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ENC2024-0070
ta Qwkra CAT FORM .% - 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: 6/24/2024 LOCATION AND CONSTRUCTION: SOUTHEAST CORNER OF WASHINGTON AND HWY 111 PURPOSE OF CONSTRUCTION: TRAFFIC CONTROL FOR CRANE LIFT FOR HVAC UNIT DESCRIPTION OF CONSTRUCTION: For LG Steakhouse; Traffic Control for HVAC Like for Like Change Out APROXIMATE TIME WHEN WORK WILL BEGIN: 7/8/2024 DATE OF COMPLETION: 7/12/2024 COMMENTS: LANE CLOSURE HOURS BETWEEN 9am to 3pm. BUILDING PERMIT, BMCH2O24-0263, REQUIRED TO INSTALL HVAC. 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. 36365 BANKSIDE DR CATHEDRAL CHAFFIN AIR - - CITY, CA 92234 (760) 328-3400 Name of Applicant Business Address Telephone No. 36365 BANKSIDE DR CATHEDRAL CHAFFIN AIR CHAFFIN PATRICK CITY, CA 92234 (760) 328-3400 Name of Contractor 661464 Contractor's License No. GUIDEONE INSURANCE COMPANY Applicant's Insurance Company Business Address FEES Traffic Control $370.00 Credit Card Convenience Fee $9.45 Technology Enhancement Fee $8.00 Total: $387.45 Telephone No. 0002815 City Business License No. 70K100701-02 Policy Number PERMIT NO: ENC2024-0070 DATE ISSUED: 7/3/2024 EXPIRATION DATE: 7/3/2025 BY: Amy Yu If the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City Council. 7/3/2024 2:13:45 PM GENERAL NOTES 1. THESE STANDARD NOTES AND PLANS SHALL NOT RELIEVE THE CONTRACTOR OF THE RESPONSIBILITY FOR JOBSITE CONDITIONS DURING THE COURSE OF CONSTRUCTION OR MAINTENANCE WORK, INCLUDING SAFETY OF ALL PERSONS, VEHICLES, AND PROPERTY. 2. ALL WORK, MATERIALS, PRACTICES, AND PRINCIPLES SHALL COMPLY WITH THE CALIFORNIA MANUAL OF UNIFORM TRAFFIC CONTROL DEVICES (MUTCD) LATEST EDITION. 3. The CALIFORNIA MANUAL OF UNIFORM TRAFFIC CONTROL DEVICES (MUTCD) LATEST EDITION, AND THE WORK AREA TRAFFIC CONTROL HANDBOOK (WATCH) LATEST EDITION, SHALL TAKE PRECEDENCE IN THE EVENT OF ANY QUESTION REGARDING THE CONTROL OF THESE STANDARDS. 4. NO DEVIATIONS OR EXCEPTIONS FROM THESE STANDARD NOTES OR PLANS SHALL BE ALLOWED WITHOUT PRIOR APPROVAL FROM THE PUBLIC WORKS DIRECTOR/CITY ENGINEER. 5. CONES AND DELINEATORS SHALL GENERALLY BE PLACED ON EXISTING LANE LINES, EXCEPT AS NECESSARY FOR LANE CLOSURE TAPERS. 6. THE CONTRACTOR SHALL BE RESPONSIBLE FOR NOTIFYING THE ADJACENT PROPERTY OWNERS. 7. THE CONTRACTOR SHALL PROVIDE ACCESS TO ALL ADJACENT PROPERTIES AT ALL TIMES EXCEPT AS NECESSARY FOR CONSTRUCTION ACTIVITIES IN THE IMMEDIATE VICINITY OF THE WORK AREA. 8. CONSTRUCTION OPERATIONS SHALL BE CONDUCTED IN A MANNER SUCH THAT AS LITTLE INCONVENIENCE AS POSSIBLE IS CAUSED TO THE PUBLIC AND ABUTTING PROPERTY OWNERS. 9. THE CONTRACTOR SHALL HAVE ALL SIGNS, DELINEATORS, BARRICADES, ETC., PROPERLY INSTALLED PRIOR TO CONSTRUCTION. 10. THE CONTRACTOR SHALL BE RESPONSIBLE FOR MAINTAINING, AT ALL TIMES, ALL SIGNS, DELINEATORS, BARRICADES, ETC., TO ENSURE PROPER FLOW AND SAFETY OF TRAFFIC. 11. A MINIMUM LANE WIDTH OF 10' SHALL BE MAINTAINED AT ALL TIMES, NO EXCEPTIONS. WHEN ADJACENT TO CURB LANE, RAISED CURB MEDIANS, OTHER VERTICAL OBSTRUCTION, OR OPPOSING TRAFFIC, THE MINIMUM LANE WIDTH SHALL BE 11'. 