PWPT2024-0004ta 0 � da ra
PUBLIC WORKS 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: 11 /20/2024
LOCATION AND CONSTRUCTION: Within Griffin Ranch in the southeast corner of Ave 54 and Madison St: Tract surrounding
Mery Griffin Estates
PURPOSE OF CONSTRUCTION: On -site street improvements including install remaining curb
DESCRIPTION OF CONSTRUCTION: Griffin Ranch TM 38083: On -Site Street Improvements including remainder of curb: Plan
Set No. 06018
APROXIMATE TIME WHEN WORK WILL BEGIN: 12/9/2024 DATE OF COMPLETION: 12/20/2024
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.
350 Commerce, Suite 200 Irvine, CA
Toll Brothers Brandon J Haskell 92602 (626) 664-4429
Name of Applicant Business Address Telephone No.
Haitbrink Asphalt Paving Inc. Dan Gelinas 1480 Magnolia Ave Corona, CA 92879 (951) 273-0111
Name of Contractor Business Address Telephone No.
517707 LIC-0772764-2024
Contractor's License No. City Business License No.
National Fire Insurance Company of Hartford 7015349126
Applicant's Insurance Company Policy Number
FEES
Technology Enhancement Fee $324.45
Digital Archiving and Records
Management Fee $24.00
Street Improvement - On -Site $6,489.00
Total: $6,837.45
PERMIT NO: PWPT2024-0004
DATE ISSUED: 12/23/2024
EXPIRATION DATE: 12/23/2025
BY: Amy Yu
If the work is covered by a Subdivision Improvement
Agreement, Subdivider shall request final acceptance of
improvements from the City Council.
12/23/2024 10:45:05 AM
City of La Quinta
The following General and Special Provisions are attached to and made a part of
Permit Number PWPT2024-0004
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
two inches (2") of SC-800 shall be placed immediately. A permanent patch of Asphalt Concrete surfacing per City of La
Quinta Standard 600 shall be placed no later than ( 5 ) days after completion of temporary road repair.
❑ R22 FOG SEAL: A fog seal coat consisting of an application of asphaltic emulsion shall be applied over all patch areas as
determined by the City Engineer.
® R23 STREET RESTRIPING: Where street striping is still visible on street to be excavated, such striping shall be replaced upon
completion of permanent repairs.
® R24 TREE RELOCATION OR REMOVAL: Tree relocation within the City of La Quinta road right-of-way shall be accomplished
by a licensed, bonded and insured tree service, and handled safely without interference or hazard to the traveling public. It
shall be the responsibility of the permitte to maintain the tree in a vigorous growing condition at its new location.
Trees to be removed shall be in sections, which can be handled safely without interference or hazard to highway traffic. The
entire width of the tree stump, shall be removed and disposed of so that no debris remains in view of the highway. The
stump hole shall be backfilled and thoroughly compacted as specified in the following paragraph. Where it becomes
necessary to restrict traffic, the work shall be restricted to a maximum of five -hundred feet (500') at any one time. Adequate
signs, flagmen and or barricades shall be provided to protect the traveling public at all times.
Large holes resulting from tree removal shall be backfilled and compacted to not less than ninety percent (90%) or
equivalent tot the surrounding ground, whichever is the greater compaction as determined by the impact or field method.
Compaction tests shall comply with Section 6.3.01 of the Standard Specifications, Division of Highways, State of California,
dated January 1973.
PERMIT NO. PWPT2024-0004
Griffin Rancho /On -Site Street Improvements / TM 38083; Within Griffin Ranch
in the Southeast Corner of Ave 54 and Madison St;
Tract surrounding Mery Griffin Estates
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 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.
4. Permittee shall not perform any digging, clearing, grubbing, or earth moving until permittee
obtains clearance from Tribal monitors (Abraham Becerra and Gary Resvaloso) on whether
monitoring is required.
5. Prior to commencing the excavation of a trench 5 feet in depth or greater and into which a person will
be required to descend, the Contractor shall first obtain a permit to do so from the Division of Industrial
Safety pursuant to 7-10.4.1.
6. Toll Brothers (Brandon Haskell) and/or Haitbrink Asphalt Paving, 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. Pursuant to Section 6.08.050 of the La Quinta Municipal Code (Ordinance 18 § 1, 1982), throughout the
work site, the Permittee shall comply with City regulated work hours. Operation and maintenance of
equipment within one-half mile of human occupancy shall be performed only during the following time
periods:
October 1st to April 30: Monday -Friday 7:00 a.m. to 5:30 p.m.
Saturday 8:00 a.m. to 5:00 p.m.
May 1st to September 30: Monday -Friday 6:00 a.m. to 7:00 p.m.
Saturday 8:00 a.m. to 5:00 p.m.
Work shall be prohibited on legal holidays and Sundays.
Note: Construction work (including setting up traffic control devices) is not permitted on any Arterial
street (ie any 4 lane street) neither before 8:30 a.m. nor after 4:30 p.m.
Special Conditions Page 1 of 9
PERMIT NO. PWPT2024-0004
Griffin Rancho /On -Site Street Improvements / TM 38083; Within Griffin Ranch
in the Southeast Corner of Ave 54 and Madison St;
Tract surrounding Mery Griffin Estates
9. 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.
10. The permittee and/or contractor placing engineered fill must provide adequate time and safety for the
Geotechnical Engineer of Record to perform soils testing during engineered fill placement. The testing
frequency shall be determined by the Geotechnical Engineer of Record such that the fill can be
determined to be placed according to the city approved plans.
