Inland Contractors/78-153 Main St. Asbestos removal 12CONTRACT
THIS CONTRACT, by and between the -'CITY OF .LA QUINTA; a municipal
corporation, herein referred to as "City," and INLAND CONTRACTORS-INC.,' herein referred
to as "Cwitractor."
WITNES'SETH:
In consideration of their. mutual covenants, the parties hereto agree as follows:
1. Contractor shall furnish' all necessary labor, material, equipment, Itransportation and
services for asbestos'nunoval at 78453 Main Street,' La"Quinta,"CA in the City of
La Quinta; California pursuant to the attached proposal listed as Exhibit A.
2. Contractor will comply with all Federal,' State, County; and La Quinta Municipal
Code, which are, as amended from time to time, incorporated herein by reference.
3. All work shall' be, done , in a manner satisfactory' to' -the Director of :Building and
Safety. -
4. Contractor shall commence work after the issuance of a. written Notice to Proceed
and agrees to have all work completed within 30 days from the date of Notification to
Proceed. -
5. � In consideration of said' work; City agrees to pay Contractor such sums as' shall be
approved by the Director.of Building and'Safety at lump sums and/or unit prices stated in
the Contractor's Bid, the base consideration of Three Thousand Two Hundred Seventy -
Two Dollars and Seventy-Sbr Cents ($3,272.76).. All payments .shall be subject to
approval by the Director of Building and Safety.
6. Prevailing Wage is not required for this project.
7. Except for the gross negligence or willful misconduct of an indemnified Party'(as
hereinafter defined), the Contractor hereby assumes liability for and agrees to defend (at
Indemnified Parties'' option), indemnify, protect' and hold harmless City and its --Project
Consultants, and Engineers, officers, 'agents, land employees (" Indemnified Parties") from
and against any, and all claims', charges, damages, "demands, actions, proceedings, losses,
stop notices, costs, expenses (including counsel fees), judgments, civil fines and penalties,
liabilities of any kind or nature whatsoever, which may be sustained or suffered by or
secured against the Indemnified Parties arising out of or encountered in connection with
this Contract or the performance of the Work including, but not limited to, death of or
bodily'or personal injury to persons or'damage to property, including' property owned' by or
under the care and custody of City, and for civil fines and penalties, that may arise from or
be -caused, in whole or in part, by any negligent or other act or omission of -Contractor; its
officers, agents, employees or Subcontractors including, 'but not'limited"to, liability arising
from:
1
a. Any dangerous, hazardous, unsafe or defective condition of, in or on the
premises, of any nature whatsoever, which may exist by reason of any act,
omission, neglect, or any use or occupation of the premises by Contractor,
its officers, agents, employees, or subcontractors;
b. Any operation conducted upon or any use or occupation of the premises by
Contractor, its officers, agents, employees, or subcontractors under or
pursuant to the provisions of this contract or otherwise;
c. Any act, omission or negligence of Contractor, its officers, agents,
employees, or Subcontractors;
d. Any failure of .Contractor, its officers, agents or employees to. comply, with
any of the terms or conditions of this Contract or any applicable federal,
state, regional, or municipal law, ordinance, rule or regulation;, and
e. The conditions, operations, uses, occupations, acts,, omissions or negligence
referred to in Sub -subsections (1), (2), (3),..and (4),, existing.or conducted
upon or arising from the use or occupation by Contractor on any other
premises in the care, custody and control of City.
The Contractor also agrees to indemnify City and pay for all damages or loss suffered by
City including but not limited to damage to or loss of City property, to the extent not
insured by City and loss of City revenue from any source, caused by or arising out of the
conditions, operations, uses, occupations, acts, omissions or negligence referred to in Sub -
subsections (a), (b), (c), (d) and (e).
Contractor's obligations under this Section apply regardless of whether or not such claim,
charge, damage, demand, action, proceeding, loss, stop notice, cost expense, judgment,
civil fine or penalty, or liability was caused in part or contributed to by an Indemnified
Party. However, without affecting the rights of City under any provision of this contract,
Contractor shall not be required to indemnify and hold harmless City for liability attributable
to the, active negligence of City, provided such active negligence is determined by
agreement between the parties or by the findings of a court of competent jurisdiction. In
instances where City is shown to have been actively negligent and where City's active
negligence accounts for only a percentage of the liability involved, the obligation of
Contractor will be for that entire portion or percentage of liability not attributable to the
active negligence of City.
Contractor agrees to obtain executed indemnity agreements ;with provisions identical to
those set forth here in this section from each and every subcontractor or any other person
or entity involved by, for, with or on behalf of Contractor in the performance of this
contract. , In the event Contractor fails to obtain, such indemnity obligations from others as
required here, Contractor agrees to be fully responsible according to the terms of this
section.
Failure of City to monitor compliance with these requirements imposes noadditional
obligations on City and will in no way act asa waiver of any rights hereunder. This
obligation to indemnify and defend City as set forth here is binding on the .successors,
assigns or heirs of .Contractor and shall survive the termination of. this contract or this
section.
2
This indemnity shall survive termination of the Contract or Final Payment hereunder. This
Indemnity is in addition to any other rights or remedies that the Indemnified Parties may
have under the law or under any other Contract Documents or Agreements. In the event
of any claim or demand made against any party which is entitled to be indemnified
hereunder, City may, ' in its sole discretion, reserve, retain or apply any monies to the
Contractor under this Contract for the purpose of resolving such claims; provided,
however, City may release such funds if the Contractor provides City with reasonable
assurance of protection of the Indemnified Parties' interests. City shall, in its sole
discretion, determine whether such assurances are reasonable.
The City will not be liable for any accident, loss, or damage to the work prior to its
completion and acceptance.
8. Except as otherwise required, Contractor shall concurrently with the execution of
this contract, furnish the City satisfactory evidence of insurance of the kinds and in
the amounts as follows: '
Commercial Gendal lia
Commercial General Liability Insurance using Insurance Services Office "Commercial
General Liability" policy form CG 00 01 or the equivalent. Defense costs must be
paid in addition to limits. There shall be no cross liability exclusion for claims or
suits by one insured against another. Limits shall be no less than One Million
Dollars ($1,000,000) per occurrence for all covered losses and no less than Two
Million Dollars ($2,000,000) general aggregate:
Contractor's policy shall contain no endorsements limiting coverage beyond the
basic policy coverage grant for any of the following:
a. Explosion, Collapse or Underground Hazard(X CU).
b. Products and Completed Operations.
C. Pollution liability.
d. Contractual liability.
Coverage shall be applicable to City for injury to employees of: contractors,
subcontractors or others involved in the project. Policy shall be endorsed to provide
a separate limit applicable to this project.
Workers' Compensaban Durance
Workers' Compensation on a state -approved policy form providing statutory
benefits as required by law with employer's liability limits no less than $1,000,000
per accident for all covered losses.
3
Business Auto Policy
Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 06 92
including symbol 1 (Any Auto) or the exact equivalent. Limits shall be no less than
$1,000,000 per accident, combined single limit. ,If Contractor owns no vehicles,
this requirement may be satisfied by a non -owned auto endorsement to the general
liability policy: described above.
Excess or Und" Liabdity Insurance
Excess or Umbrella Liability Insurance (Over Primary) if used to meet limit
requirements, shall provide coverage at least as broad as specified . for the
underlying coverage. Any such coverage provided under an,umbrella liability policy.
shall include a drop down provisions providing primary coverage for liability not
covered by primary but covered by the umbrella. Self -insured retentions are not
permitted. Coverage shall be provided, on a "pay on behalf' basis, with defense
costs payable in addition to policy limits. There shall be no cross liability exclusion
precluding coverage for claims or suits by one insured against another. Coverage
shall be applicable to City for injury to employees of Contractor, subcontractors or
others involved in the Work. The scope of coverage provided is subject to approval
of City following receipt of proof of insurance as required herein. Limits are subject
to review but in no event less than.$1,000,000 per occurrence and aggregate.
This insurance shall be kept in full force and effect by Contractor during this entire contract
andall premiums thereon shall be promptly paid by it. Each policy shall further state that it
cannot be canceled without written notice to the City and shall name the City as an
additional insured. Failure to maintain the required amounts and types of coverage
throughout the duration of this Contract shall constitute a material breach of this Contract.
a. Contractor agrees to endorse the third party general liability coverage required
herein to include as additional, insureds City, its officials, employees and agents,
using standard ISO endorsement No. CIS 2010 with an edition date of 1985 or
equivalent. Contractor also agrees to require all contractors, subcontractors, and
anyone else involved in any way with the project contemplated by this Contract to
do likewise.
b. Any waiver of subrogation express or implied on the, part of City to any party
involved in this Contract or related documents applies only to the extent of
insurance proceeds actually paid. City, having required that it- be named as an
additional ,insured to all insurance coverage required herein, expressly retains the
right to subrogate against any party for sums not paid by insurance. For its part,
Contractor agrees to waive subrogation rights against City regardless of the
applicability of any insurance proceeds,, and to require all contractors,
subcontractors or others involved in any way with the project(s) contemplated by
this Contract, to do likewise.
c. All insurance coverage maintained or procured by Contractor or required of others
by Contractor pursuant to this Contract shall be endorsed to delete the subrogation
4
condition as •to City, or to' specifically allow Contractors or others "providing
insurance herein to waive subrogation prior to aloss. This endorsement shall be
obtained7 regardless of existing - policy- wording that may appear to allow such
waivers:
:.
d.-lt'`is agreed' by Contractor and City that insurance provided'pursuant'to these
requirements is not intended by any party to,be limited to providing coverage for the
vicarious liability of City, or to the supervisory role, if any, of City. All insurance
coverage provided pursuant to this or any other Contract (express or'implied) in''any
way relating to City is intended to' apply to the full extent' of the policies' involved.
Nothing referred' to' here or contained in any Contract "involving City in relation to
the project(s)'contemplated by"this'Contract is intended to'be construed -to limit the
application of linsurance coverage in any way.
e. None of the coverages", required herein will be in compliance with these requirements
if they include any limiting endorsement of any kind that has' not been first
submitted -to City and approved of in writing.
f. All coverage types and limits required are subject to approval, modification and
additional requirements by liheCity, as the need arises. -Contractor shall not make
any reductions in scope of coverage (e.g. elimination of 'contractual liability or
reduction of discovery period) that may affect City's protection without City prior
written consent.
g. Proof of compliance with these insurance requirements, consisting of binders of
coverage, orendorsemenM or -certificates of insurance; at the option of City, shall
be delivered to City at or prior to the execution of this Contract. In the event such
proof of any insurance is not delivered as required, or in the event such'insurance is
canceled at any time and no replacement coverage is provided, City has the right,
but not the duty, to obtain any insurance it deems necessary to protect'its interests
under this or any other agreement and to pay the premium. Any premium so paid
by City shall be charged to and promptly paid by Contractor'or deducted from sums
due Contractor, at City option.
ht= Contractor agrees to endorse, and to require others' to endorse, the insurance
provided- pursuant to these requirements, to require written notice to City and the
appropriate tender prior to cancellation of such liability. coverage and notice of any
material alteration of non-renewal'of any such coverage, and to require contractors,
subcontractors, and, any other "' party in any way involved with the project
contemplated by this Contract to do likewise.
i. It is ,acknowledged by the parties of'this Contract that all insurance coverage
- required to be provided by Contractor or any' subcontractor', is intended to apply
first and on a primary non-contributing'basis in relation to any "other 'insurance
available to the City.
E
13, Contractor certifts that it As the holder of any,, necessary, California State
Contractor's License and authorized to undertake the above work.
14. The City, or its authorized auditors or representatives, shall have access to and the
right to audit and reproduce any of the Contractor records to the extent the City deems
' necessary to insure, it is, receiving all money to, which it. Is,entitled under the contract
and/or is pa'ying'-only the amounts to . which, . ContractorI is, properly, "Me I d under the
,Contract or foe.'�ihisi PurposesI to the a I Contract.
relating
15. The Contractor shall maintain and preserve all such records fora period of at least
three years after termination of the contract.''�
1.6"r The Contractor shall maintain all such recordsj n the City ofLa Quints. If.not, the
tontracbx� shail.� request, uest,"promptly deliv
er ver the records to the City qrselmburse the
I._ ,
City,for all reai6riable.and extra costs Incurred In conducting the audit at a, location other
than at City 6111ces including.; but not limited to,, such additional (out of the City). expenses
for personnel, salaries, private auditors travel,' lod"ging, meals and overhead.
IN wrrNIESS, WHEREOF, t6 perfts'ha".ezecuted dft Agreenwra as of dw dates stated
ciTy OF iA QtnriTA
a Cadforr" nunda" cowpomtion
Address:393 W. LA`.�`CADENA DR.019
RIVI§RSIDE;,-CA 92501
q. Requirements of specific coverage features are not intended as limitations on other
requirements or as a waiver of arty coverage normally provided by any given policy.
Specific reference to a given coverage feature is for purposes of clarification only as
it pertains to a given issue, and is not intended by any party or insured to be all-
inclusive.
r. Any provision in'any of the construction documents dealing with the insurance
coverage provided pursuant to these requirements is subordinate to and superseded
by the requirements contained herein. These insurance requirements are intended
to be separate and distinct from any other provision in this Contract and are
intended by the parties here to be interpreted as such.
s. All liability coverage provided according to these requirements must be endorsed to
provide a separate aggregate limit for the project that is the subject of this Contract
and evidencing products and completed operations coverage for not less than two
years after issuance, of a final certificate of occupancy by all appropriate
government agencies or acceptance of the completed work by City.
t. Contractor agrees to be responsible for ensuring that no contract used by any party
involved in any way with the project reserves the right to charge City or Contractor
for the cost of additional insurance coverage required by this Contract. Any such
provisions are to be deleted with reference to City. It is not the intent of City to
reimburse any third party for the cost of complying with these requirements. There
shall be no recourse against City for payment of premiums or other amounts with
respect thereto.
u. Contractor agrees to obtain and provide to City a copy of Professional Liability
coverage for Architects. or Engineers, if any are working on this project through
Contractor. City shall determine the liability limit.
9. In accepting this Contract, Contractor certifies that in the conduct of its business' it
does not deny the right of arty individual to seek, obtain and hold employment without
discrimination because of race, religious creed, color patirl�tcv, physical
handicap,medical condition, marital status, sex or a ��fJLL�a+�99 f e �Ciifomia Fair
Employment Practice Act (Government Code Sections 12900, et seq.) Contractor agrees
that a finding by the State Fair Employment Practices Commission that Contractor has
engaged during the term of this Contract in any unlawful employment practice shall be
deemed a breach of this Contract and Contractor shall pay to City $1,607.00 liquidated
damages for each such breach committed under this contract.
10. This Contract shall not be assignable by Contractor without the written consent of
City.
11. Contractor shall notify the Director of Building and Safety forthwith when the
Contract is deemed completed.
12. In accepting this Contract, Contractor certifies that no member or officer of the firm
or corporation is an officer or employee of the City except to the extent permitted by law.
13. Contractor certifies that it As , the holder of. any necessary. California State
Contractor's License and authorized to undertake the above work.
14. The City, or its authorized auditors or representatives, shall have access to and the
right to audit and reproduce any of the Contractor records to the extent the City deems
necessary to insure it is r receiving all Money to, which it, is entitled, under - the contract
and/or is paying only the amounts to I which. Contractor is.properly entitled under the
Contract or for, other purposes relating to the Contract.
15. The Contractor shall maintain and preserve all such records fora period of at least
three years after termination of the contract.
T
16. The Contractor shall maintain, all such records In the City of La Quinta., If, not, the
Contractor shall, upon request, promptly deliver the records to the City or reimburse the
City, for all reasonable and I extra costs incurred in conducting -the audit at a, location other
than at City offices including, but'no ' t limited to,. I s . uch additional (out of the City) expenses
for personnel, salaries, private auditors.' travel, lodging, meals and overhead.
K'VATNESS Wll1IERE4,,the pairdes; have lexecuted . this I Aipearrieca I as of the dates stated
CITY OF LA.QUINTA,
a Caff#onda nandaipal amporation
Dated:, I----12
-
APPROVED AS TO FORM:
MAD IN 0M*ffGWAff
Cft Atte"wir
By:
Manager
Weiss City Mana
Interim City Manager
Addm":393 W. Ll
CADENA DR.#19
RIVERSIDE"rCA 92501-
9
3. , cwriti es( that it 'is the., holder of any necessary. California State
; �� :
Q�ontractor Cntrqc:Xorl Lfqe_' :a dauthorized to undertake the a work.
j�ss n
14. The City, or its authorized auditors or representatives, shall have access to and the
right to audit and reproduce any of the Contractor records to the extent the City deems
necessary w insure it Is receiving all money. to. which It Is, entitled.. under -the contract
and/or is paying, only the amounts to Which'. Contractor is properly. entitled. under the
forContract or otherpurposes iretating.to the Contract.
15. The C shall rnaintain.and pr9serve.all such records fora Period of at least
ontractor or
three years after termination of the contract.
The Contractor shall maintain all -such records In the. City or. La Quinta, lf-not,the
Contractor sho. . upon. req
uest promptly deliver the records .ToJhe City or reimburse the
,
I extra costs .incur red in conducting the audit at a, location other
City,for all reasonao 0. n then at City offices including.. but no.t.lirrifted to.. su .9h.additionalJout9f the City) expenses
for personnel, salaries, private auditors, travel, lodging, meals and overhead..
jIj,WITNESS .WHEREOF, .tare poffies:have executed tide Agreement as of thW-4ft%65 stated
t$6".
OF LA QUINTA
a Callifernia municipal corporation:
000M IN COUNT6VARt
Dated .Ar . City Manager:
Mark Weiss
APPROVIEDASTO-FORM. Interim City Manager
Dated: 12116/203 1
Addrass:393 N. LA_''CAJDRNA DR-019
RIVERS�,$At. 92501
8
EXHIBIT A
Proposal & Scope of Work
October 24, 2011
PROPOSAL & CONTRACT
PROJECT # 11253A
78.153 Main St La Quinta, CA
To. City of La Quints Building & Safety Department (Hereinaflar "Owner")
FROM: Inland Contractors, Inc. (Hereinafter "Contactor')
FOR THE FOLLOWING LOCATION: 78-153 Main St. La Quints, CA
Scope of Work: Removal and manifested disposal performed in accordance with SCAQMD Rule 1403
regulations for all materials greater than one percent asbestos.
➢ 190 square feet of floor file from the living room of unit 1
D 75 square feet of linoleum from the kitchen and bathroom of unit 3
D 176 square feet of floor file from the living room of unit 3
D 180 square feet of flocr tie from tie living room of unit 4
D 660 square feet of drywall & texture coat from unit 5
➢ 180 square feet of floor file from the living mom of unit 5
D 240linear feet of window putty
• ACM will be removed and immediately bagged for manifested disposal
• The work area will be wet wiped. HEPA vacuumed and encapsulated following removal
• Bags of ACM Will be transported and disposed of by contractors hazardous waste transportation
subcontractor In accordance with 40 CFR 61.
• SCAQMD 10 working day notification permitis included
BID AMOUNT: All of the above work is to be completed in a substantial and workman like manner according to
standard practices for the sum of.
Scope of Work
SCAQMD Notification Fee
Total Bid Amount
THE CONTRACT PRICE IS • xyn.7a FOR THE SCOPE OF
WORK, AS AGREED IN WRITING BY OWNER OR INSURER,
AND OWNER HEREBY AGREES THERETO. GWNRAVMEW
QQAM-RAXNAL41T PRIOR
WBRK.
CUSTOMER INMAL
f 3,108.00
5180.76
$ 3,272.76
CUSTOMER IS RESPONSIBLE FOR EACH CREW MOBILIZATION
OF $ 300.00 F PROJECT IS CANCELLED, PERFORMED IN
PHASES OR RESCHEDULED BY THE OWNER ON THE AGREED
START DATE (REFERENCE SECTION a OF AGREEMENT).
CUSTOMER INITIAL
'T W
CERTIFICATE OF LIABILITY INSURANCE
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 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 andorsenuarUsl.
PRODUCER
renkel & Company
i50 Hudson St.
11ew York NY 10014
INSURED
Inland Contractors, Inc.
231 E. Alessandro Blvd., #A388
Riverside CA 92508
COVERAGES CERTIFICATE NUMBER: 643972352 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 REQUIRFMFNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VMICH 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.
_..__SURAI___._____.___.......__.__'_POLICYEFF POLICY Bit e-j— L1wrs
LTR TYPE Oi INSURANCE POLICY NUMBER aw MWODlYY'yY .
A
GENERAL UAIUTY IY
Y CNVO24331-09-01
hD1812009 12/1a(2011 jEACH OCCURRENCE
f1,00D,000
X
1-fFMAZ±6TG-RERTE6—
i COMMERCIAL GENERAL LIABILITY
ES {_Ea,accurzenml
E50000
CLAIMS -MADE LX CIXUR
'
MED EXP (Any on)
$5,000 .....-......_..
X Conh.P011Liab
j
IPERSONALBAOV INJURY
f7,000,000
GENERAL AGGREGATE
$2,000000
OCCuRDRCB FGNr1
GENL AGGREGATE U IATAPPLIES PER;
PRODUCTS COMPIOPAGG
$2,000,000
X PR0.
71
POLICY
IFE
A
AUTOMOBILE Lu&CITY
ENVO24331-09-01
UIAIT
�12/18Y1UD8 2/7B/20ti
1000,000
ANY AUTO
1
i BODILY WJURY(Per Person)
' -
E
__ ...... -.-..
_ ALL OWNED .......... SCHEDULED
BODILY INJURY (Per aoadeM)
(
I f
_ AUTOS �- NON -OWNED
IX
PR F� ERTYOAMAGE
-
—�
S-,_
NIRFD AUTOS AUTOS
LLPYrawQenlj__ _
j
UMBRELLA me
OCCUR
' EACH OCCURRENCE _
_$
EXCESS LIAR
CLAIMS -MADE
j
AGGREGATE . _.
E_ .
DED RETENTIONS___._-
i
S
WORKERS COMPENSATION
YvC STATU- 1 Fa
... __
AND EMPLOYERS' UNNUD' YIN
.0&YL ...
f
ANY PROPRIETOR/PARTNERIE%ECUPVE
E.L. ACCIDENT
E ..... _._.___._._.
OPFlCEPRAEMBER EXCLUDED? :NIA
(MaMabryin NH)
% EL DISEASE - EA EMPLOYEE
--- -.
yyeeI
I DESCRI�MIION OFOPERATIONS babes j
I
E.L. DISEASE -POLICY LIMIT
S
A
Pmlessional Liability IN
N NV024331-09-01
h211812009 2/18/2011 jEaCh Claim $1.00D,ODO
Clahm Made FoYn i
i
iGeneral Aggregate $2,000,ODO
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AdaNbnel Ramada SUiedWa, N m m apaceM m4nirerN
Prcjeot:78&153'Main Street, La Quinta, CA 92253 and 78-182 La Fonda, La Quinta, CA 92253
Certifidate-Holder is listed as Additional Insured with respect to General Liability, but only as respects operations of the Named Insured
performed on behalf of the Additional Insured.
City of La Quinta
78-495 Cabe Tampico
La Quinta CA 92253
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
All rights
ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD
r'1 _1W
1,<,{2
POLICYHOLDER COPY
P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 12-15-2011 GROUP. 000497
POLICY NUMBER: 0001823-2010
CERTIFICATE ID: Be
CERTIFICATE EXPIRES 08-01-2012
09-01-2011/09-01-2012
THIS CERTIFICATE SUPERSEDES AND CORRECTS
CERTIFICATE If 93 DATED 12-14-2011
CITY OF LA QUINTA SK
78153 MAIN STREET
PO BOX 1504 LA QUINTA
LA QUINTA CA 92247-1504 CA 92247
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated
This policy is notsubject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein Notwithstandurq any requirement term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the term'. exclusions, and conditions, of such policy.
t'v r4v,
tA.thorized Representative 0 President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL. INSURED EMPLOYER EFFECTIVE 2011-12-14 IS
ATTACKED TO AND FORME A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED:
CITY OF LA QUINTA
ENSXURBEMET B1SW - GREENAWALT, FRANCLIN PRESIDENT - EXCLUDED.
ENDORSEMENT H1800 - BROYLES, LINDA TREASURER - EMLIDED.
EDORSENET #1900 - MgEMANALT, ELOISA SECRETARY - EXCLUDED.
EOORSOMIT 02088 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2010 IS
ATTAINED TO AND FORMS A PART OF THIS POLICY.
EDORSEMET #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2011-12-19 IS
ATTACHED TO AND PON S A PART OF THIS POLICY. THIRD PARTY NAME:
CITY OF LA QUINRA
ENDORSEMENT 02001 ASBESTOS CERTIFICATION EFFECTIVE 09-01-2010 IS ATTACKED TO AND FORMS
A PART OF THIS POLICY.
EMPLOYER
INLAND CONTRACTORS INC SK
231 E ALESSA DRO BLVD FMB A388
RIVERSIDE CA 83508
iREy.9-20101
[Pl0,SK[
PRINTED : 12-15-2011
SK
WAIVER OF SUBROGATION NOTICE
Enclosed is your copy of a certificate of insurance on which the certificate holder
required a waiver of subrogation:
1. Please be advised that a waiver of subrogation requires that a 3% surcharge
will be applied by State Fund ONLY to the premium assessed on the payroll
of your employees earned while engaged in work for that certificate holder
who requested the waiver. (Note: if you have no employee payroll on that job,
then there is no charge.)
2. To apply the 3% surcharge, you must also agree to maintain accurately
segregated payroll records for employees engaged in work on jobs for the
certificate holder who has the waiver. The payroll records are subject to
verification by an auditor.
Example:
Payroll for job:
Sample Rate:
Regular Premium equals:
Surcharge:
Additional Waiver charge:
Total premium equals
$5,000.00
13.30%
$ 665.00
3.00%
19.95
$ 684.95 (665.00 +
19.95)
BDC SPECIAL WASTE SERVICES
A WASTE MANAGEMENT COMPANY
1211 GLADSTONE ST. • AZUSA, CA 91702
(626)969.1384 • FAX (626)969.4971
.............. .
NO.239725
CITY OF LA QUINTA ATTN.: AJ ORTEGA
NAME
EPA
ADDRESS P.O. .BOX 1 504
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NO.
LA QUINTA,CA 92247
(760)777-7018
CITY, STATE, ZIP
PHONE NO.
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SITE ADDRESS ! Q , 78-153 MAIN STREET LA UINTA CA 92253
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PROPERTIES: PH N e-. ®SOLID {-•UOUID CSLUDGE 0SLURRY ❑OTHER
HANDLING INSTRUCTIONS: USE PROPER SAFETY EQUIPMENT
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TYPED OR PRINTED FULL NAME BSIDNATURE DATE
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INLAND CONTRACTORS, INC.
Eu r,—
NAME
NO.I
231 E. ALESSANDRO BLVD.,PMB A388
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ADDRESS
SERACEORDERNO.
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RIVERSIDE,CA 92508
CITY, STATE, 21P
PICK UP DATE
(951) 276-0600
PHONE NO,
TYPED OR PRINTED FULL NAME & SIGNATURE
DATE
NAME ECTI
PA —�.
N$CAR0000 064
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P.O. BOX 7318
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ADDRESS
SERVICE ORDER NO.
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SAN BERNARDINO CA 92411
CITY, STATE, ZIP
PICK UP DATE
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PHONE NO.(800)664-7773
TYPED OR PRINTED FULL NAME &SIGNATURE
DATE
No AD009007626
AZUSA LAND RECLAMATION
NAME
DISPOSAL METHOD
1211 W. GLADSTONE STREEET
0LANDFILL 11 OTHER
ADDRESS
-t
AZUSA,CA 91702
('
CITY STATE, 21P
PHONENO.(626) 334-0719
Q
TYPED OR PRINTED FULL NAME & SIGNATURE
DATE
GEN
OLDINEW
L A
TONS
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SCAOMD (909) 39b-34Sb
21865 E.COPLEY DR.
DIAMOND BAR,CA 91789
TRANS
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HWDF NONE
DISCREPANCY
White & Yellow - TSD COPY Pink - GENERATUR cUPY t1We - I RAINz rCjm I Em C;CjP , uvmenruu - i ". r
Named Insured
Endorsement Number
Inland Contractors, Inc.
001
Policy Symbol
Policy Number
Policy Period
Effective Date of Endorsement
GL
G242Z A 001
12/18/2011 TO 12/18/2013
12/18/2011
Issued By (Name of Insurance Company)
Westchester Specialty Insurance Services, Inc.
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Projects:
Project: 78-153 Main Street, La Quinta, CA 92253 and
78-182 La Fonda, La Quinta, CA 92253
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
(If no entry appears above, information required to
as applicable to this endorsement.)
A. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences
under COVERAGE A (SECTION I ), and for all medical expenses caused by accidents under
COVERAGE C (SECTION I ), which can be attributed only to ongoing operations at a single designated
project shown in the Schedule above:
1. A separate Designated Project General Aggregate Limit applies to each designated project, and
that limit is equal to the amount of the General Aggregate Limit shown in the Declarations.
2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all
damages under COVERAGE A, except damages because of bodily Injury or property damage
included in the products -completed operations hazard, and for medical expenses under
COVERAGE C regardless of the number of:
a. Insureds;
b. Claims made or suits brought; or
C. Persons or organizations making claims or bringing suits.
3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical
expenses shall reduce the Designated Project General Aggregate Limit for that designated
project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations
nor shall they reduce any other Designated Project General Aggregate Limit for any other
designated project shown in the Schedule above.
ENV-7103 (09-04) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 2
4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense
continue to apply. However, instead of being subject to the General Aggregate Limit shown in the
Declarations, such limits will be subject to the applicable Designated Project General Aggregate
Limit.
B. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences
under COVERAGE A (SECTION I ), and for all medical expenses caused by accidents under
COVERAGE C (SECTION I ), which cannot be attributed only to ongoing operations at a single
designated project shown in the Schedule above:
Any payments made under COVERAGE A for damages or under COVERAGE C for medical
expenses shall reduce the amount available under the General Aggregate Limit or the Products -
Completed Operations Aggregate Limit, whichever is applicable; and
2. Such payments shall not reduce any Designated Project General Aggregate Limit.
C. When coverage for liability arising out of the products -completed operations hazard is provided, any
payments for damages because of bodily injury or property damage included in the products -
completed operations hazard will reduce the Products -Completed Operations Aggregate Limit, and not
reduce the General Aggregate Limit nor the Designated Project General Aggregate Limit.
D. If the applicable designated project has been abandoned, delayed, or abandoned and then restarted, or if
the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the
project will still be deemed to be the same project.
E. The provisions of Limits of Insurance (SECTION III) not otherwise modified by this endorsement shall
continue to apply as stipulated.
ENV-7103 (09-04) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 2 of 2