBILE LIABILITY ANY AUTO LL 0- a-D SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS OMBINAccDentINGLE LIMIT _ BODILY INJURY (Per Person) - BODILY INJURY (Per Accident) - PROPERTY DAMAGE I er cciden _ UMBRELLA LIAB OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE DED RETENTION $ A WORKE AND EMPLOY RSE LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N If yes, describe under DESCRIPTION OF OPERATIONS below N/A Iv CWC71949-0044 1/1/2023 1/1/2024 X WRY LIMITS TATOER TH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (California Operations Only) Coverage is extended to leased employees as approved and assigned by South East Employee Leasing Services, Inc. but not subcontractors or nonleased employees of: Gulbranson Services, Inc. Project Name: WAIVER OF SUBROGATION APPLIES IN FAVOR OF CITY OF LA QUINTA. ISSUE 08-31-22 (PH). REISSUE 02-21-23 (PH) CERTIFICATE HOLDER CANCELLATION CITY OF LA QUINTA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREDD IN ACCORDANCE WITH THE POLICY PROVISIONS. 78495 CALLE TAMPICO AUTHORIZED REPRESENTIVE — — — T LA QUINTA, CA 92253 '} ©1998-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA WC 04 03 06 (Ed. 4-84) 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 endoresement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization CITY OF LA QUINTA 78495 CALLE TAMPICO LA QUINTA, CA 92253 Schedule Job Description 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: 1/1/2023 - 1/1/2024 Insured: South East Emnlovee Leasin¢ Services, Inc. (LCF) Gulbranson Services, Inc. Policy No.: CWC71949-0044 Insurance Company: State National Insurance Company, hic. Countersigned By: or�t� Endorsement No.: CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors -with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide r 0 such additional insured with: N 0 A. coverage broader than required by the written contract; or r 0 B. a higher limit of insurance than required by the written contract. N IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX (10-16) Policy No: 7034725207 Page 1 of 2 Endorsement No: 3 The Continental Insurance Co. Effective Date: 10/01/22 Insured Name: Gulbranson Services, Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors -with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (10-16) Policy No: 7034725207 Page 2 of 2 Endorsement No: 3 The Continental Insurance Co. Effective Date: 10/01/22 Insured Name: Gulbranson Services, Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement with respect to such provision do not apply. TABLE OF CONTENTS 1. Additional Insureds 2. Additional Insured - Primary And Non -Contributory To Additional Insured's Insurance 3. Bodily Injury — Expanded Definition 4. Broad Knowledge of Occurrence/ Notice of Occurrence 5. Broad Named Insured 6. Broadened Liability Coverage For Damage To Your Product And Your Work 7. Contractual Liability - Railroads 8. Electronic Data Liability 9. Estates, Legal Representatives and Spouses 10. Expected Or Intended Injury — Exception for Reasonable Force 11. General Aggregate Limits of Insurance — Per Project 12. In Rem Actions 13. Incidental Health Care Malpractice Coverage 14. Joint Ventures/Partnership/Limited Liability Companies 15. Legal Liability — Damage To Premises / Alienated Premises / Property In The Named Insured's Care, Custody or Control 16. Liquor Liability 17. Medical Payments 18. Non -owned Aircraft Coverage 19. Non -owned Watercraft 20. Personal And Advertising Injury — Discrimination or Humiliation 21. Personal And Advertising Injury - Contractual Liability 22. Property Damage - Elevators 23. Supplementary Payments 24. Unintentional Failure To Disclose Hazards 25. Waiver of Subrogation — Blanket 26. Wrap -Up Extension: OCIP CCIP, or Consolidated (Wrap -Up) Insurance Programs CNA74705XX (1-15) Page 1 of 17 Endorsement No: VALLEY FORGE INSURANCE COMPANY Insured Name: Gulbranson Services, Inc. Policy No: 7034725207 1 Effective Date: 10/01 /22 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement 1. ADDITIONAL INSUREDS a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs A. through H. below whom a Named Insured is required to add as an additional insured on this Coverage Part under a written contract or written agreement, provided such contract or agreement: (1) is currently in effect or becomes effective during the term of this Coverage Part; and (2) was executed prior to: (a) the bodily injury or property damage; or (b) the offense that caused the personal and advertising injury, for which such additional insured seeks coverage. b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: (1) a higher limit of insurance than required by such contract or agreement; or (2) coverage broader than required by such contract or agreement, and in no event broader than that described by the applicable paragraph A. through H. below. Any coverage granted by this endorsement shall apply only to the extent permissible by law. A. Controlling Interest Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury arising out of: 1. such person or organization's financial control of a Named Insured; or 2. premises such person or organization owns, maintains or controls while a Named Insured leases or occupies such premises; provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. B. Co-owner of Insured Premises A co-owner of a premises co -owned by a Named Insured and covered under this insurance but only with respect to such co -owner's liability for bodily injury, property damage or personal and advertising injury as co-owner of such premises. C. Lessor of Equipment Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by the Named Insured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. D. Lessor of Land Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such land, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. The CNA74705XX (1-15) Policy No: 7034725207 Page 2 of 17 Endorsement No: 1 VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. E. Lessor of Premises An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate manager, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that the occurrence giving rise to such bodily injury or property damage, or the offense giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. F. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's liability for bodily injury, property damage or personal and advertising injury arising out of the Named Insured's ownership, maintenance, or use of a premises by a Named Insured. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. G. State or Governmental Agency or Subdivision or Political Subdivisions — Permits A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization but only with respect to such state or governmental agency or subdivision or political subdivision's liability for bodily injury, property damage or personal and advertising injury arising out of: 1. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which this insurance applies: the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or b. the construction, erection, or removal of elevators; or c. the ownership, maintenance or use of any elevators covered by this insurance; or 2. the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf. The coverage granted by this paragraph does not apply to: a. Bodily injury, property damage or personal and advertising injury arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or b. Bodily injury or property damage included within the products -completed operations hazard. With respect to this provision's requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. H. Trade Show Event Lessor 1. With respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom the Named Insured is required to include as an additional insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury caused by: CNA74705XX (1-15) Page 3 of 17 Endorsement No: VALLEY FORGE INSURANCE COMPANY Insured Name: Gulbranson Services, inc. Policy No: 7034725207 1 Effective Date: 10/01/22 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement a. the Named Insured's acts or omissions; or b. the acts or omissions of those acting on the Named Insured's behalf, in the performance of the Named Insured's ongoing operations at the trade show event premises during the trade show event. 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products -completed operations hazard. 2. ADDITIONAL INSURED -PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own insurance means insurance on which the additional insured is a named insured. Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess of any other insurance available to such person or organization. 3. BODILY INJURY— EXPANDED DEFINITION Under DEFINITIONS, the definition of bodily injury is deleted and replaced by the following: Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical injury, sickness or disease. 4. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is amended to add the following provisions: A. BROAD KNOWLEDGE OF OCCURRENCE The Named Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a partner, executive officer, manager or member of a Named Insured, or an employee designated by any of the above to give such notice. B. NOTICE OF OCCURRENCE The Named Insured's rights under this Coverage Part will not be prejudiced if the Named Insured fails to give the Insurer notice of an occurrence, offense or claim and that failure is solely due to the Named Insured's reasonable belief that the bodily injury or property damage is not covered under this Coverage Part. However, the Named Insured shall give written notice of such occurrence, offense or claim to the Insurer as soon as the Named Insured is aware that this insurance may apply to such occurrence, offense or claim. 5. BROAD NAMED INSURED WHO IS AN INSURED is amended to delete its Paragraph 3. in its entirety and replace it with the following: 3. Pursuant to the limitations described in Paragraph 4. below, any organization in which a Named Insured has management control: a. on the effective date of this Coverage Part; or CNA74705XX (1-15) Policy No: 7034725207 Page 4 of 17 Endorsement No: 1 VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement b. by reason of a Named Insured creating or acquiring the organization during the policy period, qualifies as a Named Insured, provided that there is no other similar liability insurance, whether primary, contributory, excess, contingent or otherwise, which provides coverage to such organization, or which would have provided coverage but for the exhaustion of its limit, and without regard to whether its coverage is broader or narrower than that provided by this insurance. But this BROAD NAMED INSURED provision does not apply to: (a) any partnership, limited liability company or joint venture; or (b) any organization for which coverage is excluded by another endorsement attached to this Coverage Part. For the purpose of this provision, management control means: A. owning interests representing more than 50% of the voting, appointment or designation power for the selection of a majority of the Board of Directors of a corporation; or B. having the right, pursuant to a written trust agreement, to protect, control the use of, encumber or transfer or sell property held by a trust. 4. With respect to organizations which qualify as Named Insureds by virtue of Paragraph 3. above, this insurance does not apply to: a. bodily injury or property damage that first occurred prior to the date of management control, or that first occurs after management control ceases; nor b. personal or advertising injury caused by an offense that first occurred prior to the date of management control or that first occurs after management control ceases. 5. The insurance provided by this Coverage Part applies to Named Insureds when trading under their own names or under such other trading names or doing -business -as names (dba) as any Named Insured should choose to employ. 6. BROADENED LIABILITY COVERAGE FOR DAMAGE TO YOUR PRODUCT AND YOUR WORK A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusions k. and I. and replace them with the following: This insurance does not apply to: k. Damage to Your Product Property damage to your product arising out of it, or any part of it except when caused by or resulting from: (1) fire; (2) smoke; (3) collapse; or (4) explosion. I. Damage to Your Work Property damage to your work arising out of it, or any part of it and included in the products -completed operations hazard. This exclusion does not apply: (1) If the damaged work, or the work out of which the damage arises, was performed on the Named Insured's behalf by a subcontractor; or CNA74705XX (1-15) Policy No: 7034725207 Page 5 of 17 Endorsement No: 1 VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement (2) If the cause of loss to the damaged work arises as a result of: (a) fire; (b) smoke; (c) collapse; or (d) explosion. B. The following paragraph is added to LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most the Insurer will pay under Coverage A for the sum of damages arising out of any one occurrence because of property damage to your product and your work that is caused by fire, smoke, collapse or explosion and is included within the product -completed operations hazard. This sublimit does not apply to property damage to your work if the damaged work, or the work out of which the damage arises, was performed on the Named Insured's behalf by a subcontractor. C. This Broadened Liability Coverage For Damage To Your Product And Your Work Provision does not apply if an endorsement of the same name is attached to this policy. 7. CONTRACTUAL LIABILITY —RAILROADS With respect to operations performed within 50 feet of railroad property, the definition of insured contract is replaced by the following: Insured Contract means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to a Named Insured or temporarily occupied by a Named Insured with permission of the owner is not an insured contract; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to the Named Insured's business (including an indemnification of a municipality in connection with work performed for a municipality) under which the Named Insured assumes the tort liability of another party to pay for bodily injury or property damage to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph If. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the Insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. 8. ELECTRONIC DATA LIABILITY CNA74705XX (1-15) Policy No: 7034725207 Page 6 of 17 Endorsement No: 1 VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following: This insurance does not apply to: p. Access Or Disclosure Of Confidential Or Personal Information And Data -related Liability Damages arising out of: (1) any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information; or (2) the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data that does not result from physical injury to tangible property. However, unless Paragraph (1) above applies, this exclusion does not apply to damages because of bodily injury. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relation expenses or any other loss, cost or expense incurred by the Named Insured or others arising out of that which is described in Paragraph (1) or (2) above. B. The following paragraph is added to LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most the Insurer will pay under Coverage A for all damages arising out of any one occurrence because of property damage that results from physical injury to tangible property and arises out of electronic data. C. The following definition is added to DEFINITIONS: Electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. D. For the purpose of the coverage provided by this ELECTRONIC DATA LIABILITY Provision, the definition of property damage in DEFINITIONS is replaced by the following: Property damage means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the occurrence that caused it; or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate electronic data, resulting from physical injury to tangible property. All such loss of electronic data shall be deemed to occur at the time of the occurrence that caused it. For the purposes of this insurance, electronic data is not tangible property. E. If Electronic Data Liability is provided at a higher limit by another endorsement attached to this policy, then the $100,000 limit provided by this ELECTRONIC DATA LIABILITY Provision is part of, and not in addition to, that higher limit. 9. ESTATES, LEGAL REPRESENTATIVES, AND SPOUSES The estates, heirs, legal representatives and spouses of any natural person Insured shall also be insured under this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives, and spouses only for CNA74705XX (1-15) Page 7 of 17 Endorsement No: VALLEY FORGE INSURANCE COMPANY Insured Name: Gulbranson Services, inc. Policy No: 7034725207 1 Effective Date: 10/01/22 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement claims arising solely out of their capacity or status as such and, in the case of a spouse, where such claim seeks damages from marital community property, jointly held property or property transferred from such natural person Insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative, or spouse outside the scope of such person's capacity or status as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are Insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named Insured's business. 10. EXPECTED OR INTENDED INJURY — EXCEPTION FOR REASONABLE FORCE Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Expected or Intended Injury and replace it with the following: This insurance does not apply to: Expected or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the Insured. This exclusion does not apply to bodily injury or property damage resulting from the use of reasonable force to protect persons or property. 11. GENERAL AGGREGATE LIMITS OF INSURANCE - PER PROJECT A. For each construction project away from premises the Named Insured owns or rents, a separate Construction Project General Aggregate Limit, equal to the amount of the General Aggregate Limit shown in the Declarations, is the most the Insurer will pay for the sum of: 1. All damages under Coverage A, except damages because of bodily injury or property damage included in the products -completed operations hazard; and 2. All medical expenses under Coverage C, that arise from occurrences or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Construction Project General Aggregate Limit of any other construction project. B. All: 1. Damages under Coverage B, regardless of the number of locations or construction projects involved; 2. Damages under Coverage A, caused by occurrences which cannot be attributed solely to ongoing operations at a single construction project, except damages because of bodily injury or property damage included in the products -completed operations hazard; and 3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a single construction project, will reduce the General Aggregate Limit shown in the Declarations. C. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project General Aggregate Limit or the General Aggregate Limit shown in the Declarations, depending on whether the occurrence can be attributed solely to ongoing operations at a particular construction project. 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 shown in the Declarations, regardless of the number of projects involved. CNA74705XX (1-15) Policy No: 7034725207 Page 8 of 17 Endorsement No: 1 VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement E. If a single construction project away from premises owned by or rented to the Insured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. F. The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. 12. IN REM ACTIONS A quasi in rem action against any vessel owned or operated by or for the Named Insured, or chartered by or for the Named Insured, will be treated in the same manner as though the action were in personam against the Named Insured. 13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE Solely with respect to bodily injury that arises out of a health care incident: A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Insuring Agreement is amended to replace Paragraphs 1.b.(1) and 1.b.(2) with the following: b. This insurance applies to bodily injury provided that the professional health care services are incidental to the Named Insured's primary business purpose, and only if: (1) such bodily injury is caused by an occurrence that takes place in the coverage territory. (2) the bodily injury first occurs during the policy period. All bodily injury arising from an occurrence will be deemed to have occurred at the time of the first act, error, or omission that is part of the occurrence; and B. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to: i. add the following to the Employers Liability exclusion: This exclusion applies only if the bodily injury arising from a health care incident is covered by other liability insurance available to the Insured (or which would have been available but for exhaustion of its limits). ii. delete the exclusion entitled Contractual Liability and replace it with the following: This insurance does not apply to: Contractual Liability the Insured's actual or alleged liability under any oral or written contract or agreement, including but not limited to express warranties or guarantees. iii. add the following additional exclusions: This insurance does not apply to: Discrimination any actual or alleged discrimination, humiliation or harassment, including but not limited to claims based on an individual's race, creed, color, age, gender, national origin, religion, disability, marital status or sexual orientation. Dishonesty or Crime Any actual or alleged dishonest, criminal or malicious act, error or omission. Medicare/Medicaid Fraud CNA74705XX (1-15) Policy No: 7034725207 Page 9 of 17 Endorsement No: I VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement any actual or alleged violation of law with respect to Medicare, Medicaid, Tricare or any similar federal, state or local governmental program. Services Excluded by Endorsement Any health care incident for which coverage is excluded by endorsement. C. DEFINITIONS is amended to: i. add the following definitions: Health care incident means an act, error or omission by the Named Insured's employees or volunteer workers in the rendering of: a. professional health care services on behalf of the Named Insured or b. Good Samaritan services rendered in an emergency and for which no payment is demanded or received. Professional health care services means any health care services or the related furnishing of food, beverages, medical supplies or appliances by the following providers in their capacity as such but solely to the extent they are duly licensed as required: a. Physician; b. Nurse; c. Nurse practitioner; d. Emergency medical technician; e. Paramedic; f. Dentist; g. Physical therapist; h. Psychologist; i. Speech therapist; j. Other allied health professional; or Professional health care services does not include any services rendered in connection with human clinical trials or product testing. ii. delete the definition of occurrence and replace it with the following: Occurrence means a health care incident. All acts, errors or omissions that are logically connected by any common fact, circumstance, situation, transaction, event, advice or decision will be considered to constitute a single occurrence; iii. amend the definition of Insured to: a. add the following: the Named Insured's employees are Insureds with respect to: (1) bodily injury to a co -employee while in the course of the co -employee's employment by the Named Insured or while performing duties related to the conduct of the Named Insured's business; and CNA74705XX (1-15) Policy No: 7034725207 Page 10 of 17 Endorsement No: I VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement (2) bodily injury to a volunteer worker while performing duties related to the conduct of the Named Insured's business; when such bodily injury arises out of a health care incident. the Named Insured's volunteer workers are Insureds with respect to: (1) bodily injury to a co -volunteer worker while performing duties related to the conduct of the Named Insured's business; and (2) bodily injury to an employee while in the course of the employee's employment by the Named Insured or while performing duties related to the conduct of the Named Insured's business; when such bodily injury arises out of a health care incident. b. delete Subparagraphs (a), (b), (c) and (d) of Paragraph 2.a.(1) of WHO IS AN INSURED. D. The Other Insurance condition is amended to delete Paragraph b.(1) in its entirety and replace it with the following: Other Insurance b. Excess Insurance (1) To the extent this insurance applies, it is excess over any other insurance, self insurance or risk transfer instrument, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by the Named Insured to be excess of this coverage. 14. JOINT VENTURES / PARTNERSHIP / LIMITED LIABILITY COMPANIES WHO IS AN INSURED is amended to delete its last paragraph and replace it with the following: No person or organization is an Insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations, except that if the Named Insured was a joint venturer, partner, or member of a limited liability company and such joint venture, partnership or limited liability company terminated prior to or during the policy period, such Named Insured is an Insured with respect to its interest in such joint venture, partnership or limited liability company but only to the extent that: a. any offense giving rise to personal and advertising injury occurred prior to such termination date, and the personal and advertising injury arising out of such offense first occurred after such termination date; b. the bodily injury or property damage first occurred after such termination date; and c. there is no other valid and collectible insurance purchased specifically to insure the partnership, joint venture or limited liability company; and If the joint venture, partnership or limited liability company is or was insured under a consolidated (wrap-up) insurance program, then such insurance will always be considered valid and collectible for the purpose of paragraph c. above. But this provision will not serve to exclude bodily injury, property damage or personal and advertising injury that would otherwise be covered under the Contractors General Liability Extension Endorsement provision entitled WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS. Please see that provision for the definition of consolidated (wrap-up) insurance program. 15. LEGAL LIABILITY — DAMAGE TO PREMISES / ALIENATED PREMISES / PROPERTY IN THE NAMED INSURED'S CARE, CUSTODY OR CONTROL A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete exclusion j. Damage to Property in its entirety and replace it with the following: This insurance does not apply to: CNA74705XX (1-15) Policy No:7034725207 Page 11 of 17 Endorsement No: 1 VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement j. Damage to Property Property damage to: (1) Property the Named Insured owns, rents, or occupies, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises the Named Insured sells, gives away or abandons, if the property damage arises out of any part of those premises; (3) Property loaned to the Named Insured; (4) Personal property in the care, custody or control of the Insured; (5) That particular part of real property on which the Named Insured or any contractors or subcontractors working directly or indirectly on the Named Insured's behalf are performing operations, if the property damage arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because your work was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to property damage (other than damage by fire) to premises rented to the Named Insured or temporarily occupied by the Named Insured with the permission of the owner, nor to the contents of premises rented to the Named Insured for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in LIMITS OF INSURANCE. Paragraph (2) of this exclusion does not apply if the premises are your work. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to property damage included in the products -completed operations hazard. Paragraphs (3) and (4) of this exclusion do not apply to property damage to: i. tools, or equipment the Named Insured borrows from others, nor ii. other personal property of others in the Named Insured's care, custody or control while being used in the Named Insured's operations away from any Named Insured's premises. However, the coverage granted by this exception to Paragraphs (3) and (4) does not apply to: a. property at a job site awaiting or during such property's installation, fabrication, or erection; b. property that is mobile equipment leased by an Insured; c. property that is an auto, aircraft or watercraft; d. property in transit; or e. any portion of property damage for which the Insured has available other valid and collectible insurance, or would have such insurance but for exhaustion of its limits, or but for application of one of its exclusions. A separate limit of insurance and deductible apply to such property of others. See LIMITS OF INSURANCE as amended below. CNA74705XX (1-15) Policy No: 7034725207 Page 12 of 17 Endorsement No: I VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement B. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete its last paragraph and replace it with the following: Exclusions c. through n. do not apply to damage by fire to premises while rented to a Named Insured or temporarily occupied by a Named Insured with permission of the owner, nor to damage to the contents of premises rented to a Named Insured for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in LIMITS OF INSURANCE. C. The following paragraph is added to LIMITS OF INSURANCE: Subject to 5. above, $25,000 is the most the Insurer will pay under Coverage A for damages arising out of any one occurrence because of the sum of all property damage to borrowed tools or equipment, and to other personal property of others in the Named Insured's care, custody or control, while being used in the Named Insured's operations away from any Named Insured's premises. The Insurer's obligation to pay such property damage does not apply until the amount of such property damage exceeds $1,000. The Insurer has the right but not the duty to pay any portion of this $1,000 in order to effect settlement. If the Insurer exercises that right, the Named Insured will promptly reimburse the Insurer for any such amount. D. Paragraph 6., Damage To Premises Rented To You Limit, of LIMITS OF INSURANCE is deleted and replaced by the following: 6. Subject to Paragraph 5. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most the Insurer will pay under Coverage A for damages because of property damage to any one premises while rented to the Named Insured or temporarily occupied by the Named Insured with the permission of the owner, including contents of such premises rented to the Named Insured for a period of 7 or fewer consecutive days. The Damage To Premises Rented To You Limit is the greater of: a. $500,000; or b. The Damage To Premises Rented To You Limit shown in the Declarations. E. Paragraph 4.b.(1)(a)(ii) of the Other Insurance Condition is deleted and replaced by the following: (ii) That is property insurance for premises rented to the Named Insured, for premises temporarily occupied by the Named Insured with the permission of the owner; or for personal property of others in the Named Insured's care, custody or control; 16. LIQUOR LIABILITY Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Liquor Liability. This LIQUOR LIABILITY provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 17. MEDICAL PAYMENTS A. LIMITS OF INSURANCE is amended to delete Paragraph 7. (the Medical Expense Limit) and replace it with the following: 7. Subject to Paragraph 5. above (the Each Occurrence Limit), the Medical Expense Limit is the most the Insurer will pay under Coverage C — Medical Payments for all medical expenses because of bodily injury sustained by any one person. The Medical Expense Limit is the greater of: (1) $15,000 unless a different amount is shown here: $N,NNN,NNN,NNN; or (2) the amount shown in the Declarations for Medical Expense Limit. CNA74705XX (1-15) Page 13 of 17 VALLEY FORGE INSURANCE COMPANY Insured Name: Gulbranson Services, Inc. Policy No: 7034725207 Endorsement No: I Effective Date: 10/01/22 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement B. Under COVERAGES, the Insuring Agreement of Coverage C — Medical Payments is amended to replace Paragraph 1.a.(3)(b) with the following: (b) The expenses are incurred and reported to the Insurer within three years of the date of the accident; and 18. NON -OWNED AIRCRAFT Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended as follows: The exclusion entitled Aircraft, Auto or Watercraft is amended to add the following: This exclusion does not apply to an aircraft not owned by any Named Insured, provided that: 1. the pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot; 2. the aircraft is rented with a trained, paid crew to the Named Insured; and 3. the aircraft is not being used to carry persons or property for a charge. 19. NON -OWNED WATERCRAFT Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete subparagraph (2) of the exclusion entitled Aircraft, Auto or Watercraft, and replace it with the following. This exclusion does not apply to: (2) a watercraft that is not owned by any Named Insured, provided the watercraft is: (a) less than 75 feet long; and (b) not being used to carry persons or property for a charge. 20. PERSONAL AND ADVERTISING INJURY —DISCRIMINATION OR HUMILIATION A. Under DEFINITIONS, the definition of personal and advertising injury is amended to add the following tort: Discrimination or humiliation that results in injury to the feelings or reputation of a natural person. B. Under COVERAGES, Coverage B — Personal and Advertising Injury Liability, the paragraph entitled Exclusions is amended to: 1. delete the Exclusion entitled Knowing Violation Of Rights Of Another and replace it with the following: This insurance does not apply to: Knowing Violation of Rights of Another Personal and advertising injury caused by or at the direction of the Insured with the knowledge that the act would violate the rights of another and would inflict personal and advertising injury. This exclusion shall not apply to discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is not done intentionally by or at the direction of: (a) the Named Insured; or (b) any executive officer, director, stockholder, partner, member or manager (if the Named Insured is a limited liability company) of the Named Insured. 2. add the following exclusions: CNA74705XX (1-15) Policy No:4725207 Page 14 of 17 Endorsement No: 1 VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement This insurance does not apply to: Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any Insured. Premises Related Discrimination discrimination or humiliation arising out of the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any Insured. Notwithstanding the above, there is no coverage for fines or penalties levied or imposed by a governmental entity because of discrimination. The coverage provided by this PERSONAL AND ADVERTISING INJURY —DISCRIMINATION OR HUMILIATION Provision does not apply to any person or organization whose status as an Insured derives solely from Provision 1. ADDITIONAL INSURED of this endorsement; or attachment of an additional insured endorsement to this Coverage Part. This PERSONAL AND ADVERTISING INJURY —DISCRIMINATION OR HUMILIATION Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 21. PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY A. Under COVERAGES, Coverage B —Personal and Advertising Injury Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Contractual Liability. B. Solely for the purpose of the coverage provided by this PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY provision, the following changes are made to the section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B: 1. Paragraph 2.d. is replaced by the following: d. The allegations in the suit and the information the Insurer knows about the offense alleged in such suit are such that no conflict appears to exist between the interests of the Insured and the interests of the indemnitee; 2. The first unnumbered paragraph beneath Paragraph 2.f.(2)(b) is deleted and replaced by the following: So long as the above conditions are met, attorneys fees incurred by the Insurer in the defense of that indemnitee, necessary litigation expenses incurred by the Insurer, and necessary litigation expenses incurred by the indemnitee at the Insurer's request will be paid as defense costs. Such payments will not be deemed to be damages for personal and advertising injury and will not reduce the limits of insurance. C. This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply if Coverage B —Personal and Advertising Injury Liability is excluded by another endorsement attached to this Coverage Part. This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 22. PROPERTY DAMAGE — ELEVATORS A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs (3), (4) and (6) of the Damage to Property Exclusion do not apply to property damage that results from the use of elevators. CNA74705XX (1-15) Page 15 of 17 VALLEY FORGE INSURANCE COMPANY Insured Name: Gulbranson Services, Inc. Policy No: 7034725207 Endorsement No: 1 Effective Date: 10/01/22 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the Other Insurance conditions is amended to add the following paragraph: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis that is Property insurance covering property of others damaged from the use of elevators. 