Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
BCOM2022-0053
BUILDING PERMIT DESIGN & DEVELOPMENT DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type: Building Commercial Permit Number: BCOM2022-0053 Property Address: 47647 CALEO BAY APN: 643200004 Legal Description Property Zoning: Valuation: $125,000.00 PHONE (760) 777-7125 WWW.LAQUINTACA.GOV APPLIED DATE: 09/13/2022 ISSUED DATE: 02/08/2023 CALIFORNIA Owner: 47647 Caleo Bay Dr LLC, a Delaware limited liability company 5055 West Park Blvd. Suite 400, Plano, TX 75093 Applicant: SMARTLINK SMARTLINK 3300 Irvine Ave., Newport Beach, CA 92660 Contractor: Trista Green / 1021440 755 Trademark Circle, Corona, Ca 92879 PRIOR TO THE ISSUANCE OF THIS PERMIT FOR CONSTRUCTION, ALTERATION, IMPROVEMENT, DEMOLITION, OR REPAIR THE OWNER, APPLICANT AND/OR CONTRACTOR UNDER PENALTY OF PERJURY HAVE AFFIRMED WHEN APPLICABLE, THROUGH THE SUBMITTAL OF FORMS OR BY OTHER ELECTRONIC MEANS, THE FOLLOWING: LICENSED CONTRACTOR OR OWNER -BUILDER DECLARATION (1 or 2) 1) They are licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and the referenced License is in full force and effect, or; 2) That they are exempt from the Contractors' State License Law for the reason(s) indicated by either (2)(a) and/or (2)(b), or (2)(c) where he or she is exempt from licensure by a valid exemption. [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code] Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).) a) As owner of the property, or my employees with wages as their sole compensation, will do all of or portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale.). b) As owner of the property, will be exclusively contracting with licensed c) Are exempt from licensure under the Contractors' State License Law. As an Owner -Builder, they acknowledge that, except for their personal residence in which they must have resided in for at least one year prior to completion of the improvements covered by this permit, they cannot legally sell a structure built as an owner -builder if it has not been constructed in its entirety by licensed contractors. It is understood that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application was submitted at the following Web site: http://www.leginfo.ca.gov/calaw.html. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY (If applicable) A construction lender will be used for completion of the improvements covered by this permit and the name and information of which is on file for public inspection during the regular business hours of the public entity. Failure of the applicant to indicate the construction lender on the application does not relieve that person of the requirement to give the WORKERS' COMPENSATION DECLARATION (1, 2 or 3) WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 1) Has and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2) Has and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3) Certifies that, in the performance of the work for which this permit is issued, shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, shall forthwith comply with those provisions. NOTICE TO APPLICANT (1, 2 and 3) 1) Each person upon whose behalf this application was made, each person at whose request and for whose benefit work is being performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2) Any permit issued as a result of this application becomes null and void if work is not commenced within 360 days from date of issuance of such permit, or if cessation of work for 180 days will subject permit to cancellation. On or after January 1, 2019, every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 12 months after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 12 months after the time the work is commenced. 