ENC2024-0006CALIFORNIA
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: 01 /11 /2024
LOCATION OF CONSTRUCTION: E/S/O DESERT CLUB DR AT AVENIDA LA FONDA
PURPOSE OF CONSTRUCTION: ACCESS MANHOLE TO SPLICE FIBER OPTIC CABLE
DESCRIPTION OF CONSTRUCTION: FRONTIER 70063-5348977; ACCESS MH#20 TO SPLICE FIBER OPTIC CABLE
APPROXIMATE TIME WHEN WORK WILL BEGIN: 02/08/2024 DATE OF COMPLETION: 03/08/2024
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.
DYNAMIC TELCO
ANDREA MAGANA
Name of Applicant
FRONTIER CALIFORNIA INC
Name of Contractor
488385
Contractor's License No.
VALLEY FORGE INSURAN
Applicant's Insurance Company
FEES
Credit Card Convenience Fee
Traffic Control
Technology Enhancement Fee
TOTAL:
1177 IDAHO ST STE 102, REDLANDS, CA 92374 (951) 992-1715
Business Address Telephone No.
7248 HARBOR WAY, GRANITE BAY, CA 95746 (916) 704-1202
Business Address Telephone No.
$9.25
$370.00
$8.00
$387.25
N/A
City Business License No.
7034725207
Policy Number
PERMIT NO: ENC2024-0006
DATE ISSUED: 01/26/2024
EXPIRATION DATE: 01/27/2025
BY: Amy Yu
If the work is covered by a Subdivision Improvement
Agreement, Subdivider shall request final acceptance of
improvements from the City Council.
5_.,
Work Area Traffic Control Handbook
Sidewalk Detour or Diversion
R9-11a
ADEWAU
CLOSED
RO-9
R9-11a
W20-1
l y � � (aptlonal)
VIL
SIDEWALK DETOUR
Note: See Tables 61-1-2 and 6111-3
for the meaning or the
symbols endlor letter
codes used In this figure.
CAMUTCD TA-28
SIDEWALK DIVERSION
DRIVEWAY TYPICAL
-------------
0 0 0 o a
0 a 0
0 a
o—
ALL DRIVEWAYS TO REMAIN OPEN (WHENEVER
POSSIBLE)
THROUGHOUT TRAFFIC CONTROL ZONE.
LEGEND
0
TRAFFIC CONE
®
WORK TRUCK
TEMPORARY SIGN
TYPE III BARRICADE
WITH SIGN
DIRECTION OF TRAVEL
O
SIGNALIZED
INTERSECTION
DIRECTION OF TRAVEL
(Existin Pavement Markin)
FLAGGER
9 9
® WORK AREA
HIGH LEVEL
FLASHING ARROW SIGN WARNING DEVICE
(FAS) (HLWD)
ti
0
Have flagman standing by to assist drivers
exiting WB La Fonda if equipment is parked in
the street blocking sight line for WB driver to
see approaching SB vehicles
SEE TABLE A
DESERT CLUB DR
(G2G2a-2 CURB OR EP, (25 MPH)
EDCE CF LANE
r- +
b
C.1*CA) Z y EDCE OF LANE
F M h h
"1 ":N E I: '�. - W21-5 ail-1/a•6-t G10-2
(CP71ONAL)
48-72 HRS PRIDR TO COMMENCING WFX
(IF REOUREC)
-0, MIN
HCLLDE4 TAPER L a CONMSTREAM
�.i
3 _ A. _ _ J_ _ HUFFER 5ACE 'AC13K AREA TAPER
fE TABLE A SEE TAF.LE A SEE TABLE 3 5C' MIN OR 50' MIN. /
TALLE D 100' MAX.
ROAD SHOULDER
AHEADK CLOSED
<&A>D
�I SHARE
THE
ROAD
W'I-I/A15-I
ROADND 7 WORK SHOULDER ('J E IF , 43.. LE
4a
VAORK SE DWG YO.�9
FOR DETAILS)
NOTE WORk CREARA THAN 15' FRON TRAYfIFll aaY O:ES NOT REO.IAE 7-'.
20 . Table A -Recommended Advance Warning Sign Spacing
Distance
a _
fn
U 2: 1
N . e AVENIDA LA FONDA
LIJ " 4 (30 MPH)
w
Ln
I'•: eao nl
LOCATION 1
WORK CREW TO UTILIZE THIS TCP TO ACCESS MH# 20 LOCATED ON THE
E/S/O DESERT CLUB DR @ AVENIDA LA FONDA TO SPLICE FIBER OPTIC
CABLE IN EXISTING SUBSTRUCTURE.
50' MIN.
RECOMMENDED DELINEATOR/CONE
& SIGN PLACEMENT
POSTED
MINIMUM TAPER LENGTH
MAXIMUM CHANNELIZER
MINIMUM SICN
SPEED
FOR 12-FT LANE
SPACING
SPACING
LIMIT
VERGING SHIFTING SHOULDER
TAPER TANGENT
(ADVANCE BTEEN SIGNS)
20 MPH
80 FT.
40 FT.
27 FT.
20 FT.
40 Fr.
100 FT.
25 MPH
125 FT.
63 FT.
42 FT.
25 FT.
50 FT.
100 FT.
30 MPH
I BD FT.
90 Fr.
60 Fr.
30 FT.
60 Fr.
250 FT.
35 MPH
245 FT.
123 FT.
82 FT.
35 FT.
70 FT.
250 FT.
40 MPH
320 FT.
16C FT.
107 FT.
40 FT.
80 FT.
250 FT.
4 45 MPH
540 Fr
270 FT
180 FT
15 FT
90 Fr.
350 FT.
4 50 MPH
500 FT.
300 FT
20E FT
5D Fr.
100 Fr.
350 FT.
4 55+MPH
560 FT.
35C FT.
22C FT
s" FT.
100 FT.
PER TABLE 'A'
Posted Speed
B
etween SIC Ins**
A g C
Urban 100 100 100
25 m h or less"
Urban 250 250 250
more than 25 mph to 40 mph-*
Urban more than 40 mph*** 350 350 350
Rural 500 500 500
ExpresswaylFreeway 1,000 1,500 2,640
Table B - Taner Lenoth Criteria for Temnorary Traffic Contra] Zones
Type of Taper
Table B - Taner Lenoth Criteria for Temnorary Traffic Contra] Zones
Type of Taper
Taper Length L
Merging Taper
at least L
Shifting Taper
at least 0.51L
Shoulder Taper
at least 0.33L
One -Lane, Two -Way Traffic Taper
50 feet minimum, 100 feet maximum
Downstream taper
50 feet min., 100 feet max. per lane
TCP
CONSTRUCTION NOTES:
1) WORK CREW TO UTILIZE THIS
TYPICAL FOR THE WORK LOCATION(S)
DEFNED TO THE LEFT.
2) WORK CREW TO UTILIZE STEEL
PLATES FOR VEHICLE INGRESS AND
EGRESS FOR DRIVEWAYS.
3) WORK CREW TO PLACE TEMPORARY
NO PARKING ANY TIME SIGNS ALONG
ENTIRE WORK AREA 72 HOURS BEFORE
CONSTRUCTION.
4) WORK CREW TO COMBINE TYPICALS
AS NEEDED TO ACHIEVE ADEQUATE
TRAFFIC CONTROL.
5) WORK CREW TO ROTATE TYPICALS
AS NEEDED TO MATCH STREET
CONDITIONS.
FRONTIERIIIIIIIIIIIII
Nor
COMMUNICATIONS
JOB ID: 70063-534897E 1 DATE: 01/11/2024
TITLE: TRAFFIC CONTROL PLAN
STREET ADDRESS: DESERT CLUB DR @ AVENIDA LA FONDA
CITY/STATE: LA QUINTA, CA 92253
FTR ENGINEER: RAUL RIVAS 909-406-3178
FTR INSPECTOR: MIKE REDDING 760-218-3902
DRAWN BY:
;1 DYNAMIC TELCO 951-992-1472
C/ EST. #: SHEET#:
NTS DYNAMIC TELCO I OF
I'0
10
Eel
+A'
VENTURA
CONSTRUCTION NOTE:
IN MH# 20 HEAT UP STRANDS F0001,101-102 FROM
THE EXISTING 144F IPID# 161028 TO THE EXISTING
24F DAT: 2094302.
�I
0
m
J
U
~I
W
N
W
1
0 MH# 20
FI • Al N DRAWN BY DYNAMIC TELCO
d FTR ENGINEER: RAUL RIVAS (909) 406-3178
FTR INSPECTOR: MIKE REDDING (760) 218-3902
_ AVENIDA LA FONDA �� ° UNITS /ACCT CODES
AVENIDA LA FON
i
I
CALLE ESTADO _
***ALL FACILITIES NOT PERTAINING TO THIS WORK ORDER WERE REMOVED FOR CLARITY***
REVISIONS
FRONTIER D
TLS-SPLICE AND PLACE
PSR# 3977865
NUMBER: 5348977
NUMB
C.O. AREA: LAQNCAXG
EXCH. CODE: LA QUINTA
DRAWN DATE:
1/912024
EIGR RAUL RIVAS
PHONE:909406-3178
CITY: RIVERSIDE
FILE: 334-70063-5348977.DWG
1
SCALE: 1:100
TAX DISTRICT: --
DWG 1 OF 2
TWNSHP: ----
RNG: ----
SEC: --
10
0
o�
I /
D
(CZ /O 2
y 5a
PB# 189 V -, �
0.9 KFT 50 0
TO C.O. a L_ J w
O O0
`� CITY OF LA QUINTA
78450 AVENIDA LA FONDA LA QUINTA
CA 92253 _
AVENIDA LA FONDA
I
D In
Im I�
m
c =
D C
***ALL FACILITIES NOT PERTAINING TO THIS WORK ORDER WERE REMOVED FOR CLARITY***
CONSTRUCTION NOTE:
IN PB# 189 PLACE +/- 232' OF NEW 48F CABLE
THROUGH THE EXISTING SUBSTRUCTURE TO THE
CUSTOMERS MPOE.
IN THE CUSTOMERS MPOE PLACE A NEW FDP.
IN PB# 189 HEAT UP STRANDS F0001,101-102 FROM
THE EXISTING 24F DAT: 2094302 TO THE NEW 48F
CABLE DAT: 5543502.
IN THE CUSTOMERS MPOE HEAT UP STRANDS
F0001,101-102 FROM THE NEW 48F CABLE DAT
5543502 TO THE NEW FDP 1699702.
TEST AND TAG FDP:
XD,1-4+
LAQNCAXG F0001,101-102+
XD.7-24
DRAWN BY DYNAMIC TELCO
FTR ENGINEER: RAUL RIVAS (909) 406-3178
UNITS /ACCT CODES I
REVISIONS
FRONTIER D
TLS-SPLICE AND PLACE
PSR# 3977865
PROJECNUMBER: 5348977
C.O. AREA: LAQNCAXG
EXCH. CODE: LA QUINTA
DRAWN DATE:
1/912024
ENGR: RAUL RIVAS
PHONE:909406-3178
CNTY: RIVERSIDE
FILE: 334-70063-5348977.DWG
2
SCALE: 1:100
ITWNSHP:
TAX DISTRICT: --
DWG 2 OF 2
----
RNG: ----
SEC: --
City of La Quinta
The following General and Special Provisions are attached to and made a part of
Permit Number ENC2024-0006
The followina shall always aDDIV.
ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within the City of La Quinta's right of way
ONLY. Whenever construction extends within private property, it is the responsibility of the permittee for his contractors to secure permission
from abutting property owners. Such authorization must be secured by the permittee prior to starting work.
TRACK -LAYING CONSTRUCTION EQUIPMENT: Cleated track -laying construction equipment shall not be permitted to operate on any paved
surface unless fitted with smoother -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect the paving
during excavations. Rubber -tired equipment only shall be used in backfill operation in paved areas. If the existing pavement is scarred, spalled,
or broken during the term of this contract or if the pavement is marred, City of La Quinta shall request that these portions of road be resurfaced
over their entire width. Resurfacing shall consist of one coat of two inches (2") of A.C. surfacing plus appropriate seal coat as specified above.
PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City
Engineer or City of La Quinta Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration of the
project. The City shall be notified twenty-four hours (24) in advance of any traffic detours or delineation.
CARE OF DRAINAGE STRUCTURES: Any drainage structure to include corrugated metal pipe, concrete pipe, steel culvert and concrete
structures encountered during excavation which necessitate removal shall be replaced in kind. In the event it becomes necessary to remove or
cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work. Drainage structures and open drains
shall be kept free of debris at all times for proper drainage.
RIGHT-OF-WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of way. All
paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill and compaction. Existing gutter line
and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed prior to paving. Water tanker
shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used immediately after backfill.
DE -WATER OPERTATIONS: If de -watering operations are required and pumps are forcing water on City of La Quinta roads, it shall be the
responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary.
CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited access for
the adjoining property owners and emergency vehicles. In the event it is felt by the permittee that he must close a street for any length of time,
permittee shall contact this office to obtain the necessary permission.
SPECIAL PROVISIONS
The following shall apply when indicated:
® R1 NOTIFICATION: Permittee shall notify the City at (760) 777 - 7097 at least forty-eight hours (48) in advance of starting
construction.
® R2 UTILITY CLEARANCE: (Substructures) Prior to making any excavations within the City of La Quinta right-of-way authorized
by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures.
Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility of the
permittee.
® R3 UTILITY CLEARANCE (Surface Structures) No work shall be done under this permit until all utilities are clear of the
proposed work site. The permittee shall notify all concerned utility companies of the proposed work.
❑ R4 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced
with ( ** N/A ** ) inches of A.C. paving placed on ( ** N/A ** ) inches of ( ** N/A ** ) aggregate sub -base course having an
"R" value of not less than ( ** N/A ") and in conformance with the City of La Quinta Road Improvement Standards and
Specifications, Ordinance #461.
❑ R5 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of
one-fourth inch ('/4") to one foot (1').
❑ R6 GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades as established by
a licensed engineer.
❑ R7 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter (** N/A **) feet shall
be removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and
concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207.
❑ R8 DRIVEWAYS: A.C. driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the property
line and the existing road paving shall be two and a half inches (2 '/2") of A.C. paving on (" N/A ") of class (" N/A " )
aggregate base.
® R9 SIGHT CLEARANCE: Sight Clearance of six -hundred feet (600') in all directions shall be assured and maintained at all
times.
❑ R10 SOIL STERILIZER: The area to be surfaced shall be treated with soil strerilizer. Rate of application shall comply with the
manufacturer's specifications.
City of La Quinta
® R11 COORDINATE WORK: The proposed work shall be subordinated to any operation, which the State of California or City of
La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La
Quinta forces to preclude delay or interference with State or City of La Quinta projects.
® R12 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the
centerline of all streets or property lines when included shall be completely tied out so they may be readily and correctly,
replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the ties
to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall be
notified upon completion or replacement of all survey monuments for proper clearance.
® R13 PAVEMENT CUTTING: Pavement will be mechanically saw cut to a straight edge prior to excavation. Method of pavement
cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment be
used to excavate prior to cutting or pavement.) Excavation material shall be placed in such a position as to best facilitate the
general flow traffic. Prior to final paving operations, any damage to pavement straight edges shall be corrected.
❑ R14 LIMIT OF EXCAVATIONS: Excavations shall be limited to one -thousand feet (1000') of open trench before backfill
operations must begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays for the
protection of the traveling public. The Public Works Inspector shall determine the suitability of excavation barricading in
each case. No excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the
construction material is actually on the work site.
® R15 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes
of producing and adequately consolidated backfill. Ant material which the City of La Quinta deems unsuitable (spongy or
saturated material) which is encountered during excavation shall not be used for backfill but shall be supplemented or
replaced by an approved sand or gravel.
❑ R16 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed on lifts not greater than
three feet (3') and vibrated using vibrostamper or equivalent equipment. Alternate methods may be substituted, but in any
case, a relative compaction of ninety-five percent (95%) shall be maintained with the structural section of the roadway.
❑ R17 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than fifty percent (50%) of the total depth of the
trench before flooding or a maximum of five feet (6) lifts where trenches are of excessive depths. Care is to be exercised
that the backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the
resulting compaction shall not be less than ninety percent (90%) or equivalent to the surrounding ground, whichever is the
greater compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to
retain the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water
supply shall be continuos.
❑ R18 COMPACTION TESTS: If so required by the inspector, compaction test shall be made at intervals of not more than one -
thousand (1000') feet and a maximum of one (1) test on each road. One (1) copy of each test shall be forwarded tot the City
Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section
6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973.
® R19 COMPACTION TESTS: If so required by the Inspector, compaction tests shall be made for each crossing or service line.
One (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs.
Compaction tests shall be made as outlined in Sections 6.3.001 of the Standard Specifications, Division of Highways, State
of California, dated January 1973.
® R20 TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch consisting
of two inches (2") of SC-800 shall be placed on a prepared sub -grade. The SC-800 temporary paving shall be placed after a
maximum of three -thousand linear feet (3000') or trench has been excavated and backfill operations completed, but in no
case shall the placement of the temporary pavement exceed a five (5) day limit.
® R21 PERMANENT PAVEMENT REPAIR: After backfill and compaction have been completed, a temporary patch consisting of
three inches (Y) of SC-800 shall be placed immediately. A permanent patch of Asphalt Concrete surfacing per City of La
Quinta Standard 600 shall be placed no later than ( 5 ) days after completion of temporary road repair.
❑ R22 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as
determined by the City Engineer.
❑ R23 STREET RESTRIPING: Where street striping is still visible on street to be excavated, such striping shall be replaced upon
completion of permanent repairs.
❑ R24 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right-of-way shall be accomplished
by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public. It
shall be the responsibility of the permitte to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be in sections, which can be handled safely without interference or hazard to highway traffic. The
entire width of the tree stump, shall be removed and disposed of so that no debris remains in view of the highway. The
stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it becomes
necessary to restrict traffic, the work shall be restricted to a maximum of five -hundred feet (500') at any one time. Adequate
signs, flagmen and or barricades shall be provided to protect the traveling public at all times.
Large holes resulting from tree removal shall be backfilled and compacted to not less than ninety percent (90%) or
equivalent tot the surrounding ground, whichever is the greater compaction as determined by the impact or field method.
Compaction tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California,
dated January 1973.
PERMIT NO. ENC2024-0006
Frontier 70063-5348977/ Access 1 Manhole to Splice Fiber Cable/
Desert Club Dr North of Avenida La Fonda (See Traffic Control Plan)
In addition to the standard permit conditions, the following shall apply:
1. Pursuant to Section 14.16.320 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), all
work shall be performed in accordance with the latest edition of the Standard Specifications For Public
Works Construction (SSPWC) and as directed by and to the satisfaction of the City Engineer.
2. The permittee may only work at night if approved by the City Manager. If approved by the city
manager, night work may be halted if the city receives complaints about the night work.
3. Prior to commencing the excavation of a trench 5 feet in depth or greater and into which a person will
be required to descend, the Contractor shall first obtain a permit to do so from the Division of Industrial
Safety pursuant to 7-10.4.1.
4. This permit is for work within the R/W. The permittee shall not encroach upon private property without
prior written approval (submit to the Public Works Department, attention to the Associate Engineer) of
the private land owner whom is being encroached upon.
5. The City of La Quinta reserves the right to require modifications of the work be made at permittee's
sole cost for further modifications as it relates to any sight distance concerns and/or improvement plan
requirements as required by the City Engineer.
6. "The permittee shall not construct an improvement that reduces vehicular sight distances. If such
improvement is found to reduce the vehicular sight distance, then the permittee shall relocate the
improvement prior to sign off of their encroachment permit."
7. The permittee shall not install improvements with the intention of providing video transmission services
unless the permittee obtains a valid Franchise Agreement.
8. The permittee shall remove any underground utility markings that are no longer being used for this
project. The permittee shall remove markings on paved areas using high pressure wash or a method
equivalent and at the discretion of the City Engineer.
9. Any asphaltic or concrete repairs shall closely match the existing paved areas in color at the discretion
of the City Engineer. A finish product with a checkerboard appearance will not be accepted.
10. The permittee shall maintain the existing pedestrian path of travel and must maintain accessible
compliant pathways leading to areas for use of public transportation systems.
11. No stockpiling of any materials will be allowed within the City R/W without an approved permit
explicitly stating the use for stockpiling and/or storage.
12. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during the
actual work performed.
Special Conditions Page 1 of 6
PERMIT NO. ENC2024-0006
Frontier 70063-5348977/ Access 1 Manhole to Splice Fiber Cable/
Desert Club Dr North of Avenida La Fonda (See Traffic Control Plan)
13. Frontier California Inc., hereinafter referred to as "Permittee", shall be responsible for providing
continuous dust and erosion control.
14. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more
frequently, if required.
15. The permittee shall submit inspection requests by calling the City Inspection Hotline at (760) 777-7097
before 1:30 p.m. and at least twenty-four (24) hours prior to the anticipated inspection.
16. The permittee is required to provide a changeable message board informing the commuters using the
affected Major and Primary Arterial roads of major construction and possible traffic delays, time of
construction, and if possible alternate routes. The message board shall be provided for the commuters
48 hours prior to the start of traffic delays.
17. Pursuant to Section 6.08.050 of the La Quinta Municipal Code (Ordinance 18 § 1, 1982), throughout the
work site, the Permittee shall comply with City regulated work hours. Operation and maintenance of
equipment within one-half mile of human occupancy shall be performed only during the following time
periods:
October 1st to April 30: Monday -Friday 7:00 a.m. to 5:30 p.m.
Saturday 8:00 a.m. to 5:00 p.m.
May 1st to September 30: Monday -Friday 6:00 a.m. to 7:00 p.m.
Saturday 8:00 a.m. to 5:00 p.m.
Work shall be prohibited on legal holidays and Sundays.
Note: Construction work (including setting up traffic control devices) is not permitted on any Arterial
street (ie any 4 lane street) before 8:00 a.m.
18. Work within 500 feet of a signalized intersection shall be performed between the hours of 9 a.m. - 3
p.m. Traffic control shall be set up after 9 a.m. and removed before 3 p.m. The Permittee shall contact
the City Traffic Signal Maintenance Division at (760) 777-7070 if signal operation at the intersection is
to be altered in any way.
19. Pursuant to Section 14.16.110 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
Permittee shall assume responsibility for repair of any pavement damage to any public or private street
and for any damage to other City streets or facilities as a result of work performed under this permit.
20. The permittee shall place temporary no parking signs along the parking area affected by the
construction. The signs shall be placed along the area 48hrs prior to the start of closing the area, and
removed immediately after the construction completion date.
Special Conditions Page 2 of 6
PERMIT NO. ENC2024-0006
Frontier 70063-5348977/ Access 1 Manhole to Splice Fiber Cable/
Desert Club Dr North of Avenida La Fonda (See Traffic Control Plan)
21. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 811. It shall
be the Permittee's responsibility to notify the Public Works Department of anticipated excavation
which impact City facilities, including but not limited to traffic signal conduits and loops, irrigation
lines, electrical conduits, and storm drain facilities.
This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to
start of construction, a letter from any owners of the driveways/access ways that will be closed down
due to the construction. The letter must be approved by the city and at minimum state from the owner
the following:
A. Approval of the construction
B. Plan identification
C. Time Frame of Closure
D. Alternative Routes
22. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), at
residential streets, advance warning signs and traffic control shall be installed and maintained in
accordance the latest edition of the California Manual of Uniform Traffic Control Devices (CA
MUTCD) or the latest edition of the Work Area Traffic Control Handbook (WATCH).
On Collectors to Arterial Streets, the permittee must submit a traffic control plan which shall be from or
prepared under the guidance of the latest edition of the California Manual of Uniform Traffic Control
Devices (CA MUTCD) or the latest edition of the Work Area Traffic Control Handbook (WATCH).
Traffic Control plans not from the CA MUTCD or the WATCH shall be signed and stamped by a civil
or traffic engineer registered in the State of California. It shall be the Permittee's responsibility to
appropriately detour and barricade all construction sites.
Pursuant to Section 14.16.290 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
street closures shall not be permitted. A minimum of two (2) travel lanes of paved surface shall
be maintained at all times.
23. Should additional work, materials, or modifications of the work be required in order to meet City
standards, safety requirements, signage requirements, or to fit actual field conditions, the work shall
be performed by the Permittee as directed by and to the satisfaction of the City Engineer at no cost to
the City of La Quinta.
24. The City of La Quinta reserves the right to require modifications of the work be made at permittee's
sole cost for proper sight distance requirements per guidelines in the AASHTO "A Policy on
Geometric Design of Highways and Streets, 5th Edition" or latest, in the installation of all
appurtenances abutting and within the public street right-of-way.
Special Conditions Page 3 of 6
PERMIT NO. ENC2024-0006
Frontier 70063-5348977/ Access 1 Manhole to Splice Fiber Cable/
Desert Club Dr North of Avenida La Fonda (See Traffic Control Plan)
25. The permittee shall be responsible for calling the city inspector to arrange the city inspector to observe
random trench compaction testing performed by a city approved material testing firm. If the inspector's
phone number is unknown, the permittee shall call the Public Works front counter phone at 777-7075 or
the Associate Engineer at 777-7047 to determine the city inspector's phone number. The inspector shall
determine the number and location of the test location/s. The above testing does not relieve the
permittee's responsibility for future repairs due to settlement at and near the locations of the work area.
Materials testing must be performed under direct supervision of a California Registered Civil Engineer.
26. The issuance of this permit and the City approval of the related construction improvement plans do not
provide a vested entitlement for all design parameters that may have been utilized for the plans. As
such, plans approved for this permit may be "at risk" for further modifications as it relates to any
follow up improvement plan requirements as required by the city or existing errors & omissions by the
architect or engineer of record.
27. This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to
start of construction, the name of the City approved contractor, who shall submit to the City the
following items:
a. General Liability Insurance Company and Policy Number
b. City Business License
c. Contractors State License Number
28. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts
provided in the Engineering Bulletin for Indemnification & Insurance Requirements. This insurance
shall be kept in full force and effect at all times by Applicant or Contractor during the prosecution of
the permitted work and updated Certificate of Liability Insurance shall be submitted to the City. Each
policy shall name the City as an additional insured.
29. The permittee shall not encroach upon private property without prior written approval (submit to the
Public Works Department, attention to the Associate Engineer) of the private land owner whom is
being encroached upon.
30. The permittee shall haul all offsite debris to a certified landfill. Prior to hauling debris, the permittee
shall inform the City (Inspection staff or 777-7047) of the name and location of the certified dump site.
31. If public traffic lanes are required to be closed, this permit is not valid until the permittee submits, to
the Public Works Department, a traffic control plan for review and approval prior to start of
construction or parking on the paved R/W.
32. The permittee is required to provide an informative message board (approved by the City Engineer)
informing the commuters using the affected Primary Arterial roads or heavier traffic of possible traffic
delays, time of construction, and if possible alternate routes. The message board shall be provided for
the commuters 48 hours prior to the start of traffic delays.
Special Conditions Page 4 of 6
PERMIT NO. ENC2024-0006
Frontier 70063-5348977/ Access 1 Manhole to Splice Fiber Cable/
Desert Club Dr North of Avenida La Fonda (See Traffic Control Plan)
33. All excavations within City of La Quinta right-of-way shall be backfilled, and temporarily paved if
within the existing travel way, at the end of every workday as directed by and to the satisfaction of the
City Engineer for the protection of the public. Lengths of open trench shall not greatly exceed that
which can not be backfilled in the same day. Excavated trenches shall not be allowed open overnight,
however, Permittee may leave a length of excavated trench, not to exceed twenty (20) feet in length,
open overnight at a point where construction will begin the next day, provided that this length of trench
is completely covered by steel plating.
34. Access and egress to all local properties shall be maintained at all times.
35. Pursuant to Section 14.16.375 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
permanent pavement replacement shall be completed no later than seven (7) days after the completion
of the work. Permanent pavement replacement shall conform to the following conditions:
A. Existing asphalt concrete pavement shall be sawcut one (1) foot beyond trench edges. Edges
shall be straight and clean.
B. Permanent pavement replacement structural section, within all trenches, shall be 1" thicker than
existing of asphalt concrete over the same existing thickness of crushed aggregate base or crushed
miscellaneous base, meeting the requirements of Sections 200-2.2 and 200-2.4 of the Standard
Specifications for Public Works Construction. The replaced pavement and base material shall be
compacted to 95% relative compaction and respectively tested, for each 300 linear feet of trench.
Verify exact structural replacement section thicknesses with the City prior to installation.
C. Permanent pavement replacement shall be installed using a City approved 3/4" max medium
asphalt concrete as the base course lift and a City approved'/2" max medium finish course lift for
capping. Asphalt concrete mix design shall be approved by the City prior to its placement.
D. Cold -Mill and Overlay - The existing pavement which was properly protected in place during the
trenching operation located adjacent to the trench saw cut shall be cold -milled to a depth of 0.10
feet with butt joint created next to the existing unmilled pavement surface. The cold -milled area
and base asphalt concrete in the trench area shall be overlaid with a City approved C2-AR-4000
asphalt concrete mix. The width of the cold milling area shall be as follows:
• For longitudinal trenches located in a parking lane: three (3) feet outside the sawcut
removal lines.
• For longitudinal trenches located in a traffic lane: three (3) feet outside the sawcut removal
lines, or to the lane line striping, whichever is greater.
• For transverse trenches across existing street: two (2) feet outside the sawcut removal lines.
Special Conditions Page 5 of 6
PERMIT NO. ENC2024-0006
Frontier 70063-5348977/ Access 1 Manhole to Splice Fiber Cable/
Desert Club Dr North of Avenida La Fonda (See Traffic Control Plan)
E. If grinding and capping operations are not performed in the same day as base paving operations,
the base course lift of 3/4" max medium asphalt concrete shall be installed from saw -cut edge to
saw -cut edge flush with the existing street surface. The base course lift of paving shall not be left
0.10' low in anticipation of grinding and capping.
F. Any existing lane striping or any existing detour lane striping affected by this resurfacing shall be
replaced in kind by the Permittee, as directed by and to the satisfaction of the City Engineer.
Affected traffic signal loops shall be removed and replaced in kind. The finished pavement
surface shall be smooth, consistent, and shall conform to the surrounding grades.
36. All landscaping, irrigation, decorative rock, decorative concrete, lighting, sidewalk, etc., shall be
replaced to its original condition.
37. Permittee shall permanently stabilize any and all soil that was disturbed as a result of work performed
under this permit with an approved dust control treatment. Soil stabilization shall be done
immediately after completing the operation.
38. Pursuant to Chapter 12.56 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982) the City
has designated certain city streets as Truck Routes. The weight limit for restricted streets (i.e., streets
not part of the Truck Route network) is three (3) tons; trucks exceeding the weight limit may use a
restricted street if making a delivery or pickup on the subject street, or if this permit specifically grants
permission to use the street to deliver street construction materials and/or equipment.
39. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time.
40. The permittee shall indemnify, hold harmless and assume the defense of the City from all damages,
delay costs, costs or expenses in law or equity that may arise out of work under this permit.
41. If it is the intent of the permittee to cut the pavement and have it restored by a third party, the
permittee shall postpone cutting the pavement until the intended third parry has acquired a permit from
the City to perform the required restoration work.
Special Conditions Page 6 of 6
ATE
R CERTIFICATE OF LIABILITY INSURANCE D06/14/2023D/YYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER NAM£: CT Marsh I U.S. Operations
MARSH USA LLC. PHONE 540 W. MADISON (866) 966-4664 FAXX 212-948-0770
�„19.w F.�f).' _..I—�aY•
CHICAGO, IL 60661 le -MAIL AbORE5a: CertRe uest o Chico9 q @ marsh.com
CN 102898337--GAW-23-24
INSURED
Frontier California Inc.
401 Merritt 7
Norwalk, CT 06851
INSURER 5 AFFORDING COVERAGE NAIC #
FC650 GAW INSURER A: Steadfast Insurance Company 26387
INSURER B: Zurich American Insurance Company 16535
INSURER C : American Zurich Insurance Company 40142
INSURER D :
I _ I INSURER F : I
COVERAGES CFRTIFICATF NIIMRFR CHI-010079173-10 RFVICIf1N NIIMRFR• A
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR POLICY EXP
LTR TYPE OF INSURANCE i NSD'z UBRI POLICY NUMBER MMrrDDrYYPOLICY YYJ I..IMMIDDIYYYYILIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE TIOCCUR
X
GLO 0285992 06 06/0112023
06/01/2024
EACH OCCURRENCE
$ 1,000,000
P PREB
MiSElj�Ea occur(ertce
$ 500,000
$ 10,000
MED EXP (Any one person)
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L
X
GENERAL AGGREGATE
$ 2,000,000
AGGREGATE LIMIT APPLIES PER:
POLICYEl PRO- ❑ LOC
JECT
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER!
B
AUTOMOBILE
LIABILITY
BAP 0285990 06
061011202
06101/2024
COMBINED SINGLE LIMIT
£aaccident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTYDAMAGE
L e(�ddenl
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
C WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/�
B
ANYPROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N I A
X WC 0285988 06 (ADS)
WC 0285989 06 RETRO
()
U6701 r2023
06101/2023
06101/2024
06101/2024
X STAT T ER
IE.LEACH ACCIDENT
$ 1,000,000
EL DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of La Quinta, its officers, officials, employees, and agents shall be named as Addilional Insureds as respects the General Liability policy where required by written contract.
Coverage under the General Liability policy shall be Primary and Nan -Contributory to any other insurance available to the Additional Insureds where required by written contract.
Waiver of Subrogation in favor of the Additional Insureds shall apply to the Workers' Compensation policy,as permitted by law where required by written contract.
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
GANGt
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Additional Insured — Automatic — Owners, Lessees Or
Contractors
0
ZURICH
Policy No. Eff, Date of Pal. Exp. Date of Pol. Eft: Date of End.
Producer No.
AMA. Prem
Retum Prem.
GL00285992-08 06/01/2023 06/01/2024
1 18232000
INCL
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured: FRONTIER COMMUNICATIONS PARENT, INC.
Address (including ZIP Code):
401 MERRITT 7
NORWALK, CT 06851
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization whom you
are required to add as an additional insured on this policy under a written contract or written agreement. Such person
or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal
and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf,
in the performance of your ongoing operations or "your work" as included in the "products -completed operations
hazard", which is the subject of the written contract or written agreement.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the written contract or written agreement to provide for
such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to
render, any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the
"bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the
rendering of or the failure to render any professional architectural, engineering or surveying services.
U-GL-1175-F CW (04113)
Page 1 of 2
Includes copyrighted material of Insurance Services Office, Inc., with its permission
C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV —
Commercial General Liability Conditions:
The additional insured must see to it that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by
another insurer under which the additional insured may be an insured in any capacity. This provision does not
apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement
requires that this coverage be primary and non-contributory.
D. For the purposes of the coverage provided by this endorsement:
1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability
Conditions:
Primary and Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional
insured provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by written contract or written agreement that this insurance be primary and not seek
contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same "occurrence", offense, claim or "suit'. This provision does not apply to any
policy in which the additional insured is a Named Insured on such other policy and where our policy is required by
a written contract or written agreement to provide coverage to the additional insured on a primary and non-
contributory basis.
E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement
showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to
that identified additional insured.
F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to
Section III — Limits Of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or
2. Available under the applicable Limits of Insurance shown in the Declarations,
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
All other terms and conditions of this policy remain unchanged.
U-GL-1175-F CW (04/13)
Page 2 of 2
Includes copyrighted material of Insurance Services Office, Inc., with its permission
Other Insurance Amendment — Primary And Non -
Contributory
ZURICH�
Policy No.
Ef. Date of Pol.
ExI3. Date of Pol.
Eff. Date of End. Producer No.
AddT Prem
Return Prem.
GLO 0285992-05
06/01/2023
06/01/2024
18232000
INCL
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured: FRONTIER COMMUNICATIONS PARENT, INC.
Address (including ZIP Code):
401 MERRITT 7
NORWALK, CT 06851
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
1. The following paragraph is added to the Other Insurance Condition of Section IV — Commercial General Liability
Conditions:
This insurance is primary insurance to and will not seek contribution from any other insurance available to an
additional insured under this policy provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by a written contract or written agreement that this insurance would be primary and would not
seek contribution from any any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in
which the additional insured is a Named Insured on such other policy and where our policy is required by written
contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis.
All other terms and conditions of this policy remain unchanged.
U-GL-1327-8 CW (04/13)
Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that
you perform work undera written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN
CONTRACT, OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE
ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS
POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement Is Issued subsequent to preparation of the policy.)
Endorsement Effective 06-01-23 Policy No. WC 0285988-06 Endorsement No.
Insured FRONTIER COMMUNICATIONS PARENT. INC. Premium $ INCL .
Insurance Company AMERICAN ZURICH INSURANCE COMPANY DocuSlgnedby:
Countersigned By Ew au%ro-1
We 00 03 13
(Ed. 4-84)
0 1983 National Council on Compensation Insurance.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that
you perform w0rk under a written, contract that requ ires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN
CONTRACT, OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE
ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS
POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 06-01-23 Policy No. WC 0285989-06 Endorsement No.
Insured FRONTIER COMMUNICATIONS PARENT, INC. Premium $ INCL.
Insurance Company ZURICH AMERICAN INSURANCE COMPANY 6vca5lanadby
�� Gawtpa
Countersigned By l4i[i1962E2323d69 .
WC000313
(Ed.4-84)
0 1983 National Council on Compensation Insurance.