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ENC2023-0064ta (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: 6/28/2023 LOCATION OF CONSTRUCTION (Street address or Description): DESERT CLUB DR AT AVENIDA LA FONDA PURPOSE OF CONSTRUCTION: ACCESS 1 MANHOLE TO SPLICE EX CABLE FOR 78015 MAIN ST DESCRIPTION OF CONSTRUCTION: FRONTIER PSR3904391; ACCESS 1 MANHOLE TO SPLICE EX CABLE DIMENSION OF INSTALLATION OR REMOVAL: 0 APPROXIMATE TIME WHEN WORK WILL BEGIN: 6/26/2023 TIME OF COMPLETION: 9/26/2023 ESTIMATED CONSTRUCTION COST: $500.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing permanent resurfacing and/or replacing improvements) COMMENTS: In consideration of the granting of this permit, the applicant hereby agrees to: Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started at (760) 777-7097. To submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at least twenty-four (24) hours prior to the anticipated inspection. Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of La Quinta and to pay for any additional replacement necessary as the result of this work. MOUNTAIN TOP COMM SERVICES - DEBBIE WILLIAMS 1902 ORANGE TREE LN, STE 140 REDLANDS, CA 92376 Name of Applicant (please print) Business Address FRONTIER CALIFORNIA 1400 PHILLIPS BLVD POMONA, CA 91766 Name of Contractor and Job Foreman Business Address 488385 NA Contractor's License No. STEADFAST INSURANCE COMPANY Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION TRAFFIC CONTROL $353.00 TECHNOLOGY ENHANCEMENT FEE $8.00 TOTAL: $0.00 City Business License No. GL00285992 06 Policy Number PERMIT NO: ENC2023-0064 DATE ISSUED: 6/28/2023 EXPIRATION DATE: 6/28/2024 BY: AMY YU A Y WORK INSPECTED BY*: PERMIT COMPLETION DATE*: APPLIED ON ETRAKIT Signature of Applicant or Agent (909)798-1246 Telephone No. (760)342-1240 Telephone No. *If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. T4,!t 4 4a" PUBLIC WORKS DEPARTMENT APPLICATION FOR PERMIT Date: 06/12/2023 Tract No: Project Name: PSR 3904391 Vicinity Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.) Work crew to access (1) existing manhole within city row to splice existing cable within existing conduit inside city row to Description of Construction (i.e.: See Plan Set No. 01234) Nearest address: 78150 E AVENIDA LA FONDA, LA QUINTA, CA, 92253; E/S/O Desert Club Dr - N/O Avienda La Fond Dimension of Installation or Removal: Duration of work: 1 Day Approximate Construction Start Date: 06/26/2023 Approximate Construction Completion Date: 09/26/2023 Estimated Construction Cost: $ Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back -filling, compaction and placing permanent resurfacing and or replacing improvements Contact Name: Debbie Williams Phone Number: (909)-798-4400' Name of Applicant/Owner: Frontier California Inc Ftr Applicant Address:'1400 Phillips Blvd, Pomona CA 91766 Applicant Telephone Number: (909) 406-3178 Applicant E-mail Address: permits@mountaintcs.com Engineer: Raul Rivas Name of Contractor: Frontier California Inc Contractor Address: 1400 Phillips Blvd, Pomona CA 91766 Contractor Telephone Number: Mike Reddings (760) 342-1240 Contractor State License Number: 488385 Contractor City Business License Number: N/A Public Utility Contractor E-mail Address:rke.redding@ftr.com ►A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 1Dlicant or Contractor General Liabilitv Insurance Comnanv: or Contractor General Office Use Only: Inspection Fee: Permit Fee: As -Built Deposit:_ Dust Control Deposit: Credit Amount: TOTAL FEE DUE: ilit Insurance Polic Number: Office Use Only: Assigned Permit Number: Approval Date: Expiration Date: Issue Date: Administrative Authority: 'Application for ermft pose - - DIGALERT AT TOLL T27-2FREE TRAFFIC CONTROL PLANS ® 1-800-227-2600 AT LEAST TWO DAYS BEFORE VOU DIG TILE LA Q UINTA, CA WARNING SIGNS MISCELLANEOUS DEVICES ® m m m ® m ® m m ® m (TYP.) FLASHING ARROW SIGN TRAILER (TYP.) (FAS) WORK HOURS: 9AM - 2PM WORK DATES: XX/XX/XX - XX/XX/XX ACTUAL WORK DAYS: 3 HIGH LEVEL WARNING DEVICE (HLWD) z G c ALL WORK ZONE TRAFFI CONTROL SIGNS AND MARKINGS ARE TO BE REMOVED AT THE END OF THE DAY TYPE 1 BARRICADE NOTE: 1.ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH THE 2014 CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIA M.U.T.C.D) 2. TRAFFIC CONTROL SHOWN HEREIN IS THE MINIMUM REQUIRED. ADDITIONAL TRAFFIC CONTROL MAY BE REQUIRED TO FACILITATE PUBLIC SAFETY AND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LA QUINTA REPRESENTATIVE. 3. THROUGHOUT EACH WORK PERIOD, CONTRACTOR SHALL INSPECT TRAFFIC CONTROL (SIGNS, BARRICADES AND DELINEATORS) AND MAINTAIN SAME IN ACCORDANCE WITH TRAFFIC CONTROL PLANS. 4. CONTRACTOR SHALL MAINTAIN A MINIMUM 10' (12' TYP.) TRAFFIC LANE WIDTH AT ALL TIMES. THERE SHALL BE A MINIMUM 2' BETWEEN THE EDGE OF CUT AND THE NEAREST TRAFFIC LANE. 5. ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED AT ALL TIMES. 6. THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING WORK HOURS ONLY. AT THE END OF WORK HOURS, THE ROAD SHALL BE CLEAR OF DEBRIS AND TRAFFIC RETURNED TO NORMAL. 7. CLOSURE HOURS TO COINCIDE WITH WORK HOURS 9AM-2PM " NO NOTIFY TRAFFIC SIGNAL MAINTENANCE STAFF 48 HOURS BEFORE TRAFFIC SIGNALS OPERATIONS HAVE TO BE MOTIFIED, TURNED OFF OR PUT INTO FLASHING OPERATION �\cl /,?s(36 in) . yI ROAD = END WORK AHEAD ErlROADWORKI G20-2 W20-1 W 12-1 TRAFFIC CONE BIKE LANE CLOSED SC11 (MOD) (30 in) CA TYPE N-3 OBJECT MARKER (OM1-3) �J (24 in) qC30(CA) RIGHT LANEkW20-5R R� M U S TTURN RIGHT R3-7R (30 in) (30 in) (30 in) SIDEWALK CLOSED SIDEWALK CLOSED `,50 AHEAD w �J= CROSHERECROSS HERE W11- SIDEWALK R9-11 (LT) R9-11A (LT) CLOSED W16-1 SHARE THE ROAD R9- W11-1 ASSEMBLY c c (24 in) M � M (3S3i8) Iq DETAIL SHEET LEGEND ---► EXISTING TURN ONLY EXISTING NO TURN LANE S$) TRAFFIC SIGNAL TRAFFIC FLOW DIRECTION O Traffic Cone Work Area FTR ENGINEER: RAUL RIVAS (909) 406-3178 FTR INSPECTOR: MIKE REDDING (760) 342-1240 Temporary Sign ® Work Vehicle , • * 0 0 0 • Direction of Travel Fr*ontier S Signalized Intersection •'s••••• Flashing Arrow Sign (FAS) COMMUNICATIONS H Type III Barricade with sign 0 6 FAS Support or Trailer CONSTRUCTION & TRAFFIC CON1 NOTES Portable Flashing Beacon HLWD High Level Warning Device PROJECT ID / WORK ORDER: 70063-5336108 CROSS STREETS. DESERT CLUB DR & AVENIDA LA FC ® CITY, STATE LA QUINTA, CA, 92253 Flagger CONE SPACING TO BE 25MAXIMUM DATE: 6/28/2023 — w SHEET: CONSTRUCTION NOTE: ALL DRIVEWAYS TO REMAIN OPEN (WHENEVER POSSIBLE) THROUGHOUT TRAFFIC CONTROL ZONE. TAPER cuRe • • • • r a 3 0 SHOULDER CA MUTCD (California Manual on Uniform Traffic Control Devices) Approved by the Federal Highway Administrator as the National Standard in accordance with Title 23 U.S. Code, Sections 109(d),114(a), 217,315, and 402(a), 23 CFR 655, and 49 CFR 1.48(b)(8), 1.48(b)(33), and 1.48(c)(2). Q z O LL Q J L-OZM Q OVI H 3Hom END 0tl0a ROAD WORK z G20-2 \ d U) INSTALL TEMP. NO PARKING 72 HOURS PRIOR TO COMMENCING WOI 250' 150' MINI I 139' TO C/L SIGN SPACING 50' MIN WORK 1771 AREA MH#20 dolS a m LOCATION a w tea; I �om N"ALTAIN, 24' TO C/L WORK AREA CONSTRUCTION NOTES 1. WORK CREW TO MAINTAIN 4' MIN. WALKWAY OR ASSIST PEDESTRIANS AROUND WORK AREA WHEN NECESSARY. 2. WORK CREW TO COORDINATE WORK WITH PROPERTY OWNERS WHEN NECESSARY. 3. WORK HOURS ARE AS FOLLOWS 08:30 A.M. TO 3:30 P.M. 6. IF A SCHOOL IS IN PROXIMITY OF THE WORK AREA, WORK HOURS ARE AS FOLLOWS 09:00 A.M. TO 2:30 P.M. 7. WHEN PERFORMING WORK ON ROADWAYS DESIGNATED AS A BIKE ROUTE OR WHERE SEPARATE BIKE LANES ARE PRESENT, SPECIAL ATTENTION SHALL BE GIVEN TO BICYCLISTS. 8. WORK CREW TO ADJUST TRAFFIC CONTROL PER FIELD CONDITIONS. DESERT CLUB DR (25 MPH INSTALL TEMP. NO PARKING 72 HOURS PRIOR TO COMMENCING WORK 112'MIN. 60' 250' SHOULDER TAPER SIGN SPACING 50' MIN ADDRESS NEAREST TO WORK LOCATION: 78150 AVENIDA LA FONDA, LA QUINTA, CA, 92253 NOTE: FLAGGER TO ASSIST WB LA FONDA VEHICLES EXITING. FLAGGER TO ALSO ASSIST PEDESTRIANS AROUND WORK AREA. 0 N Qua o�w a 250' SIGN SPACING SHOULDER o UURD / A LEGEND N 1=1 TYPE III BARRICADE W/ SIGN 1-1 TYPE III BARRICADE W/O SIGN FTR ENGINEER: RAUL RIVAS (909) 406-3178 >-( TYPE II BARRICADE W/ SIGN ESS p FTR INSPECTOR: MIKE REDDING (760) 342-1240 )--( TYPE II BARRICADE W/O SIGN F.Y L NQ l {1d • • • CHANNELIZING DEVICE y W 3 ier C 8043 C� T TRAFFIC CONE WITH SLIP ON SIGN M Front T SIGN EXP.03/31/24 COMMUNICATIONS OS SIGNALIZED INTERSECTION %P 0/22/202' �Q WORKSITE TRAFFIC CONTROL PLAN [FASI ARROW PANEL (FLASHING ARROW) '9TF CIV I` 1) W SHOULDER CLOSURE 0 OF CAS\F �'��s HIGH LEVEL WARNING DEVICE (FLAGTREE) (OPTIONAL) PROJECT IDIWORK ORDER _ 70063-5336108 GROSS STREETS: DESERT CLUB DR & AVEDIDA LA F( ' FLAGGER 0 X CITY, STATE: LA QUINTA, CA, 92253 ® WORK ZONE (ACTIVITY AREA) LIMITS DATE 6/28/2023 S-1 DRAWN BY NOT NOT TO SCALE . DIRECTION OF TRAFFIC (NOT PAVEMENT MARKING) CA MUTCD DRAWN. NO. 2 SCALE: NTS o City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2023-0064 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. ENC2023-0064 Frontier PSR3904391/ Access 1 Manhole to Splice Ex Cable for 78015 Main St Desert Club Dr at Avenida La Fonda 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. 8. 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. 13. Frontier California Inc., hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. Special Conditions Page 1 of 6 PERMIT NO. ENC2023-0064 Frontier PSR3904391/ Access 1 Manhole to Splice Ex Cable for 78015 Main St Desert Club Dr at Avenida La Fonda 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. ENC2023-0064 Frontier PSR3904391/ Access 1 Manhole to Splice Ex Cable for 78015 Main St / Desert Club Dr at Avenida La Fonda 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. ENC2023-0064 Frontier PSR3904391/ Access 1 Manhole to Splice Ex Cable for 78015 Main St Desert Club Dr at Avenida La Fonda 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. ENC2023-0064 Frontier PSR3904391/ Access 1 Manhole to Splice Ex Cable for 78015 Main St Desert Club Dr at Avenida La Fonda 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. ENC2023-0064 Frontier PSR3904391/ Access 1 Manhole to Splice Ex Cable for 78015 Main St Desert Club Dr at Avenida La Fonda 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 ATE R CERTIFICATE OF LIABILITY INSURANCE D06/14/2023D/YYYY) 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 NAM£: CT Marsh I U.S. Operations MARSH USA LLC. PHONE 540 W. MADISON (866) 966-4664 FAXX 212-948-0770 �„19.w F.�f).' _..I—�aY• CHICAGO, IL 60661 le -MAIL AbORE5a: CertRe uest o Chico9 q @ marsh.com CN 102898337--GAW-23-24 INSURED Frontier California Inc. 401 Merritt 7 Norwalk, CT 06851 INSURER 5 AFFORDING COVERAGE NAIC # FC650 GAW INSURER A: Steadfast Insurance Company 26387 INSURER B: Zurich American Insurance Company 16535 INSURER C : American Zurich Insurance Company 40142 INSURER D : I _ I INSURER F : I COVERAGES CFRTIFICATF NIIMRFR CHI-010079173-10 RFVICIf1N NIIMRFR• A 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 POLICY EXP LTR TYPE OF INSURANCE i NSD'z UBRI POLICY NUMBER MMrrDDrYYPOLICY YYJ I..IMMIDDIYYYYILIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE TIOCCUR X GLO 0285992 06 06/0112023 06/01/2024 EACH OCCURRENCE $ 1,000,000 P PREB MiSElj�Ea occur(ertce $ 500,000 $ 10,000 MED EXP (Any one person) PERSONAL & ADV INJURY $ 1,000,000 GEN'L X GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICYEl PRO- ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER! B AUTOMOBILE LIABILITY BAP 0285990 06 061011202 06101/2024 COMBINED SINGLE LIMIT £aaccident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE L e(�ddenl $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/� B ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N I A X WC 0285988 06 (ADS) WC 0285989 06 RETRO () U6701 r2023 06101/2023 06101/2024 06101/2024 X STAT T ER IE.LEACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of La Quinta, its officers, officials, employees, and agents shall be named as Addilional Insureds as respects the General Liability policy where required by written contract. Coverage under the General Liability policy shall be Primary and Nan -Contributory to any other insurance available to the Additional Insureds where required by written contract. Waiver of Subrogation in favor of the Additional Insureds shall apply to the Workers' Compensation policy,as permitted by law where required by written contract. City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 GANGt 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 @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Additional Insured — Automatic — Owners, Lessees Or Contractors 0 ZURICH Policy No. Eff, Date of Pal. Exp. Date of Pol. Eft: Date of End. Producer No. AMA. Prem Retum Prem. GL00285992-08 06/01/2023 06/01/2024 1 18232000 INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: FRONTIER COMMUNICATIONS PARENT, INC. Address (including ZIP Code): 401 MERRITT 7 NORWALK, CT 06851 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products -completed operations hazard", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. U-GL-1175-F CW (04113) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit'. This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. U-GL-1175-F CW (04/13) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission Other Insurance Amendment — Primary And Non - Contributory ZURICH� Policy No. Ef. Date of Pol. ExI3. Date of Pol. Eff. Date of End. Producer No. AddT Prem Return Prem. GLO 0285992-05 06/01/2023 06/01/2024 18232000 INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: FRONTIER COMMUNICATIONS PARENT, INC. Address (including ZIP Code): 401 MERRITT 7 NORWALK, CT 06851 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part 1. The following paragraph is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is primary insurance to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by a written contract or written agreement that this insurance would be primary and would not seek contribution from any any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. All other terms and conditions of this policy remain unchanged. U-GL-1327-8 CW (04/13) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 undera written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT, OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION 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 06-01-23 Policy No. WC 0285988-06 Endorsement No. Insured FRONTIER COMMUNICATIONS PARENT. INC. Premium $ INCL . Insurance Company AMERICAN ZURICH INSURANCE COMPANY DocuSlgnedby: Countersigned By Ew au%ro-1 We 00 03 13 (Ed. 4-84) 0 1983 National Council on Compensation Insurance. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 w0rk under a written, contract that requ ires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT, OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION 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 06-01-23 Policy No. WC 0285989-06 Endorsement No. Insured FRONTIER COMMUNICATIONS PARENT, INC. Premium $ INCL. Insurance Company ZURICH AMERICAN INSURANCE COMPANY 6vca5lanadby �� Gawtpa Countersigned By l4i[i1962E2323d69 . WC000313 (Ed.4-84) 0 1983 National Council on Compensation Insurance.