3) Certified that they read the application and state that the information provided is correct. Agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. IMPORTANT: An Application for Permit was made to the Building Official, subject to the conditions and restrictions set forth at the time of application, which is now hereby an Issued Permit. If any part of the information being supplied on this permit is inaccurate or untrue, please contact the City of La Quinta at (760) 777-7125 immediately for correction. Printed: 6/12/25 10:16 am Page 1 of 5 BUILDING PERMIT Permit Type: Building Commercial Permit Number: BCOM2022-0053 Property Address: 47647 CALEO BAY construction lender preliminary notice from that duty. Printed: 6/12/25 10:16 am Page 2 of 5 Permit Type Building Commercial BUILDING PERMIT Permit Number: Property Address BCOM2022-0053 47647 CALEO BAY NEW AT&T ROOFTOP CELLULAR SITE ATOP EXISTING BUILDING *"* REVISION #1 - REVISE SERVICE EQUIPMENT RATING, TYPE A LOCATION. #111# NEW AT&T ROOFTOP CELLULAR SITE ATOP EXISTING BUILDING ... NEW AT&T ROOFTOP CELLULAR FACILTY ATOP EXISTING BUILDING. (12) NEW ANTENNAS, SHADE CANOPY, (36) RRU'S, (9) SURGE SUPPRESSORS + NEW 100A 480V ELECTRICAL SERVICE, 50kVA XFMR & 200A PANELBOARD. PROJECT TO COMPLY WITH CONDITIONS OF CUP2022-0001. 2019 CALIFORNIA BUILDING CODES. ,instruction Det;:. Commercial Work Type Remodel Building/Unit U: Utility/Mist Structures Gross Square Footage 871 Occupancy Classification(s) Conditioned Square 0 Construction Type V-B Code Edition 2019 Footage Remodel Area Square 871 Footage Number of 62 Receptacle/Switch/L ig ht(s) Number of Power 1 Electrical Service? Yes Miscellaneous 1 Apparatus Electrical Transportation Uniform No City Development No Art in Public Places No Mitigation Fee Impact Fee Applicable Fund Exempt Applicable New Electrical Square 0 Footage Type Group Sq Ft Value Invoice No. Fee PERMIT-BCOM2022_001 HOURLY CHARGE - CITY BUILDING STAFF 3 REMODEL, EA ADDITIONAL 500SF PC OTHER ELECTRICAL EQUIPMENT PC TECHNOLOGY ENHANCEMENT FEE OTHER ELECTRICAL EQUIPMENT SERVICES BSAS SB1473 FEE REMODEL, FIRST 100SF PC DEVICES/FIXTURES, ADDITIONAL PC SERVICES PC POWER APPARATUS PC RECORDS MANAGEMENT FEE - MAJOR REMODEL, FIRST 100SF HOURLY CHARGE - INTERWEST PLANS EXAMINER ALTERATIONS/ADDITIONS - NON-RESIDENTIAL DEVICES, FIRST 20 REMODEL, EA ADDITIONAL 500SF SMI - COMMERCIAL POWER APPARATUS DEVICES, FIRST 20 PC Total for Invoice PERMIT-BCOM2022-0053 Fee Amount Amount Paid $131.25 $131.25 $40.02 $40.02 $27.79 $27.79 $5.00 $5.00 $27.79 $27.79 $27.79 $27.79 $5.00 $5.00 $155.06 $155.06 $28.98 $28.98 $13.89 $13.89 $27.79 $27.79 $21.00 $21.00 $56.69 $56.69 $150.00 $150.00 $161.00 $161.00 $27.79 $27.79 $50.02 $50.02 $35.00 $35.00 $27.79 $27.79 $27.79 $27.79 $1,047.44 $1,047.44 Grand Total for Permit $1,047.44 $1,047.44 Printed: 6/12/25 10:16 am Page 3 of 5 BUILDING PERMIT Permit Type: Building Commercial Permit Number: BCOM2022-0053 Property Address: 47647 CALEO BAY Workflow Step / Action Name Action Type Start Date End Date Inspections v.1 09/13/2022 0:00 ---------------------------------------------------------------------------------------------------------------------------------------- TEMP USE OF PERM PWR v.2 Inspection ---------------------------------------------------------------------------------------------------------------------------------------- FRAMING v.2 Inspection ------------------------------------------------------------------------------------ ROUGH ELEC v.2 --------- Inspection ------------------------------------------- TEMP USE OF PERM PWR v.1 Inspection ---------------------------------------------------------------------------------------------------------------------------------------- ROUGH ELEC v.1 Inspection - -- ----------------------------------------------------------------------------------------------------------------------------- UNDERGROUND ELEC v.2 Inspection --------------------------------------------------------- FRAMING v.1 ------------------------------------ Inspection ------------------------ ------------------ --------------------------------------------------------- UNDERGROUND ELEC v.1 ------------------------------------ Inspection ------------------------ ------------------ Inspections - Cover No Work Until Approved v.1 10/06/2023 17:01 --------------------------------------------------------- Roof Nail v.1 ------------------------------------ Inspection ------------------------ ------------------ --------------------------------------------------------- Okay to Wrap v.1 ------------------------------------ Inspection ------------------------ ------------------ --------------------------------------------------------- Framing v.1 ------------------------------------ Inspection ------------------------ ------------------ --------------------------------------------------------- Rough Electrical v.1 ------------------------------------ Inspection ------------------------ 