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Home My WebLink AboutLQ_Dune Palms Bridge_IID Applications_BMcKinney Signature required on next page. IID-760 (05-17) APPLICATION FOR SERVICE PROJECT INFORMATION PROJECT ADDRESS CITY STATE ZIP CODE IN-SERVICE DATE ELECTRICAL INSTALLATION □Overhead □Underground □Area/Streetlight □Net Meter □Distributed Generation □Temporary Service □Service Relocate □Service Removal Main Panel Size ________ (Amps) Voltage Required ________ □1 Phase □3 Phase Number of Meters ________ Total Connected Load (HP) _______ TYPE OF PROJECT: □Single Family Residential □Subdivision Residential □Commercial □Industrial □Agricultural Bus. Hrs. ______________________ # Workdays in Week ______ # Workdays in Month _______ CONSTRUCTION CONTACT NAME CELL NUMBER OTHER PHONE EMAIL CONTRACT ACCOUNT NUMBER METER NUMBER(S) PROJECT DESCRIPTION (attach additional pages as necessary) Electrical one-line / panel schedules / panel specifications may be required SINGLE FAMILY RESIDENTIAL APPPLICATION INFORMATION (IF OTHER, SKIP TO NEXT SECTION) CUSTOMER NAME (if different than above) CELL NUMBER OTHER PHONE EMAIL BILLING ADDRESS (if different than above) CITY STATE ZIP CODE DRIVER LICENSE NUMBER SOCIAL SECURITY NUMBER DATE OF BIRTH PLACE OF EMPLOYMENT MARITAL STATUS OTHER CONTACT (If any) CELL NUMBER OTHER PHONE EMAIL COMMERCIAL, INDUSTRIAL, RESIDENTIAL SUBDIVISION, TEMPORARY SERVICE OR AGRICULTURAL PROJECT OWNER BUSINESS TYPE: □Corporation □Partnership □Sole Proprietor □LLC □LLP BUSINESS NAME DOING BUSINESS AS (if applicable) BILLING ADDRESS (if different than above) CITY STATE ZIP CODE IF PARTNERSHIP, LIST PARTNER NAMES 1. 2. IF CORPORATION, LIST THE FOLLOWING: President/Member Secretary/Member Vice President/Member Treasurer/Member Federal Tax ID # SIGNATORY #1 (if applicable) TITLE DRIVER LICENSE NUMBER STATE CELL NUMBER OTHER PHONE SOCIAL SECURITY NUMBER (if applicable) SIGNATORY #2 (if applicable) TITLE DRIVER LICENSE NUMBER STATE CELL NUMBER OTHER PHONE SOCIAL SECURITY NUMBER (if applicable) Dune Palms Rd Widening La Quinta CA 92253 X Street Widening Improvement - City project Leonard St. Sauver 760.275.2143 lstsauver@la-quinta.org NA Relocation of overhead distribution lines to underground system for street widening. City of La Quinta 78495 Calle Tampico La Quinta CA 92253 City Engineer 760.275.0049 760.777.7045 NA NA 100 X 1240 Service Panel Application lstsauve@laquinta.gov Dune Palms Bridge Overhead Line Relocation Street widening & bridge improvements Relocation of overhead distribution lines for street widening & bridge. Signature required on next page. IID-760 (05-17) APPLICATION FOR SERVICE PROJECT INFORMATION PROJECT ADDRESS CITY STATE ZIP CODE IN-SERVICE DATE ELECTRICAL INSTALLATION □Overhead □Underground □Area/Streetlight □Net Meter □Distributed Generation □Temporary Service □Service Relocate □Service Removal Main Panel Size ________ (Amps) Voltage Required ________ □1 Phase □3 Phase Number of Meters ________ Total Connected Load (HP) _______ TYPE OF PROJECT: □Single Family Residential □Subdivision Residential □Commercial □Industrial □Agricultural Bus. Hrs. ______________________ # Workdays in Week ______ # Workdays in Month _______ CONSTRUCTION CONTACT NAME CELL NUMBER OTHER PHONE EMAIL CONTRACT ACCOUNT NUMBER METER NUMBER(S) PROJECT DESCRIPTION (attach additional pages as necessary) Electrical one-line / panel schedules / panel specifications may be required SINGLE FAMILY RESIDENTIAL APPPLICATION INFORMATION (IF OTHER, SKIP TO NEXT SECTION) CUSTOMER NAME (if different than above) CELL NUMBER OTHER PHONE EMAIL BILLING ADDRESS (if different than above) CITY STATE ZIP CODE DRIVER LICENSE NUMBER SOCIAL SECURITY NUMBER DATE OF BIRTH PLACE OF EMPLOYMENT MARITAL STATUS OTHER CONTACT (If any) CELL NUMBER OTHER PHONE EMAIL COMMERCIAL, INDUSTRIAL, RESIDENTIAL SUBDIVISION, TEMPORARY SERVICE OR AGRICULTURAL PROJECT OWNER BUSINESS TYPE: □Corporation □Partnership □Sole Proprietor □LLC □LLP BUSINESS NAME DOING BUSINESS AS (if applicable) BILLING ADDRESS (if different than above) CITY STATE ZIP CODE IF PARTNERSHIP, LIST PARTNER NAMES 1. 2. IF CORPORATION, LIST THE FOLLOWING: President/Member Secretary/Member Vice President/Member Treasurer/Member Federal Tax ID # SIGNATORY #1 (if applicable) TITLE DRIVER LICENSE NUMBER STATE CELL NUMBER OTHER PHONE SOCIAL SECURITY NUMBER (if applicable) SIGNATORY #2 (if applicable) TITLE DRIVER LICENSE NUMBER STATE CELL NUMBER OTHER PHONE SOCIAL SECURITY NUMBER (if applicable) Dune Palms Rd Widening La Quinta CA 92253 X Street Widening Improvement - City project Leonard St. Sauver 760.275.2143 lstsauver@la-quinta.org NA Relocation of overhead distribution lines to underground system for street widening. City of La Quinta 78495 Calle Tampico La Quinta CA 92253 City Engineer 760.275.0049 760.777.7045 NA NA 100 X 1240 Service Panel Application lstsauve@laquinta.gov Dune Palms Bridge Street widening & bridge improvements Service Panel installation south of channel and north of Corporate Ctr Drive, west side. IID-760 (1-17) APPLICATION FOR SERVICE - CONTINUED REGULATIONS GOVERNING SALE AND USE OF ELECTRIC ENERGY Excerpts from Regulation No. 6 The customer shall, at his own risk and expense, furnish, install and keep in good and safe condition all electric wires, lines, machinery and apparatus of any sort which may be required for receiving electric energy from the District, and for applying and utilizing such energy, including all necessary protective appliances and suitable housing therefor. The District shall not be responsible for any loss or damage occasioned or caused by the negligence or want of proper care or wrongful act of the customer or any of his agents, employees or licensees on the part of the customer in installing, maintaining, using, operating or interfering with any such wires, lines, machinery or apparatus. Excerpts from Regulation No. 11 The district shall, at its option, have the right to disconnect its services until the customer has complied with all the terms of the agreement and of the District’s regulation. Excerpts from Regulation No. 15 The District will construct, own, operate and maintain lines only along public streets, roads and highways which the District has the legal right to occupy and on public lands and private property across which rights-of-way satisfactory to the District may be obtained without cost or condemnation by the District. All Imperial Irrigation District Regulations Governing the Sale and Use of Electric Energy are available for viewing at all IID Division Offices, Imperial Operating Headquarters and online at www.iid.com. □ I have read and agree to the Regulations listed above. Signature: _______________________ Title: ___________________________ Print Name: ______________________ Date: ___________________________ INTERNAL USE ONLY BP no. □ CO □ DO □ Urban □ Rural Cycle Book ARDMS segment no. New seg. ARDMS sequence no. Contract account no. CO date DO date Rate SE HP SIC HP/Schedule change From To STAPP □ Yes □ No Meter no. Reading Multi. Demand Serial no. Credit est. □ Yes □ No G.D. no. Amount □ New installation □ Re-install □ Re-connect □ Removed □ Left on premise Remarks Notes Nearest meter no. Approved by Received by CA Keyed in computer City Engineer Bryan McKinney X CONTRACTOR INFORMATION SHEET If applicable, please select the level of authorization for communication with your contractor. Contractor Address Contact Contact Phone Email Address □ Attend meetings and/or respond to correspondence regarding this project. □ Pick-up the contractor notes packet for this project. □ Receive electronic files for this project, including energy account information. □ Obtain approvals, to complete this project. Signature: _______________________ Title: ___________________________ Print Name: ______________________ Date: ___________________________ TBD TBD Brad Donais - Design; Leonard St. Sauver - Construction Oversight 760-.902.9367 Brad; 760.275.2143 Leonard bdonais@hept7.com; lstsauver@la-quinta.org City Engineer Bryan McKinney X X X X 760.902.9367 Brad; 760.275.2143 Leonard Terms & Conditions Indemnification Agreement In consideration for the provision of electrical utility service by IID for the development project identified in the Standards Specifications and Contractor Information Sheet, Applicant and IID agree as follows: The provision of electric utility service to Applicant is conditioned on compliance by Applicant with all applicable laws including the Imperial Irrigation District Regulations Governing the Sale and Use of