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ENC2023-1006CALIFORNIA ENCROACHMENT PERMIT PUBLIC WORKS CONSTRUCTION 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/or APPROVED SUBDIVISIONS. DATE: 09/14/2023 LOCATION OF CONSTRUCTION: Jefferson St, Ave 58, Monroe, and Madison St PURPOSE OF CONSTRUCTION: Traffic control for bicycling component of Triathlon on Oct 21, 2023 DESCRIPTION OF CONSTRUCTION: Traffic control for Alpha Win Triathlon at Lake Cahuilla Veterans Regional Park APPROXIMATE TIME WHEN WORK WILL BEGIN: 10/21/2023 DATE OF COMPLETION: 10/21/2023 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. ALPHA WIN Jonathan Viola Name of Applicant TOPS N BARRICADES INC Name of Contractor 787664 Contractor's License No. Everest National Insurance Applicant's Insurance Company FEES Traffic Control Technology Enhancement Fee Technology Enhancement Fee TOTAL: 319 MAIN STREET, SAUGERTIES, NY 12477 (845) 247-7275 Business Address 44631 Jackson Street, Indio, CA 92201 Business Address $707.00 $8.00 $8.00 $723.00 LIC-0103875 City Business License No. S18ML02108-231 Policy Number Telephone No. (760) 347-2111 Telephone No. PERMIT NO: ENC2023-1006 DATE ISSUED: 10/17/2023 EXPIRATION DATE: 10/16/2024 BY: Amy Yu If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. OF LA QUINTA LAKE CAH U I ENTRY 1SON ST. MONROE ST. X4 11\1T►, JACKSON ST. V ST. 03 CT0:777 A 1CONTROL .01 THE � oas A POLICE OFFICER SHALL BE POSTED AT EACH END OF THIS SECTION. THE PARTICIPANTS WILL COME FROM THE LAKE AND STAY OF THE SIDE OF THE ROAD OPPOSITE THE LAKE WHILE THE OFFICERS DIRECT VEHICLE TRAFFIC, ONE DIRECTION AT A TIME ON THE LAKE SIDE OF THE ROAD. AS THE PARTICIPANTS RETURN, THEY WILL STAY ON THE LAKE SIDE OF THE ROAD WHILE THE OFFICERS DIRECT VEHICLE TRAFFIC, ONE DIRECTION AT A TIME ON THE SIDE OPPOSITE OF THE LAKE. BIKES & CARS WILL BE SEPARATED BY DELINEATORS WITH TAPE STRUNG BETWEEN THEM ON THE STRAIGHT SECTION AND CROWD CONTROL BARRICADES ON THE CURVE & HILL Alpha Win Triathlon Palm Alpha Win xx '�l Johnathan 601-540-677 Tops N Barricades, Inc. (800)852-TOPS Ran Fifield 1 of 2 REV 10/09/23 To Be Issued on Approval 4-OPEN ROUTE a SPRINT ROUTE aOLYMPIC ROUTE ♦ HALF ROUTE G- TRAFFIC DIRECTION POLICE fftVOLUNTEER OFFICER CROWD CONTROL BARRICADE NOTES: 1. ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH REVISION 7 OF THE 2014 CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROLS Ca,(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 AND/OR COUNTY OF RIVERSIDE 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. PARTICIPANTS SHALL FOLLOW ALL TRAFFIC LAWS. 5. ACCESS TO PRIVATE PROPERTY SHALL BE MAINTAINED ATALL TIMES. AVE fit EAST OF JACKSON HAS CNLY 3 HOUSES ON IT AND ISADEAD END ROAD. REPRESENTATIVE FROM HITS SHALL CONTACT THEM IN ADVANCE AND ADVISE THEM OF THE LIMITED ACCESS DURING THE EVENT. THERE WILL HAVE TO BE A GAP IN THE CLOSURE BARRICADES FOR EMERGENCY VEHICLE ACCESS, 6. THIS TRAFFIC CONTROL SHALL BE IN PLACE DURING EVENT HOURS ONLY. THE EVENT IS ON SATURDAY OCT 21, 7:30 AM TO 5:30 PM., ALL TRAFFIC CONTROL DEVICES USED DURING HOURS OF DARKNESS SHALL BE RETRO- REFLECTIVE, ALL CYCLISTS SHALL, WEAR RETRO-REFLECTIVE GARMENTS DURING HOURS OF DARKNESS AND BICYCLES SHALL BE EQUIPPED WITH HEADLAMPS & TAIL LAMPS AS REQUIRED BY THE CALIFORNIA VEHICLE CODE., 7. CYCLISTS SHALL RIDE WITH TRAFFIC IN THE BIKE LANES WHEN AVAILABLE OR ON THE RIGHT HAND SHOULDER. 8, A POLICE OFFICER OR VOLUNTEER SHALL BE POSTED AT EACH INTERSECTION ALONG THE ROUTE, THE OFFICER IS REQUESTED TO STOP TRAFFIC FOR THE CYCLISTS TO CONTINUE THE RACE. FOR THE BIKE M COURSE k'� J TO SHEET Z 2 City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2023-1006 The following shall always apply: ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within the City of La Quinta's right of way ONLY. Whenever construction extends within private property, it is the responsibility of the permittee for his contractors to secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work. TRACK -LAYING CONSTRUCTION EQUIPMENT: Cleated track -laying construction equipment shall not be permitted to operate on any paved surface unless fitted with smoother -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect the paving during excavations. Rubber -tired equipment only shall be used in backfill operation in paved areas. If the existing pavement is scarred, spalled, or broken during the term of this contract or if the pavement is marred, City of La Quinta shall request that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2") of A.C. surfacing plus appropriate seal coat as specified above. PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City Engineer or City of La Quinta Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration of the project. The City shall be notified twenty-four hours (24) in advance of any traffic detours or delineation. CARE OF DRAINAGE STRUCTURES: Any drainage structure to include corrugated metal pipe, concrete pipe, steel culvert and concrete structures encountered during excavation which necessitate removal shall be replaced in kind. In the event it becomes necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work. Drainage structures and open drains shall be kept free of debris at all times for proper drainage. RIGHT-OF-WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill and compaction. Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used immediately after backfill. DE -WATER OPERTATIONS: If de -watering operations are required and pumps are forcing water on City of La Quinta roads, it shall be the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary. CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited access for the adjoining property owners and emergency vehicles. In the event it is felt by the permittee that he must close a street for any length of time, permittee shall contact this office to obtain the necessary permission. SPECIAL PROVISIONS The following shall apply when indicated: ® R1 NOTIFICATION: Permittee shall notify the City at (760) 777 - 7097 at least forty-eight hours (48) in advance of starting construction. ® R2 UTILITY CLEARANCE: (Substructures) Prior to making any excavations within the City of La Quinta right-of-way authorized by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures. Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility of the permittee. ❑ R3 UTILITY CLEARANCE (Surface Structures) No work shall be done under this permit until all utilities are clear of the proposed work site. The permittee shall notify all concerned utility companies of the proposed work. ❑ R4 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced with ( ** N/A ** ) inches of A.C. paving placed on ( ** N/A ** ) inches of ( ** N/A ** ) aggregate sub -base course having an "R" value of not less than ( ** N/A **) and in conformance with the City of La Quinta Road Improvement Standards and Specifications, Ordinance #461. ❑ R5 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of one-fourth inch ('/d') to one foot (1'). ❑ R6 GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades as established by a licensed engineer. ❑ R7 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter (** N/A **) feet shall be removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207. ❑ R8 DRIVEWAYS: A.C. driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the property line and the existing road paving shall be two and a half inches (2 ''/2") of A.C. paving on (** N/A **) of class (** N/A ** ) aggregate base. ® R9 SIGHT CLEARANCE: Sight Clearance of six -hundred feet (600') in all directions shall be assured and maintained at all times. ❑ R10 SOIL STERILIZER: The area to be surfaced shall be treated with soil strerilizer. Rate of application shall comply with the manufacturer's specifications. City of La Quinta ® R11 COORDINATE WORK: The proposed work shall be subordinated to any operation, which the State of California or City of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects. ❑ R12 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the centerline of all streets or property lines when included shall be completely tied out so they may be readily and correctly, replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall be notified upon completion or replacement of all survey monuments for proper clearance. ❑ R13 PAVEMENT CUTTING: Pavement will be mechanically saw cut to a straight edge prior to excavation. Method of pavement cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment be used to excavate prior to cutting or pavement.) Excavation material shall be placed in such a position as to best facilitate the general flow traffic. Prior to final paving operations, any damage to pavement straight edges shall be corrected. ❑ R14 LIMIT OF EXCAVATIONS: Excavations shall be limited to one -thousand feet (1000') of open trench before backfill operations must begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays for the protection of the traveling public. The Public Works Inspector shall determine the suitability of excavation barricading in each case. No excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction material is actually on the work site. ❑ R15 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes of producing and adequately consolidated backfill. Ant material which the City of La Quinta deems unsuitable (spongy or saturated material) which is encountered during excavation shall not be used for backfill, but shall be supplemented or replaced by an approved sand or gravel. ❑ R16 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed on lifts not greater than three feet (3') and vibrated using vibrostamper or equivalent