12. THE CONTRACTOR SHALL UTILIZE FLAG MEN DURING WORK HOURS AS REQUIRED BY THESE STANDARD PLANS AND AS DEEMED NECESSARY BY THE CITY TO ASSIST IN MAINTAINING SAFE TRAFFIC FLOW. 13. FLASHING ARROW BOARD (FAB) SHALL BE USED FOR ALL LANE CLOSURES AND SHALL BE SOLAR POWERED. 14. THE FIRST SIGN IN A SERIES OF ADVANCED WARNING SIGNS SHALL BE EQUIPPED WITH FLAGS. 15. FLASHING YELLOW BEACONS, TYPE B, SHALL BE USED ON ALL BARRICADES THAT PROTECT THE WORK AREA AFTER NORMAL WORKING HOURS. 16. ALL SIGNS SHALL BE REFLECTORIZED AND OF STANDARD SIZES. 17. THE CONTRACTOR SHALL BE REQUIRED TO REPLACE STRIPING AND LEGENDS TO THEIR ORIGINAL CONDITION AND EQUIPMENT AFTER COMPLETION OF CONSTRUCTION. 18. ALL DELINEATORS SHALL BE 36" MINIMUM PORTABLE, REFLECTORIZED RUBBER GUIDE POST TUBES, ORANGE IN COLOR, WITH WEIGHTED BASES OR SANDBAG RINGS AND SHALL BE KEPT IN THEIR PROPER POSITION AT ALL TIMES, AND SHALL BE REPAIRED, REPLACED, OR CLEANED AS NECESSARY TO PRESERVE THEIR APPEARANCE AND CONTINUITY. 19. ALL CONES, SHALL BE 28" MINIMUM, ORANGE IN COLOR, AND SHALL BE KEPT IN THEIR PROPER POSITION AT ALL TIMES, AND SHALL BE REPAIRED, REPLACED, OR CLEANED AS NECESSARY TO PRESERVE THEIR APPEARANCE AND CONTINUITY. ALL CONES SHALL BE FITTED WITH 13" MINIMUM REFLECTIVE SLEEVES FOR NIGHTTIME TRAFFIC CONTROL. MAXIMUM SPACING BETWEEN DELINEATORS SHALL BE 25'. 20. AT LEAST EVERY THIRD CONE AND/OR DELINEATOR SHALL HAVE DELINEATOR OR CONE -MOUNTED DIRECTIONAL ARROWS PER THE WORK AREA TRAFFIC CONTROL HANDBOOK (WATCH) LATEST EDITION. 21. BARRICADES SHALL BE USED, IN LIEU OF OR IN ADDITION TO RUBBER GUIDE POSTS, AS REQUIRED BY THESE STANDARD PLANS AND AT THE DIRECTION OF THE COUNTY, WHEN THEY ARE INTENDED TO PROVIDE ADDITIONAL EMPHASIS IN AREAS WHERE WORKERS ARE PRESENT. 22. C27 (CA) "OPEN TRENCH" SIGNS SHALL BE USED IN CONJUNCTION WITH TYPE II BARRICADES DURING CONSTRUCTION AND NIGHTTIME CLOSURES AS APPLICABLE. 23. WHERE LIGHTS ARE USED TO DELINEATE THE TRAVELED WAY THROUGH AND AROUND THE WORK AREA, THEY SHALL BE TYPE C (STEADY BURN LAMPS). 24. WHEN A STREET CLOSURE IS APPROVED, THE CONTRACTOR SHALL NOTIFY THE POLICE DEPARTMENT, THE FIRE DEPARTMENT, THE LOCAL TRANSIT DISTRICT, AFFECTED RESIDENTS AND BUSINESSES AT LEAST ONE WEEK IN ADVANCE OF THE CLOSURE. 25. ALL STREET ACCESS RESTRICTED BY CONSTRUCTION OR MAINTENANCE ACTIVITIES SHALL BE RESTORED AT THE END OF EACH WORKING DAY UNLESS OTHERWISE APPROVED BY THE PUBLIC WORKS DIRECTOR/CITY ENGINEER. 26. TEMPORARY `NO STOPPING" SIGNS SHALL BE POSTED 100' APART, AS NECESSARY DURING CONSTRUCTION OPERATIONS. WHEN A TEMPORARY "NO STOPPING" ZONE ON A STREET IS APPROVED BY THE CITY'S REPRESENTATIVE, THE CONTRACTOR SHALL NOTIFY THE POLICE DEPARTMENT AND POST "TOW AWAY, TEMPORARY NO STOPPING" AT LEAST TWO (2) WORKING DAYS IN ADVANCE. THE DURATION OF THE TEMPORARY PARKING RESTRICTION SHALL BE INDICATED ON THE SIGNS. 27. WHEN SIGNAL TIMING AND/OR SIGNAL MODIFICATIONS ARE NECESSARY BEFORE OR DURING THE CONSTRUCTION, AND IF APPROVED BY THE TRAFFIC ENGINEER, THE CONTRACTOR SHALL NOTIFY THE CITY TRAFFIC DEPARTMENT AT LEAST THREE (3) WORKING DAYS IN ADVANCE OF THE WORK TO BE DONE IN ORDER TO COORDINATE THE CHANGES. THE CONTRACTOR SHALL PROVIDE THE PERSONNEL AND EQUIPMENT TO MAKE THE SIGNAL MODIFICATIONS; THE CITY SHALL MAKE THE NECESSARY SIGNAL TIMING CHANGES. 28. CONTRACTOR SHALL REPLACE ALL TRAFFIC DETECTION DEVICES, SIGNING, STRIPING, MARKINGS, AND LEGENDS DAMAGED DURING CONSTRUCTION. 29. THESE PLANS INDICATE TRAFFIC CONTROL IN THE WORK AREA DURING CONSTRUCTION ACTIVITIES. ADDITIONAL TRAFFIC CONTROLS, TRAFFIC SIGNS, AND/OR BARRICADES MAY BE NECESSARY OR REQUIRED IN THE FIELD. THE CONTRACTOR SHALL BE RESPONSIBLE FOR THE PLACEMENT OF ANY ADDITIONAL DEVICES NECESSARY AS DIRECTED BY THE CITY'S REPRESENTATIVE TO ASSURE SAFETY TO THE PUBLIC AT ALL TIMES DURING CONSTRUCTION. 30. CONTRACTOR SHALL COMPLY WITH THE REQUIREMENTS OF THE AMERICAN DISABILITY ACT (ADA) AS RELATED TO PEDESTRIAN ACCESS AND SHALL MAINTAIN PEDESTRIAN ACCESS AT ALL TIMES PER ADA REQUIREMENTS. 31. INSTALL TEMPORARY NO PARKING SIGNS (IF REQUIRED) 72 HOURS PRIOR TO THE CLOSURE. SPEED LIMIT DIMENTION "A" ADVANCE WARNING SIGN SPACING DIMENSION "L" MERGING TAPER LENGTH DIMENSION "L/2" SHIFTING TAPER LENGTH DIMENSION "E" BUFFER SPACE (0% SLOPE) MAXIMUM CHANNELIZER TAPER SPACING MAXIMUM CHANNELIZER TANGENT SPACING 25 MPH 100 FT 125 FT 65 FT 155 FT 25 FT 50 FT 30 MPH 250 FT 180 FT 90 FT 200 FT 30 FT 60 FT 35 MPH 250 FT 245 FT 125 FT 250 FT 35 FT 70 FT 40 MPH 250 FT 320 FT 160 FT 305 FT 40 FT 80 FT 45 MPH 350 FT 540 FT 270 FT 360 FT 45 FT 90 FT 50 MPH 350 FT 600 FT 300 FT 425 FT 50 FT 100 FT 55 MPH 500 FT 600 FT 300 FT 495 FT 50 FT 100 FT 60 MPH 500 FT 720 FT 360 FT 570 FT 50 FT 100 FT m J a m L r tan Care 9; RIGHT LANE CLOSURE OF WASHIGTON ST FOR LG'S PROJECT W 1ai PROJECT L 0 CA T/O 1� cameo paim Dr 1!21i M I�Lrp vein I4 N q6 OR tuurc!; � 4 oL DF ,.+ M WARNING SIGNS ROAD ROAD IGHT LANE RIGHT LANE LEFT LANE LEFT LANE BIKE LADE HODUJ WORK DETOUR> < CLOSED CLOSED CLOSED CLOSED CLOSED CLOSED WORK AHEAD AHEAD AHEAD AHEAD AHEAD AHEAD AHEAD AHEAD EAD W20-1 W20-2 W20-3 C2 CAR C20 CA 2R C20 CAL C2 CA 2L W20-5E31C W21--5 OPEN LANE BIKLANE 1I tons TRENCH CLOSED CLOSED > < < <k < > < > < > W12-1 WI-4(L) WI-4(R) W4-2 R W4-2 L C27 CA C3 CA W1-8 L C CA BK M0D REGULATORY SIGNS ROAD CLOSED ROAD CLOSED THRu 1�RAFFIC SIDEWALK CLOSED �A nay H�CROSS "am H�HERE ESUWA1:XCLOSIM ��CROSS sDEw CLOSM CIM HIX KEEP RIGHT KEEP LEFT R11-2 R11-4 R9-9 R9-11 R R9-11 L R9-11a R R9-1Ia L R4-7a R4-8a NO Gt06S1t1G •WAY WRONGPEDESWAAN - - *IT* 4 -@a R9-3 R9-3a R5-1 R5-1a R1-1 R60B CA R3-6 R R3-6 L R3-18 MISCELLANEOUS DEVICES CHANGEABLE MESSAGE SIGN TRAILER (TYP.) PLASHING ARROW SIGN TRAILER (TYP.) (CMS) (PAS) IJ HIGH LEVEL WARNING DEVICE (HLWD) LEGEND: TRAFFIC CONE POST TUBE 1. - PROPOSED WORK AREA 2. - EXISTING STRIPING 3. - EXISTING CURB & GUTTER 4. --- -- - - MUNICIPALITY BOUNDARY LINES 5. D WY - EXISTING DRIVEWAYS) S, CALTRANS BOUNDARY LINES 7. 