Electric Energy and Rate Schedules. Applicant shall defend and indemnify IID, from any: liability, claims, suite or actions; losses, expenses, fees, or costs of any kind, so long as such things are in relation to, as a consequence of, arising out of, or in any way attributable actually, allegedly or impliedly, in whole or in part, to the provision of electrical service by IID to Applicant for the development project identified in the Standards Specifications and Contractor Information Sheet; however, Applicant shall not be required to indemnify and hold harmless IID as set forth above for liability attributable to the sole fault of IID. Customer Initials ____ Environmental Impact Information The work IID has to undertake to provide the electric service requested may cause impacts to the environment. Since the work is customer-driven and not a system upgrade, it is IID’s policy that any environmental impacts created by new, relocated, modified or reconstructed IID facilities (which can include, but are not limited to, substations, transmission and distribution lines, IID-owned canals and drains, etc.) required to provide electric service to the customer need to be assessed in accordance with the California Environmental Quality Act and National Environmental Policy Act, if applicable, and, if required, mitigated. Failure to comply with such requirements will result in the postponement of the service requested until the appropriate environmental documentation is obtained by the customer from the lead agency having jurisdiction to permit the customer’s project and the environmental impacts are fully assessed and mitigated. Any and all mitigation necessary as a result of the impacts on the environment caused by the construction, relocation and/or update of the IID facilities is the responsibility of the customer. At its discretion IID will verify, via its field crews and project inspectors, if impacts are being mitigated per customer’s environmental document and if customer is providing on-site mitigation monitoring. If not, customer will be advised of this and IID work will be halted until the appropriate mitigation measures and monitoring are in place. Customer Initials ____ Engineering Fee I acknowledge that failure to complete and return all pertinent forms to IID could cause a delay in electric service. I agree and understand that the Engineering Fee will be paid to begin engineering a project and will be applied as a credit toward the construction cost of the project. The Engineering Fee is non-refundable. Any design changes that result in the redesign of the project, and therefore alters prior schedule IID commitments will require an additional non- refundable Engineering Fee and may cause delays in construction schedules(s). Customer Initials ____ Signature: _______________________ Title: ___________________________ Print Name: ______________________ Date: ___________________________ Bryan McKinney City Engineer JOINT TRENCHING INDEMNITY AGREEMENT The joint trenching of utilities, as opposed to the trenching of utilities in separate trenches, is a development and construction method which provides cost savings to Contractors. However, joint trenching also presents additional risks of danger due to the proximity of utilities in a common trench. In consideration for permission given by IID to Contractor to install all utilities in a joint trench, Contractor agrees to indemnify IID as set forth herein. In consideration for permission given by IID to Contractor to install all utilities in a joint trench, Contractor and IID agree that Contractor shall defend and indemnify IID, from any: liability, claims, suit or actions; losses, expenses, fees, or costs of any kind, so long as such things are in relation to, as a consequence of, arising out of, or in any way attributable actually, allegedly or impliedly, in whole or in part, to the joint trenching of utilities by Constrictor and/or its subcontractors. However, Contractor shall not be required to indemnify and hold harmless IID as set forth above for liability attributable to the sole fault of IID. Signature: _______________________ Title: ___________________________ Print Name: ______________________ Date: ___________________________ City Engineer Bryan McKinney