equipment. Alternate methods may be substituted, but in any case, a relative compaction of ninety-five percent (95%) shall be maintained with the structural section of the roadway. ❑ R17 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than fifty percent (50%) of the total depth of the trench before flooding or a maximum of five feet (5) lifts where trenches are of excessive depths. Care is to be exercised that the backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the resulting compaction shall not be less than ninety percent (90%) or equivalent to the surrounding ground, whichever is the greater compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water supply shall be continuos. ❑ R18 COMPACTION TESTS: If so required by the inspector, compaction test shall be made at intervals of not more than one - thousand (1000') feet and a maximum of one (1) test on each road. One (1) copy of each test shall be forwarded tot the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ❑ R19 COMPACTION TESTS: If so required by the Inspector, compaction tests shall be made for each crossing or service line. One (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Sections 6.3.001 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ❑ R20 TEMPORARY PAVEMENT REPAIRS: After completion of Backfill and compaction operations, a temporary patch consisting of two inches (2") of SC-800 shall be placed on a prepared sub -grade. The SC-800 temporary paving shall be placed after a maximum of three -thousand linear feet (3000') or trench has been excavated and backfill operations completed, but in no case shall the placement of the temporary pavement exceed a five (5) day limit. ❑ R21 PERMANENT PAVEMENT REPAIR: After backfill and compaction have been completed, a temporary patch consisting of two inches (2") of SC-800 shall be placed immediately. A permanent patch of 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. ENC2023-1006 Alpha Win Triathlon /Temp Traffic Control / Lake Cahuilla, Ave 58, Monroe St, and Madison St In addition to the standard permit conditions, the following shall apply: 1. The applicant shall be available during the event by phone at (845) 247-7275. 2. 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. 3. Alpha Win (Jonathan Viola), hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. 4. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 5. The permittee shall remove all signs immediately after the completion of the event. Sign removal should be accomplished by the completion of the event on October 21, 2023. 6. The Permittee shall contact the City Traffic Signal Division at (760) 777-7070 if signal operation at the intersection is to be altered in any way. 7. The permittee is responsible for obtaining a valid separate permit from the California Department of Transportation Department (CalTrans), other City, or County jurisdictions if any of the work or traffic control devices extend into the CalTrans, other City, or County right of way. 8. 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. 9. 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 without Public Works Director approval. Special Conditions Page 1 of 2 PERMIT NO. ENC2023-1006 Alpha Win Triathlon /Temp Traffic Control / Lake Cahuilla, Ave 58, Monroe St, and Madison St 10. 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. 11. Should additional work, materials, or modifications of the work be required in order to meet City standards, safety requirements, signage requirements, or to fit actual field conditions, the work shall be performed by the Permittee as directed by and to the satisfaction of the City Engineer at no cost to the City of La Quinta. 12. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts provided in the 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. 13. The applicant shall provide informative message boards on Madison St and Monroe St for the Bike Course and other locations as shown on the traffic control plan for the Run Course informing the commuters of possible traffic delays due to this event and time of the event. The message board shall be provided for the commuters 48 hours prior to the start of event. 14. 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. 15. Pursuant to Section 14.16.370 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), backfill compaction within street rights -of -way shall conform to Section 306-1.3 of the latest edition of the Standard Specifications for Public Works Construction (SSPWC), except as otherwise specified herein. No excavation or backfill will be required on this project. Reapply if excavation is required. 16. All landscaping, irrigation, decorative rock, decorative concrete, sidewalk, lighting, etc., shall be replaced to its original condition. 17. Access and egress to all local properties shall be maintained at all times. 18. 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. 19. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 20. The permittee shall indemnify, hold harmless and assume the defense of the City from all damages, delay costs, costs or expenses in law or equity that may arise out of work under this permit. Special Conditions Page 2 of 2 / A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 4/25/2023 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 Insurance Office of America, Inc. 1855 West State Road 434 Longwood FL 32750 CONTACT NAME: PHONE FFAX A/C No Ext : A/C No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Everest National Insurance Company 10120 License#: OE67768 INSURED USATRIA-01 USA Triathlon of Colorado INSURERB: United States Fire Insurance Company 21113 5825 Delmonico Dr INSURERC: INSURER D: Colorado Springs CO 80919 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:2145019782 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y S18ML02108-231 1/1/2023 1/1/2024 EACH OCCURRENCE $1,000,000 Fv� CLAIMS -MADE OCCUR DAMAGE TO PREMISES('a a oNcur ence)$ 1,000,000 MED EXP (Any one person) $ Excluded 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 X $ OTHER: Event AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ 4077887933 A UMBRELLA LIAB X OCCUR Y Y S18EX01472-231 1/1/2023 1/1/2024 EACH OCCURRENCE $10,000,000 X AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Participant Accident US1929842 1/1/2023 1/1/2024 Accident Medical 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage applies to the USA Triathlon sanctioned or approved event specified on this certificate. The certificate holder is an additional insured, where required by written contract or agreement, but only with respect to the operations of the named insured, and subject to the provisions and limitations of form ECG20 600 - Additional Insured - Blanket when required by written contract, but only with respect to the USAT sanctioned or approved event specified on this certificate. The General Liability policy is primary as per Form ECG24 520 (04/02)and the General Liability policy contains Form ECG24 522 (04/02): Waiver of Transfer of Rights of Recovery Against others to US, but only as required by written contract or agreement executed by the named insured prior to an occurrence resulting See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of La Quinta and its Employees 78-495 Calle Tampico La Quinta CA 92253 AUTHORIZED REPRESENTATIVE Y4�i �i4+ni,Z�i� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: USATRIA-01 LOC #: ,a`oRo° ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Insurance Office of America, Inc. USA Triathlon of Colorado 5825 Delmonico Dr POLICY NUMBER Colorado Springs CO 80919 CARRIER I NAIC CODE EFFECTIVE DATE: kDDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE in a loss or a claim. Alpha Win - Palm Springs, CA 1 2023-10-20 1 2023-10-21 1 La Quinta, CA 92253 Page 1 of 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A� �® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/18/2023 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 Insurance Naccarato NAME: The NaccaratDInsurance Agency, Inc. a'C ao E (845)246-7134 AID No): (845)246-0852 E-MAIL ADDRESS: 100 Ulster Avenue INSURER(S) AFFORDING COVERAGE NAIC # PO Box 263 INSURERA: Progressive Casualty Insurance 24260 Saugerties NY 12477 INSURED INSURER B : INSURER C : Genzhomes Inc INSURER D : dba Alpha Win INSURER E: 319 Main Street INSURER F : Saugerties NY 12477 COVERAGES CERTIFICATE NUMBER: CL2381841032 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 INSURANCEADULIbUtSIR INSD WVD POLICY NUMBER POLICY EFF MMIODIYYYY POLICY EXP MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ AMA N CLAIMS -MADE OCCUR PREMISES Ea occurrence S MED EXP (Any one person) S PERSONAL B ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ POLICY ❑ PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG S S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident g 2,000,OOD BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y Y 03259757-2 02/10/2023 02/10/2024 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY r $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED I I RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ElN OFFICER/MEMBER EXCLUDED? / A E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) L9GlliL'a 111 L'1D.L9li1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of La Quinta ACCORDANCE WITH THE POLICY PROVISIONS. 78-495 Calle Tampico AUTHORIZEFSENTATIVE La Quinta CA 92253 n eeoo a 4E Arnon rnoononrinru All .:..tia� ..........,.a ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/21/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Marc VanBuren United States Insurance Services PHONE FAX IC No Ext : A/C No): A/C, E-MAIL ADDRESS: 1190 Winterson Road, Suite 100 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Zurich American Insurance Company Linthicum MD 21090 INSURED Genzhomes Inc INSURER B : 319 Main ST INSURER C : INSURER D : INSURER E : Saugerties NY 12477 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY r r DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE1:1 OCCUR I I MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC JECT $ AUTOMOBILE LIABILITY F F COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR F F EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE El OFFICE/MEMBER EXCLUDED? N / A WC 5579017-00 03/27/2023 11/10/2023 x WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 F F DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of La Quinta SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 78-495 Calle Tampico ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE La Quinta CA 92253 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY ECG 20 600 05 09 THIS ENDORSEMENT CHANGES THE COVERAGE PART. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or or- ganization with whom you have a written agree- ment that such person or organization be added as an additional insured on your Coverage Part. Such person or organization is an additional in- sured only with respect to liability for "bodily in- jury", "property damage" or "personal and advertis- ing injury" but only to the extent 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 operations for an addi- tional insured. B. The insurance afforded to an additional insured shall only include the insurance required by the terms of the written agreement and shall not be broader than the coverage provided within the terms of the Coverage Part. C. The Limits of Insurance afforded to an additional insured shall be the lesser of the following: 1. The Limits of Insurance required by the written agreement between the parties; or 2. The Limits of Insurance provided by this Cov- erage Part. D. With respect to the insurance afforded to an addi- tional insured, this insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of any act or omis- sion of an additional insured or any of its employ- ees. ECG 20 600 05 09 Copyright, Everest Reinsurance Company 2009 Page 1 of 1 ❑ Includes copyrighted material of Insurance Services Office, Inc., used with its permission. INSURED COPY COMMERCIAL GENERAL LIABILITY ECG 24 522 04 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV —COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your operations or "your work" done under a written agreement that requires you to waive your rights of recovery. The written agreement must be made prior to the date of the 'occurrence". This waiver applies only to the person or organization shown in the Schedule above. ECG 24 522 04 02 Includes copyrighted material of Insurance Services Office, Page 1 of 1 ❑ Inc., with its permission. INSURED COPY COMMERCIAL GENERAL LIABILITY ECG 24 520 04 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - OTHER INSURANCE (PRIMARY NONCONTRIBUTORY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph a. Primary Insurance of 4. Other Insur- ance of SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONSis replaced by the following: a. Primary Insurance This insurance is primary except when b. below applies. If this insurance is primary, our obliga- tions are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method de- scribed in c. below, except that we will not seek contribution from any party with whom you have agreed in a written contract or agreement that this insurance will be primary and noncon- tributory, if the written contract or agreement was made prior to the subject `occurrence" or offense. ECG 24 520 04 02 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 ❑ with its permission. INSURED COPY \\ 1\ i `II 1� I�u m � m lu IL IL WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC 00 03 13 (Ed. 04-84) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) 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 06/12/2023 Insured Genzhomes Inc Policy No. WC 5579017 - 00 Insurance Company Zurich American Insurance Company Countersigned by Endorsement No. Premium $ WC124 (4-84) Copyright 1983 National Council on Compensation Insurance, Inc. WC 00 03 13 Page 1 of 1 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4 84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 06/12/2023 at 12:01 A.M. standard time, forms a part of (DATE) Policy No. WC 5579017 - 00 of the Zurich American Insurance Company (NAME OF INSURANCE COMPANY) issued to Genzhomes Inc Premium (if any) $ Endorsement No. Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be due on such remuneration Person or Organization ALL CA Operations % of the California workers' compensation premium otherwise Schedule Job Description WC 04 03 06 (Ed. 4-84) Page 1 of 1