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GRP2023-0002
ta (2a�W GEM ofthe DESERT — — GRADING 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: 6/8/2023 LOCATION OF CONSTRUCTION (Street address or Description): 57600 CORAL MOUNTAIN CT; LOT 3 PURPOSE OF CONSTRUCTION: PRECISE GRADING FOR SFR; PM-10 DUST CONTROL AND EROSION CONTROL DESCRIPTION OF CONSTRUCTION: GRADING TM 29963 LOT 3: PM-10 DUST CONTROL & EROSION CONTROL DIMENSION OF INSTALLATION OR REMOVAL: 2 1/2 ACRE SITE; SEE APPROVED PRECISE GRADIN PLAN, PM-10 PLAN, AND EROSION CONTROL PLAN APPROXIMATE TIME WHEN WORK WILL BEGIN: 6/12/2023 TIME OF COMPLETION: 7/31/2023 ESTIMATED CONSTRUCTION COST: $75,000.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS: In consideration of the granting of this permit, the applicant hereby agrees to: Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started at (760) 777-7097. To submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at least twenty-four (24) hours prior to the anticipated inspection. Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the result of this work. APPLIED ON ETRAKIT Signature of Applicant or Agent MICHAEL KINER 70177 HIGHWAY 111 STE 200 RANCHO MIRAGE, CA 92270 Name of Applicant (please print) K P HUDSON CONSTRUCTION INC Business Address 40905 AMADOR DR INDIO, CA 92203 Name of Contractor and Job Foreman Business Address 818121 Contractor's License No. GEMINI INSURANCE CO Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION PRECISE GRADING $3,501.00 TECHNOLOGY ENHANCEMENT FEE $8.00 TOTAL: $0.00 LIC-0005285 City Business License No. VCG P028503 Policy Number PERMIT NO: GRP2023-0002 DATE ISSUED: 6/8/2023 EXPIRATION DATE: 6/8/2024 BY: AMY YU WORK INSPECTED BY*: PERMIT COMPLETION DATE*: (760)340-3360 Telephone No. (760)275-6137 Telephone No. *If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number GRP2023-0002 The followina shall always avvly: 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 ('/4") 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 GRP2023-0002 Precise Grading/ TM 29963 Lot 3; Coral Mtn Ct North of Ave 58 In addition to the standard permit conditions, the following shall apply: 1. Pursuant to Section 14.16.320 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), all work shall be performed in accordance with the latest edition of the Standard Specifications For Public Works Construction (SSPWC) and as directed by and to the satisfaction of the City Engineer. 2. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during the actual work performed. 3. 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. K P Hudson Construction Inc., hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. 5. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 6. 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. 7. Pursuant to Section 6.08.050 of the La Quinta Municipal Code (Ordinance 18 § 1, 1982), throughout the work site, the Permittee shall comply with City regulated work hours. Operation and maintenance of equipment within one-half mile of human occupancy shall be performed only during the following time periods: October 1 st to April 30: Monday -Friday 7:00 a.m. to 5:30 p.m. Saturday 8:00 a.m. to 5:00 p.m. May 1st to September 30: Monday -Friday 6:00 a.m. to 7:00 p.m. Saturday 8:00 a.m. to 5:00 p.m. Work shall be prohibited on legal holidays and Sundays. Note: Construction work (including setting up traffic control devices) is not permitted on any Arterial street (ie any 4 lane street) before 8:30 a.m. nor after 4:30 p.m. 8. Work within 500 feet of a signalized intersection shall be performed between the hours of 9 a.m. - 3 p.m. Traffic control shall be set up after 9 a.m. and removed before 3 p.m. The Permittee shall contact the City Traffic Signal Maintenance Technician at (760) 250-0571 if signal operation at the intersection is to be altered in any way. 9. The permittee and/or contractor placing engineered fill must provide adequate time and safety for the Geotechnical Engineer of Record to perform soils testing during engineered fill placement. The testing frequency shall be determined by the Geotechnical Engineer of Record such that the fill can be determined to be placed according to the city approved plans. Special Conditions Page 1 of 6 PERMIT NO GRP2023-0002 Precise Grading/ TM 29963 Lot 3; Coral Mtn Ct North of Ave 58 10. The permittee and/or contractor shall provide surveyor staking information adequate for the City Inspector to determine horizontal and vertical locations relative to the approved city plans. The minimum required wood lath type stakes shall be placed at all proposed building corners, and they shall state the horizontal location relative to building corner and the elevation of the top of hub next to the lath. 11. Building areas should be overexcavated to a depth of at least X feet (see Soils Report) below existing grade or X feet (see Soils Report) below the bottom of the footings, whichever is deeper. The exposed surface should be scarified, moisture conditioned, and compacted so that a minimum of 90 percent relative compaction is attained. Once deleterious materials are removed, the native material may be placed as controlled compacted fill. Overexcavation should be observed by a representative of the Geotechnical Engineer of Record and compaction should be verified by testing. Any deviations from this permit, soils report, or grading plan must be approved by the City Engineer prior to the construction of the deviations. 12. Pursuant to Section 14.16.110 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), Permittee shall assume responsibility for repair of any pavement damage to any public or private street and for any damage to other City streets or facilities as a result of work performed under this permit. 13. 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 14. Any land on which Williamson Act contracts apply shall remain undisturbed. 15. K P Hudson Construction Inc. hereinafter, hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. The following Fugitive Dust Control rules shall apply during soil import/export activities: a. A valid grading permit shall be active at both the import and export site b. The import/export material during hauling shall be near 70% optimum moisture content. c. Street cleaning shall occur, as necessary, at import and export location. d. Trucks hauling export or import material must maintain 6 inches of freeboard and be tarped. e. The haul route shall be attached to this permit or a City approved plan. 16. 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 GRP2023-0002 Precise Grading/ TM 29963 Lot 3; Coral Mtn Ct North of Ave 58 17. 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. 18. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 1-800-422- 4133. It shall be the Permittee's responsibility to notify the Public Works Department of anticipated excavation which impact City facilities, including but not limited to traffic signal conduits and loops, irrigation lines, electrical conduits, and storm drain facilities. 19. 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. 20. 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, 51h Edition" or latest, in the installation of all appurtenances abutting and within the public street right-of-way. 21. The permittee shall be responsible for notifying the inspection staff of import fill and overexcavated areas on a daily base's. If the inspector's phone number is unknown, the permittee shall call the Public Works front counter phone at 777-7075 or the Assistant Civil Engineer at 777-7047 to determine the city inspector's phone number. If the imported fill or overexcavated locations indicate to the inspector that inadequate soils exist based on the criteria set forth in the Project Soils Report, Public Works Greenbook, or California Building Code, the Public Works inspector may halt grading operations until the inadequate soil has either been removed or the Public Works Director authorizes grading to continue. The above testing or observations does not relieve the permittee's responsibility for future repairs due to settlement at and near the locations of the work area. Prior to the city issuing a building permit, the permittee's Geotechnical Engineer of Record shall submit a certified letter indicating that the grading has been completed per the approved plan. A compaction report on all fill is required following pad certification and prior to building permit issuance. Special Conditions Page 3 of 6 PERMIT NO GRP2023-0002 Precise Grading/ TM 29963 Lot 3; Coral Mtn Ct North of Ave 58 22. 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 Assistant Civil 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. 23. 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. 24. 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 25. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts provided in Engineering Bulletin on 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. 26. The permittee shall not encroach upon private property without prior written approval (submit to the Public Works Department, attention to the Assistant Civil Engineer) of the private land owner whom is being encroached upon. 27. During work hours, the permittee shall provide and maintain a traffic lane that diverts traffic off the paved roadway. The traffic lane must be located within the existing R/W with the following requirements: a. Class II Base with a minimum depth of 2" b. A 6 inch thick subgrade layer compacted to 95% based on ASTM D 1557 c. An unobstructed travel width of 10 feet. d. In addition, a minimum of 5 feet clearance from open trenches. e. A minimum of 2 feet from vertical obstructions like curbs. f. Maximum speed of 25 mph 28. 