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ENC2023-1030CALIFORNIA 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: 12/11 /2023 LOCATION OF CONSTRUCTION: JEFFERSON STREET NORTH OF CHANNEL PURPOSE OF CONSTRUCTION: SEWER LATERAL TIE-IN ICLUDING NEW 48" MANHOLE DESCRIPTION OF CONSTRUCTION: PM 37891 JEFFERSON ST APARTMENTS; SEWER LATERAL TIE-IN ICLUDING NE 48" MANHOLE APPROXIMATE TIME WHEN WORK WILL BEGIN: 12/18/2023 DATE OF COMPLETION: 01/18/2024 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. B L WILSON BACKHOE SERVICE Brice Wilson Name of Applicant B L WILSON BACKHOE SERVICE Brice Wilson Name of Contractor Contractor's License No. State National Insurance Cc Applicant's Insurance Company FEES Technology Enhancement Fee Traffic Control Sewer and Water Encroachment Fee TOTAL: 80340 AVE 43 P O BOX 1687, Indio, CA 92201 (760) 347-6946 Business Address Telephone No. 80340 AVE 43 P O BOX 1687, Indio, CA 92201 (760) 347-6946 Business Address $8.00 $1,109.00 $1,465.00 $2,582.00 Telephone No. LIC-0002427 City Business License No. NXTJCLY90Q-02-GL Policy Number PERMIT NO: ENC2023-1030 DATE ISSUED: 12/18/2023 EXPIRATION DATE: 12/18/2024 BY: Amy Yu If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. W20.1 A WORK C30 c20-2 Sewer Line to New Apartments END ftm coded ROADWORK J Brice Wilson Brice 760-275-1568 iMftCmWDmWby Ptep-I9y ch@*d4 Tops N Barricades, Inc. Ron Fifield Ph" spew uffft 00 shMNLffnber (800)852-TOPS 50 11/28/23 1 REV LEFT LANE MUST W1-6 \ LLj1mr-'=1 co! :�q� G20-2 END ROADWORK �I ?R' Cam' WESTWARD HO DR 600' INDIAN SPRINGS DR y�x NO SCALE LEFT LAN MUST 500' Q�(WESS1 SRO Fyn V24577 CITY INDIO F c: s S°�1 CIVIL �0���� I �RDAo� Lu AUGU�STA w2o_1 OF CAST f j C20 +J (cAj (LT) a R3-7 I + y \AIIEq[I LUTLANE Lu MUST J NT 200' 600' 325' CITY OF LA QUINTA iK W20-1 C20 (CA) (LT) /-\ 2 � F 011.0 ✓LEFTL3E[I LANE �" AHEAD C- 500' 500' JEFFERSON ST CITY OF CITY OF INDIO END2 Ex;sT;Nc I N D I O W20-1 ROAD WORK vzo•1 ww> W20-1 PEBBLE D20.2 END BEACH DR ROADWORi �AHEAD HIGHWAY 111 W20.1 (REDUCED TO FIT) w2 0-1 �✓ >eoaa \ �ti END "� WORK, HOME 1. ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH REVISION 7 OF THE 2014 CALIFORN[A 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 SAFETYAND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF INDIO AND/OR CITY OF LA QUINTA REPRESENTATIVE, 3. THROUGHOUT EACH WORK PERIOD, CONTRACTOR SHALL INSPECTTRAFFIC CONTROL (SIGNS, BARRICADES AND DELINEATORS) AND MAINTAIN SAME IN ACCORDANCE WITH TRAFFIC CONTROL PLANS. 4. CONTRACTOR SHALL MAINTAIN A MINIMUM 12' 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. WORK HOURS SHALL BE DETERMINED BY THE CITY AGENCIES 7 ANYTRAFFIC CONTROL DEVICES USED DURING HOURS OF DARKNESS SHALL BE RETRO-REFLECTIVE AND ALL BARRICADES SHALL BE EQUIPPED WITH FLASHING LIGHTS. 8. THE CONTRACTOR SHALL CONTACT THE CVAG REGIONAL TRAFFIC MANAGEMENT CENTER AND BOTH CITIES AT LEAST 3 DAYS IN ADVANCE FCR SIGNAL TIMING ADJUSTMENTS. FI SRTA JEFFERSON ST E2 -2 END NOTES; W20.1 HIGHWAY ill ROAD (REDUCED To FIT) 1�FORK c20-2 HO M E AHEAD ENn T ROAn WORK DEPOT 500, kQn M G20-2 £HD R0AD WORK (CA) C20 (CA) (RT) I /RIGH2LAN1 AHEAD VISTA aHFan R9.11A LT SIOEWALKr1UH GRANDE AHEAD 4— A n CROSS HERE W20-1 Rf3AD �, WORK AHEAD 1. ALL TRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH REVISION 7 OF THE 2014 CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIAM.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 INDIO AND10R 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 12' 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. WORK HOURS SHALL BE DETERMINED BY THE CITYAGENCIES 7- ANY TRAFFIC CONTROL DEVICES USED DURING HOURS OF DARKNESS SHALL BE RETRO-REFLECTIVE AND ALL BARRICADES SHALL BE EQUIPPED WITH FLASHING LIGHTS. 8, THE CONTRACTOR SHALL CONTACT THE CVAG REGIONAL TRAFFIC MANAGEMENT CENTER AND BOTH CITIES AT LEAST 3 DAYS IN ADVANCE FORANY SIGNAL TIMING ADJUSTMENTS. 1fLe! NO SCALE -13 24577 RffiiWW By Appr-W By PNM Number {x " Tmft Cmw Ran far CMS Sewer Line to New Apartments �`Q FOF CAL% � Brice Wilson Brice 760-275-1568 Tmft CmW DUO by PMWW By Checked By t'�12-pt3 Tops N Barricades, Inc. Ron Fifield Phone Speed urra Date Sheet Number (800)852-TOPS 50 11/28/23 2A City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2023-1030 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 OPERATIONS: 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 be notified 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. 1. 2. 3. L� 5. 31 PERMIT NO. ENC2023-1030 Jefferson Street Apartments /Sewer Lateral Tie -In and New 48" Manhole / PM 37891; Jefferson St North of the Channel In addition to the standard permit conditions, the following shall apply: All work shall be performed in accordance with the latest edition of the Standard Specifications for Public Works Construction (SSPWC) and as directed by and to the satisfaction of the City Engineer. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during the actual work performed. The 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. Kin Yu and/or Brice L Wilson dba B L Wilson Backhoe Service, hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 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) neither before 8:00 a.m. nor after 4:30 p.m. 7. 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. 8. In accordance with the latest edition of the Standard Specifications for Public Works Construction (SSPWC), the 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. The permittee is responsible for obtaining a valid separate permit from other Cities, County jurisdictions, or other agencies if any of the work or traffic control devices extend into the other Cities, County, or agencies right of way. 10. The permittee shall submit inspection requests by calling the City Inspection Hotline at (760) 777-7097 before 1:30 p.m. at least 24hrs prior to the anticipated inspection. Special Conditions Page 1 of 7 PERMIT NO. ENC2023-1030 Jefferson Street Apartments /Sewer Lateral Tie -In and New 48" Manhole / PM 37891; Jefferson St North of the Channel 11. 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 12. 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. 13. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 1-800-422- 4133. It shall be the Permittee's responsibility to notify the Public Works Department of anticipated excavation which impact City facilities, including but not limited to traffic signal conduits and loops, irrigation lines, electrical conduits, and storm drain facilities. 14. 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 Pennittee as directed by and to the satisfaction of the City Engineer at no cost to the City of La Quinta. 15. The permittee shall be responsible for calling the city inspector to arrange the city inspector to observe random trench compaction testing performed by a city approved material testing firm. If the inspector's phone number is unknown, the permittee shall call the Public Works front counter phone at 777-7075 or the Assistant Civil Engineer at 777-7047 to determine the city inspector's phone number. The inspector shall determine the number and location of the test location/s. The above testing does not relieve the permittee's responsibility for future repairs due to settlement at and near the locations of the work area. Materials testing must be performed under direct supervision of a California Registered Civil Engineer. Special Conditions Page 2 of 7 PERMIT NO. ENC2023-1030 Jefferson Street Apartments /Sewer Lateral Tie -In and New 48" Manhole / PM 37891; Jefferson St North of the Channel 16. The permittee shall not encroach upon private property without prior written approval of the private land owner whom is being encroached upon. A copy of the authorization letter shall be provided to the city prior to start of the work. 17. 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 18. 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. 19. The permittee and/or contractor placing engineered fill must provide adequate time and safety for the Geotechnical Engineer of Record to perform soils testing during engineered fill placement. The testing frequency shall be determined by the Geotechnical Engineer of Record such that the fill can be determined to be placed according to the city approved plans. 20. At the approval of the City Engineer, during work hours and when no lanes are provided in the work area, the permittee shall provide and maintain a traffic lane that diverts traffic off the paved roadway. The traffic lane must be located within the existing R/W with the following requirements: a. Class II Base with a minimum depth of 2" b. A 12 inch thick subgrade layer compacted to 95% based on ASTM D 1557 c. An unobstructed travel width of 10 feet. d. In addition, a minimum of 5 feet clearance from open trenches. e. A minimum of 2 feet from vertical obstructions like curbs. f. Maximum speed of 25 mph Without the approval of the City Engineer, the permittee must maintain a drivable surface made of existing Asphalt Concrete or Portland Concrete. 21. 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. 22. Prior to excavating in native soils, the owner of the project shall have employed an archaeological observer for the site excavations within native undisturbed soils. The name of the archaeological observer must be submitted to the Public Works Department and attention this to the Associate Engineer. If the archaeologist determines the site is not to be required to be observed, please submit a letter signed by the archaeologist stating their determination. Special Conditions Page 3 of 7 PERMIT NO. ENC2023-1030 Jefferson Street Apartments /Sewer Lateral Tie -In and New 48" Manhole / PM 37891; Jefferson St North of the Channel 23. 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. 24. The permittee is required to provide an informative message board (approved by the City Engineer) informing the commuters using the affected roadways 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. 25. Pursuant to Section 14.16.370 of the La Quinta Municipal Code (Ordinance 10 § I (part), 1982), backfill compaction within street rights -of -way shall conform with Section 306-1.3 of the latest edition of the Standard Specifications For Public Works Construction (SSPWC), except as otherwise specified herein. Native material may be used as backfill material provided that minimum compaction, achieved in the manner prescribed herein, is achieved. Backfill shall be performed by mechanical means; no water densified compaction via jetting or flooding or other means shall be allowed. It shall be the Permittee's responsibility to provide appropriate geotechnical supervision, testing, and inspection, onsite, at all times during backfill operations. Backfill compaction shall be achieved by the following conditions: A. When a firm foundation is not encountered due to soft, spongy or other unsuitable material, such material shall be removed to the limits directed by the Geotechnical Inspector and/or the City Inspector and the resulting excavation backfilled with pipe bedding material. B. Backfill materials shall be brought to or maintained at appropriate moisture content for compaction. The appropriate moisture content range shall be established at the onset of the project and ensured prior to use of the materials through progress testing on the stockpiles. C. The first length of trench backfilled shall be backfilled in the presence of the City Inspector. Compaction shall be tested at random depths at approximate three-foot vertical intervals as backfill is placed to ensure the effectiveness of the compaction methods and to establish the depth of lift that can be compacted. D. If lifts greater than one foot are attempted in this trial length of trench, compaction tests shall be taken within the lifts to ensure that the full depth of the lift is compacted. Upon satisfactory completion of this portion of trench, the City Inspector shall establish the maximum lift thickness to be compacted for the remainder of the project. E. In subsequent lengths of trench, the frequency of compaction tests shall equal one per each lift of backfill, per 300 linear feet of open trench, at randomly selected locations within the open length of trench. Special Conditions Page 4 of 7 PERMIT NO. SEW2016-0002 Floresta (Former Watermark) /Sewer Tie -In and On -Site Sewer Improvements /TM 36762; Northwest Corner of Jefferson St and Ave 52 F. The depth of the randomly selected compaction tests shall also be randomly selected except that where multiple tests are required in a given length of trench, the tests shall be no closer than three feet (vertically) from each other. G. If any compaction test fails, previously placed backfill (in the same length of open trench or previous lengths of trench) which is represented by the failing test (as determined by the City Inspector), shall be tested for compliance with compaction requirements. H. All costs incurred due to the conditions above shall be borne by the Permittee. Copies of all test results shall be furnished to the City Inspector. 26. 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. 27. 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. 28. All landscaping, irrigation, decorative rock, decorative concrete, sidewalk, lighting, etc., shall be replaced to its original condition. 29. Access and egress to all local properties shall be maintained at all times. 30. 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. Special Page 5 of 7 PERMIT NO. SEW2016-0002 Floresta (Former Watermark) /Sewer Tie -In and On -Site Sewer Improvements /TM 36762; Northwest Corner of Jefferson St and Ave 52 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. 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. 31. 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. 32. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 33. 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. 34. 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 party has acquired a permit from the City to perform the required restoration work. 35. 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 Page 6 of 7 PERMIT NO. SEW2016-0002 Floresta (Former Watermark) /Sewer Tie -In and On -Site Sewer Improvements /TM 36762; Northwest Corner of Jefferson St and Ave 52 36. 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. Special Page 7 of 7 ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/12/2023 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 Ascend Insurance Agency 36917 Cook St. Ste 101 CONTACT NAME:PHONAnabel Romero WC, No, Ext: (760)341-3477 A/C No; (760)341-3476 ADDRESS: anabel@ascendins.com Palm Desert, CA 92211 INSURER(S)AFFORDING COVERAGE NAIC# License #: OF44130 INSURERA: State National Insurance Company Inc. 12831 INSURED Brice L Wilson INSURER B: United Financial Cas Co. 11770 DBA: B L Wilson Backhoe Service INSURERC: 80340 Avenue 43 INSURER D : Indio, CA92201 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 00008483-283531 REVISION NUMBER: 12 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 D IN SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y NXTJCLY90Q-02-GL 04/20/2023 04/20/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR X DAMAGE TO RENTED PREMISES Ea occurrence $ 100 000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PE� LOC X PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY Y Y 01100184-02 10/03/2023 04/03/2024 Ea INED acccidentSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / 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 $ A Contractors E&O NXTJCLY90Q-02-GL 04/20/2023 04/20/2024 Aggregate Limit $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is an Additional Insured on the General Liability and Auto Liability policy per the Additional Insured Automatic Status Endorsement. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured, and are subject to policy terms and conditions. Waiver of Subrogation also applicable as per Blanket conditions. CERTIFICATE HOLDER CANCELLATION City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by ARC on 12/12/2023 at 01:38PM A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/13/2023 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 NAME: biBERK PHONE 844-472-0967 FAx 203-654-3613 o Ext : A/C No P.O. Box 113247 E-MAIL ADDRESS: customerservice@biBERK.com Stamford, CT 06911 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: National Liability & Fire Insurance Company 20052 INSURED BRICE WILSON INSURER B : BL WILSON BACKHOE SERVICE INSURERC: INSURER D 7 80340 AVE 43 INSURERE: Indio, CA 92201 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 INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 0 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 0 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0 POLICY ❑ PRO JECT ❑ LOG PRODUCTS - COMP/OP AGG $ 0 $ OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT 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 F $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ AOFFICER/MEMBER WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? 19 (Mandatory in NH) NIA X N9WC649489 07/18/2023 07/18/2024 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,�0�,0�0 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ Professional Liability (Errors & Per Occurrence/ Omissions): Claims -Made Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Exclusions: BRICE WILSON; Additional Named Insured:BL WILSON BACKHOE SERVICE A Blanket Waiver of Subrogation exists on this policy as it pertains to worker's compensation. (see endorsement attached) CERTIFICATE HOLDER CANCELLATION CITY OF LA QUINTA 78-495 Calle Tampico La Quinta, CA 92253 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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 1.00 _% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver - Any person or organization for whom the All CA Operations Named Insured has agreed by written contract to furnish this waiver. 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 Insured Policy No. N9WC649489 Insurance Company Countersigned By Endorsement No. ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. ASCEND INSURANCE 36917 COOK ST # 101 PALM DESERT, CA 92211 BRICE WILSON B.L.WILSON BACKHOE SERVIC 80340 AVENUE43 INDIO, CA 92201 Additional insured endorsement PROGREJ3ZYF' COMMERC/AL Policy number: 01100184 Underwritten by: United Financial Cas Co Insured: BRICE WILSON December 13, 2023 Policy Period: Oct 3, 2023 - Apr 3, 2024 Mailing Address United Financial Cas Co PO Box 94739 Cleveland. OH 44101 1-800-444-4487 Name of Person or Organization For customer service, 24 hours a day, City of La Quinta 7 days a week 78495 Calle Tampico La Quinta, CA 92253 This endorsement modifies insurance provided under the commercial auto policy and any endorsements thereto affording liability coverage. The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page and showing liability coverage. Limit of Liability Bodily Injury Not applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 01100184 Issued to (Name of Insured): BRICE WILSON B.L.WILSON BACKHOE SERVIC Effective date of endorsement: December 12, 2023 Policy expiration date: April 3, 2024 Form 1198 (07/16) ASCEND INSURANCE 36917 COOK ST # 101 PALM DESERT, CA 92211 BRICE WILSON B.L.WILSON BACKHOE SERVIC 80340 AVENUE43 INDIO, CA 92201 COMMERCIAL Policy number: 01100184 Underwritten by: United Financial Cas Co Insured: BRICE WILSON December 13, 2023 Policy Period: Oct 3, 2023 - Apr 3, 2024 Mailing Address United Financial Cas Co PO Box 94739 Cleveland, OH 44101 1-800-444-4487 For customer service, 24 hours a day, 7 days a week Waiver of Subrogation Endorsement This endorsement modifies insurance provided under the following: Commercial Auto Policy Motor Truck Cargo Liability Coverage Endorsement Commercial General Liability Coverage Endorsement We agree to waive any and all subrogation claims against the person or organization designated below. Name of Person or Organization: City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 This endorsement applies to policy number: 01100184 Issued to: BRICE WILSON B.L.WILSON BACKHOE SERVIC Endorsement effective: December 12, 2023 Expiration: April 3, 2024 All other terms, limits and provisions of this policy remain unchanged. Form 8610 (02/19) Policy Number: NXTJCLY90Q-02-GL COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION 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 organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. 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 for the additional insured. 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 contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the 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. CG 20 33 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, 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 contract or agreement you have entered into with the additional insured; 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 33 04 13 POLICY NUMBER: NXTJCLY90Q-02-GL COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization against whom you have agreed to waive such right of recovery in a written contract or agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: 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 ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ Policy Number: NXTJCLY90Q-02-GL COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II -WHO IS AN INSURED is amended to include the following as insureds: 1. Lessor of Leased Equipment Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured only with respect to their liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. No such person or organization is an insured under this section: a. Upon expiration or termination of their contract or agreement with you for such leased equipment ends; b. For any "bodily injury" or "property damage" caused by an "occurrence" which takes place after expiration or termination of their contract or agreement with you; or c. For any "personal and advertising injury" caused by an 'offense" which takes place after expiration or termination of their contract or agreement with you. 2. Managers or Lessors of Premises Any person or organization from whom you lease premises when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured only with respect to liability arising out of your ownership, maintenance or use of that part of the premises leased to you. No such person or organization is an insured under this section for any: a. For "bodily injury" or "property damage" caused by an 'occurrence" which takes place after you cease to be a tenant in that premises. b. Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 3. Grantor of Franchise Any person or organization (referred to below as grantor of a franchise) with whom you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy, but only with respect to "bodily injury" or "property damage" arising out of " liability as grantor of a franchise to you B. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III LIMITS OF INSURANCE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. NXT-0115 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 1 of 2 permission COMMERCIAL GENERAL LIABILITY C. With respect to the provisions of this endorsement, the following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance: Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary. All other terms and conditions of the policy remain unchanged. NXT-0115 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 2 of 2 permission Policy Number: NXTJCLY90Q-02-GL COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. A. 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 with respect to: a. Premises you own, rent, lease, or occupy; or b. Your ongoing operations performed for that insured. B. 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 contract or agreement to provide for such additional insured. C. The Limits of Insurance applicable to the additional insured are the lesser of those specified in: 1. The written contract or agreement; or 2. The Declarations for this policy, whichever is less. Such are included in, and not in addition to, the Limits of Insurance shown in the Declarations. D. Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary. All other terms and conditions of the policy remain unchanged. NXT-0308 BM GL 0619 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 1 of 1 permission