23. SUPPLEMENTARY PAYMENTS The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows: A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000. limit; and B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a $1,000. limit. 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named Insured's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure. 25. WAIVER OF SUBROGATION - BLANKET Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations; or 2. your work included in the products -completed operations hazard. However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: 1. is in effector becomes effective during the term of this Coverage Part; and 2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim. 26. WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up) insurance program by applicable state statute or regulation. If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance Programs (C.C.I.P.) is attached, then the following changes apply: A. The following wording is added to the above -referenced endorsement: With respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of: 1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project, or during such operations of anyone acting on the Named Insured's behalf; nor CNA74705XX (1-15) Policy No: 7034725207 Page 16 of 17 Endorsement No: 1 VALLEY FORGE INSURANCE COMPANY Effective Date: 10/01/22 Insured Name: Gulbranson Services, inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement 2. Bodily injury or property damage included within the products -completed operations hazard that arises out of those portions of the project that are not residential structures. B. Condition 4. Other Insurance is amended to add the following subparagraph 4.b.(1)(c): This insurance is excess over: (c) Any of the other insurance whether primary, excess, contingent or any other basis that is insurance available to the Named Insured as a result of the Named Insured being a participant in a consolidated (wrap-up) insurance program, but only as respects the Named Insured's involvement in that consolidated (wrap-up) insurance program. C. DEFINITIONS is amended to add the following definitions: Consolidated (wrap-up) insurance program means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled Insurance Program (O.C.I.P.) or Contractor Controlled Insurance Program (C.C.I.P.). Residential structure means any structure where 30% or more of the square foot area is used or is intended to be used for human residency, including but not limited to: 1. single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments; and 2. the common areas and structures appurtenant to the structures in paragraph 1. (including pools, hot tubs, detached garages, guest houses or any similar structures). However, when there is no individual ownership of units, residential structure does not include military housing, college/university housing or dormitories, long term care facilities, hotels or motels. Residential structure also does not include hospitals or prisons. This WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA74705XX (1-15) Page 17 of 17 VALLEY FORGE INSURANCE COMPANY Insured Name: Gulbranson Services, inc. Policy No: 7034725207 Endorsement No: I Effective Date: 10/01/22 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA63359XX (Ed. 04/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILITY COVERAGE A. Who Is An Insured The following is added to Section II, Paragraph A.1., Who Is An Insured: 1. a. Any incorporated entity of which the Named Insured owns a majority of the voting stock on the date of inception of this Coverage Form; provided that, b. The insurance afforded by this provision A.1. does not apply to any such entity that is an "insured" under any other liability "policy" providing "auto" coverage. 2. Any organization you newly acquire or form, other than a limited liability company, partnership or joint venture, and over which you maintain majority ownership interest. The insurance afforded by this provision A.2.: a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form, or the next anniversary of its inception date, whichever is earlier. b. Does not apply to (1) "Bodily injury" or "property damage" caused by an "accident" that occurred before you acquired or formed the organization; or (2) Any such organization that is an "insured" under any other liability "policy" providing "auto" coverage. 3. Any person or organization that you are required by a written contract to name as an additional insured is an "insured" but only with respect to their legal liability for acts or omissions of a person, who qualifies as an "insured" under Section II — Who Is An Insured and for whom Liability Coverage is afforded under this policy. If required by written contract, this insurance will be primary and non-contributory to insurance on which the additional insured is a Named Insured. 4. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. "Policy," as used in this provision A. Who Is An Insured, includes those policies that were in force on the inception date of this Coverage Form but: 1. Which are no longer in force; or 2. Whose limits have been exhausted. B. Bail Bonds and Loss of Earnings Section II, Paragraphs A.2. (2) and A.2. (4) are revised as follows: 1. In a.(2), the limit for the cost of bail bonds is changed from $2,000 to $5,000; and 2. In a.(4), the limit for the loss of earnings is changed from $250 to $500 a day. C. Fellow Employee Section II, Paragraph B.5 does not apply. Such coverage as is afforded by this provision C. is excess over any other collectible insurance. II. PHYSICAL DAMAGE COVERAGE A. Glass Breakage — Hitting A Bird Or Animal — Falling Objects Or Missiles The following is added to Section III, Paragraph A.3.: With respect to any covered "auto," any deductible shown in the Declarations will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. B. Transportation Expenses Section III, Paragraph AA.a. is revised, with respect to transportation expense incurred by you, to provide: a. $60 per day, in lieu of $20; subject to b. $1,800 maximum, in lieu of $600. CNA63359XX Copyright, CNA Corporation, 2000. Page 1 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. CNA63359XX (Ed. 04/12) C. Loss of Use Expenses Section III, Paragraph AA.b. is revised, with respect to loss of use expenses incurred by you, to provide: a. $1,000 maximum, in lieu of $600. D. Hired "Autos" The following is Paragraph A.: 5. Hired "Autos" Section III, Paragraphs B.4.c and B.4.d. are deleted and replaced by the following: c. Physical Damage Coverage on a covered "auto" also applies to "loss" to any permanently installed electronic equipment including its antennas and other accessories. added to Section III. d. A $100 per occurrence deductible applies to the coverage provided by this provision. G. Diminution In Value If Physical Damage coverage is provided under this policy, and such coverage does not extend to Hired Autos, then Physical Damage coverage is extended to: a. Any covered "auto" you lease, hire, rent or borrow without a driver; and b. Any covered "auto" hired or rented by your "employee" without a driver, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. The most we will pay for any one "accident" or "loss" is the actual cash value, cost of repair, cost of replacement or $75,000, whichever is less, minus a $500 deductible for each covered auto. No deductible applies to "loss" caused by fire or lightning. d. The physical damage coverage as is provided by this provision is equal to the physical damage coverage(s) provided on your owned "autos." e. Such physical damage coverage for hired "autos" will: (1) Include loss of use, provided it is the consequence of an "accident" for which the Named Insured is legally liable, and as a result of which a monetary loss is sustained by the leasing or rental concern. (2) Such coverage as is provided by this provision will be subject to a limit of $750 per "accident." E. Airbag Coverage The following is added to Section III, Paragraph B.3.: The accidental discharge of an airbag shall not be considered mechanical breakdown. F. Electronic Equipment The following is added to Section III, Paragraph B.6.: Subject to the following, the "diminution in value" exclusion does not apply to: a. Any covered "auto" of the private passenger type you lease, hire, rent or borrow, without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b. Any covered "auto" of the private passenger type hired or rented by your "employee" without a driver for a period of 30 days or less, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. Such coverage as is provided by this provision is limited to a "diminution in value" loss arising directly out of accidental damage and not as a result of the failure to make repairs; faulty or incomplete maintenance or repairs; or the installation of substandard parts. d. The most we will pay for "loss" to a covered "auto" in any one accident is the lesser of: (1) $5,000; or (2) 20% of the "auto's" actual cash value (ACV). III. Drive Other Car Coverage — Executive Officers The following is added to Sections II and III: 1. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by, and for Physical Damage Coverage while in the care, custody or control of, any of your "executive officers," except: a. An "auto" owned by that "executive officer" or a member of that person's household; or CNA63359XX Copyright, CNA Corporation, 2000. Page 2 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. CNA63359XX (Ed. 04/12) b. An "auto" used by that "executive officer" while working in a business of selling, servicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision. (1) Equal to the greatest of those coverages afforded any covered "auto"; and (2) Excess over any other collectible insurance. 2. For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described in this provision. IV. BUSINESS AUTO CONDITIONS A. Duties In The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph A.2.a.: (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. The following is added to Section IV, Paragraph A.2.b.: (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Transfer Of Rights Of Recovery Against Others To Us The following is added to Section IV, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have, because of payments we make for injury or damage, against any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. This injury or damage must arise out of your activities under a contract with that person or organization. You must agree to that requirement prior to an "accident" or "loss." C. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph B.2.: Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not intentional. D. Other Insurance The following is added to Section IV, Paragraph B.5.: Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy shall be on a primary non-contributory basis. This provision is applicable only when required by a written contract. That written contract must have been entered into prior to "Accident" or "Loss." E. Policy Period, Coverage Territory Section IV, Paragraph B. 7.(5).(a). is revised to provide: a. 45 days of coverage in lieu of 30 days. V. DEFINITIONS Section V. Paragraph C. is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these. CNA63359XX Copyright, CNA Corporation, 2000. Page 3 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. DNA Business Auto Policy Policy Endorsement WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) -1 A I - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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. Named Insured: Gulbranson Services, . Endorsement Effective Date: 10/01/22 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. Form No: CA 04 44 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 9; Page: 1 of 1 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 Policy No: BUA 7034725224 Policy Effective Date: 10/1 /2022 Policy Page: 24 of 101 ° Copyright Insurance Services Office, Inc., 2011