11. The permittee and/or contractor shall provide surveyor staking information adequate for the City
Inspector to determine horizontal and vertical locations relative to the approved city plans. The
minimum required wood lath type stakes shall be placed at all proposed building corners, and they shall
state the horizontal location relative to building corner and the elevation of the top of hub next to the
lath.
12. 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.
13. This permit is not valid until the permittee submits, to the Public Works Department 2 weeks prior to
start of construction, a letter from any owners of the driveways/access ways that will be closed down
due to the construction. The letter must be approved by the city and at minimum state from the owner
the following:
A. Approval of the construction
B. Plan identification
C. Time Frame of Closure
D. Alternative Routes
14. 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.
15. Toll Brothers (Brandon Haskell) and/or Haitbrink Asphalt Paving, Inc, hereinafter referred to as
"Permittee", shall be responsible for providing continuous dust and erosion control during construction
material hauling procedures.
The following Fugitive Dust Control rules shall apply during soil import/export activities:
a. A valid grading permit shall be active at both the import and export site
b. The import/export material during hauling shall be near 70% optimum moisture content.
c. Street cleaning shall occur, as necessary, at import and export location.
d. Trucks hauling export or import material must maintain 6 inches of freeboard and be tarped.
e. The haul route shall be attached to this permit or a City approved plan.
Special Conditions Page 2 of 9
PERMIT NO. PWPT2024-0004
Griffin Rancho /On -Site Street Improvements / TM 38083; Within Griffin Ranch
in the Southeast Corner of Ave 54 and Madison St;
Tract surrounding Mery Griffin Estates
16. Prior to excavating, if required, the Permittee shall contact Underground Service Alert at 811. It shall
be the Permittee's responsibility to notify the Public Works Department of anticipated excavation
which impact City facilities, including but not limited to traffic signal conduits and loops, irrigation
lines, electrical conduits, and storm drain facilities.
17. 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.
18. 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.
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.
The permittee shall be responsible for notifying the inspection staff of import fill and overexcavated
areas on a daily base's. 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.
If the imported fill or overexcavated locations indicate to the inspector that inadequate soils exist based
on the criteria set forth in the Project Soils Report, Public Works Greenbook, or California Building
Code, the Public Works inspector may halt grading operations until the inadequate soil has either been
removed or the Public Works Director authorizes grading to continue.
Special Conditions Page 3 of 9
PERMIT NO. PWPT2024-0004
Griffin Rancho /On -Site Street Improvements / TM 38083; Within Griffin Ranch in
the Southeast Corner of Ave 54 and Madison St;
Tract surrounding Mery Griffin Estates
The above testing or observations does not relieve the permittee's responsibility for future repairs due to
settlement at and near the locations of the work area.
Prior to the city issuing a building permit, the permittee's Geotechnical Engineer of Record shall submit a
certified letter indicating that the grading has been completed per the approved plan. A compaction report
on all fill is required following pad certification and prior to building permit issuance.
20. The permittee shall be responsible for calling the city inspector to arrange the city inspector to observe
random trench compaction testing performed by a city approved material testing firm. If the inspector's
phone number is unknown, the permittee shall call the Public Works front counter phone at 777-7075 or
the Assistant Civil Engineer at 777-7047 to determine the city inspector's phone number. The inspector
shall determine the number and location of the test location/s. The above testing does not relieve the
permittee's responsibility for future repairs due to settlement at and near the locations of the work area.
Materials testing must be performed under direct supervision of a California Registered Civil Engineer.
21. 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.
22. The permittee is responsible for obtaining a valid separate permit from other Cities, County jurisdictions,
or other agencies if any of the work or traffic control devices extend into the other Cities, County, or
agencies right of way.
23. 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
24. The Applicant or Contractor shall furnish the City satisfactory evidence of insurance in the amounts
provided in the Engineering Bulletin for Indemnification & Insurance Requirements. This insurance shall
be kept in full force and effect at all times by Applicant or Contractor during the prosecution of the
permitted work and updated Certificate of Liability Insurance shall be submitted to the City. Each policy
shall name the City as an additional insured.
25. Work within 500 feet of any designated School Zone shall be performed between the hours of 8 a.m. —
1:30 p.m. Traffic control shall be set up after 8 a.m. and removed before 1:30 p.m.
26. The permittee shall not encroach upon private property without prior written approval (submit to the Public
Works Department, attention to the Assistant Civil Engineer) of the private land owner whom is being
encroached upon.
Special Conditions Page 4 of 9
PERMIT NO. PWPT2024-0004
Griffin Rancho /On -Site Street Improvements / TM 38083; Within Griffin Ranch in
the Southeast Corner of Ave 54 and Madison St;
Tract surrounding Mery Griffin Estates
27. Prior to excavating in native soils, the owner of the project shall have employed by proposal contract an
archaeological observer for the site excavations within native undisturbed soils. A copy of the contract
must be submitted to the Public Works Department and attention this to the Associate Engineer. If the
archaeologist determines the site note to be required to be observed, please submit a letter signed by the
archaeologist stating their determination.
28. During work hours, the permittee shall provide and maintain a traffic lane that diverts traffic off the paved
roadway. The traffic lane must be located within the existing R/W with the following requirements:
a. Class II Base with a minimum depth of 2"
b. A 12 inch thick subgrade layer compacted to 95% based on ASTM D1557
c. An unobstructed travel width of 10 feet.
d. In addition, a minimum of 5 feet clearance from open trenches.
e. A minimum of 2 feet from vertical obstructions like curbs.
f. Maximum speed of 25 mph
29. The permittee shall haul all offsite debris to a certified landfill. Prior to hauling debris, the permittee shall
inform the City (Inspection staff or 777-7047) of the name and location of the certified dump site.
