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Inland Contractors/78-182 La Fonda 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 "Contractor.,, u WITNESSETH: In consideration of their mutual covenants, the parties hereto agree as follows: 1. Contractor shall furnish all necessary labor, material, equipment, transportation and services for asbestos removal at and 78-182 Avenida' La Fonda, La Quetta, 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 Proceeds 5. In consideration of said work; City agrees to pay Contractor such sums as shall be approved by the Director of Building, andr Safety at lump sums and/or unit prices stated in the Contractor's Bid, the base consideration of One Thousand Eght Hwidned Ninety -Three Dollars and Eighty -Wine Cents ($1,893.89). 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, 'and 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 r 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,, Inthe event Contractor, fails to obtain such indemnity obligations from others as required, here, Contractor, agrees to: be fully responsible according to the .termsof, this section. Failure of City .to monitor, compliance, with these requirements .imposes no. additional obligations on City and_will in no way,,act. as,,a :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. 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 concurrentlywith the execution of this contract, furnish the City satisfactory evidence of insurance of the kinds and in the amounts as follows: Comrnweial General Liabillity Palley 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' Compensation Insurance 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. Q 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 Urnbrea liability insuoance 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 .butcovered 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 sha11 be kept in fu11 force and effect by Contractor during this entire contract anq;all 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 require ii 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. CG 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 projects) 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 a loss. This endorsement shall be obtained regardless of existing policy wording that may appear to allow such waivers. d. It 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 insurance 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 the City, 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's prior written consent. g. Proof of compliance with these insurance requirements, consisting of binders of coverage, or endorsements, 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. h. 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 r this Contract that all L 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. 5 j. ..Contractor agrees to ensure that subcontractors, and any other party involved with the project that is brought onto. or involved in the project by contractor, provide the same minimum insurance, coverage required of Contractor, Contractor agrees to monitor and review all such coverage and assumes all responsibility for,ensuring that such coverage is provided in conformity with the requirements of this section. Contractor.agrees that upon request, all agreements withsubcontractors and others engaged in the project will.be submitted to City for,review, . k. Contractor agrees not to. self -insure or to use any. self -insured retentions or deductibles on any portion of the insurance required herein and further agrees that it will not allow any contractor, subcontractor, Architect, Engineer or other entity or person,in any way involved in the performance of work -on the project contemplated by this Contract to self -insure its obligations • to City. , If contractor's existing coverage includes a deductible or self -insured retention, the deductible or self - insured retention must be declared to the,City. At that time the City. shall review options . with the: contractor, which may include reduction or elimination. of the deductible or self -insured retention, substitution, of other coverage, or other solutions. 1. The City reserves the right at, any time during the term. of. the contract to, change the amounts and types of insurance required by giving the Contractor ninety (90) days advance written notice of such change. If such change results in, substantial additional cost to the Contractor, the City will negotiate additional compensation proportional to the increased benefit to City. m. For purposes of applying insurance coverage .only, all contracts pertaining, to the project will be deemed to be executed when. finalized and any; activity commences In furtherance,of performance under.this Contract. n. Contractor acknowledges and agrees that any actual or alleged failure on the part of City to. inform Contractor of non-compliance with, any insurance requirement in no way .imposes any additional ;obligations on, City . nor does it ,waive any rights hereunder in this or any other regard. o. Contractor will, renew the required .coverage annually as long. as City, or its employees or agents face an exposure from operations of any type pursuant to this Contract. This obligation :applies r whether or not the Contract is canceled or terminated..for any reason. The insurance shall include but not be limited to products and completed operations and discontinued,operations, where applicable. Termination of this obligation is not effective . until City. executes a written statement to that effect. p., Contractor agrees to waive its'statutory immunity, under any workers' compensation statute or similar statute, in relation to the City, and to require all subcontractors and any other person or entity involved in, the project contemplated by this Contract to do likewise. q. Requirements of specific coverage features are not intended as limitations on other requirements or as a waiver of any 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 arty 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 aseparate 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 any individual to seek, obtain and hold employment without discrimination because of race, religious creed, color,F:r�aifi� physical handicap, medical condition, marital status, sex or age as provided in the lifornia 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. 7 13. Contractor certifies that it is, 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 paying, only „the amountsto to which. Contractor is properly entitled under the Contractor for other, purposes relating to the Contract., 15. The Contractor shall maintain.and preserve all such records for -a period of at least three years after termination of the contract. 16. The Contractor shall maintain ail 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 extra costs Incurred in conducting the audit at a location other than at City offices including, but, not limited to, such additional (out of the City) expenses for personnel, salaries, private auditors, travel, lodging, meals and overhead. IN WITNESS WHEREOF, the parties. haveexecuted, this Agreement as of the dates stated below. CITY OF LA QUINTA a Conform" naudeipid corporation Dated:. -, .2 By: ✓ �l, �� d _ - Mark Weiss — ---i Manager City Manass APPROVED AS TO FORM: Interim City Manager I ... SIO pNCOUNTWART Dated: C" AttomaY ' �"CONTRACTOR" . IN mrPorwarr. aKer • .. . Dated: 12 / 16 / 201 1 By Name` AN GREUNAWALT Titre• PRESIDENT Address:393 W. LA 't CADENA D11.#19 RIVERSIDE;CA 92501 8 13 ' -Contractor certifies Ahat it Is, the._holder or, any, necessary. Califlon-rie State Contractor s,Uca7pe.and.authpri?tp.d.,to: undertake _the .above Work. 14. The City, or Its , authorized auditors or representatives, shall have accessto 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 . onder - the. contract andlor I is paying,, only ,the: p d under the prnountsto which Contractor. is pro erly, entitle 69ri"pt.orfor.oth rel,ati . no to the Contract.,. Frpu., 'rposes I 5. The G"ontractor shall maintaip;and pMserve.all such, records fora period of, at least three years after termination of the contract. 16_ The, Contractor shall maintain allst", records -ln;t sCI ntR ot y of La Qui If, . t h t -n he C ractor shall, upon-.requ",..prprrpoy,.d!Dliv_e,r.tl�p records to the :City or reimburse the C for. I nd e audit at. 4, location other . Iall reasonable and extra costs Incurred i,conPCIAWIg th than at City offices ,iricluoing, but. not limited to, such #dqftlMal,,(oL4 .of the City) expenses for personnel, salaries, private auditors, travel, lodging, meals and overhead. IN vdnTjm.WHEP AOF, the Wwoes: Itaveexecuteo this AWmnmw* as, of dates Stated below. "CITY CITY OF LA QVINTA . ::, , : : - 1 : a California nwrdaipal corporation RIVERSIDE;CA 8 EXHIBIT A Proposal & Scope of Work �pNTRA�po 1, October 1 PROPOSAL & CONTRACT ••• 78-182 La Fonda La Quints, CA TO: City of La Quints Building & Safety Department (Hereinafter "Owner") FROM: Inland Contractors, Inc. (Hereinafter "Contractor") FOR THE FOLLOWING LOCATION: M182 Le Fonda 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. 528 linear feet of window putty • Windows will be removed in their entirety • 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 contractor's hazardous waste transportation subcontractor in accordance with 40 CFR 61. • SCAQMD 10 working day notification permit is included BID AMOUNT: All of the above work is to be completed in a substantial and workmen like manner according to standard practices for the sum of. Scope of Work $1,840.00 SCAQMD Notification Fee $ 53.89 Total Bid Amount $1,893.89 s46.�►COR[7® CERTIFICATE OF LIABILITY INSURANCE DATE 12114l2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(tas) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condNlons of the policy, certain policies may require an endorsement. A statement on this certificate does not colder rights to the certificate holder In Ileu of such andoreamen s . PRODUCER WNTACT.EYiE-ElphiGk Frankel &Company PHONE _-____ r AX 350 Hudson St. E.n.212-488-1869-_._— Noi �12-9@&1892. n°DnEs$eelphidcCd{r�nkel com New York NY 10014 INSURER AFFORDING COYEMOE __.......... .............__—LBL....._ INSURER&AMeIIOsanlWety_ lnd CO INSURED .--.._.. __ { _--.................. INSURER B: Inland COntraCfOTS, Inc. INSURERC: 231 E. Alessandro Blvd., AA388 --- -_— "'"— -- -- - --- Riverside CA 92508 INSURER 0: INSURER E INSURER F : .w IQQ CERI Ir•IL:A I t NUMt tK: P.dO97�gRl REVISION Ni IAADCrA• 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. �..._ LTR TYPE OF INSURANCE POLICYEFF POLICY EXP _-- "---_-- R POLICY NUMBER MM' pD1YYYY. UMRS A GENERAL LIABILITY Y 9NVO24331-09-01 12/1&2009 IIV1812011 i EACH OCCURRENCE $1000000 (Y X I COMMERCIAL GENERAL LIABILITY ias eAiFFiEga£Urr(5 E50000 I CLAIMS-MAOE IX OCCUR MEU EXP (An�wre person) E5000 X cono-.Pal UaD I PERSONAL& ADVINJURY S1000,000 Oocunenceab. '_GENERAL AGGREGATE _ $2000001) - GENLAGGREGATE LIMIT APPLIES PER. I PRO -POT PRODUCTS COMPIOPAGG ... __ E2000000 "--- - X POLICY LOC i A AUTOMOOaE L-.0 LU&CITY IENVO24331-09-01 jt211&2008 I 2/ie/IOtt CEO aciclergj___ £1000000 _. ANY AUTO _.. ( BODILY INJURY IPer person) S ALL OWNED SCHEDULED AUTOS AUTOS I BODILY INJURY(Par acti ) E HIREp AUTOS 'A AUTOS : PROPERTY DAMAGE 1Pg/gcaEmO—_ S S r Ji UMBRELLA LWB OCCUR ! r__ EXCESS LIAB EACH pCCUHRENCE .. __....-.... E - ________......... CLAIMS MADE - t _ AGGREGATE E I DED I RETENTIONS I I i S WORKERS COMPENSATION WC STATU- TH- AND EMPLOYERsL/ABILRY Y/N �Y EL EACH ACCIDENT $ ANY PROPRIETORRTNERIEXECUTIVE IP OFFICERMIEMBER EXCLUDED? N/A Et DISEASE -,EA EMPLOYEES E L DISEASE- POLICY LIMIT ___.__—_.._..... E I {Manddawar NH) r my®-RIKI ba ones' DESCRIPTION OF OPERATIONS 0elow A ! Professional Liability IN IN NV024331-09-01 2/18/2009 Claims Made Form 2/1812011 ''Ganerel Each Claim $1,D00,000 -, i i Aggregate E2,000,000 DESCRIPTION OF OfTAA7BONSI LOCATIONS i VEHICLES UMMM ACORDd01, Ae IM"Rename; Sc la, N more apace M rtgWren Project: 78-153 Main Street, La Quinta, CA 92253 and 78-182 La FondaaLa Quinta, CA 92253 Certificate Holder is listed as Additional Insured with`Tespecfto GenerahLiability, but only as respects operations of the Named Insured performed on behalf of the Additional Insured. City of to Quints 78-495 Calls Tampico La Quints 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. ®1989-2010 AWRY 2D tgulunuol I ne ACORD name and logo are registered marks of ACORD r ISSUE DATE: 12-16-2011 CITY OF LA. i81INTA PO BOX 1604 LA QUINTA CA 92247-1504 POLICYHOLDER COPY P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORII COMPENSATION INSURANCE L..4 GROUP: 000497 POLICY NUMBER: 0001823-2010 CERTIFICATE ID: 9s CERTIFICATE EXPIRES 09-01-2012 09-01-2011109-01-2012 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE 0 94 DATED 12-14-2011 78182 LA FONDA LA QUINTA CA 92263 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 Irldleated. This policy is not subject to cancellation by the Fund except upon 30 daysadvance 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 insurer" is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed hereht Notwithstanding 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 terms exclusions, and conditions, of such policy. "YAM L tAhorized Representative 6 President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,*00,000 PER OCCURRENCE. ENDORSEMENT 90018 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2011-12-14 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF LA QUINTA EOORSEMENT #1800 GREENAWALT, FRANKLIN PRESIDENT EXCLUDED. ENDORSEMENT N16010 - BROYLES, LINDA TREASURER - EXCLUDEO. ENDORSEMENT #1600 - GREENAWALT, ELOISA SECRETARY - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2010 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. CEMENT #2570 ENTITLED WAIVER OF StBRDOATION EFFECTIVE 2011-12-15 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF LA QUINTA ENDORSEMENT #2001 ASBESTOS CERTIFICATION EFFECTIVE 00-01-2010 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER INLAND CONTRACTORS INC 231 E ALESSANDRO BLVD P B A388 RIVERSIDE CA 92008 Im[v.9.20101 EK' IP10,Siq PRINTED : 12-16-2011 0 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 engagedin work on job/s 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 13.309d $ 665.00 3.00% $ 19.95 $ 684.95 {665.00 + 19.95) BDC SPECIAL WASTE SERVICES N0. 2 3 g 7 2 7 A WASTE MANAGEMENT COMPANY 1211 GLADSTONE ST. •AZUSA, CA 91702 (626)969-1384 • FAX (626)969.4971 NAME 1•1-1-Y FIF rA QTJTNTA --TN.: AJ ORTEGA P.O. BOX 1504 E RA D ADDRESS clTv,STATE, Zip _LA QUINT.A, CA 92247 PHONENO.(760) 777-7018 R O CONTAINERS: No. BA VOLUME/CY Y WEIGHT/TONS TYPE: ® TRUCKROLL-OFF DUMP DRUMS CARTONS ® ROLL OFFS%CUBE LLI flUCK TRUCK OTHER VAN z NON -FRIABLE. ASBESTOS REMOVAL }W WASTE DESCRIPTION GENERATING PROCESS H7 COMPONENTS OF WASTE - PPM % COMPONENTS OF WASTE PPM % (yrG WINDOW PUTTY 100% J a � Z. a. O U � voc-OVAREAOINGs _ 78-182 LA FONDA, / LA QUINTA CA 92253 SITE ADDRESS m ''T PROPERTIES: PHI" I09SOUD ❑LIQUID ❑SLUDGE ❑SLURRY 0OTHER USE PROPER SAFETY EQUIPMENT HANDLING INSTRUCTIONS: n RATIXt5 @RTFMATKKJ: i NERESV CFRnFv'iHATIFE WNIENFS Of TMS SaIPAF-Nt MEFU1Y ApO pOCIMATELV OE ANOAREINP1LRESPECTN PROPER CONDT.W f04 TRANSPORT. THE MATEPNI9 DESCRIEiD Cry TM9 RR, MAN•EETaRE No*suascr Tp FEOERN.. NpZARpp{)$WASTf AEc;unays TYPED OR PRINTED FULL NAME&SIGNATURE DATE UJI wMe INLAND CONTRACTORS INC. EPA I.D. 231 E.ALESSANDRO BLVD.,PMB A388 a ADDRESS SERVICE ORDER NO. OA RIVERSIDE/ CA 92508 CITY, STATE, ZIP PICK UP DATE (951) 276-0600 PHONE NO. r TYPED OR PRINTED FULL NAME &SIGNATURE DATE Q w NAME ECTI Eon CAR 00049064 NO. 0 ADDRESS P.O. BOX 7318 SERVICE ORDER NO. .. in SAN BERNARDINO,CA 92411 CITY,STATE.ZIP PICK UP DATE (800)664-7773 m PHONE NO. TYPED OR PRINTED FULL NAME 8 SIGNATURE DATE AZUSA LAND RECLAMATION No CAD009007626 NAME DISPOSAL METHOD ADDRESS 1211 W.GLADSTONE STREET CINDFILL ❑OTHER -) AZUSA,CA 91702 CITY STATE, ZIP Q LL PHONENO.(626) 334-0719 TYPED -OR -PRINTED FULL NAME B SIGNATURE DATE H SCAQMD (909)396-3456 21865 E.COPLEY DR. DIAMOND BAR,CA 91789 DISCREPANCY GEN OLD/NEW l A TONS TRANS S e G!O - RT/CD HNDF .NONE Yvnlle Oc yellow -IOU t'V1'T rIDK•UGrvCtINI Vts VVrT tllUe-IF(NIVJYVISICH IiVYYI (aOIOBRf00-IHAIVSYVFiitIi GVPY 11 Named Insured Endorsement Inland Contractors, Inc. Endorsement Number 001 Policy Symbol Policy Number Policy Period Effective Date of Endorsement GL G242451OA 001 12/18/2011 TO 12/18/2013 12/18/2011 Issued By (Name of Insurance Company) Westchester Specialty Insurance Services, Inc. .-... •... ••,FIe 11 narinenon is m oe compietea 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 Desianated Proiects: 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 complete this endorsement will be shown in the 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 1), 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 POLICY NUMBER: G2424510A 001 COMMERCIAL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of La Quinta 78-495 Calls Tampico La Quinta, CA 92253 Project: 78-153 Main Street, La Quinta, CA 92253 and 78-182 La Fonda, La Quinta, CA 92253 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 0 POLICY NUMBER: G242451OA 001 COMMERCIAL GENERAL LIABILITY CG20101001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or City of La Quinta 78495 Calle Tampico La Quints, CA 92253 Project: 78-153 Main Street, La Quints, CA 92253 and 78-182 La Fonda, La Quints, CA 92253 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section If — Who Is An Insured is amended to (1) All work, including materials, parts or include as an insured the person or organization equipment fumished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations service, maintenance or repairs) to be performed for that insured. performed by or on behalf of the addi- B. With respect to the insurance afforded to these tional insured(s) at the site of the cov- additional insureds, the following exclusion is ered operations has been completed; added: or 2. Exclusions (2) That portion of "your work" out of which the injury or damage arises has This insurance does not apply to "bodily in- been put to its intended use by any jury" or "property damage" occurring after: person or organization other than an- other contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 0