6 6 PROPOSED CHANNELIZATION LINE S. - EXISTING FENCE LINE 9. , - PROPOSED FLAG PERSON W/ 2-WAY RADIO 10. -- PROPOSED PORTABLE ARROW BOARD 11. ] - PROPOSED PORTABLE MESSAGE SIGN 12. - PROPOSED SIGN W/ POST 13. -- PROPOSED TYPE II BARRICADE W/ SIGN(S) 14. - PROPOSED TYPE III BARRICADE W/ SIGN(S) 15. m - K-RAIL 16, - CRASH CUSHION O�FoR yoG Under Traffic Control Plans Prepared By: Q�pFESSli DESIGN BY: SYED MUHAMMAD ABBAS CONTRACTOR INFORMATION: CITY OF LA QUINTA TRAFFIC CONTROL PLAN Ground o q ° Service Alert \ Q� �PvuN q��F REVIEW BY: AIRCONDITICMINe RIGHT LANE CLOSURE OF WASHIGTON ST FOR TC - 00 of Southern California I� s HNwnNc ' z r' HUMAYUN Azlz LG'S PROJECT III/ C75713 r z 17601 328-3400 nil Call: TOLL FREE m r-nd EXP.06 24 www.ehaffinaircom 1-800 ` * 30 APPROVED BY: 36-365 Bankside Drive 227-2600 WWW.MZBINC.COM OF'�AL�\P Cathedral City, CA 92234 APPROVED BY: ENGINEER TITLE PAGE O1 O02 SHEET F TWO WORKING DAYS BEFORE YOU DIG CELL: 949-254-4792 DATE HUMAYUN AZIZ. P.E. Ph:760-328-3400 Fax:760-770-4365 MARK REVISIONS APPR. DATE HORIZ. SCALE: 1 "= 40' VERT. SCALE: I/ w 0 m Q w w Q I Q w z U Q • SPEED LIMIT DIMENTION "A" ADVANCE WARNING SIGN SPACING DIMENSION "L" MERGING TAPER LENGTH DIMENSION "E" BUFFER SPACE (0% SLOPE) MAXIMUM CHANNELIZER TAPER SPACING MAXIMUM CHANNELIZER TANGENT SPACING 25 MPH 100 FT 125 FT 155 FT 25 FT 50 FT 30 MPH 250 FT 180 FT 200 FT 30 FT 60 FT 35 MPH 250 FT 245 FT 250 FT 35 FT 70 FT 40 MPH 250 FT 320 FT 305 FT 40 FT 80 FT 45 MPH 350 FT 540 FT 360 FT 45 FT 90 FT 50 MPH 350 FT 600 FT 425 FT 50 FT 100 FT 55 MPH 500 FT 600 FT 495 FT 50 FT 100 FT 60 MPH 500 FT 720 FT 570 FT 50 FT 100 FT Ofp�ORE k, Under Traffic Control Plans Prepared By: Ground Service Alert rrr(/ of Southern California - IIIII,I� Call: TOLL FREE 1-800 227-2600 WWW.MZBINC.COM TWO WORKING DAYS BEFORE YOU DIG CELL: 949-254-4792 LIV 4 4"0 #0 - % * 1 t d* . , �.. . SIGN LEGENDS: RIGHT LANE CLOSED AHEAD C20(CA)(R) KEEP LEFT ., ie W12-1 �i�l N MA • • 40 ri►- 40 �t • • ell WASHINGTON ST (50MPH) BUFFER SPACE 425' dSkIP OC30 (CA),R4-8a LANE CLOSED ON RED C30(CA) R13A(CA) ROAD o000 O00 END WORK AHEADROAD WORK O00000 G20-2 FAB W4-2(R) W20-1 DESIGN BY: CONTRACTOR INFORMATION• O�= Q � VtiAp' P 7tj 30 (CA), R4-8a FESS/p�9 SYED MUHAMMAD ABBAS U N aZ lF REVIEW BY: AIR CONDITIONING C75713 �= HUMAYUN AZIZ N HEATING z 17601 338-3400 d EXP.06 30 24 www.chaffinair.com J� CIVt� \P APPROVED BY: 36-365 Bankside Drive 9lFOF C0F�Q Cathedral City, CA 92234 HUMAYUN AZIZ. P.E. Ph:760-328-3400 Fax:760-770-4365 MARK REVISIONS APPR. DATE N moo' OR -- - * C30 (CA), R4-8a CITY OF LA DUINTA APPROVED BY: ENGINEER. DATE MERGING TAPER 600' W12-1 i '�- LL_ LEI m — w w cn Q W z 7 SCALE 1 " = 40' 411110 ClosureLane • Between 9am to 3pm 1. ACCESS TO DRIVEWAYS AND SIDE STREETS MUST BE MAINTAINED AT ALL TIMES. 2. CONTACT PROPERTY OWNER(S) 72 HOURS PRIOR TO START OF WORK. 3. FLAGGER TO ASSIST PEDESTRIAN CROSSING AS REQUIRED. TRAFFIC CONTROL PLAN RIGHT LANE CLOSURE OF WASHIGTON ST FOR LG'S PROJECT LA CIENEGA BLVD HORIZ. SCALE: 1 "= 40' VERT. SCALE: TC-01 SHEET 02 OF OG City of La Quinta The following General and Special Provisions are attached to and made a part of Permit Number ENC2024-0070 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 be notified the City at (760) 777 - 7097 at least forty-eight hours (48) in advance of starting construction. ® R2 UTILITY CLEARANCE: (Substructures) Prior to making any excavations within the City of La Quinta right-of-way authorized by permit, the permittee