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ENC2024-0011
CALIFORNIA 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 /18/2024 LOCATION OF CONSTRUCTION: Monroe St and Avenue 60 PURPOSE OF CONSTRUCTION: Install IID Conduit; CSP 4034323 DESCRIPTION OF CONSTRUCTION: Andalusia; IID Conduit Work at Monroe St and Ave 60 APPROXIMATE TIME WHEN WORK WILL BEGIN: 01/25/2024 DATE OF COMPLETION: 02/29/2024 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. NATIONAL MORTGAGE & LAND COMPANY Nolan Sparks Name of Applicant T B U, INC. Name of Contractor 781050 Contractor's License No. 81570 Carboneras, La Quinta, CA 92253 Business Address 244 MAPLE AVENUE SUITE T, BEAUMONT, CA 92223 Business Address 763244 City Business License No. Upland Specialty Insurance USPCL0094123 Applicant's Insurance Company Policy Number FEES Traffic Control $739.00 Credit Card Convenience Fee $18.48 Technology Enhancement Fee $8.00 TOTAL: $765.48 PERMIT NO: ENC2024-0011 (760) 408-0106 Telephone No. (951) 769-0647 Telephone No. DATE ISSUED: EXPIRATION DATE: BY: Amy Yu If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. NOTES: 1. ALLTRAFFIC CONTROL DEVICES FOR THIS PROJECT SHALL BE IN ACCORDANCE WITH REVISION 7 OF THE 2014 CALIFCRNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIA M.U.TC,D,) 2. TRAFFIC CONTROL SHOWN HEREIN IS THE MINIMUM REQUIRED, ADDITIONAL TRAFFIC CONTROL MAYBE REQUIRED TO FACILITATE PUBLIC SAFETY AND TRAFFIC FLOW IF DEEMED NECESSARY BY CITY OF LA QUINTA REPRESENTATIVE. 3. THROUGHOUT EACH WORK PERIOD, CONTRACTOR SHALL INSPECT TRAFFIC CONTROL (SIGNS, BARRICADES AND DELINEATORS) AND MAINTAIN SAME IN ACCORDANCE WITH TRAFFIC CONTROL PLANS, 4, CONTRACTOR SHALL MAINTAIN A MINIMUM 10' (12' TYP.) TRAFFIC LANE WIDTH ATALL TIMES, THERE SHALL BE A MINIMUM Z 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 END OF WORK HOURS, THE ROAD SHALL BE CLEARED OF DEBRISAND TRAFFIC RETURNED TO NORMAL UNLESS THE CONTRACTOR CBTAINS PERMISSION FROM THE CITY OF LAQUINTATO LEAVE IN PLACE OVERNIGHT, 7. ALLTRAFFIC CONTROL DEVICES USED DURING HOURS OF DARKNESS SHALL BE RETRO-REFLECTIVE AND ALL BARRICADES SHALL BE EQUIPPED WITH FLASHING LIGHT, 8, THE SIDEWALK SHALL BE LEFT OPENAS MUCH AS POSSIBLE DUE TO LACK OF ALTERNATE ROUTE, Pending Water Connection for Andalusia C C Prime Cmbadw conte T B U David (760) 391-133 Tops N Barricades, Inc. Ron Fifield (800)852-TOPS 50 1115/24 CONDUIT NOTES: 1) INSTALL 1-3" CND.R-R PER SHOWN LENGTH FOR ALL HOUSE SERVICES & SECONDARY RUNS. (REFER TO SHEETS 10-11,111-123, OF THE D.E.P.G. REV. 5.24 2020) 2) TYPICAL, ALL SECONDARY STREET CROSSINGS TO BE ENCASED WITH A 3 SACK SLURRY. REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 3) TYPICAL, STUBOUTS ARE REQUIRED TO AVOID UNDERMINING TRANSFORMER3 PADS AND SEC. PULLBOXES IN THE FUTURE. AAINSTALL 1-4" CND SCH.40 PVC PER SHOWN LENGTH. (REFER TO SHEETS 10-11,111-123, OF THE D.E.P.G. REV. 5.24 2020) 24 INSTALL 2-4" CND SCH.40 PVC PER SHOWN LENGTH. p (REFER TO SHEETS 10-11,111-125, OF THE D.E.P.G. REV. 5.24 2020) STUB -OUT AINSTALL 2-5" CND SCH.40 PVC PER SHOWN LENGTH. p5 (REFER TO SHEETS 10-11,111-123, OF THE D.E.P.G. REV. 5.24 2020) AINSTALL 2-5" CND SCH.40 PVC PER SHOWN LENGTH. p (REFER TO SHEETS 10-11,111-125, OF THE D.E.P.G. REV. 5.24 2020) STUB -OUT AINSTALL 3-6" CND SCH.40 PVC PER SHOWN LENGTH. p6 (REFER TO SHEETS 10-11,111-123, OF THE D.E.P.G. REV. 5.24 2020) AINSTALL 3-6" CND SCH.40 PVC PER SHOWN LENGTH. p6 (REFER TO SHEETS 10-11,111-125, OF THE D.E.P.G. REV. 5.24 2020) STUB -OUT TRENCH DETAILS: STRUCTURE DETAILS: qLARGE SWITCH PAD REFER TO SHEETS 192-193, 210-212, 219-221, 235-240 OF THE D.E.P.G. REV. 5.24 2020 SUBSTRUCTURE MEDIUM VAULT EQUIPMENT m ENCLOSURE REFER TO SHEETS 184-185, 210-212, 235-240 OF THE D.E.P.G. REV. 5.24 2020 THREE PHASE SECTOR SLEEVE REFER TO SHEETS 200-206, 210-212, 216-219, 235-240 OF THE D.E.P.G. REV. 5.24 2020 ® PRECAST PAD FOR SINGLE PHASE TRANSFORMER REFER TO SHEETS 158-159, 163-165, 176, 179-181, 210-215 OF THE D.E.P.G. REV. 5.24 2020 LA QUINTA SECONDARY BOX O REFER TO SHEET 140 & 224 OF THE D.E.P.G. REV. 5.24 2020 STUB OUT MARKER DETAIL REFER TO SHEETS 124-125 OF THE D.E.P.G. REV. 5.24 2020 RT RETAINING WALL REFER TO SHEETS 235-240 OF THE D.E.P.G. REV. 5.24 2020 F- .� SINGLE PRI. DUCT TRENCHING NOTES: B B REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 TYPICAL: CONTRACTOR SHALL INSTALL SINGLE SEC.OR SERV.DUCT 2" LINE GUARD TAPE (RED) "CAUTION: C� REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 BURIED ELECTRIC LINE BELOW." (REFER TO SHEET 120-122 OF THE D.E.P.G. REV. 5.24. 2020) 2-4 PRI. DUCT CONC. ENCASED TYPICAL: T FROM FACE OF CURB D REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 TO CENTER OF TRENCH. CONDUITS SHALL BE INSTALLED WITHIN 10' P.U.E. EE 5-9 PRI. DUCT CONC. ENCASED UNLESS OTHERWISE NOTES. REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 (REFER TO SHEET 113 OF THE D.E.P.G. REV. 5.24 2020) L-� COMPACTION BACK FILL MULTI PRI. DUCT G G REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 CURVE DATA TABLE # RADIUS < LENGTH ® 25.0' 900 39.26' R3 12.5' 900 19.63' r VAULT DETAILS: VAULT: UN1246364S LOOKING: EAST PROJECT SITE AVENUE 60 z p 7L() 11D q �61ao�3 SCALE:1:65 T.6, R.7, SEC.27 0 r m N r z m N U4' INTERCEPT EX. 2-5" 10' e OBS 25 �\ CNDS(7-8) t 15' UN1122703P V UN1207391 P ,w Gib /. SEVILLE ST E" CAUTION: Rl EXISTING ENERGIZED NOTE: �- UNDERGROUND CABLE. nas --- P.U.E. R� UN1122701H .......... -_ �_..._. ,-.,.�... _ ... UN11 UN 11688�0H 141 P I NOTE: i BLOCK WALL A 285' UN1122700S 4l ]ki H U W Q 2 NOTE: IID INSPECTOR & TROUBLE SHOOTER TO VERIFY ALL EX. CONDUITS RUNS GOING SOUTH OF UN1122700S CNDS(1-3) I NOTE: 211 Q' IF 3-6" KNOCKOUTS ARE NOT AVAILABLE INTERCEPT EX. 2-5"! ON SOUTH SIDE OF UN1122700S FOR P 8) R2 jl INCOMING 3-6"PVC CNDS. CUSTOMER V1246 0oas. 246371V - - TO INTERCEPT EX. 3-6" STUB -OUT. Lk 1 EX CAUTION: ENERGIZED UG CABLE. 1_ 85' 60TH AVE _ 3-6" STUB -OUT CUSTOMER TO CUT &REROUTE EX. 2-5" PVC 3G CONDUITS. COORDINATE WITH IID PLANER & CAUTION: - - — — — INSPECTOR FOR CABLE REMOVAL. T EXISTING ENERGIZED - ggt4 6) UNDERGROUND CABLE. — - _ UN1088115S I, VAULT: UN1246367V LOOKING: EAST VAULT: UN1246365S LOOKING: EAST VAULT DETAILS: VAULT: UN1246371V LOOKING: EAST VAULT: UN1 122700S LOOKING: NORTH NOTE: JOB REF: P-5545 & P-5542 NO OUTSIDE VAULT DETAIL IN JOB. N W z_ J U H Q N W z_ J U Q CONDUIT NOTES LINE TYPE LEGEND EXITING FACILITIES NEW FACILITIES -- NEW SEC. RUNS P.U.E. 1) INSTALL 1-3" CND.R-R PER SHOWN LENGTH FOR ALL HOUSE SERVICES & SECONDARY RUNS. (REFER TO SHEETS 10-11,111-123, OF THE D.E.P.G. REV. 5.24 2020) 2) TYPICAL, STUB -OUTS ARE REQUIRED TO AVOID UNDERMINING TRANSFORMER3 PADS AND SEC. PULL BOXES IN THE FUTURE. INSTALL 1-4" CND SCH.40 PVC PER SHOWN LENGTH. ,P (REFER TO SHEETS 10-11,111-123, OF THE D.E.P.G. REV. 5.24 2020) AINSTALL 1-4" CND SCH.40 PVC PER SHOWN LENGTH. p4 STUB -OUT (REFER TO SHEETS 10-11,111-125, OF THE D.E.P.G. REV. 5.24 2020) INSTALL 2-5" CND SCH.40 PVC PER SHOWN LENGTH. P (REFER TO SHEETS 10-11,111-123, OF THE D.E.P.G. REV. 5.24 2020) AINSTALL P6 3-6" CND SCH.40 PVC PER SHOWN LENGTH. (REFER TO SHEETS 10-11,111-125, OF THE D.E.P.G. REV. 5.24 2020) INSTALL 3-6" CND SCH.40 PVC PER SHOWN LENGTH. 36 P STUB -OUT (REFER TO SHEETS 10-11,111-125, OF THE D.E.P.G. REV. 5.24 2020) TRENCH DETAILS: SINGLE PRI. DUCT B B REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 SINGLE SEC.OR SERV.DUCT OF THE D.E.P.G. REV. 5.24 2020 REFER TO SHEETS 116-122 2-4 PRI. DUCT CONC. ENCASED D REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 PRI. DUCT CONC. ENCASED E5-9 REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 COMPACTION BACK FILL MULTI PRI. DUCT G REFER TO SHEETS 116-122 OF THE D.E.P.G. REV. 5.24 2020 STRUCTURE DETAILS: LARGE SWITCH PAD ❑❑ REFER TO SHEETS 192-193, 210-212, 219-221, 235-240 OF THE D.E.P.G. REV. 5.24 2020 m SUBSTRUCTURE MEDIUM VAULT EQUIPMENT ENCLOSURE REFER TO SHEETS 184-185, 210-212, 235-240 OF THE D.E.P.G. REV. 5.24 2020 ® PRECAST PAD FOR SINGLE PHASE TRANSFORMER REFER TO SHEETS 158-159, 163-165, 176, 179-181, 210-215 OF THE D.E.P.G. REV. 5.24 2020 RT RETAINING WALL REFER TO SHEETS 235-240 OF THE D.E.P.G. REV. 5.24 2020 ®CAUTION ENERGIZED STRUCTURES: CALL IID INSPECTOR BEFORE PERFORMING ANY TYPE OF WORK ON OR AROUND ENERGIZED STRUCTURES TRENCHING NOTES: TYPICAL: CONTRACTOR SHALL INSTALL 2" LINE GUARD TAPE (RED) "CAUTION: BURIED ELECTRIC LINE BELOW." (REFER TO SHEET 120-122 OF THE D.E.P.G. REV. 5.24. 2020) TYPICAL: 7' FROM FACE OF CURB TO CENTER OF TRENCH. CONDUITS SHALL BE INSTALLED WITHIN 10' P.U.E. UNLESS OTHERWISE NOTES. (REFER TO SHEET 113 OF THE D.E.P.G. REV. 5.24 2020) CURVE DATA TABLE # RADIUS < LENGTH R1 25.0' 450 19.63' RD 25.0' 900 39.26' R3 12.5' 900 19.63' R4 12.5' 450 9. 81' 17� 9-u- u. QL(j III) 1lb/g a_�SCALE:1:65 T.6, R.7, SEC.27 City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2024-0011 The followina shall always avvly: ENCROACHMENT ON PRIVATE PROPERTY: This permit authorizes work to be accomplished within the City of La Quinta's right of way ONLY. Whenever construction extends within private property, it is the responsibility of the permittee for his contractors to secure permission from abutting property owners. Such authorization must be secured by the permittee prior to starting work. TRACK -LAYING CONSTRUCTION EQUIPMENT: Cleated track -laying construction equipment shall not be permitted to operate on any paved surface unless fitted with smoother -faced street pads. All mechanical outriggers shall be fitted with rubber street shoes to protect the paving during excavations. Rubber -tired equipment only shall be used in backfill operation in paved areas. If the existing pavement is scarred, spalled, or broken during the term of this contract or if the pavement is marred, City of La Quinta shall request that these portions of road be resurfaced over their entire width. Resurfacing shall consist of one coat of two inches (2") of A.C. surfacing plus appropriate seal coat as specified above. PROTECTION OF TRAFFIC: All excavations and work areas shall be properly lighted and barricaded as deemed necessary by the City Engineer or City of La Quinta Public Works Inspectors. Suitable detours and detour signs shall be placed and maintained for the duration of the project. The City shall be notified twenty-four hours (24) in advance of any traffic detours or delineation. CARE OF DRAINAGE STRUCTURES: Any drainage structure to include corrugated metal pipe, concrete pipe, steel culvert and concrete structures encountered during excavation which necessitate removal shall be replaced in kind. In the event it becomes necessary to remove or cut existing drainage structures, City of La Quinta shall be notified prior to commencement of this work. Drainage structures and open drains shall be kept free of debris at all times for proper drainage. RIGHT-OF-WAY CLEANUP: Any surplus material resulting from excavation and backfill operations shall be removed from the right of way. All paved surfaces shall be broomed clean of earth and other objectionable materials immediately after backfill and compaction. Existing gutter line and drainage ditches shall be replaced to their original standard or better. All excess material shall be removed prior to paving. Water tanker shall be used, as required, to sprinkle the job site to keep down dust conditions and shall be used immediately after backfill. DE -WATER OPERTATIONS: If de -watering operations are required and pumps are forcing water on City of La Quinta roads, it shall be the responsibility of the permittee (contractor) to control this water and to provide off-street barricades when necessary. CLOSING STREETS: No street shall be closed. A minimum of one lane of traffic shall be maintained at all times to provide limited access for the adjoining property owners and emergency vehicles. In the event it is felt by the permittee that he must close a street for any length of time, permittee shall contact this office to obtain the necessary permission. SPECIAL PROVISIONS The following shall apply when indicated: ® R1 NOTIFICATION: Permittee shall notify the City at (760) 777 - 7097 at least forty-eight hours (48) in advance of starting construction. ® R2 UTILITY CLEARANCE: (Substructures) Prior to making any excavations within the City of La Quinta right-of-way authorized by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures. Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility of the permittee. ® R3 UTILITY CLEARANCE (Surface Structures) No work shall be done under this permit until all utilities are clear of the proposed work site. The permittee shall notify all concerned utility companies of the proposed work. ❑ R4 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced with ( ** N/A ** ) inches of A.C. paving placed on ( ** N/A ** ) inches of ( ** N/A ** ) aggregate sub -base course having an "R" value of not less than ( ** N/A **) and in conformance with the City of La Quinta Road Improvement Standards and Specifications, Ordinance #461. ® R5 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of one-fourth inch ('/4") to one foot (1'). ❑ R6 GRADE CHECKING: City of La Quinta shall check grades upon receipt of plan and profile and/or grades as established by a licensed engineer. ❑ R7 CURB REMOVAL FOR DRIVEWAYS: A portion of the existing concrete curb and/or curb and gutter (** N/A **) feet shall be removed. Curb and/or curb and gutter shall be saw cut prior to removal. Depressed curb, matching concrete gutter and concrete driveway approach shall be constructed in conformance with City of La Quinta Standard #207. ❑ R8 DRIVEWAYS: A.C. driveways shall be constructed as not to alter existing drainage pattern. Surfacing between the property line and the existing road paving shall be two and a half inches (2 '/2") of A.C. paving on (" N/A ") of class (" N/A " ) aggregate base. ® R9 SIGHT CLEARANCE: Sight Clearance of six -hundred feet (600') in all directions shall be assured and maintained at all times. ❑ R10 SOIL STERILIZER: The area to be surfaced shall be treated with soil strerilizer. Rate of application shall comply with the manufacturer's specifications. City of La Quinta ® R11 COORDINATE WORK: The proposed work shall be subordinated to any operation, which the State of California or City of La Quinta may conduct in this area during the period of this permit. Work shall be coordinated with the State or City of La Quinta forces to preclude delay or interference with State or City of La Quinta projects. ® R12 SURVEY MONUMENTS: Prior to excavation or beginning of construction, all survey monuments which exist on the centerline of all streets or property lines when included shall be completely tied out so they may be readily and correctly, replaced by a licensed civil engineer or surveyor at the expense of the permittee. A complete set of notes showing the ties to these monuments shall be furnished to the City Engineer prior to the removal of any monuments. This office shall be notified upon completion or replacement of all survey monuments for proper clearance. ❑ R13 PAVEMENT CUTTING: Pavement will be mechanically saw cut to a straight edge prior to excavation. Method of pavement cutting shall be approved through the office of the City Engineer. (Under no circumstances shall excavating equipment be used to excavate prior to cutting or pavement.) Excavation material shall be placed in such a position as to best facilitate the general flow traffic. Prior to final paving operations, any damage to pavement straight edges shall be corrected. ❑ R14 LIMIT OF EXCAVATIONS: Excavations shall be limited to one -thousand feet (1000') of open trench before backfill operations must begin. All excavations shall be properly barricaded with lights overnight, on weekends and holidays for the protection of the traveling public. The Public Works Inspector shall determine the suitability of excavation barricading in each case. No excavation shall remain open for a period exceeding five (5) days. No excavation shall be made unless the construction material is actually on the work site. ® R15 BACKFILL MATERIAL: Backfill shall be free of brush, roots or other organic substance detrimental to its use for purposes of producing and adequately consolidated backfill. Ant material which the City of La Quinta deems unsuitable (spongy or saturated material) which is encountered during excavation shall not be used for backfill, but shall be supplemented or replaced by an approved sand or gravel. ❑ R16 BACKFILL SAND: Backfill shall be approved transit -mix sand or equivalent and shall be placed on lifts not greater than three feet (3') and vibrated using vibrostamper or equivalent equipment. Alternate methods may be substituted, but in any case, a relative compaction of ninety-five percent (95%) shall be maintained with the structural section of the roadway. ® R17 BACKFILL PLACEMENT: Backfill shall be applied in layers of not more than fifty percent (50%) of the total depth of the trench before flooding or a maximum of five feet (6) lifts where trenches are of excessive depths. Care is to be exercised that the backfill material is not subjected to extreme swell by flooding operations. Backfill material shall be placed so that the resulting compaction shall not be less than ninety percent (90%) or equivalent to the surrounding ground, whichever is the greater compaction. Where ponding or flooding is used for a maximum settlement, adequate dikes will be constructed to retain the water. Where jetting is used, the jets shall be of sufficient length to reach the bottom of each layer and the water supply shall be continuos. ® R18 COMPACTION TESTS: If so required by the inspector, compaction test shall be made at intervals of not more than one - thousand (1000') feet and a maximum of one (1) test on each road. One (1) copy of each test shall be forwarded tot the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ❑ R19 COMPACTION TESTS: If so required by the Inspector, compaction tests shall be made for each crossing or service line. One (1) copy of each test shall be forwarded to the City Engineer for approval and filed prior to making permanent repairs. Compaction tests shall be made as outlined in Sections 6.3.001 of the Standard Specifications, Division of Highways, State of California, dated January 1973. ® R20 TEMPORARY PAVEMENT REPAIRS: After completion of backfill and compaction operations, a temporary patch consisting of two inches (2") of SC-800 shall be placed on a prepared sub -grade. The SC-800 temporary paving shall be placed after a maximum of three -thousand linear feet (3000') or trench has been excavated and backfill operations completed, but in no case shall the placement of the temporary pavement exceed a five (5) day limit. ® R21 PERMANENT PAVEMENT REPAIR: After backfill and compaction have been completed, a temporary patch consisting of three inches (Y) of SC-800 shall be placed immediately. A permanent patch of Asphalt Concrete surfacing per City of La Quinta Standard 600 shall be placed no later than ( 5 ) days after completion of temporary road repair. ❑ R22 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as determined by the City Engineer. ® R23 STREET RESTRIPING: Where street striping is still visible on street to be excavated, such striping shall be replaced upon completion of permanent repairs. ❑ R24 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right-of-way shall be accomplished by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public. It shall be the responsibility of the permitte to maintain the tree in a vigorous growing condition at its new location. Trees to be removed shall be in sections, which can be handled safely without interference or hazard to highway traffic. The entire width of the tree stump, shall be removed and disposed of so that no debris remains in view of the highway. The stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it becomes necessary to restrict traffic, the work shall be restricted to a maximum of five -hundred feet (500') at any one time. Adequate signs, flagmen and or barricades shall be provided to protect the traveling public at all times. Large holes resulting from tree removal shall be backfilled and compacted to not less than ninety percent (90%) or equivalent tot the surrounding ground, whichever is the greater compaction as determined by the impact or field method. Compaction tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California, dated January 1973. PERMIT NO. ENC2024-0011 For Andalusia / Install III) Conduit / TM 38188; 31681; Monroe St and Ave 60 In addition to the standard permit conditions, the following shall apply: 1. Pursuant to Section 14.16.320 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), all work shall be performed in accordance with the latest edition of the Standard Specifications For Public Works Construction (SSPWC) and as directed by and to the satisfaction of the City Engineer. 2. This permit or copy of it shall be on the work site (usually the job trailer) for inspection during the actual work performed. 3. The permittee is responsible for obtaining a valid separate permit from other City, or County jurisdictions if any of the work or traffic control devices extend into other City, or County right of way. 4. The permittee must compact any disturbed soil within the paved right of way back to its original condition or compact to a minimum density of 95% based on ASTM D1557 and be placed while the soil is at +/- 2% of optimum moisture, which ever compacting effort produces the greatest density. 5. Any asphalt removed during potholing shall be replaced with City approved mix asphalt or equivalent. Temporary (Cold Patch) is not acceptable as an approved asphalt mix. The asphalt shall have a thickness equivalent or greater than the removed asphalt thickness and shall obtain a density of 95% or greater based on maximum density obtained by the ASTM Marshall Mix Design Method. 6. Sunrise LO, LLC (Nolan Sparks) and/or TBU, Inc., hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. 7. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 8. 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. 9. 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 1 st to September 30: Monday -Friday 6:00 a.m. to 7:00 p.m. Saturday 8:00 a.m. to 5:00 p.m. Work shall be prohibited on legal holidays and Sundays. Note: Construction work (including setting up traffic control devices) is not permitted on any Arterial street (ie any 4 lane street) before 8:00 a.m. Special Conditions Page 1 of 4 PERMIT NO. ENC2024-0011 For Andalusia / Install III) Conduit / TM 38188; 31681; Monroe St and Ave 60 10. 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. 11. 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. 12. 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. 13. 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. 14. 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. 15. 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. 16. The permittee shall be responsible for calling the city inspector to arrange the city inspector to observe random pothole backfill compaction and testing if requested by the inspector. 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. Special Conditions Page 2 of 4 PERMIT NO. ENC2024-0011 For Andalusia / Install III) Conduit / TM 38188; 31681; Monroe St and Ave 60 17. 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. 18. 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 19. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts provided in 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. 20. 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. 21. 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. 22. All landscaping, irrigation, decorative rock, decorative concrete, lighting, etc., shall be replaced to its original condition. 23. Access and egress to all local properties shall be maintained at all times. 24. 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 Special Conditions Page 3 of 4 PERMIT NO. ENC2024-0011 For Andalusia / Install IID Conduit / TM 38188; 31681; Monroe St and Ave 60 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. 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. 25. 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. 26. 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. 27. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time. 28. 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. 29. If it is the intent of the permittee to cut the pavement and have it restored by a third parry, the permittee shall postpone cutting the pavement until the intended third party has acquired a permit from the City to perform the required restoration work. Special Conditions Page 4 of 4 / A� " CERTIFICATE OF LIABILITY INSURANCE DATE (M M/DD/YYYY) 12/22/2023 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 Anthony Katzdorn NAME: Michael Ehrenfeld Company Insurance Agents aCC Ext : (619) 683-9990 A/XC, No): (619) 683-9999 E-MAIL akatzdorn@ehrenfeldinsurance.com ADDRESS: An Acrisure Agency CA OK07568 INSURER(S) AFFORDING COVERAGE NAIC # 2655 Camino Del Rio North #200 INSURERA: Upland Specialty Insurance Company 16988 San Diego CA 92108 INSURED INSURER B : United States Fire Insurance Company 21113 INSURER C : Starstone Specialty Insurance Co 44776 TBU, INC. INSURER D : Redwood Fire & Casualty Company 11673 244 Maple Ave. Ste T INSURER E : Colony Insurance Company 39993 INSURER F : Beaumont CA 92223 COVERAGES CERTIFICATE NUMBER: 23-24 GLAUTO XS I REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCEADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �X OCCUR DAMAGE TO PREM SES Ea oNcRETE ante $ 100,000 _7CLAIMS-MADE MED EXP (Any one person) $ EXCLUDED PERSONAL &ADV INJURY $ 1,000,000 A Y Y USPCLOO94123 09/13/2023 09/13/2024 LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO ❑ LOC JECT: MOTHER PRODUCTS-COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS Y Y 33-755488-1 09/13/2023 09/13/2024 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED HNON-OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 X AGGREGATE $ 3,000,000 C EXCESS LAB CLAIMS -MADE 87113X233ALI 09/13/2023 09/13/2024 DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA Y TBWC428843 03/24/2023 03/24/2024 X1 STATUTE ERER H E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ Limit/ACV $100,000 E Leased Rented Equipment Installation Floater IM255048-5 09/13/2023 09/13/2024 Limit/ACV $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Encroachment Permit -ACC IID Underground Work Corner of Monroe and 60 City of La Quinta is included as additional insured on a primary & non-contributory basis with waivers of subrogation as indicated above. Attached endorsements only apply as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of La Quinta ACCORDANCE WITH THE POLICY PROVISIONS. 78-495 Calle Tampico AUTHORIZED REPRESENTATIVE La Quinta CA 92253 % A Z1tiC/q @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: USPCL0094123 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Any person or organization when you have agreed in a All locations and completed operations for which you written and executed contract, prior to an "occurrence", have agreed in a written and executed contract prior that such person or organization be added as an to an "occurrence." additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: USPCL0094123 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization when you have agreed in a written and executed contract, prior to an `occurrence", that such person or organization be added as an additional insured on your policy. All locations and completed operations for which you have agreed in a written and executed contract prior to an "occurrence." Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: USPCL0094123 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization you have agreed in a written and executed contract, prior to an "occurrence", that you would provide such person or organization a waiver of transfer of rights of recovery against others to us on your policy. 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: USPCL0094123 CL00160721 PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other Commercial General Liability insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other Commercial General Liability insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other Commercial General Liability insurance available to the additional insured. CL00160721 Policy Number: USPCL0094123 CL00070721 DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT - SUBJECT TO A MAXIMUM AGGREGATE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All construction projects for which you have agreed in writing in a contract, prior to an occurrence that causes "bodily injury", "property damage" or "personal and advertising injury", to provide project specific limits. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. 5. All payments under this endorsement are subject to a Maximum Aggregate Limit of: $5,000,000 The Maximum Aggregate Limit is the most we will pay under this endorsement regardless of the number of Designated Construction Project General Aggregate Limits. CL 00 07 07 21 1 of 2 B. For all sums which the insured becomes legally C. obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. CL00070721 2of2 ❑ Policy Number: 33-755488-1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: TBU, Inc. Endorsement Effective Date: 09/13/2022 SCHEDULE A. Broadened Insured Status N. Audio, Visual, and Data Electronic Equipment Blanket Additional Insured When Required O. Loan/Lease Payoff Coverage P. Airbag Coverage B. Under Written Contract C. Employee Hired Autos Liability Coverage Q, Multiple Deductible Protection — Covered Auto and Trailer D. Employees as Insureds R. Duties in the Event of an Accident, Claim, Suit, or Loss E. Coverage Extensions — Supplementary S. Non -Owned Auto Waiver of Subrogation Payments F. Limited Fellow Employee Coverage T. Blanket Waiver of Subrogation When Required Under Written Contract Limited Hired Auto — Physical Damage G. Coverage — Private Passenger (Includes U Coverage Territory — Short Term Hired Employee Hired Autos Physical Damage Commercial Autos Coverage) H. Custom Signs and Decoration V. Limited Mexico Coverage I. Extended Towing Coverage W. Unintentional Failure to Disclose Hazards J. Glass Breakage X. Mental Anguish Resulting From Bodily Injury Reimbursement for Increased Temporary K. Transportation Expense for Private Passenger Y. Waiver of Sovereign Immunity and Commercial Vehicles L. Extra Expense — Stolen Vehicles Z. Application of This Endorsement M. Personal Effects Coverage MA 04 008 01 18 Includes copyrighted information of Insurance Services Office, Page 1 of 9 Inc., with its permission. A. Broadened Insured Status Paragraph A.1. Who Is An Insured under Section II — Covered Autos Liability Coverage is amended to include the following as "insureds": 1. Any subsidiary which is a legally incorporated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of this Coverage Form, while using with your permission a covered "auto." However, the insurance afforded by this provision, A.1., does not apply to any subsidiary that is an insured under any other automobile liability policy, or would be an insured under such policy but for the termination of such policy or the exhaustion of such policy's limits of insurance. 2. Any organization you newly acquire or form, and over which you maintain majority interest, while using with your permission a covered "auto". The insurance afforded by this provision, A.2.: a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form, or the next anniversary of its inception date, whichever is earlier. b. Does not apply to "bodily injury" or "property damage" resulting from an "accident" that occurred before you acquired or formed the organization. c. Does not include any newly acquired or formed organization that is: (1) A joint venture or partnership; or (2) An insured under any other automobile liability policy, or would be an insured under such policy but for the termination of such policy or the exhaustion of such policy's limits of insurance. B. Blanket Additional Insured When Required Under Written Contract 1. Paragraph A.1. Who Is An Insured under Section II — Covered Autos Liability Coverage is amended to include the following as "insureds": a. Any person, organization or governmental entity with respect to the operation, maintenance, or use of a covered "auto" if you are required to add such person, organization or governmental entity to this policy as an additional "insured" in order to comply with the terms of a written contract or written agreement. This additional insured status is not conferred when such written contract or written agreement: (1) Involves the owner or anyone else from whom you hire or borrow a covered "auto" unless it is a "trailer" connected to a covered "auto" you own; or (2) Is executed after the date of "accident" or "loss". Paragraph B.1.a.(2) above does not apply if: (a) The terms and conditions of the written contract or written agreement had been agreed upon prior to the "accident" or "loss"; and (b) You can definitively establish that the terms and conditions of the written contract or written agreement ultimately executed are the same as those which had been agreed upon prior to the "accident" or "loss". 2. Paragraph B.S.a. under Section IV — Business Auto Conditions is amended by the addition of the following: Otherinsurance Regardless of whether other insurance is maintained by an additional insured on a primary basis, the coverage provided by Provision B. of the Commercial Auto Broad Form Endorsement will be primary to and noncontributing with other insurance maintained by the additional insured if the written contract or written agreement between you and the additional insured specifically requires that this insurance be primary. MA 04 008 01 18 Includes copyrighted information of Insurance Services Office, Page 2 of 9 Inc., with its permission. C. Employee Hired Autos Liability Coverage Paragraph A.1. Who Is An Insured under Section II — Covered Autos Liability Coverage is amended to include the following as "insureds": 1. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a written contract or written agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. D. Employees as Insureds Paragraph A.1. Who Is An Insured under Section II — Covered Autos Liability Coverage is amended to include the following as "insureds": 1. Any "employee" of yours while using with your permission a covered "auto" you don't own, hire or borrow if such "auto" is being used in your business or your personal affairs. E. Coverage Extensions — Supplementary Payments Paragraphs A.2.a.(2) and A.2.a.(4) under Section II — Covered Autos Liability Coverage are deleted and replaced by the following: Coverage 2. Coverage Extensions a. Supplementary Payments We will pay for the "insured": (2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 a day because of time off from work. F. Limited Fellow Employee Coverage Paragraph B.S. under Section II — Covered Autos Liability Coverage is amended by the addition of the following: Exclusions S. Fellow Employee However, this exclusion does not apply if: c. The "bodily injury" results from the use of a covered "auto" you own or hire, and d. You have Workers' Compensation insurance in force covering all of your "employees". Such coverage as is afforded by provisions F.S.c. and F.S.d. above are excess over any other collectible insurance. G. Limited Hired Auto - Physical Damage Coverage — Private Passenger (Includes Employee Hired Autos Physical Damage Coverage) Paragraph A.1. under Section III — Physical Damage Coverage is amended by the addition of the following: Coverage 1. We will pay for "loss" to a covered "auto" or its equipment under: d. Limited Hired Auto — Physical Damage — Private Passenger If hired "autos" are covered "autos" for Covered Autos Liability Coverage, and if Physical Damage Coverage of Comprehensive or Collision is provided under this Coverage Form for any "auto" you own, then Comprehensive and Collision Physical Damage Coverages as provided under Section III — Physical Damage Coverage of this Coverage Part are extended to "autos" of the private passenger type you or your "employee" hires under a written contract or written agreement without a driver, at your direction, for the purpose of conducting your business, subject to the following: MA 04 008 01 18 Includes copyrighted information of Insurance Services Office, Page 3 of 9 Inc., with its permission. (1) The most we will pay for "loss" to any hired "auto" is the lessor of $35,000 or the actual cash value or cost to repair or replace, (2) The deductible will be equal to the largest deductible applicable to any owned "auto" of the private passenger type for that coverage, or $1,000, whichever is less, (3) Limited Hired Auto — Physical Damage — Private Passenger coverage is excess over any other collectible insurance, and (4) Subject to the above limit, deductible, and excess provisions we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own of the private passenger type insured under this policy. Coverage includes loss of use of that hired "auto", provided it results from an "accident' for which you are legally liable and as a result of which a monetary loss is sustained by the leasing or rental concern. The most we will pay for any one "accident' is $20 per day subject to a maximum of $1,000. If a limit for Hired Auto — Physical Damage is shown in the Schedule of any other endorsement, then that limit replaces, and is not added to, the $35,000 limit indicated above. This extension of coverage does not apply to any "auto" you hire or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company), or members of their households. H. Custom Signs and Decoration The following is added to Paragraph A.1. under Section III — Physical Damage Coverage: In the event of a total loss to an "auto" insured for Physical Damage Coverage on this policy, in addition to the actual cash value of the "auto", we will pay the actual cost to repair or replace signage or custom paint details up to $5,000. I. Extended Towing Coverage 1. If the named insured carries Comprehensive and Collision Coverage for the damaged covered "auto", then this coverage extension, I., applies to that covered "auto". If the damaged covered "auto" is of the private passenger type, then in addition to Comprehensive and Collision Coverage, the damaged covered "auto" must also carry Towing Coverage in order for this coverage extension, I., to apply. 2. Paragraph A.2. under Section III — Physical Damage Coverage is deleted and replaced by the following: Towing We will pay for towing and associated labor costs each time a covered "auto" is disabled. All labor must be performed at the place of disablement. If the "auto" is of the private passenger type, there will be no deductible. If the "auto" is not a private passenger type, a $250 deductible will apply to this coverage but it will not reduce the available limit of insurance. For all types of "autos", the most we will pay under this coverage is $1,000 per disablement. "Autos" which are disabled do not include stolen vehicles. J. Glass Breakage If you carry Comprehensive Coverage for the damaged covered "auto", then this coverage extension applies to that covered "auto": Paragraph A.3. Glass Breakage - Hitting A Bird Or Animal — Falling Objects Or Missiles under Section III — Physical Damage Coverage is amended by the addition of the following: Any deductible shown in the Declarations will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. If the glass must be replaced and there is no other damage associated with the 'loss", the deductible will be $100 unless a lower deductible is shown on the declarations page for this coverage. K. Reimbursement for Increased Temporary Transportation Expense for Private Passenger and Commercial Vehicles 1. If the Covered "Auto" has Comprehensive or Specified Causes Of Loss Physical Damage Coverage: Paragraph A.4.a. under Section III — Physical Damage Coverage is deleted and replaced by the following: Coverage Extensions MA 04 008 01 18 Includes copyrighted information of Insurance Services Office, Page 4 of 9 Inc., with its permission. a. Transportation Expenses If your covered "auto" is damaged or stolen and the damage or theft is covered by Comprehensive or Specified Causes of Loss coverage provided by this policy, we will pay up to $50 per day subject to a maximum limit of $1,500 for the necessary and actual temporary transportation expenses (including rental reimbursement) incurred by you during the period beginning 24 hours after the theft or damage and ending, regardless of the policy's expiration: (1) When the covered "auto" is returned to use or we pay for its "loss" in the event of a total theft of the covered "auto", or (2) When the covered "auto" is repaired or replaced, or we pay for its "loss", whichever is earlier in the event of a "loss" due to a cause other than the total theft of the covered "auto". Except with respect to losses pertaining to the total theft of covered "autos" of the private passenger type, this coverage does not apply while there are spare or reserve "autos" available to you. No deductible applies to this coverage. 2. If the Covered "Auto" has Collision Physical Damage Coverage: If your covered "auto" is damaged and the damage is covered by Collision coverage provided by this policy, we will pay up to $50 per day subject to a maximum limit of $1,500 for necessary and actual temporary transportation expenses (including rental reimbursement) incurred by you during the period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, when the covered "auto" is repaired or replaced, or we pay for its "loss", whichever is earlier. This coverage does not apply while there are spare or reserve "autos" available to you. No deductible applies to this coverage. L. Extra Expense — Stolen Vehicles Paragraph A.4.a. under Section III — Physical Damage Coverage is amended by the addition of the following: We will pay for all reasonable and necessary expenses to return a stolen covered "auto" to the named insured if such covered "auto" carries Comprehensive coverage. M. Personal Effects Coverage Paragraph A. Coverage under Section III — Physical Damage Coverage is amended to include the following coverage: 1. Personal Effects Coverage a. We will pay for "loss" to personal property or effects which are owned by an insured and in or on your covered "auto" at the time of "loss" in the event of a total theft of that covered "auto". b. Subject to Paragraph C. Limit Of Insurance under Section III — Physical Damage Coverage, we will pay up to $500 for "loss" of personal property or effects in any one "accident" involving total theft of a covered "auto". This insurance will not apply if, at the time of "loss", the covered "auto" is unattended, unless the "loss" is the result of forced entry into the covered "auto" while all doors, windows or other openings are closed and locked and there is evidence of forced entry. Under this coverage, we will not pay for "loss" to the following: accounts, bills, currency, deeds, evidences of debt, money, notes or securities, electronic equipment or tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment, jewelry, watches, necklaces, bracelets, gems, gold, platinum, silver, furs, animals, birds, or fish or any motorized vehicle. This coverage will be excess over any other collectable insurance. No deductible applies to this coverage. N. Audio, Visual, and Data Electronic Equipment The sub -limit in Paragraph CA.b. of the Limit of Insurance Provision of Section III — Physical Damage Coverage is increased to $1,500. O. Loan/Lease Payoff Coverage Paragraph C. Limit of Insurance of Section III — Physical Damage Coverage is amended by the addition of the following: MA 04 008 01 18 Includes copyrighted information of Insurance Services Office, Page 5 of 9 Inc., with its permission. In the event of a total 'loss" to a covered "auto" shown in the schedule or declarations for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on the lease or loan for that covered "auto," less: 1. The amount paid under the Physical Damage Coverage Section of the policy, and 2. Any: a. Overdue lease/loan payments at the time of the 'loss", b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage, c. Security deposits not returned by the lessor, d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, and e. Carry-over balances from previous loans or leases. This coverage is limited to a maximum of $1,500 for each covered "auto". P. Airbag Coverage 1. If the Named Insured carries Comprehensive and Collision Coverage for the damaged covered "auto", then this coverage extension, P., applies to that covered "auto". 2. Paragraph B.3.a. under Section III — Physical Damage Coverage is amended by the addition of the following: The accidental discharge of an airbag shall not be considered mechanical or electrical breakdown and therefore shall not be excluded. This provision does not apply to "autos" you hire with a driver and it is excess over any warranty specifically designed to provide this coverage. Q. Multiple Deductible Protection — Covered Auto and Trailer 1. If you carry Comprehensive and Collision coverages for the damaged covered "autos", then this coverage extension, Q., applies to those covered "autos". 2. Paragraph D. Deductible under Section III — Physical Damage Coverage is amended by the addition of the following: Whenever a covered "auto" and 'trailer" are each damaged in the same 'loss" while operating as a combined truck and 'trailer" unit, only one deductible shall apply to the "accident'. The larger of the two deductibles shall apply. If another policy or coverage form issued by us, that is not an automobile policy or coverage form, applies to the same 'loss" or "accident', the following applies: a. If the deductible under this Business Auto Coverage Form is not the largest deductible, it will be waived. b. If the deductible under this Business Auto Coverage Form is the largest deductible, it will be reduced by the amount of the smaller (or smallest) deductible. R. Duties in the Event of an Accident, Claim, Suit, or Loss 1. Paragraph A.2.a. under Section IV — Business Auto Conditions is amended so that your obligations relative to notification requirements apply only when the "accident' or "loss" is known to: a. You, if your are an individual, b. A partner, if you are a partnership, c. A member, if you are a joint venture, d. An executive officer, insurance manager or any other person designated by you to send notices of "accidents" or "loss" to insurers, if you are a corporation, or e. A member, if you are a limited liability company. 2. Paragraph A.2.b.(2) under Section IV — Business Auto Conditions is amended so that your obligations relative to providing us with documents concerning a claim or "suit' will not be considered breached unless the breach occurs after such claim or "suit' is known to: a. You, if your are an individual, b. A partner, if you are a partnership, c. A member, if you are a joint venture, MA 04 008 01 18 Includes copyrighted information of Insurance Services Office, Page 6 of 9 Inc., with its permission. d. An executive officer, insurance manager or any other person designated by you to send notices of "accidents" or "loss" to insurers, if you are a corporation; or e. A member, if you are a limited liability company. S. Non -Owned Auto Waiver of Subrogation Paragraph A.S. under Section IV— Business Auto Conditions is amended by the addition of the following: Loss Conditions S. Transfer Of Rights Of Recovery Against Others To Us We hereby waive any right of subrogation against any of your officers, directors, or "employees" which might arise by reason of any payment under the insurance afforded by this policy for the operation, maintenance, use, loading, or unloading of non -owned "autos". This waiver extends only to payments in excess of other valid and collectible insurance available to the officer, director, or "employee". Blanket Waiver of Subrogation When Required Under Written Contract Paragraph A.S. under Section IV— Business Auto Conditions is amended by the addition of the following: Loss Conditions S. Transfer Of Rights Of Recovery Against Others To Us However, we waive any right of recovery we may have against a person, organization or governmental entity when you have waived such right of recovery under a written contract or written agreement provided such written contract or agreement is: a. Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the "accident" or "loss"; or c. Executed after the "accident" or "loss" if: (1) The terms and conditions of the written contract or written agreement had been agreed upon prior to the "accident" or "loss"; and (2) You can definitively establish that the terms and conditions of the written contract or written agreement ultimately executed are the same as those which had been agreed upon prior to the "accident" or "loss". U. Coverage Territory — Short Term Hired Commercial "Autos" Paragraph B.7.b.(5) under Section IV — Business Auto Conditions is deleted and replaced by the following: General Conditions 7. Policy Period, Coverage Territory b. Within the Coverage territory The coverage territory is: (5) Anywhere in the world if a covered "auto" of the private passenger type, commercial van, pick-up, or truck type is leased, hired, rented or borrowed for a period of 30 days or less, provided that the "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada, or in a settlement we agree to. We also cover "loss" to, or "accidents" involving, a covered "auto" while being transported between any of these places. V. Limited Mexico Coverage WARNING AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE LAWS OF MEXICO ONLY - NOT THE LAWS OF THE UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS ANY AUTO ACCIDENT A CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER. MA 04 008 01 18 Includes copyrighted information of Insurance Services Office, Page 7 of 9 Inc., with its permission. IN SOME CASES THE COVERAGE PROVIDED UNDER THIS ENDORSEMENT MAY NOT BE RECOGNIZED BY THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT THIS COVERAGE AT ALL IN MEXICO. YOU SHOULD CONSIDER PURCHASING AUTO COVERAGE FROM A LICENSED MEXICAN INSURANCE COMPANY BEFORE DRIVING INTO MEXICO. THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR OUTSIDE OF 25 MILES FROM THE BOUNDARY OF THE UNITED STATES OF AMERICA. 1. Paragraph B.7. under Section IV — Business Auto Conditions is amended by the addition of the following: Policy Period, Coverage Territory The coverage territory is extended to include Mexico but only for: a. "Accidents" or "losses" occurring within 25 miles of the United States border, and b. Trips into Mexico of 10 days or less. 2. For purposes of this Provision, V., Paragraph B.S. under Section IV — Business Auto Conditions is deleted and replaced by the following, Otherinsurance The insurance provided by this Provision, V., will be excess over any other collectible insurance. 3. Paragraph A. Coverage under Section III — Physical Damage Coverage is amended by the addition of the following: If a 'loss" to a covered "auto" occurs in Mexico, we will pay for such 'loss" in the United States. If the covered "auto" must be repaired in Mexico in order to be driven, we will not pay more than the actual cash value of such "loss" at the nearest United States point where the repairs can be made. 4. Additional Exclusions The following exclusions are added: This insurance does not apply: a. If the covered "auto" is not principally garaged and principally used in the United States. b. To any "insured" who is not a resident of the United States. W. Unintentional Failure to Disclose Hazards Paragraph B. General Conditions under Section IV — Business Auto Conditions is amended by the addition of the following: If you unintentionally fail to disclose any hazards existing on the effective date of this policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium due to us as a result of these undisclosed hazards in accordance with our filed rating plans. X. Mental Anguish Resulting From Bodily Injury The definition of "bodily injury" under Section V — Definitions is deleted and replaced by the following: "Bodily Injury" means physical injury, physical sickness or physical disease sustained by any person, including "mental anguish" or death resulting from any of these. It does not include mental anguish to any person which occurs in the absence of physical injury, physical sickness or physical disease to that person. For the purpose of this provision, "mental anguish" shall mean any type of mental or emotional illness or distress. Y. Waiver of Sovereign Immunity The following provision applies if you are a "governmental entity" or we have added a "governmental entity" to your policy as an additional insured, and the "governmental entity" requires us to obtain permission prior to asserting a defense involving governmental immunity or the jurisdiction of the tribunal over the "governmental entity": MA 04 008 01 18 Includes copyrighted information of Insurance Services Office, Page 8 of 9 Inc., with its permission. 1. We shall not raise any defense involving, in any way, the jurisdiction of the tribunal over the "governmental entity", the immunity of the "governmental entity" or its commissioners, officers, agents or employees, the governmental nature of such entity, or the provisions of any statutes respecting suits against the "governmental entity" without first obtaining express advance permission from the designated representative of the "governmental entity". Application of this provision shall not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. For the purposes of this provision, "governmental entity" means a state, county, district, municipality, town, township, borough, parish, village, or other political subdivision or governmental agency or subdivision. Z. Application of This Endorsement The enhancements provided by this endorsement apply to the Business Auto Coverage Form. If your policy includes other endorsements in addition to this Commercial Automobile Broad Form Endorsement, and there is a conflict between any of the terms of such endorsement(s) and this Commercial Automobile Broad Form Endorsement, the terms of the other endorsement(s) shall be given priority and control over the terms set forth in this Commercial Automobile Broad Form Endorsement, even if the terms of such other endorsement(s) have the effect of limiting, excluding or reducing the coverage provided under this Commercial Automobile Broad Form Endorsement. MA 04 008 01 18 Includes copyrighted information of Insurance Services Office, Page 9 of 9 Inc., with its permission. UIMAi191 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10 C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description All CA Operations 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: 03/24/2023 PolicyNo.: TBWC428843 Endorsement No.: Insured: TBIJ, Inc. Premium $ Insurance Company: Redwood Fire and Casualty Ins Co Countersigned by WC990410C (Ed. 01-19) POLICY NUMBER: USPCL0094123 COMMERCIAL GENERAL LIABILITY CG 20 12 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1