30. 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.
31. The permittee is required to provide an informative message board (approved by the City Engineer)
informing the commuters using the affected roadways of
a. Possible traffic delays
b. Time of construction
c. Alternate routes.
The message board shall be provided for the commuters 48 hours prior to the start of traffic delays, and
the entire message should be readable at the posted speed limit.
32. 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.
Native material may be used as backfill material provided that minimum compaction, achieved in the
manner prescribed herein, is achieved. Backfill shall be performed by mechanical means; no water
densified compaction via jetting or flooding or other means shall be allowed. It shall be the Permittee's
responsibility to provide appropriate geotechnical supervision, testing, and inspection, onsite, at all
times during backfill operations.
Special Conditions Page 5 of 9
PERMIT NO. PWPT2024-0004
Griffin Rancho /On -Site Street Improvements / TM 38083; Within Griffin Ranch in
the Southeast Corner of Ave 54 and Madison St;
Tract surrounding Mery Griffin Estates
Backfill compaction shall be achieved by the following conditions:
A. When a firm foundation is not encountered due to soft, spongy or other unsuitable material, such
material shall be removed to the limits directed by the Geotechnical Inspector and/or the City
Inspector and the resulting excavation backfilled with pipe bedding material.
B. Backfill materials shall be brought to or maintained at appropriate moisture content for
compaction. The appropriate moisture content range shall be established at the onset of the
project and ensured prior to use of the materials through progress testing on the stockpiles.
C. The first length of trench backfilled shall be backfilled in the presence of the City Inspector.
Compaction shall be tested at random depths at approximate three-foot vertical intervals as
backfill is placed to ensure the effectiveness of the compaction methods and to establish the depth
of lift that can be compacted.
D. If lifts greater than one foot are attempted in this trial length of trench, compaction tests shall be
taken within the lifts to ensure that the full depth of the lift is compacted. Upon satisfactory
completion of this portion of trench, the City Inspector shall establish the maximum lift thickness
to be compacted for the remainder of the project.
E. In subsequent lengths of trench, the frequency of compaction tests shall equal one per each lift of
backfill, per 300 linear feet of open trench, at randomly selected locations within the open length
of trench.
F. The depth of the randomly selected compaction tests shall also be randomly selected except that
where multiple tests are required in a given length of trench, the tests shall be no closer than three
feet (vertically) from each other.
G. If any compaction test fails, previously placed backfill (in the same length of open trench or
previous lengths of trench) which is represented by the failing test (as determined by the City
Inspector), shall be tested for compliance with compaction requirements.
H. All costs incurred due to the conditions above shall be borne by the Permittee. Copies of all test
results shall be furnished to the City Inspector.
33. All excavations within City of La Quinta right-of-way shall be backfilled, and temporarily paved if
within the existing travel way, at the end of every workday as directed by and to the satisfaction of the
City Engineer for the protection of the public. Lengths of open trench shall not greatly exceed that
which can not be backfilled in the same day. Excavated trenches shall not be allowed open overnight,
however, Permittee may leave a length of excavated trench, not to exceed twenty (20) feet in length,
open overnight at a point where construction will begin the next day, provided that this length of trench
is completely covered by steel plating.
Special Conditions Page 6 of 9
PERMIT NO. PWPT2024-0004
Griffin Rancho /On -Site Street Improvements / TM 38083; Within Griffin Ranch
in the Southeast Corner of Ave 54 and Madison St;
Tract surrounding Mery Griffin Estates
34. All landscaping, irrigation, decorative rock, decorative concrete, sidewalk, lighting, etc., shall be
replaced to its original condition.
35. Access and egress to all local properties shall be maintained at all times.
36. Pursuant to Section 14.16.375 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982),
permanent pavement replacement shall be completed no later than seven (7) days after the completion
of the work. Permanent pavement replacement shall conform to the following conditions:
A. Existing asphalt concrete pavement shall be sawcut one (1) foot beyond trench edges. Edges
shall be straight and clean.
B. Permanent pavement replacement structural section, within all trenches, shall be 1" thicker than
existing of asphalt concrete over the same existing thickness of crushed aggregate base or crushed
miscellaneous base, meeting the requirements of Sections 200-2.2 and 200-2.4 of the Standard
Specifications for Public Works Construction. The replaced pavement and base material shall be
compacted to 95% relative compaction and respectively tested, for each 300 linear feet of trench.
Verify exact structural replacement section thicknesses with the City prior to installation.
C. Permanent pavement replacement shall be installed using a City approved 3/4" max medium
asphalt concrete as the base course lift and a City approved'/2" max medium finish course lift for
capping. Asphalt concrete mix design shall be approved by the City prior to its placement.
D. Cold -Mill and Overlay - The existing pavement which was properly protected in place during the
trenching operation located adjacent to the trench saw cut shall be cold -milled to a depth of 0.10
feet with butt joint created next to the existing unmilled pavement surface. The cold -milled area
and base asphalt concrete in the trench area shall be overlaid with a City approved C2-AR-4000
asphalt concrete mix. The width of the cold milling area shall be as follows:
• For longitudinal trenches located in a parking lane: three (3) feet outside the sawcut
removal lines.
• For longitudinal trenches located in a traffic lane: three (3) feet outside the sawcut removal
lines, or to the lane line striping, whichever is greater.
• For transverse trenches across existing street: two (2) feet outside the sawcut removal lines.
E. If grinding and capping operations are not performed in the same day as base paving operations,
the base course lift of 3/4" max medium asphalt concrete shall be installed from saw -cut edge to
saw -cut edge flush with the existing street surface. The base course lift of paving shall not be left
0.10' low in anticipation of grinding and capping.
Special Conditions Page 7 of 9
PERMIT NO. PWPT2024-0004
Griffin Rancho /On -Site Street Improvements / TM 38083; Within Griffin Ranch
in the Southeast Corner of Ave 54 and Madison St;
Tract surrounding Mery Griffin Estates
F. Any existing lane striping or any existing detour lane striping affected by this resurfacing shall be
replaced in kind by the Permittee, as directed by and to the satisfaction of the City Engineer.
Affected traffic signal loops shall be removed and replaced in kind. The finished pavement
surface shall be smooth, consistent, and shall conform to the surrounding grades.
37. Permittee shall permanently stabilize any and all soil that was disturbed as a result of work performed
under this permit with an approved dust control treatment. Soil stabilization shall be done
immediately after completing the operation.
38. Pursuant to Chapter 12.56 of the La Quinta Municipal Code (Ordinance 10 § 1 (part), 1982) the City
has designated certain city streets as Truck Routes. The weight limit for restricted streets (i.e., streets
not part of the Truck Route network) is three (3) tons; trucks exceeding the weight limit may use a
restricted street if making a delivery or pickup on the subject street, or if this permit specifically grants
permission to use the street to deliver street construction materials and/or equipment.
39. The City of La Quinta reserves the right to revoke, suspend or void this permit at any time.
40. The permittee shall indemnify, hold harmless and assume the defense of the City from all damages,
delay costs, costs or expenses in law or equity that may arise out of work under this permit.
41. If it is the intent of the permittee to cut the pavement and have it restored by a third 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.
42. Flagger Requirements
A. Minimum Requirements
1. Receive and communicate specific instructions clearly, firmly, and courteously;
2. Move & maneuver quickly;
3. Provide clear and positive guidance;
4. Understand and apply safe traffic control practices;
5. Recognize dangerous traffic situations in sufficient time to avoid injury.
B. Flagger Safety Apparel
1. Background
a. Fluorescent orange -red, or
b. Fluorescent yellow -green
2. Retroreflective material (Orange, yellow, white, silver, yellow -green, or fluorescent
version.
3. Material shall be visible at 1000 ft
4. Apparel shall be designed to identify the wearer as a person
5. Law enforcement personnel should adhere to the same standard
Special Conditions Page 8 of 9
PERMIT NO. PWPT2024-0004
Griffin Rancho /On -Site Street Improvements / TM 38083; Within Griffin Ranch
in the Southeast Corner of Ave 54 and Madison St;
Tract surrounding Mery Griffin Estates
C. Hand -Signaling Devices
1. Stop/Slow paddle octagonal in shape with minimum 18" width and 6" letters. Must
have white legend on red background.
D. Directing Traffic
1. Only three (3) signals are required.
STOP SLOW PROCEED
E. Flagger Communications
1. If work area is too long for relay (2 flaggers can't see each other)
a. One flagger given the responsibility to coordinate
b. Use Radios or
c. Field phones
F. Flagger warning signs must be removed or covered when flagging is finished, when work is
not going to start immediately, or when work is completed.
Special Conditions Page 9 of 9
HAITASP-01
14L[•f .�ie7:l
CERTIFICATE OF LIABILITY INSURANCE
DATE(MMrDD1YYYY)
11/1512024
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 # OM63276
C NTACT Lisa Taylor
Hardy Insurance Services, Inc.
2911 Bonita Avenue Suite A
La Verne, CA 91750
PHONE JI M
INC. No, Ext): (909) 593-7776 7927 Arc, No):
E-MAIL . ltaylor@hardyirrn.com
INSURERS AFFORDING COVERAGE
NAIC N
INSURER A: National Fire Insurance Company of Hartford
20478
INSURED
INSURER B:Valley Forge Insurance Company
20508
INSURER C : The Continental Insurance Company of New Jersey
42625
Haitbrink Asphalt Paving Inc.
INSURER D : insurance Company of the West
27847
1480 Magnolia Ave.
Corona, CA 92879
INSURER E; Colony Insurance Company
39993
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
I TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE [X] OCCUR
X
X
7015349126
8/112024
811/2025
EACH OCCURRENCE
$ 11000,000
DAMAGE TO RSES (E.ENTED occurrignral$
PRE MMED
100,000
EXP (Any one rson
$ 15,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
POLICY [X] jref LOC
X OTHER: $6,000 Deduct BI & PD
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMPIOPAGG
$ 2,000,000
$
B
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X AUTOS ONLY X AUTOS ONLDY
X
X
7015349143
8/1/2024
81112026
COiEaMBINED accicIent)SINGLE LIMIT
$ 1,000,000
BODILY INJURY Perperson)
$
BODILY INJURY Per accident)$
-BODILY
PeOapcEc,d nIDAMAGE
$
$
C
X
UMBRELLA LIAR
EXCESSLIAB
X
OCCUR
CLAIMS -MADE
7015349157
8/1/2024
811/2025
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 6,000,000
DED RETENTION $
r
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN
KFFICERIMEMgV EXCLUDED? I
Mandatory in NHj
IF S describe under
DESCRIPTION OF OPERATIONS below
NIA
X
SD5066730-02
811/2024
811/2025
X T T PEROTH
E L EACH ACCIDENT
1,000,000
$
E L. DISEASE - EA EMPLOYE
$ 1,000,000
E L. DISEASE - POLICY LIM T
1,000,000
$
E
E
Pollution Liability
Pollution Liability
CSPRPS4213693124
CSPRPS4213693124
811/2024
8/1/2024
811/2025
8/1/2025
Each Pollution Event
Policy Aggregate
1,000,000
2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedu)e, may be affached H more space is required)
Re: All operation performed by the names Inured.
The City, its officials, officers, employees, agents, and volunteers are Included as additional insured per CNA63359XX (01115) including primary wording &
waiver of subrogation & CNA75079XX (10116).
Auto additional Insured & waiver of subrogation applies per CNA63359XX (01115).
WIC waiver of subrogation applies per WC990634 (08100).
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of La Quints
78495 La into o
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
La Quinta, CA 92263
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016103) C 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CAN
CNA63359XX
(Ed. 04112)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS EXTENDED COVERAGE ENDORSEMENT
- BUSINESS AUTO PLUS -
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
I. LIABILITY COVERAGE
A. Who Is An Insured
The following is added to Section II, Paragraph
A.1., Who Is An Insured:
1. a. Any incorporated entity of which the
Named Insured owns a majority of the
voting stock on the date of inception of
this Coverage Form; provided that,
b. The insurance afforded by this
provision A.I. does not apply to any
such entity that is an "insured" under
any other liability "policy" providing
"auto" coverage.
2. Any organization you newly acquire or form,
other than a limited liability company,
partnership or joint venture, and over which
you maintain majority ownership interest.
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:
(1) "Bodily injury" or "property damage"
caused by an "accident' that
occurred before you acquired or
formed the organization; or
(2) Any such organization that is an
"insured" under any other liability
"policy" providing "auto" coverage.
3. Any person or organization that you are
required by a written contract to name as
an additional insured is an "insured" but
only with respect to their legal liability for
acts or omissions of a person, who qualifies
as an "insured" under Section II — Who Is
An Insured and for whom Liability Coverage
is afforded under this policy. If required by
written contract, this insurance will be
primary and non-contributory to insurance
on which the additional insured is a Named
Insured.
4. An "employee" of yours is an "insured"
while operating an "auto" hired or rented
under a contract or agreement in that
"employee's" name, with your permission,
while performing duties related to the
conduct of your business.
"Policy," as used in this provision A. Who Is An
Insured, includes those policies that were in
force on the inception date of this Coverage
Form but:
1. Which are no longer in force; or
2. Whose limits have been exhausted.
B. Bail Bonds and Loss of Earnings
Section II, Paragraphs A.2. (2) and A.2. (4)
are revised as follows:
1. In a.(2), the limit for the cost of bail bonds is
changed from $2,000 to $5,000; and
2. In a.(4), the limit for the loss of earnings is
changed from $250 to $500 a day.
C. Fellow Employee
Section II, Paragraph B.5 does not apply.
Such coverage as is afforded by this provision
C. is excess over any other collectible
insurance.
II. PHYSICAL DAMAGE COVERAGE
A. Glass Breakage — Hitting A Bird Or Animal —
Falling Objects Or Missiles
The following is added to Section III,
Paragraph A.3.:
With respect to any covered "auto," 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.
B. Transportation Expenses
Section III, Paragraph A.4.a. is revised, with
respect to transportation expense incurred by
you, to provide:
a. $60 per day, in lieu of $20; subject to
b. $1,800 maximum, in lieu of $600.
C. Loss of Use Expenses
CNA63359XX Copyright, CNA Corporation, 2000. Page i of 3
(Ed. 04112) Includes copyrighted material of the Insurance Services Office used with its permission.
CAFA
C NA63359XX
(Ed. 04112)
Section III, Paragraph A.4.b. is revised, with
respect to loss of use expenses incurred by
you, to provide:
a. $1,000 maximum, in lieu of $600.
D. Hired "Autos"
The following is added to Section III.
Paragraph A.:
5. Hired "Autos"
If Physical Damage coverage is provided under
this policy, and such coverage does not extend
to Hired Autos, then Physical Damage coverage
is extended to:
a. Any covered "auto" you lease, hire, rent
or borrow without a driver; and
b. Any covered "auto" hired or rented by
your "employee" without a driver, under
a contract in that individual
"employee's" name, with your
permission, while performing duties
related to the conduct of your business.
c. The most we will pay for any one
"accident" or "loss" is the actual cash
value, cost of repair, cost of
replacement or $75,000, whichever is
less, minus a $500 deductible for each
covered auto. No deductible applies to
"loss" caused by fire or lightning.
d. The physical damage coverage as is
provided by this provision is equal to
the physical damage coverage(s)
provided on your owned "autos."
e. Such physical damage coverage for
hired "autos" will:
(1) Include loss of use, provided it is
the consequence of an "accident'
for which the Named Insured is
legally liable, and as a result of
which a monetary loss is sustained
by the leasing or rental concern.
(2) Such coverage as is provided by
this provision will be subject to a
limit of $750 per "accident."
E. Airbag Coverage
The following is added to Section III,
Paragraph B.3.:
The accidental discharge of an airbag shall not
be considered mechanical breakdown.
c. Physical Damage Coverage on a covered
"auto" also applies to "loss" to any
permanently installed electronic equipment
including its antennas and other
accessories.
d. A $100 per occurrence deductible applies
to the coverage provided by this provision.