shall contact all concerned utility companies relative to the location of existing substructures. Damage to existing substructures resulting from operations conducted under this permit shall be the sole responsibility of the permittee. ® R3 UTILITY CLEARANCE (Surface Structures) No work shall be done under this permit until all utilities are clear of the proposed work site. The permittee shall notify all concerned utility companies of the proposed work. ❑ R4 PAVEMENT WIDENING: Area between the proposed concrete gutter line and the existing road pavement shall be surfaced with ( ** N/A ** ) inches of A.C. paving placed on ( ** N/A ** ) inches of ( ** N/A ** ) aggregate sub -base course having an "R" value of not less than ( ** N/A ") and in conformance with the City of La Quinta Road Improvement Standards and Specifications, Ordinance #461. ® R5 PARKWAY GRADING: Area between the property line and top of the proposed concrete curb shall be graded to a slope of one-fourth inch ('/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 ( " N/A ** ) 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. ENC2024-0070 LG Prime Steakhouse / Traffic Control for Lift HVAC Unit by Crane / Southeast Corner of Washington and Hwy III 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. Chaffin Air, hereinafter referred to as "Permittee", shall be responsible for providing continuous dust and erosion control. 3. This permit or copy of it shall be on the work site for inspection during the actual work performed. 4. Streets shall be kept clean. They shall be completely cleaned at the end of each working day and more frequently, if required. 5. Pursuant to Section 6.08.050 of the La Quinta Municipal Code (Ordinance 18 § 1, 1982), throughout the work site, the Permittee shall comply with City regulated work hours. Operation and maintenance of equipment within one-half mile of human occupancy shall be performed only during the following time periods: October 1 st to April 30: Monday -Friday 7:00 a.m. to 5:30 p.m. Saturday 8:00 a.m. to 5:00 p.m. May 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 8:30 a.m. and after 4:30 p.m. 6. 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 Maintenance Technician at (760) 250-0571 if signal operation at the intersection is to be altered in any way. 7. 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. 8. Pursuant to Section 14.16.110 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), Permittee shall assume responsibility for repair of any pavement damage to any public or private street and for any damage to other City streets or facilities as a result of work performed under this permit. Special Conditions Page 1 of 3 PERMIT NO. ENC2024-0070 LG Prime Steakhouse / Traffic Control for Lift HVAC Unit by Crane / Southeast Corner of Washington and Hwy III 9. 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. 10. Pursuant to Section 14.16.250 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), advance warning signs and traffic control shall be installed and maintained in accordance with the latest edition of the Work Area Traffic Control Handbook (WATCH Manual) and the latest version of the California Manual of Uniform Traffic Control Devices (CA MUTCD). A traffic control plan shall be prepared in accordance with the WATCH Manual or under the guidance of the latest version of the MUTCD and submitted to the City for review and approval prior to starting any construction. 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. 11. 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. 12. 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. 13. Pursuant to Section 14.16.370 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982), backfill compaction within street rights -of -way shall conform with Section 306-1.3 of the latest edition of the Standard Specifications For Public Works Construction (SSPWC), except as otherwise specified herein. No excavation is anticipated in the Scope of Work or within this permit. 14. 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. 15. All landscaping, irrigation, decorative rock, decorative concrete, sidewalk, lighting, etc., shall be replaced to its original condition. 16. Access and egress to all local properties shall be maintained at all times. Special Conditions Page 2 of 3 PERMIT NO. ENC2024-0070 LG Prime Steakhouse / Traffic Control for Lift HVAC Unit by Crane / Southeast Corner of Washington and Hwy III 17. 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: No asphalt work is anticipated within the scope of work or this permit. 18. Permittee shall permanently stabilize any and all soil that was disturbed as a result of work performed under this permit with an approved dust control treatment. Soil stabilization shall be done immediately after completing the operation. 19. The City of La Quinta reserves the right to 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. 20. 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. 21. The City of La Quinta reserves the right to revoke, suspend or void this permit at anytime. 22. The permittee shall indemnify, hold harmless and assume the defense of the City from all damages, delay costs, costs or expenses in law or equity that may arise out of work under this permit. Special Conditions Page 3 of 3 CHAFAIR-01 DNIELSEN ,4coR0 CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 6/20/2024 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 License # 0757776 CONTACT Diane Nielsen NAME: PHONE , Ext): (760) 360-4700 4742 FAX No):(760) 200-9706 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 ADDRESS: diane.nielsen@hubinternational.com Palm Desert, CA 92211 INSURERS AFFORDING COVERAGE NAIC # INSURER A:GUIdeOne Insurance Company 15032 INSURED INSURER B : Everest Premier Insurance Company 16045 INSURER C Pat Chaffin DBA: Chaffin Air 36365 Bankside Dr. INSURER D : INSURER E : Cathedral City, CA 92234 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM DD YYY POLICY EXP MM DD YYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X 70K100701-02 9/20/2023 9/20/2024 DAMAGE TO RENTED PREMISES Ea occurrence 100,000 $ X MED EXP (Any oneperson) $ 5,000 XCU Coverage X $2,500Deductible PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PECOT- ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Perperson) $ ANY AUTO 70K100557-02 7/6/2023 7/6/2024 OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident) ent $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A X 7600025595241 5/1/2024 5/1/2025 X PER OTH- STATUTE ER 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 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of La Quinta is named as additional insured per attached CG2010 1219 & CG2037 1219. Insurance is primary/Non-Contributory per attached. Waiver of Subrogation applies to workers compensation per attached. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico La Quinta, CA 92253 REPRESENTATIVE AUTHORIZED ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 70K100701 02 00 CA COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 (Blkt) 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 Blanket as required by written contract and effective Primary Insurance applies: It is agreed that such during the policy period as stated on the policy insurance as is afforded by this policy for the declarations. benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured or its subcontractors, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the result of the additional insured's negligence or solely the additional insured's responsibility. 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. 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 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 CG 20 10 12 19 (Blkt) © Insurance Services Office, Inc., 2018 Page 1 of 2 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: 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 applicable limits of insurance. increase the Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 (Blkt) POLICY NUMBER: 70K100701 02 00 CA COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 (Blkt) 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 Blanket as required by written contract and Primary Insurance applies: It is agreed that such effective during the policy period as stated on the insurance as is afforded by this policy for the policy declarations. benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the result of the additional insured's negligence or solely the additional insured's responsibility. This insurance also does not apply to any structure intended to be occupied as a private residence, not including apartments. 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 CG 20 37 12 19 (Blkt) © Insurance Services Office, Inc., 2018 Page 1 of 2 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 37 12 19 (Blkt) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by tli s 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.) Yon must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 05/01/2024 Insured: Chaffin, at Policy No. 7600025595241 Insurance Company: Everest Premier Insurancr ^�-•---•----• Countersigned By: - 1998 by the Wm•kers' Compensation Insurance Rating Bm•eau of California. All rights reserved. From the WCIRB's Califm•ia Workers' Compensation Insurance Fm•ms Manual - 1999. Endorsement No. 001 Premium $ INCL.