10/06/2023 17:01 ------------------ 10/06/2023 17:02 -------------------------------------------------------------------------------- Rough Mechanical v.1 Inspection -------------------------------------- --------------------------------------------------------- Rough Plumbing v.1 ------------------------------------ Inspection ------------------------ ------------------ --------------------------------------------------------- Rough Fire Clearance Bldg v.1 ------------------------------------ Inspection ------------------------ ------------------ --------------------------------------------------------- Shower Pan v.1 ----------------------- Inspection --------------------------------------------------------- Insulation v.1 ------------------------------------ Inspection ------------------------ ------------------ --------------------------------------------------------- Drywall Nail v.1 ------------------------------------ Inspection ------------------------ ------------------ --------------------------------------------------------- T-Bar/Overhead v.1 ------------------------------------ Inspection ------------------------ ------------------ --------------------------------------------------------------------------- Exterior Lath v.1 -- -- Inspection --------------------------------------------------------- Gas Test v.1 ------------------------------------ Inspection ------------------------ ----------------- - --------------------------------------------------------- Sewer Connection v.1 ------------------------------------ Inspection ------------------------ ----------------- - Inspections - Electrical for Meter Release v.1 09/14/2023 10:31 10/06/2023 17:02 ---------------------------------------------------------------------------------------------------------------------------------------- Temp Use of Permanent Power v.1 Inspection 09/14/2023 10:31 09/14/2023 14:11 ------------------------------------------------------------------------------------ Temp Use of Permanent Power v.2 --------- Inspection ------------------------------------------- 09/18/2023 7:58 09/18/2023 16:19 ------------------------------------------------------------------------------------ Temp Use of Permanent Power v.3 --------- Inspection ------------------------------------------- 10/06/2023 17:02 10/06/2023 17:02 Inspections - Final v.1 09/15/2023 16:03 10/06/2023 16:38 --------------------------------------------------------------------------- Pa^"'.-�r.vFireC -."'� ••v I ------------------------ Inspection ------------------ ------------------- 10/02/2023 13:27 -------------------------------------------------------------------------------------------------------------------------------------- Final Building v.1 Inspection 09/15/2023 16:03 - 09/20/2023 17:32 -------------------------------------------------------------------------------------------------------------------------------------- Final Building v.2 Inspection 09/29/2023 16:18 - 10/02/2023 16:31 --------------------------------------------------------------------------------------------------------------------------------------- Final Building v.3 Inspection 10/05/2023 16:12 10/06/2023 16:38 Certificate of Occupancy v.1 --------------------------------------------------------------------------------------------------------------------------------------- Issue Certificate of Occupancy v.1 Create Report Printed: 6/12/25 10:16 am Page 4 of 5 BUILDING PERMIT Permit Type: Building Commercial Permit Number: BCOM2022-0053 Property Address: 47647 CALEO BAY Construction or work for which a permit is required shall be subject to inspection by the building official and such construction or work shall remain visible and able to be accessed for inspection purposes until approved. Approval as a result of an inspection shall not be construed to be an approval of a violation of the provisions of the applicable code and other ordinances of the jurisdiction. Inspections presuming to give authority to violate or cancel the provisions of the applicable code and other ordinances of the jurisdiction shall not be valid. It shall be the duty of the owner or the owner's authorized agent to cause the work to remain visible and able to be accessed for inspection purposes. Neither the building official nor the jurisdiction shall be liable for expense entailed in the removal or