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. 29. If public traffic lanes are required to be closed, this permit is not valid until the permittee submits, to the Public Works Department, a traffic control plan for review and approval prior to start of construction or parking on the paved R/W. Special Conditions Page 4 of 6 PERMIT NO GRP2023-0002 Precise Grading/ TM 29963 Lot 3; Coral Mtn Ct North of Ave 58 ---------------------------- 1 30. As shown on the sketch to the left, a minimum distance of 18 feet between the surface and power lines must be kept at all time. 31. All landscaping, irrigation, decorative rock, decorative concrete, sidewalk, and lighting, etc., shall be replaced to its original condition. 32. Access and egress to all local properties shall be maintained at all times. 33. 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'/2" max medium finish course lift for capping. Asphalt concrete mix design shall be approved by the City prior to its placement. D. 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. Special Conditions Page 5 of 6 PERMIT NO GRP2023-0002 Precise Grading/ TM 29963 Lot 3; Coral Mtn Ct North of Ave 58 E. 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. 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. 34. 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. 35. 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. 36. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 37. 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. 38. If it is the intent of the permittee to cut the pavement and have it restored by a third parry, 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 Proof of insurance only - precise grading work on private property ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06/01 /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 CONTACT Quetha Rodriguez Garcia Insurance Inc PHONE (760) 320-1111 FAX (760) 320-1115 A/C No. o EXt : A/C, No): 2099 E. Tahquitz Canyon Way E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Palm Springs CA 92262 INSURERA: Gemini Insurance Cc INSURED INSURER B : Undelwritters At Loyds KP Hudson Construction, Inc., DBA: Drew Hudson INSURER C : 40905 Amador Drive INSURER D : INSURER E : Indio CA 92203 INSURERF: COVERAGES CERTIFICATE NUMBER: CL2312407655 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH E POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE17— PREMISES a occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A Y VCGP028503 10/07/2022 10/07/2023 GEN'LAGGREGATELIMIT APPLIES PER: PROX POLICY JEC ❑ JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE ccident Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below B Professional Liability PSLO139538753 10/07/2022 10/07/2023 Occurance Aggregate $1,000,000 $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Job: 57600 Coral Mountain Court, La Quinta, CA. Rayson, LLC., Kevin & Sherri Murray Family Trust, 8450 Hinterland Dr., San Diego, CA 92127 are named as additional insureds. *10 day notice of cancellation may be issued for nonpayment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rayson, LLC ACCORDANCE WITH THE POLICY PROVISIONS. 11035 Technology PI. Suite 100 AUTHORIZED REPRESENTATIVE San Diego CA 92127 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Policy Number: VCGP028503 CG 20 3712 19 Insured Name: KP Hudson Construction, Inc. Number: 36 Effective Date: 10/07/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Additional Insured Person(s) Location And Description Of Or Organization(s) Completed Operations Any person or organization when you have agreed in All locations and completed operations for a written and executed contract, prior to an which you have agreed in a written and "occurrence", that such person or organization be executed contract prior to an "occurrence." added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. All other terms and conditions of this Policy remain unchanged, CG 20 37 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: VCGP028503 Insured Name: KP Hudson Construction, Inc. Number: 33 CG 20 10 12 19 Effective Date:10/0712022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Any person or organization when you have agreed in All locations for which you have agreed in a a written and executed contract, prior to an written and executed contract prior to an "occurrence", that such person or organization be 'occurrence". added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. All other terms and conditions of this Policy remain unchanged. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 u/aaranesa /nsarance BENJAMIN D HUDSON 40905 AMADOR DR INDIO CA 92203 PERSONAL AUTOMOBILE POLICY VEHICLE IDENTIFICATION CARDS WAWANESA INSURANCE PO BOX 82867 SAN DIEGO CA 92138-9492 TELEPHONE: 800-640-2920 SPECIAL NOTICE: The vehicle identification cards you have received are intended to be used as proof that the vehicle listed is insured under a liability automobile policy. Two cards have been provided for each vehicle insured. One card must be carried in the proper insured vehicle. Due to space limitations on the ID card, only the Primary Named Insured and Secondary Named Insured are listed. For a full list of drivers covered under this policy, please reference the Drivers section of your Declarations Page. r____________________________________________________T____________________________________________________�. I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX � XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX : XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I � XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX : XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX � XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX : XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I � XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX : XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I � XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX l XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX : XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX II XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXTI L--------------------------------------------------------------------------------------------------------- CALIFORNIA INSURANCE VEHICLE IDENTIFICATION CARD i CALIFORNIA INSURANCE VEHICLE IDENTIFICATION CARD ____ lUauranesa POLICY NUMBER i M lUauranesa POLICY NUMBER Insurance 16722430 i /esarance 16722430 I I Named BENJAMIN D HUDSON Named BENJAMIN D HUDSON Insured i Insured Address 40905 AMADOR DR i Address 40905 AMADOR DR INDIO CA 92203 i INDIO CA 92203 FROM Jan 20, 2023 TO Jul 20, 2023 i FROM Jan 20, 2023 TO Jul 20, 2023 YEAR MAKE VEHICLE ID NUMBER i YEAR MAKE VEHICLE ID NUMBER 2022 BMW 3MW53CM02N8C36460 i 2022 BMW 3MW53CM02N8C36460 I I COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS i COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW I PRESCRIBED BY LAW SEE IMPORTANT NOTICE ON REVERSE SIDE NAIC NUMBER: 10683 SEE IMPORTANT NOTICE ON REVERSE SIDE NAIC NUMBER: 10683 I I I I ------------------------------------------------------------------------------------------------------------� CALIFORNIA INSURANCE VEHICLE IDENTIFICATION CARD i CALIFORNIA INSURANCE VEHICLE IDENTIFICATION CARD lUaicvanesa POLICY NUMBER i YV" lUaicvanesa POLICY NUMBER INSWI fice 16722430 i /nsararace 16722430 I I Named BENJAMIN D HUDSON Named BENJAMIN D HUDSON Insured (Insured Address 40905 AMADOR DR i Address 40905 AMADOR DR INDIO CA 92203 i INDIO CA 92203 FROM Jan 20, 2023 TO Jul 20, 2023 i FROM Jan 20, 2023 TO Jul 20, 2023 I I YEAR MAKE VEHICLE ID NUMBER ; YEAR MAKE VEHICLE ID NUMBER 2020 Chrysler 2C4RC1N70LR105514 i 2020 Chrysler 2C4RC1N70LR105514 I I COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS i COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW I PRESCRIBED BY LAW I SEE IMPORTANT NOTICE ON REVERSE SIDE NAIC NUMBER: 10683 SEE IMPORTANT NOTICE ON REVERSE SIDE NAIC NUMBER: 10683 I I r r THIS CARD MUST BE CARRIED IN THE INSURED MOTOR THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE FOR PRESENTATION UPON DEMAND. VEHICLE FOR PRESENTATION UPON DEMAND. THE COVERAGE PROVIDED BY THE POLICY MEETS THE THE COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW. MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW. IN CASE OF AN ACCIDENT i IN CASE OF AN ACCIDENT i 1. Report accident immediately by web, phone, fax, letter or in person directly to the 1 1. Report accident immediately by web, phone, fax, letter or in person directly to the address below. i address below. 2. Obtain names, addresses, phone numbers (work & home) of all persons involved i 2. Obtain names, addresses, phone numbers (work & home) of all persons involved including passengers and witnesses. including passengers and witnesses. 3. Make no statements of any kind before or after making the report regarding the accident i 3. Make no statements of any kind before or after making the report regarding the accident to anyone except the proper police authorities or a representative of this company. to anyone except the proper police authorities or a representative of this company. 4. Your policy is confidential - do not show it to anyone except an authorized representative i 4. Your policy is confidential - do not show it to anyone except an authorized representative of this company. of this company. Above all, report the accident promptly no matter how small or who is at fault. i Above all, report the accident promptly no matter how small or who is at fault. WAWANESA INSURANCE i WAWANESA INSURANCE PO Box 82867 i PO Box 82867 San Diego, California 92138-9492 ; San Diego, California 92138-9492 wawanesa.com ; wawanesa.com 888-WAWA-CLAIM (929-2252) 888-WAWA-CLAIM (929-2252) -------------------------------------------------------+------------------------------------------------------- THIS CARD MUST BE CARRIED IN THE INSURED MOTOR THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE FOR PRESENTATION UPON DEMAND. i VEHICLE FOR PRESENTATION UPON DEMAND. THE COVERAGE PROVIDED BY THE POLICY MEETS THE i THE COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW. MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW. IN CASE OF AN ACCIDENT i IN CASE OF AN ACCIDENT 1. Report accident immediately by web, phone, fax, letter or in person directly to the 1. Report accident immediately by web, phone, fax, letter or in person directly to the address below. i address below. 2. Obtain names, addresses, phone numbers (work & home) of all persons involved i 2. Obtain names, addresses, phone numbers (work & home) of all persons involved including passengers and witnesses. including passengers and witnesses. 3. Make no statements of any kind before or after making the report regarding the accident i 3. Make no statements of any kind before or after making the report regarding the accident i to anyone except the proper police authorities or a representative of this company. to anyone except the proper police authorities or a representative of this company. 4. Your policy is confidential - do not show it to anyone except an authorized representative i 4. Your policy is confidential - do not show it to anyone except an authorized representative of this company. of this company. Above all, report the accident promptly no matter how small or who is at fault. i Above all, report the accident promptly no matter how small or who is at fault. WAWANESA INSURANCE i WAWANESA INSURANCE PO Box 82867 i PO Box 82867 San Diego, California 92138-9492 ; San Diego, California 92138-9492 wawanesa.com wawanesa.com 888-WAWA-CLAIM (929-2252) i 888-WAWA-CLAIM (929-2252) -------------------------------------------------------- -------------------------------------------------------- THIS CARD MUST BE CARRIED IN THE INSURED MOTOR THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE FOR PRESENTATION UPON DEMAND. VEHICLE FOR PRESENTATION UPON DEMAND. THE COVERAGE PROVIDED BY THE POLICY MEETS THE THE COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW. MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW. IN CASE OF AN ACCIDENT IN CASE OF AN ACCIDENT i 1. Report accident immediately by web, phone, fax, letter or in person directly to the i 1. Report accident immediately by web, phone, fax, letter or in person directly to the address below. i address below. i 2. Obtain names, addresses, phone numbers (work & home) of all persons involved 2. Obtain names, addresses, phone numbers (work & home) of all persons involved including passengers and witnesses. i including passengers and witnesses. 3. Make no statements of any kind before or after making the report regarding the accident i 3. Make no statements of any kind before or after making the report regarding the accident i to anyone except the proper police authorities or a representative of this company. i to anyone except the proper police authorities or a representative of this company. 4. Your policy is confidential - do not show it to anyone except an authorized representative i 4. Your policy is confidential - do not show it to anyone except an authorized representative i of this company. i of this company. Above all, report the accident promptly no matter how small or who is at fault. i Above all, report the accident promptly no matter how small or who is at fault. WAWANESA INSURANCE i WAWANESA INSURANCE PO Box 82867 i PO Box 82867 San Diego, California 92138-9492 i San Diego, California 92138-9492 wawanesa.com ; wawanesa.com 888-WAWA-CLAIM (929-2252) 888-WAWA-CLAIM (929-2252) Declaration Reeardine California Workers' Compensation You are required to complete this form because you have not filed a certificate regarding workers' compensation insurance with City of La Quinta. California law requires all employers to carry workers' compensation insurance, even if they have only one employee. If you do not know whether you are required to carry workers' compensation insurance, find out by contacting the California Department of Industrial Relations ("DIR"). Information is also available on the DIR's website at http://www.dir.ca.gov. You should also consult with your attorney, insurance agent or broker, or carrier regarding the specifics of your situation and your options. If you are subject to the Workers' Compensation Laws of California, you must promptly file a certificate of Workers' Compensation Insurance with City of La Quinta. If you have a certificate of self-insurance from the DIR, you must file that certificate with City of La Quinta. When completing this form, remember that the term "employee" includes clerical persons as well as any other persons employed by your company including drivers. ACKNOWLEDGMENT initial) California Labor Code § 3700 requires employers to carry workers' compensation insurance or to obtain a certificate from the Director of Industrial Relations demonstrating that the employer is self -insured. California Labor Code § 3700.5 makes it a criminal offense for an employer to fail to secure compensation as required by the workers' compensation provisions of the Labor Code. Violation of Labor Code § 3700 is punishable by a fine of up to $10,000 and/or imprisonment for up to one year. e�(initial) California Labor Code § 3710.1 provides that where an employer fails to provide compensation required under § 3700, the Director of the Department of Industrial Relations shall issue a stop order, prohibiting the employer from using employee labor until such time as the employer complies with the provisions of § 3700. Labor Code § 3710.2 makes it a criminal offense to disregard such stop orders. , (initial) I acknowledge that if evidence is found that contradicts this declaration, City of La Quinta will promptly notify all relevant state agencies to ensure full insurance compliance required by Workers' Compensation Laws of California. (initial) I understand that California Labor Code § 3700 et seq. requires employers to provide workers' compensation insurance coverage for any employees of my business. I hereby warrant that this business is exempt from the California Labor Code provisions regarding workers' compensation insurance because it has no employees. RE�/(Initial) I agree to hold City of La Quinta and its officers, officials, employees, and agents harmless for loss or liability which may arise from the failure of my business to comply with the laws of the State of California regarding workers' compensation insurance. _ (initial) If I hire employees in the future, I will immediately notify City of La Quinta and provide a certified Workers' Compensation certificate to the City. CERTIFICATION I (we) certify under penalty of perjury, under the laws of the State of California, that I (we) have read and understood the above stated requirements regarding Workers' Compensation and that I(we) am (are) in compliance. I(we) certify that the forgoing is true and correct. Executed this June day of 8th 20 23at . California Signature of Declarant Benjamin Drew Hudson Print Name of Declarant KP Hudson Construction, Inc. Print Name of Company GEN3EAR-01 CMAYO ACORO CERTIFICATE OF LIABILITY INSURANCE DATE6/5/2 DYYYY) /5/2023 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 # 0757776 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 Palm Desert, CA 92211 CONTACT Christy Mayo NAME: PHONE , Ext : (760) 360-4700 4249 Fvc, No :(760) 200-0790 MAI E-L ADDRE : christy.mayo@hubinternational.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Kinsale Insurance Company 38920 INSURED INSURER B : California Automobile Insurance Company 38342 INSURER C : State Compensation Insurance Fund of California 35076 Gen3 Earthworks Inc. INSURER D: Ohio Casualty Insurance Company 24074 54960 Avenida Diaz La Quinta, CA 92253 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM DD POLICY EXP MM DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE �X OCCUR X 0100077230-4 12/5/2022 12/5/2023 DAMAGE TO RENTED PREMISES Ea occurren SO,000 MED EXP (Any one person $ 0 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY EOMBINED SINGLE LIMIT 1,00ccident)0,000 X BODILY INJURY Perperson) ANY AUTO BA040000056038 1/5/2023 1/5/2024 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I RETENTION $ $ C WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 9264423-22 11/16/2022 11/16/2023 X I PER OTH- TAT TE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ D Equipment Floater BM059298411 11/8/2022 11/8/2023 max Per Item 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: 57600 Coral Mountain Ct La Quinta CA -Kevin & Sherri Murray Family Trust Rayson LLC and Kevin & Sherri Murray Family Trust are included as Additional Insureds as per the attached endorsement. In the event of cancellation , 30 days notioce shall be provided, 10 days for non payment of premium . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ra son, LLC y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11035 Technology PI. St 100 San Diego, CA 92127 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100077230-4 12/05/2022 12:01AM at the Named Insured Gen3 Earthworks Inc address shown on the Declarations Additional Premium: Return Premium: $0 1 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Location(s) of Covered Operations Blanket, as required by written contract, executed prior to the start of work on the project. Locations as required and specified by written contract, executed prior to the start of work on the project. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2