G. Diminution In Value
The following is added to Section III,
Paragraph B.6.:
Subject to the following, the "diminution in
value" exclusion does not apply to:
a. Any covered "auto" of the private
passenger type you lease, hire, rent or
borrow, without a driver for a period of
30 days or less, while performing duties
related to the conduct of your business;
and
b. Any covered "auto" of the private
passenger type hired or rented by your
"employee" without a driver for a period
of 30 days or less, under a contract in
that individual "employee's" name, with
your permission, while performing
duties related to the conduct of your
business.
c. Such coverage as is provided by this
provision is limited to a "diminution in
value" loss arising directly out of
accidental damage and not as a result
of the failure to make repairs; faulty or
incomplete maintenance or repairs; or
the installation of substandard parts.
d. The most we will pay for "loss" to a
covered "auto" in any one accident is
the lesser of:
(1) $5,000; or
(2) 20% of the "auto's" actual cash
value (ACV).
Ill. Drive Other Car Coverage — Executive Officers
The following is added to Sections II and III:
1. Any "auto" you don't own, hire or borrow is a
covered "auto" for Liability Coverage while
being used by, and for Physical Damage
Coverage while in the care, custody or control
of, any of your "executive officers," except:
a. An "auto" owned by that "executive officer"
or a member of that person's household; or
F. Electronic Equipment b. An "auto" used by that "executive officer"
while working in a business of selling,
Section III, Paragraphs B.4.c and B.4.d. are servicing, repairing or parking "autos."
deleted and replaced by the following:
CNA63359XX Copyright, CNA corporation, 2000. Page 2 of 3
(Ed. 04112) Includes copyrighted material of the Insurance services Office used with its permission.
CAFA
CNA63359XX
(Ed. 04/12)
Such Liability and/or Physical Damage
Coverage as is afforded by this provision.
(1) Equal to the greatest of those
coverages afforded any covered "auto'%
and
(2) Excess over any other collectible
insurance.
2. For purposes of this provision, "executive
officer" means a person holding any of the
officer positions created by your charter,
constitution, by-laws or any other similar
governing document, and, while a resident of
the same household, includes that person's
spouse.
Such "executive officers" are "insureds" while
using a covered "auto" described in this
provision.
IV. BUSINESS AUTO CONDITIONS
A. Duties In The Event Of Accident, Claim, Suit
Or Loss
The following is added to Section IV,
Paragraph A.2.a.:
(4) Your "employees" may know of an
"accident" or "loss." This will not mean
that you have such knowledge, unless
such "accident' or "loss" is known to
you or if you are not an individual, to
any of your executive officers or
partners or your insurance manager.
The following is added to Section IV,
Paragraph A.2.b.:
(6) Your "employees" may know of
documents received concerning a claim
or "suit." This will not mean that you
have such knowledge, unless receipt of
such documents is known to you or if
you are not an individual, to any of your
executive officers or partners or your
insurance manager.
B. Transfer Of Rights Of Recovery Against
Others To Us
The following is added to Section IV,
Paragraph A.S. Transfer Of Rights Of
Recovery Against Others To Us:
We waive any right of recovery we may have,
because of payments we make for injury or
damage, against any person or organization for
whom or which you are required by written
contract or agreement to obtain this waiver from
US.
This injury or damage must arise out of your
activities under a contract with that person or
organization.
You must agree to that requirement prior to an
"accident' or "loss."
C. Concealment, Misrepresentation or Fraud
The following is added to Section IV,
Paragraph B.2.:
Your failure to disclose all hazards existing on the
date of inception of this Coverage Form shall not
prejudice you with respect to the coverage afforded
provided such failure or omission is not intentional.
D. Other Insurance
The following is added to Section IV,
Paragraph B.S.:
Regardless of the provisions of Paragraphs S.a.
and S.d. above, the coverage provided by this
policy shall be on a primary non-contributory
basis. This provision is applicable only when
required by a written contract. That written
contract must have been entered into prior to
"Accident" or "Loss."
E. Policy Period, Coverage Territory
Section IV, Paragraph B. 7.(S).(a). is revised
to provide:
a. 45 days of coverage in lieu of 30 days.
V. DEFINITIONS
Section V. Paragraph C. is deleted and replaced
by the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by a person, including mental
anguish, mental injury or death resulting from any of
these.
CNA63359XX copyright, CNA corporation, 2000. Page 3 of 3
(Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission.
CNA
Blanket Additional Insured - Owners, Lessees or
Contractors -with Products -Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required
by written contract to add as an additional insured on this coverage part, but only with respect to liability for
bodily injury, property damage or personal and advertising Injury caused in whole or in part by your acts or
omissions, or the acts or omissions of those acting on your behalf:
A. in the performance of your ongoing operations subject to such written contract; or
B. in the performance of your work subject to such written contract, but only with respect to bodily Injury or
property damage included in the products -completed operations hazard, and only if:
1. the written contract requires you to provide the additional insured such coverage; and
2. this coverage part provides such coverage.
II. But if the written contract requires:
A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the
10-01 edition of CG2037; or
B. additional insured coverage with "arising out of language; or
C. additional insured coverage to the greatest extent permissible by law;
then paragraph I. above is deleted in its entirety and replaced by the following:
WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required
by written contract to add as an additional insured on this coverage part, but only with respect to liability for
bodily Injury, property damage or personal and advertising Injury arising out of your work that is subject to
such written contract.
III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not
provide such additional insured with:
A. coverage broader than required by the written contract; or
B. a higher limit of insurance than required by the written contract.
IV. The insurance granted by this endorsement to the additional insured does not apply to bodily Injury, property
damage, or personal and advertising injury arising out of:
A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services,
including:
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
B. any premises or work for which the additional insured is specifically listed as an additional insured on another
endorsement attached to this coverage part.
V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended
to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this
coverage part:
Primary and Noncontributory Insurance
CNA75079XX (10-16)
Page 1 of 2
Insured Name: Haitbrink Asphalt Paving Inc
Copyrfght CNA Ag Rights Reserved. Includes copyrighted material of Insurance services Office, Inc., with its permission.
rWA
Blanket Additional Insured - Owners, Lessees or
Contractors -with Products -Completed
Operations Coverage Endorsement
With respect to other insurance available to the additional insured under which the additional insured is a named
insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a
written contract requires the insurance provided by this policy to be.
1. primary and non-contributing with other insurance available to the additional insured; or
2. primary and to not seek contribution from any other insurance available to the additional insured.
But except as specified above, this insurance will be excess of all other insurance available to the additional
insured.
VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition
of the following:
Any additional insured pursuant to this endorsement will as soon as practicable:
1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim;
2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the
investigation, defense, or settlement of the claim; and
3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer
or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part.
However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3.
does not apply to insurance on which the additional insured is a named insured.
The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer
receives written notice of a claim from the additional insured.
VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended
to add the following definition:
Written contract means a written contract or written agreement that requires you to make a person or
organization an additional insured on this coverage part, provided the contract or agreement:
A. is currently in effect or becomes effective during the term of this policy; and
B. was executed prior to:
1. the bodily injury or property damage; or
2. the offense that caused the personal and advertising Injury;
for which the additional insured seeks coverage.
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes
effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown
below, and expires concurrently with said Policy.
CNA75079XX (10-16)
Page 2 of 2
Copyright CNA M Rights Reserved. Includes copyrighted material of Insurance Servioes Office, Inc., with its permission.
CAFA
CNA63359XX
(Ed. 04112)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS EXTENDED COVERAGE ENDORSEMENT
- BUSINESS AUTO PLUS -
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
I. LIABILITY COVERAGE
A. Who Is An Insured
The following is added to Section II, Paragraph
A.1., Who Is An Insured:
1. a. Any incorporated entity of which the
Named Insured owns a majority of the
voting stock on the date of inception of
this Coverage Form; provided that,
b. The insurance afforded by this
provision A.I. does not apply to any
such entity that is an "insured" under
any other liability "policy" providing
"auto" coverage.
2. Any organization you newly acquire or form,
other than a limited liability company,
partnership or joint venture, and over which
you maintain majority ownership interest.
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:
(1) "Bodily injury" or "property damage"
caused by an "accident" that
occurred before you acquired or
formed the organization; or
(2) Any such organization that is an
"insured" under any other liability
"policy" providing "auto" coverage.
3. Any person or organization that you are
required by a written contract to name as
an additional insured is an "insured" but
only with respect to their legal liability for
acts or omissions of a person, who qualifies
as an "insured" under Section II — Who Is
An Insured and for whom Liability Coverage
is afforded under this policy. If required by
written contract, this insurance will be
primary and non-contributory to insurance
on which the additional insured is a Named
Insured.
4. An "employee" of yours is an "insured"
while operating an "auto" hired or rented
under a contract or agreement in that
"employee's" name, with your permission,
while performing duties related to the
conduct of your business.
"Policy," as used in this provision A. Who Is An
Insured, includes those policies that were in
force on the inception date of this Coverage
Form but:
1. Which are no longer in force; or
2. Whose limits have been exhausted.
B. Bail Bonds and Loss of Earnings
Section II, Paragraphs A.2. (2) and A.2. (4)
are revised as follows:
1. In a.(2), the limit for the cost of bail bonds is
changed from $2,000 to $5,000; and
2. In a.(4), the limit for the loss of earnings is
changed from $250 to $500 a day.
C. Fellow Employee
Section II, Paragraph B.5 does not apply.
Such coverage as is afforded by this provision
C. is excess over any other collectible
insurance.
II. PHYSICAL DAMAGE COVERAGE
A. Glass Breakage — Hitting A Bird Or Animal —
Falling Objects Or Missiles
The following is added to Section III,
Paragraph A.3.:
With respect to any covered "auto," 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.
B. Transportation Expenses
Section III, Paragraph A.4.a. is revised, with
respect to transportation expense incurred by
you, to provide:
a. $60 per day, in lieu of $20; subject to
b. $1,800 maximum, in lieu of $600.
C. Loss of Use Expenses
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CAR
CNA63359XX
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Section III, Paragraph A.4.b. is revised, with
respect to loss of use expenses incurred by
you, to provide:
a. $1 000 maximum, in lieu of $600.
D. Hired "Autos"
The following is added to Section III.
Paragraph A.:
S. Hired "Autos"
If Physical Damage coverage is provided under
this policy, and such coverage does not extend
to Hired Autos, then Physical Damage coverage
is extended to:
a. Any covered "auto" you lease, hire, rent
or borrow without a driver; and
b. Any covered "auto" hired or rented by
your "employee" without a driver, under
a contract in that individual
"employee's" name, with your
permission, while performing duties
related to the conduct of your business.
c. The most we will pay for any one
"accident" or "loss" is the actual cash
value, cost of repair, cost of
replacement or $75.000, whichever is
less, minus a $500 deductible for each
covered auto. No deductible applies to
"loss" caused by fire or lightning.
d. The physical damage coverage as is
provided by this provision is equal to
the physical damage coverage(s)
provided on your owned "autos."
e. Such physical damage coverage for
hired "autos" will:
(1) Include loss of use, provided it is
the consequence of an "accident"
for which the Named Insured is
legally liable, and as a result of
which a monetary loss is sustained
by the leasing or rental concern.
(2) Such coverage as is provided by
this provision will be subject to a
limit of $750 per "accident."
E. Airbag Coverage
The following is added to Section III,
Paragraph B.3.:
The accidental discharge of an airbag shall not
be considered mechanical breakdown.
c. Physical Damage Coverage on a covered
"auto" also applies to "loss" to any
permanently installed electronic equipment
including its antennas and other
accessories.
d. A $100 per occurrence deductible applies
to the coverage provided by this provision.
G. Diminution In Value
The following is added to Section 111,
Paragraph B.6.:
Subject to the following, the "diminution in
value" exclusion does not apply to:
a. Any covered "auto" of the private
passenger type you lease, hire, rent or
borrow, without a driver for a period of
30 days or less, while performing duties
related to the conduct of your business;
and
b. Any covered "auto" of the private
passenger type hired or rented by your
"employee" without a driver for a period
of 30 days or less, under a contract in
that individual "employee's" name, with
your permission, while performing
duties related to the conduct of your
business.
c. Such coverage as is provided by this
provision is limited to a "diminution in
value" loss arising directly out of
accidental damage and not as a result
of the failure to make repairs; faulty or
incomplete maintenance or repairs; or
the installation of substandard parts.
d. The most we will pay for "loss" to a
covered "auto" in any one accident is
the lesser of:
(1) $5,000; or
(2) 20% of the "auto's" actual cash
value (ACV).
III. Drive Other Car Coverage — Executive Officers
The following is added to Sections II and III:
1. Any "auto" you don't own, hire or borrow is a
covered "auto" for Liability Coverage while
being used by, and for Physical Damage
Coverage while in the care, custody or control
of, any of your "executive officers," except:
a. An "auto" owned by that "executive officer"
or a member of that person's household; or
F. Electronic Equipment b. An "auto" used by that "executive officer"
while working in a business of selling,
Section III, Paragraphs B.4.c and B.4.d. are servicing, repairing or parking "autos."
deleted and replaced by the following:
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CNA63359XX
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CAFA
Such Liability and/or Physical Damage
Coverage as is afforded by this provision.
(1) Equal to the greatest of those
coverages afforded any covered "auto';
and
(2) Excess over any other collectible
insurance.
2. For purposes of this provision, "executive
officer' means a person holding any of the
officer positions created by your charter,
constitution, by-laws or any other similar
governing document, and, while a resident of
the same household, includes that person's
spouse.
Such "executive officers" are "insureds" while
using a covered "auto" described in this
provision.
IV. BUSINESS AUTO CONDITIONS
A. Duties In The Event Of Accident, Claim, Suit
Or Loss
The following is added to Section IV,
Paragraph A.2.a.:
(4) Your "employees" may know of an
"accident' or "loss." This will not mean
that you have such knowledge, unless
such "accident' or "loss" is known to
you or if you are not an individual, to
any of your executive officers or
partners or your insurance manager.
The following is added to Section IV,
Paragraph A.2.b.:
(6) Your "employees" may know of
documents received concerning a claim
or "suit." This will not mean that you
have such knowledge, unless receipt of
such documents is known to you or if
you are not an individual, to any of your
executive officers or partners or your
insurance manager.
B. Transfer Of Rights Of Recovery Against
Others To Us
The following is added to Section IV,
Paragraph A.S. Transfer Of Rights Of
Recovery Against Others To Us:
We waive any right of recovery we may have,
because of payments we make for injury or
damage, against any person or organization for
whom or which you are required by written
contract or agreement to obtain this waiver from
us.
This injury or damage must arise out of your
activities under a contract with that person or
organization.
You must agree to that requirement prior to an
"accident" or "loss."
C. Concealment, Misrepresentation or Fraud
The following is added to Section IV,
Paragraph B.2.:
Your failure to disclose all hazards existing on the
date of inception of this Coverage Form shall not
prejudice you with respect to the coverage afforded
provided such failure or omission is not intentional.
D. Other Insurance
The following is added to Section IV,
Paragraph B.S.:
Regardless of the provisions of Paragraphs S.a.
and S.d. above, the coverage provided by this
policy shall be on a primary non-contributory
basis. This provision is applicable only when
required by a written contract. That written
contract must have been entered into prior to
"Accident" or "Loss."
E. Policy Period, Coverage Territory
Section IV, Paragraph B. 7.(S).(a). is revised
to provide:
a. 45 days of coverage in lieu of 30 days.
V. DEFINITIONS
Section V. Paragraph C. is deleted and replaced
by the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by a person, including mental
anguish, mental injury or death resulting from any of
these.
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WORKERS COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE POLICY
WC 99 06 34
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -BLANKET
(Ed. 8-00)
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 2% of the total California Workers' Compensation premium
otherwise due.
Person or Or-ganization
Any person or organization when
required by written contract.
Policy Number: WSD 5066730 00
Endorsement Effective: 8/1/2022
Issue Date:7/25/2022
WC 99 06 34
(Ed. 8-00)
Schedule
Job Description
All California operations
Insured: Haitbrink Asphalt Paving Inc,
Coverage Provided by: Insurance Company of the West