replacement of any material required to allow inspection. It shall be the duty of the holder of the building permit or their duly authorized agent to notify the building official when work is ready for inspection. It shall be the duty of the permit holder to provide access to and means for inspections of such work that are required by this code. A building or structure shall not be used or occupied in whole or in part, and a change of occupancy of a building or structure or portion thereof shall not be made, until the building official has issued a certificate of occupancy therefor as provided herein. Issuance of a certificate of occupancy shall not be construed as an approval of a violation of the provisions of the applicable code and other ordinances of the jurisdiction. Certificates presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid. A person shall not make connections from a utility, a source of energy, fuel, or power, or a water system or sewer system to any building or system that is regulated by the applicable code and other ordinances of the jurisdiction for which a permit is required, until approved by the buildinq official. Printed: 6/12/25 10:16 am Page 5 of 5 @smartlink To: Christie Asari-Price From: Will Kazimi Date: 12-15-2022 Re: AT&T Site ID CSL05919 Please be advised that AT&T Site ID CSL05919 has reached READY TO ISSUE (RTI) status. Confirmation has been made with LL. Site Name: CSL05919 Site Number: Caleo Bay Project Address: 47647 Caleo Bay Dr. La Quinta, CA 92253 APN: 643-200-004 Planning#: CUP2022-0001 Plan Check #: BCOM2022-0053 PW#: N/A Electrical Plans: N/A Building Permit Fees: GC to confirm with JX regarding fee. Fire# - N/A The plans have been approved and the permit is ready to issue pending the assignment of a contractor. If the contractor has worked recently in La Quinta and has a current city business license and eTRAKiT account I can add them to the permit. If they are new to working in La Quinta, don't have an account to our online system or their business license has lapsed please have them reach out to our permit technicians at (760) 777-7125 or customercenter@laquintaca.gov to finish the permit issuance process. Please note that the contractor must be the one to make the fee payment through their contractor account to effectively issue the permit. Feel free to reach out with any questions. Questions: Contact Will Kazimi — will.kazimi@smartlinkgroup.com MOTIVE ENERGY TELECOM INC. October 5, 2023 AT&T site Caleo Bay / CSLOS919 47547 Caleo Bay Drive La Quinta, Ca 92253 Electrical Torque Letter Motive Energy Telecommunications, fully guarantees its workmanship and materials for all the work that was completed at the AT&T site Caleo Bay. All electrical conductors and grounds for been torqued to manufactures spec and have been marked with orange torque paint. Sincerely, Motive Energy Telecommunications Electrical PM : Casey England `p%s'1f3 pffTrr� rn-7r7 r" PHONE 951-284-0189 755 Trademark Cir. FAX 951-284-0202 Corona, Ca 92879 EMAIL jarchibald@motiveis.com WEBSITE www.motive-energy.com MOTIVE ENERGY TELECOM INC. January 4, 2022 REFERENCE: CONTRACTORS STATE LICENSE#1021440 ATTENTION: BUILDING & SAFETY EFFECTIVE Jan. 4,2022 THROUGH Jan. 4,2024 THIS LETTER IS TO INFORM YOU THAT TRISTA GREEN IS ACTING AS AN AGENT OF MOTIVE ENERGY TELECOMMUNCATIONS GROUP. FOR THE PURPOSE OF OBTAING ALL NECCSSARY PERMITS AND CITY LICENSES FOR WORK DONE IN YOUR CITY AND COUNTY. PLEASE FEEL FREE TO CONTACT US WITH ANY QUESTIONS OR CONCERNS YOU MAY HAVE. WE ARE PROPERLY REGISTERED AND LICENSED AS REQUIRED BY THE STATE OF CALIFORNIA. RESPECTFULLY, 1►/_1:1pxcf-.l31►1:1:7 i'i1r)1`11.~ yyw7, PHONE 951-284-0189 755 Trademark Cir. FAX 951-284-0202 Corona, Ca 92879 EMAIL tareen@motive-eneray.com WEBSITE www.motive-energy.com ride-t otary public or other officer completing this certificate verifies only the ity ofthe individual who signed the document to which this certificate ttached, and not the truthfulness, accuracy, or validity of that document. State of California County ofl��e- before me, ` (here Insert name and title of the officer) On 1 aG personally appeared CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the ,,,,,,,, rnIlnllnulnullllrnlnelnu „nminlg State of California that the foregoing is true and correct. a4V:�' ri►RasT�I uNcsg g oMMrzisNotary Public CalitanleRitria d CountyExp tea AprWITNESS my hand and official seal. Signature _ (Seal) OPTIONAL INFORMATION Ah hough the Information In this section is not required bylaw, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titled/for the purpose of containing pages, and dated The signer(s) capacity or authority is/are as: ❑ Individual(s) ❑ Attorney -in -Fact ❑ Corporate Officer(s) ❑ Guardian/Conservator ❑ Partner - Limited/General ❑ Trustee(s) ❑ Other: ralals) representing: Name(s) or Persons) or Enti[y{ies) Signer Is Representing „iJdS s . Method of Signer Identification Proved to me on the basis of satisfactory evidence: L o forms) of identification Clcredible witnesses) Notarial event is detailed in notary journal on: Page r Entry r Notary contact: Other ❑ Additional stgnerls) ❑ Signer(s)Thumbprint(s) _ra..eue,,,. n.,,rhau rnnto% of this form. 0 Copyright 2007-2014 Notary Rotary, Inc. PO Box 41400, DCS MO.nC%IA >nx 1I-V'W' ,.n -y-s ..rs.•.— -• . • • - Structural Observaton Group, Inc. A California Corporation 8941 Atlanta Ave #518 Huntington Beach, CA 92646 VC g�R ` �BSERV G Dispatch (714) 330-6333 �uRA AT /p� R��p H ❑ FU NCToll S ❑ 7O764-3939 / / Other ❑ We Just Do A Better Job Observation Report and Observation Agreement Observed the installation of 165 Hilti kwik bolts. Followed Detail 2 for support frame section. All hilti bolts were installed per plan. Support frame mounting done Job Notes Client Acknowledgment Acknowledged by: Matt Howe Email: mhowe@motiveis.com Date/Time: Wed Jul 05 2023 17:04:56 GMT-0700 (Pacific Daylight Time) Doc.Sign: 959fObf8b017b93198949a1 a2eO69eca vve nereo certi that at the ti f th b (Certification of Compliance Specialty No. Agency y ty , me o is o servation, we have observed all of the above reporteo work, unless otherwise noted To the best of our knowledge and belief, we have found this work to comply with the approved plans, specifcations, and applicable section(s) of the California Building Code, as applicable to the locality where this project is located. This report cannot be construed to be a recommendation of work of any nature to be performed. The Owner or a successor in interest shall hold harmless Structural Observation Group, Inc. from any and all legal proceedings of any nature whatsoever, that is related to the observation services provided. Thank You For Your Business C�Cc'-3 STACONTRACTORS E L CENSE BOARD it ACTIVE LICENSE *a ... 1021440 Em., CORP a....N.�. MOTIVE ENERGY TELECOMMUNICATIONS GROUP INC 1ft--C1oBC31 hipm ... i 2024 / W I f,. �. 2l31 vvww csfb.ca qov �1 ® A o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/31/2022 I 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 AOn Risk Services Central, Inc. Chicago IL Office CONTACT NAME: Ext): (866) 283-7122 �aC No.): (800) 363-0105 -(A/C. E-MAIL ADDRESS: 200 East Randolph Chicago IL 60601 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Zurich American Ins CO 16535 Motive Energy Telecommunications Group, INSURERB: Travelers Property Cas CO of America 25674 Inc. INSURER C: 755 Trademark Circle Corona CA 92879 USA INSURER D: INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: 570092280387 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL0348720214 04 Ol 202Z 04 01 2023 EACH OCCURRENCE $2 , 000, 000 CLAIMS -MADE X❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $500 , 000 MED EXP (Any one person) $10 , 000 PERSONAL & ADV INJURY $2 , 000, 000 GEN'LAGGREGAATTE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 X POLICY I ]JECT PRO-❑ LOC uJ PRODUCTS - COMP/OP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY BAP 3487201-14 04/01/2022 04/01/2023 COMBINED SINGLE LIMIT Ea accident $2 , 000, 000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) B X UMBRELLALIAB X OCCUR CUP2T33565622NF 04/01/2022 04/01/2023 EACH OCCURRENCE $10,000,000 EXCESS LAB CLAIMS -MADE EX FollOW Form & Umbrella AGGREGATE $10,000,000 DED RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE WC348720014 04/01/2022 04/01/2023 X PER STATUTE I JOTH- JER E.L. EACH ACCIDENT $1,000,000 D? OFFICER/MEMBER EXCLUDE (Mandatory in NH) ❑ N / A 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) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Motive Energy Telecommunications AUTHORIZED REPRESENTATIVE Group 755 Trademark Circle Corona CA 92879 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD