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Home My WebLink AboutLD24-2233Permit Number: LD24-2233 LD - Utilities/ Utility Maintenance Issued: 05/22/2024 Expired: 01/13/2025 Job Address: 40150 Winchester Rd Legal Description: Parcel Map 26232-2:5 City of Temecula - Land Development Division 41000 Main Street - Temecula, CA 92590 Mailing Address: P.O. Box 9033 Temecula, CA 92589-9033 Phone: (951) 308-6395 Fax: (951) 694-6475 Jeff Dixon 42135 Winchester Rd Temecula, CA 92590 Applicant: Npg, Inc. 1354 Jet Way Perris, CA 92572 (909) 940-0200 Contractor: Utility Work Order Number: 392233 Description: RCWD WO392233 Proposed work: Asphalt repair form main line leak. Permitee Date City Engineer or Authorized Representative Date 05/22/2024 Page 1 of 1 400 EAST SIXTH ST. TELEPHONE: (951) 736-7600 P.O. BOX 2229 FAX: (951) 736-7646 CORONA, CA 92878 LICENSE NO. 267073 SUBMITTAL TRANSMITTAL TO: CITY OF TEMECULA TRANSMITTAL DATE: 10/10/2022 41000 MAIN ST DDDDDDDD TRANSMITTAL NO: 3 TEMECULA, CA 92590 AAA JOB NO: 34729 ATTN: CHRIS WHITE Re: PAVEMENT REHABILITATION PROGRAM CITYWIDE ITEM NO. COPIES DESCRIPTION COMMENTS 3.1 ARHM-GG-C PG 70-10 ALL AMERICAN ASPHALT 3.2 TYPE B PG 70-10 ALL AMERICAN ASPHALT 3.3 CRUSHED AGGREGATE BASE ALL AMERICAN ASPHALT APPROVED REVISE & RESUBMIT APPROVED AS NOTED REJECTED COMMENTS 6.1 6.2 6.3 6 10/11/2022 Quote # : 34729 City of Temecula Re: Asphalt Concrete Mix Design Pavement Rehabilitation Program Citywide Submitted herewith is our proposed design for the above referenced project to conform to The Standard Specifications for Public Works Construction Section 203-11 Mix Type: ARHM-GG-C PG 70-10 Mix # : 100423 The design is proposed for use from the following plants: Corona Drum Mix Facility Plant # : 2 Perris Facility Plant # : 11 Should any further assistance be needed please call at any time. Sincerely, Robert S. Schwartz Technical Services Manager All American Asphalt Carson 310.684.4854 | Concord 925.243.6662 | Rancho Cucamonga 909.989.1751 Rancho Cordova 916.631.7194 | San Diego 858.609.7138 | San Jose 408.362.4920 All American Asphalt, Inc. 400 East 6th Street Corona, CA 92878 Attention: Robert Schwartz Subject: Asphalt Mix Design Renewal SSPWC/Greenbook Specification Mr Schwartz, Asphalt Mix Designs are presented on the following pages for use on the subject project. The forms presented for each material are as follow: Material Forms CEM 3512 - Mix Design Info CEM 3513 - Verification Results Info Mix designs were performed in accordance with California Test 367. Verification tests were performed in accordance with the standard methods indicated on the verification report form, on mixes batched in accordance with the design proportions. Please contact our office at your convenience regarding any questions concerning the above. Respectfully submitted, RMA Group Carl Bachler, PE Project Engineer RMA Project #20-0902-01 June 1, 2022 ARHM-GG-C PG 70-10 #100423 Page 1 of 10 CONTRACTOR HOT MIX ASPHALT DESIGN DATA CEM-3512 (NEW 3/2008) ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. Name and address of qualified laboratory preparing the mix design: Aggregate Gradation Bin 1 2 3 4 5 Reclaimed Asphalt Pavement Lime Combined Gradation (JMF TV) Material Size Bin % (JMF TV) 100% Sieve Size % Passing No. 4 No. 8 No. 16 No. 30 No. 50 No. 100 No. 200 Aggregate Sources and California Mine and SMARA Identification Numbers for each bin: the California Test Method indicated. For information concerning this form, contact the Office of Flexible Pavement Materials at (916) 227 5383. Hot Mix Asphalt (HMA) Producer Name, Address and Phone Number: HMA Type: Date: Producer Mix Identification Number: 6/1/2022 Update/RenewARHM-GG-C PG 70-10 100423 Page 2 of 10 CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) Page 3 of 10 CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) HMA Type: Producer Name: Producer Mix Identification Number: Date: Aggregate Quality 1 Quality Characteristic/Property Test Method Test Result Crushed particles, coarse aggregate One fractured face (%) CT 205 Crushed particles, coarse aggregate Two fractured faces (%) CT 205 Crushed particles, fine aggregate (Passing No. 4 sieve and retained on No. 8 sieve) One fractured face (%) CT 205 Los Angeles Rattler, Loss at 100 Rev. (%) CT 211 Los Angeles Rattler, Loss at 500 Rev. (%) CT 211 Sand equivalent CT 217 Average Fine aggregate angularity (%) AASHTO T 304 (Method A) Flat and elongated particles (% by mass at 3:1) ASTM D 4791 Flat and elongated particles (% by mass at 5:1) ASTM D 4791 Plasticity Index CT 204 Sodium sulfate soundness CT 214 Cleanness Value CT 227 Fine aggregate Durability Index CT 229 Coarse aggregate Durability Index CT 229 K c factor (Not mandatory until further notice) CT 303 K f factor (Not mandatory until further notice) CT 303 Bulk specific gravity (oven dry) of coarse aggregate CT 206 Absorption of coarse aggregate CT 206 Bulk specific gravity (SSD) of fine aggregate CT 207 Bulk specific gravity (oven dry) of fine aggregate LP-2 Absorption of fine aggregate CT 208/LP-2 Apparent specific gravity of supplemental fines CT 207 Bulk specific gravity of the aggregate blend LP-2 Note: 1 Aggregate must comply with the quality specifications before it is treated with lime. 6/1/2022 Update/RenewARHM-GG-C PG 70-10 All American Asphalt 100423 Page 4 of 10 Reclaimed Asphalt Pavement (RAP) Aggregate Gradation, Asphalt Binder Content, and Theoretical Maximum Specific Gravity HMA Type: Producer Name: Producer Mix Identification Number: Date: RAP Source: Sieve Size ASTM D 2172 (Method B), CT 202, and CT 309 1 CT 382 and CT 202 2 Aggregate Gradation Correlation Factor 3 Sample 1 Sample 2 Sample 3 Average 4 Sample 1 Sample 2 Sample 3 Average % P a s s i n g No. 4 No. 8 No. 16 No. 30 No. 50 No. 100 No. 200 Asphalt Binder Content Report Only Report Only Report Only Report Only Maximum Specific Gravity Note: 1 A minimum of three samples are required. Determine the asphalt binder content of each RAP sample under ASTM D 2172, Method B . Perform a sieve analysis on each sample of recovered aggregate under CT 202, Appendix A. Determine the theoretical maximum specific gravity (Rice) of each RAP sample under CT 309, Section J. 2 A minimum of three samples are required. Burn asphalt from each RAP sample in accordance with CT 382. Calculate and report asphalt binder content for information only. Perform a sieve analysis on each sample of recovered aggregate in accordance with CT 202, Appendix A for each ignition oven to be used for testing during production. 3 The correlation factor for each sieve is determined by taking the average gradation of the AST M D 2172 samples minus the average gradation of the CT 382 samples. 4 Average aggregate gradation and asphalt binder content (ASTM D 2172 test results) used to calculate mix design batch weights. CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) 6/1/2022 Update/RenewARHM-GG-C PG 70-10 100423 Page 5 of 10 HMA Type: Producer Name: Producer Mix Identification Number: Date: Asphalt Binder 1,2 Asphalt binder supplier: Supplier recommended mixing temperature: Quality Characteristic Test Method Test Result Specific gravity AASHTO T 228 Dynamic Shear (RTFO residue), Test Temp. at 10 rad/s, 60°C AASHTO T 315 3 Note: 1 Including base asphalt in asphalt rubber binder 2 Asphalt Binder treated with liquid antistrip must comply with Section 92, " Asphalt," of the Standard Specificati ons for the grade specified. 3 For use in CT 303 Antistrip Additives Antistrip type: Antistrip source: Antistrip percentage (JMF TV): 1, 2 Method of antistrip addition: Quality Characteristics Test Method Test Result Liquid antistrip (LAS) total amine value (min.) ASTM D 2074 Note: 1 Liquid Antistrip must be between 0.5 and 1.0 percent by weight of asphalt binder. 2 Combined lime ratio must be between 0.8 and 1.5 by weight of dry aggregate (may be reduced to 0.5 to 1.0 for OGFC). CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) 6/1/2022 Update/Renew Asphalt binder grade: PG 70-10 ARHM-GG-C PG 70-10 100423 70 Page 6 of 10 HMA Type: Producer Name: Producer Mix Identification Number: Date: Asphalt Rubber Binder Asphalt Modifier Asphalt modifier supplier: Asphalt modifier percentage (2.0% - 6.0% by weight of asphalt binder): Base asphalt and asphalt modifier percentage (78.0% - 82.0% by weight of asphalt rubber binder): Quality Characteristic Test Method Test Result Specification Limit Viscosity, m2/s (x106) at 100 C ASTM D445 19 to 36 (± 3) Flash Point, CL.O.C., C (min.) ASTM D92 207 Asphaltenes, % by mass (max.) ASTM D2007 0.1 Aromatics, % by mass (min.) ASTM D2007 55 Crumb Rubber Modifier (CRM) Scrap tire CRM supplier: High natural CRM supplier: Scrap Tire CRM percentage (73.0% - 77.0% by total weight of CRM): High natural CRM percentage (23.0% - 27.0% by total weight of CRM): Combined scrap tire and high natural CRM percentage (18.0% - 22.0% by weight of asphalt rubber binder): Quality Characteristic Test Method Test Result Specification Limits Scrap tire CRM gradation (% passing No. 8 sieve) LP-10 100 High natural CRM gradation (% passing No. 10 sieve) LP-10 100 Wire in CRM (% max.) LP-10 0.01 Fabric in CRM (% max.) LP-10 0.05 CRM particle length (inch max.) 3/16 CRM specific gravity CT 208 1.1 - 1.2 Natural rubber content in high natural CRM (%) ASTM D 297 40.0 48.0 Asphalt Rubber Binder Design and Profile Quality Characteristics Test Method Minutes of Reaction 1 Specification Limits 45 60 90 120 240 360 1440 Cone penetration @ 77 °F, (0.10-mm) ASTM D 217 25 70 Resilience @ 77 °F, % rebound (min.) ASTM D 5329 18 Field softening point, °F ASTM D 36 125 165 Viscosity, centipoises LP-11 1,500 4,000 Reaction temperature from 1320 minutes to 1440 minutes : Note: 1 Six hours (360 minutes) after CRM addition, reduce the oven temperature to 275 degrees F for a period of 16 hours. After the 16-hour cool-down (1320 minutes after CRM addition), reheat the binder to the reaction temperature expected during production (350 °F) for sampling and testing at 24 hours (1440 minutes). CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) 6/1/2022 Update/RenewARHM-GG-C PG 70-10 100423 Page 7 of 10 HMA Type: Producer Name: Producer Mix Identification Number: Date: Approximate Bitumen Ratio (ABR) 1 Property Test Method Test Result Surface area of aggregate blend (ft2/lb) CT 303 Surface constant of aggregate blend, Km CT 303 ABR CT 303 Corrected ABR 2 CT 303 Note: 1 Not Mandatory until further notice. 2 Determine ABR using LP-9 if reclaimed asphalt pavement (RAP) is used. Hot Mix Asphalt Design Data Quality Characteristics Test Method ABR (Corrected) - 0.5% ABR (Corrected) Asphalt binder content (%) CT 367 Briquette height (inches) CT 304 Briquette bulk specific gravity CT 308 (Method A) Maximum specific gravity CT 309 Air voids content (%) CT 308 (A) and CT 309 Voids in mineral aggregate (%) LP-2 Effective specific gravity of RAP aggregate LP-2 Voids filled with asphalt (%) LP-3 Dust proportion LP-4 Effective specific gravity of aggregate LP-1/LP-4 Stabilometer value CT366 Modified stabilometer value CT366 Quality Characteristics Test Method ABR (Corrected) + 0.5% ABR (Corrected) + 1.0% Asphalt binder content (%) CT 367 Briquette height (inches) CT 304 Briquette bulk specific gravity CT 308 (Method A) Maximum specific gravity CT 309 Air voids content (%) CT 308 and CT 309 Voids in mineral aggregate (%) LP-2 Effective specific gravity of RAP aggregate LP-2 Voids filled with asphalt (%) LP-3 Dust proportion LP-4 Effective specific gravity of aggregate LP-1/LP-4 Stabilometer value CT366 Modified stabilometer value CT366 CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) 6/1/2022 Update/RenewARHM-GG-C PG 70-10 100423 Page 8 of 10 HMA Type: Producer Name: Producer Mix Identification Number: Date: Hot Mix Asphalt Design Data at Job Mix Formula 1 Quality Characteristic Test Method Test Result Asphalt binder content (%) CT 367 Briquette bulk specific gravity CT 308 (Method A) Average Maximum specific gravity CT 309 Air voids content (%) CT 308 (A) and CT 309 Average Voids in mineral aggregate (%) LP-2 Average Effective specific gravity of RAP aggregate LP-2 Voids filled with asphalt (%) LP-3 Average Dust proportion LP-4 Effective specific gravity of aggregate LP-4 Stabilometer value CT 366 Average Modified stabilometer value CT 366 Average Surface abrasion (%) CT 360 Average Tensile strength ratio (TSR) untreated CT 371 Tensile strength ratio (TSR) treated CT 371 Note: 1 For mix design, prepare three briquettes separately at the proposed JMF and test for compliance. Report the average of three tests. Prepare new briquettes and test if the range of stability for the 3 briquettes is more than 12 points. 2 Attach Figure 1 from CT 371. Notes/Remarks: CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) 6/1/2022 Update/RenewARHM-GG-C PG 70-10 100423 Page 9 of 10 CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) % A i r V o i d s Page 10 of 10 CONTRACTOR HOT MIX ASPHALT DESIGN DATA (Continued) CEM-3512 (NEW 3/2008) CALTRANS HOT MIX ASPHALT VERIFICATION (Continued) CEM-3513 (NEW 3/2008) Page 3 of 4 Hot Mix Asphalt Test ResultTest MethodQuality Characteristic Asphalt binder content (%)CT 379/CT 382 Tensile strength ratio (TSR) treated CT 371 Tensile strength ratio (TSR) untreated CT 371 Surface abrasion (%)CT 360 Modified stabilometer value CT 366 Stabilometer value CT 366 Effective specific gravity of aggregate LP-4 Dust proportion LP-4 Voids filled with asphalt (%)LP-3 Effective specific gravity of RAP aggregate LP-2 Voids in mineral aggregate (%)LP-2 Air voids content (design value + 2%)CT 308 (A) and CT 309 Maximum specific gravity CT 309 Briquette bulk specific gravity CT 308 (Method A)Average Average Average Average Average Average Average Report only. Do not delay acceptance waiting for test results. Note: Attach Figure 1 from CT 371. 2,3 2,3 Notes: 2 3 1 1 NoYes Meets Specifications? Crumb Rubber Modifier (CRM)1 Test ResultTest MethodQuality Characteristic NoYes Meets Specifications?Specification Limits LP-10Scrap tire CRM gradation (% passing No. 8 sieve)100 ASTM D 297Natural rubber content in high natural CRM (%)40.0 - 48.0 CT 208CRM specific gravity 1.1 - 1.2 —CRM particle length (inch max.)3/16 LP-10Fabric in CRM (% max.)0.05 LP-10Wire in CRM (% max.)0.01 LP-10High natural CRM gradation (% passing No. 10 sieve)100 May be provided with Certificate of Compliance with testing performed by an AASHTO certified laboratory. Note: 1 N/A N/A N/A N/A N/A N/A HMA Type:Producer Mix Identification Number:Date:Producer Name: Report only if the adjustment for asphalt binder content TV < 0.3% from OBC.1 2.283 2.324 2.308 2.305 2.422 5.7 4.0 4.7 4.8 21.1 19.7 20.2 20.3 - 72.8 79.4 76.7 76.2 0.4 2.727 24 23 24 24 100 40.5 1.1 - 1.2 1/16 0.05 0.0 100 06/01/2022 7.50 %DWA ARHM-GG-C PG 70-10 All American Asphalt 100423 Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\FORMS\Permit Applications\EP App.docx Page 1 of 2 Revised: 05/13/2019 APPLICATION INFORMATION PA No.: PERMIT NO.: Type of Encroachment:  Street/Storm Drain  Sewer/Water  Utility Trenching  Signing & Striping  Traffic Signal  Miscellaneous (SPECIFY BELOW) The undersigned hereby applies to excavate, construct and otherwise encroach on City street right-of-way, as follows: Name(s) of street(s) and/or street address: Utility Work Order #: Start Date: End Date: In consideration of granting this application, all applicants including utility companies hereby agree to: 1. If applicable, submit two (2) sets of Construction Drawings along with two (2) sets of the appropriate Traffic Control Plans, proof of City Business License for all parties involved, proof of Contractor’s License along with this application at the time of submittal. See the Traffic Control Plan Checklist for details. 2. Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or dam age to persons or property happening or occurring as a proximate result of any work under taken under the permit granted pursuant to this application. (See below for specific liability insurance requirements.) 3. Remove/relocate any encroachment installed/maintained under this permit, upon written notice from the City Engineer. 4. Notify the Land Development Inspection Division via email at LDInspections@temeculaca.gov at least two (2) working days prior to commencing construction. Hold a pre-construction meeting prior to the start of construction. The developer/general contractor must be present for the timely request of inspections. 5. Comply with the Standard Specifications, most current Improvement Standard Drawings for Public Works Construction, City of Temecula Municipal Code Chapters 13.04 and 18.12, terms and conditions of the permit and all applicable rules and regulations for the City of Temecula and other public agencies having jurisdiction. LIABILITY INSURANCE REQUIREMENTS PROVIDE PROOF OF INSURANCE COVERAGE MEETING THE REQURIEMENTS STATED BELOW OR A CITY ATTORNEY APPROVED EQUIVALENT WITH THE CITY NAMED AS ADDITIONAL INSURED. IN THE EVENT THAT THE INSURANCE IS PROVIDED BY THE CONTRACTOR, THE CITY AND THE OWNER/DEVELOPER MUST BE NAMED AS ADDITIONAL INSURED. THIS REQUREMENT SHALL BE MET BY EITHER THE APPLICANT (DEVELOPER, OWNER, PUBLIC UTILITY AGENCY OR FRANCHISE) OR BY THE CONTRACTOR PERFORMING THE SUBJECT WORK, PRIOR TO BEGININNG ANY WORK PROPOSED UNDER THE SUBJECT ENCROACH MENT PERMIT. Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\FORMS\Permit Applications\EP App.docx Page 2 of 2 Revised: 05/13/2019 Proof of coverage shall be by certificate (Accord or equivalent) naming the City of Temecula as certificate holder and the minimum limits of insurance coverage shall be as follows: a. General Liability: One million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate lim it shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. b. Automobile Liability: One million dollars ($1,000,000) per accident for bodily injury and property damage. c. Worker’s Compensation as required by the State of California; Employer’s Liability: One million dollars ($1,000,000) per accident for bodily injury or disease. d. Course of Construction: Completed value of the project. There is a limited exception to this requirement. Owners of single family homes doing work on the home’s driveway approach located in the public right-of-way, may use their homeowners insurance with public liability and property damage coverage in at least the following minimum limits and which will name the City of Temecula as an additional insured for the duration of the encroachment permit: BODILY INJURY $250,000.00 EACH PERSON $500,000.00 EACH OCCURANCE $500,000.00 AGGREGATE PRODUCTS AND COMPLETED OPERATIONS PROPERTY DAMAGE $100,000.00 EACH OCCURANCE $250,000.00 AGGREGATE PRODUCTS AND COMPLETED OPERATIONS A combined single limit homeowner’s policy with aggregate limits in the amount of $1,000,000.00 will be considered equivalent to the required minimum limits. Homeowners: a copy of the required homeowners insurance and a Certificate of Insurance showing the City named as an additional insured shall be attached to the application. The undersigned applicant and/or contractor states that they have read and agrees to meet all the conditions on this application, including provisions of required liability insurance or a City Attorney approved equivalent, and acknowledges that this application will be made a part of the encroachment permit. APPLICANT’S INFORMATION (THIS SECTION MUST BE COMPLETED) Company Name: Mailing Address: Contact: Phone #: E-mail: I hereby warrant and represent to the City that I am authorized to execute this permit application on behalf of the permittee and bind the permittee to the agreements contained herein and any conditions of the permit. Authorized Signature: Date Applied: CONTRACTOR’S INFORMATION Company Name: Mailing Address: Contact: Phone #: 24-HR Emergency #: State Contractor’s License #: Class: City Business License #: Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\FORMS\Permit Applications\EP App.docx Page 1 of 2 Revised: 05/13/2019 APPLICATION INFORMATION PA No.: PERMIT NO.: Type of Encroachment:  Street/Storm Drain  Sewer/Water  Utility Trenching  Signing & Striping  Traffic Signal  Miscellaneous (SPECIFY BELOW) The undersigned hereby applies to excavate, construct and otherwise encroach on City street right-of-way, as follows: Name(s) of street(s) and/or street address: Utility Work Order #: Start Date: End Date: In consideration of granting this application, all applicants including utility companies hereby agree to: 1. If applicable, submit two (2) sets of Construction Drawings along with two (2) sets of the appropriate Traffic Control Plans, proof of City Business License for all parties involved, proof of Contractor’s License along with this application at the time of submittal. See the Traffic Control Plan Checklist for details. 2. Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or dam age to persons or property happening or occurring as a proximate result of any work under taken under the permit granted pursuant to this application. (See below for specific liability insurance requirements.) 3. Remove/relocate any encroachment installed/maintained under this permit, upon written notice from the City Engineer. 4. Notify the Land Development Inspection Division via email at LDInspections@temeculaca.gov at least two (2) working days prior to commencing construction. Hold a pre-construction meeting prior to the start of construction. The developer/general contractor must be present for the timely request of inspections. 5. Comply with the Standard Specifications, most current Improvement Standard Drawings for Public Works Construction, City of Temecula Municipal Code Chapters 13.04 and 18.12, terms and conditions of the permit and all applicable rules and regulations for the City of Temecula and other public agencies having jurisdiction. LIABILITY INSURANCE REQUIREMENTS PROVIDE PROOF OF INSURANCE COVERAGE MEETING THE REQURIEMENTS STATED BELOW OR A CITY ATTORNEY APPROVED EQUIVALENT WITH THE CITY NAMED AS ADDITIONAL INSURED. IN THE EVENT THAT THE INSURANCE IS PROVIDED BY THE CONTRACTOR, THE CITY AND THE OWNER/DEVELOPER MUST BE NAMED AS ADDITIONAL INSURED. THIS REQUREMENT SHALL BE MET BY EITHER THE APPLICANT (DEVELOPER, OWNER, PUBLIC UTILITY AGENCY OR FRANCHISE) OR BY THE CONTRACTOR PERFORMING THE SUBJECT WORK, PRIOR TO BEGININNG ANY WORK PROPOSED UNDER THE SUBJECT ENCROACH MENT PERMIT. Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\FORMS\Permit Applications\EP App.docx Page 2 of 2 Revised: 05/13/2019 Proof of coverage shall be by certificate (Accord or equivalent) naming the City of Temecula as certificate holder and the minimum limits of insurance coverage shall be as follows: a. General Liability: One million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate lim it shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. b. Automobile Liability: One million dollars ($1,000,000) per accident for bodily injury and property damage. c. Worker’s Compensation as required by the State of California; Employer’s Liability: One million dollars ($1,000,000) per accident for bodily injury or disease. d. Course of Construction: Completed value of the project. There is a limited exception to this requirement. Owners of single family homes doing work on the home’s driveway approach located in the public right-of-way, may use their homeowners insurance with public liability and property damage coverage in at least the following minimum limits and which will name the City of Temecula as an additional insured for the duration of the encroachment permit: BODILY INJURY $250,000.00 EACH PERSON $500,000.00 EACH OCCURANCE $500,000.00 AGGREGATE PRODUCTS AND COMPLETED OPERATIONS PROPERTY DAMAGE $100,000.00 EACH OCCURANCE $250,000.00 AGGREGATE PRODUCTS AND COMPLETED OPERATIONS A combined single limit homeowner’s policy with aggregate limits in the amount of $1,000,000.00 will be considered equivalent to the required minimum limits. Homeowners: a copy of the required homeowners insurance and a Certificate of Insurance showing the City named as an additional insured shall be attached to the application. The undersigned applicant and/or contractor states that they have read and agrees to meet all the conditions on this application, including provisions of required liability insurance or a City Attorney approved equivalent, and acknowledges that this application will be made a part of the encroachment permit. APPLICANT’S INFORMATION (THIS SECTION MUST BE COMPLETED) Company Name: Mailing Address: Contact: Phone #: E-mail: I hereby warrant and represent to the City that I am authorized to execute this permit application on behalf of the permittee and bind the permittee to the agreements contained herein and any conditions of the permit. Authorized Signature: Date Applied: CONTRACTOR’S INFORMATION Company Name: Mailing Address: Contact: Phone #: 24-HR Emergency #: State Contractor’s License #: Class: City Business License #: