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HomeMy WebLinkAboutLD24-4145Permit Number: LD24-4145 LD - Utilities/ Excavation - Parallel Issued: 11/06/2024 Expired: 05/05/2025 Job Address: 27371 Jefferson Ave Legal Description: 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 Stephen Wade 7337 Central Ave Riverside, CA 92504 Applicant: Hhs Construction, Llc 2042 S Grove Avenue Ontario, CA 91761 (909) 393-3322 Contractor: Utility Work Order Number: PID 5587346 Description: Charter PID 5587346 WORK HOURS SHALL BE MONDAY – FRIDAY, NO HOLIDAYS, 8:30am - 3:30pm Location: Enterprise Cir S E/S 955' N/O Enterprise Cir W Proposed work: Tie into one (1) CATV pedestal and one (1) manhole as shown on CharterSpectrum "EXCAVATION PLAN 27371 JEFFERSON AVE, LD24-4145" All facilities shall be installed in accordance with City Standard Drawing 117. Traffic Control shall be in accordance with approved Traffic Control Plan LD24-4145 Permittee shall comply with all applicable Traffic Control General Notes. Safe pedestrian/bicycle traffic and driveway access shall be maintained at all times. Concrete repair shall be in accordance with City Standards and the Greenbook. Trench repair shall be in accordance with City Standard Drawing 407. Final compaction test results shall be provided by a soils engineer. Concrete curbs, walks, gutters, cross gutters and driveway approaches damaged during construction shall be removed from joint to joint and reconstructed in accordance with City Standards and the Greenbook. All disturbed landscaping and other improvements shall be removed/repaired and replaced to the satisfaction of the City Engineer or their designated assignee. Permittee shall contact LDInspections@temeculaca.gov a minimum of two (2) business days prior to any work. Page 1 of 3*****See Page 2 of this Permit for Permittee Responsibilities***** Permit Number: LD24-4145 LD - Utilities/ Excavation - Parallel Permittee must also request a final inspection to verify completion of project. Permittee Responsibilities This Permittee agrees to 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 damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Trench repair shall be pursuant to City of Temecula Standard Drawing No. 407. 3.Traffic control devices shall be utilized to protect and control pedestrian and vehicular traffic in the construction area in accordance with the latest revision of the “Manual of Uniform Traffic Control Devices for Streets and Highways” (MUTCD). The contractor shall submit a specific traffic control plan for review and approval by the City in accordance with City “Traffic Control Plan Guidelines” for all work within Major Circulation Element streets. 2.BEFORE YOU DIG - CALL (TOLL FREE) 800-422-4133 A pre-construction meeting is required two (2) business days prior to any scheduled work. Permittee shall contact LDInspections@TemeculaCA.gov to schedule a meeting. 1. 4. Water Quality: Contractor shall remain in compliance with the City Water Pollution Control Ordinance. Contractor is required to provide protection of the City storm drain system. 5. Work hours shall be limited between 7:30 AM and 4:30 PM, Monday through Friday, unless otherwise noted. No work shall be allowed during City-recognized holidays." 6. THIS PERMIT IS ISSUED AND ACCEPTED SUBJECT TO THE FOLLOWING CONDITIONS AND ANY ATTACHED PROVISIONS: All U.S.A. mark outs shall be removed prior to completion of project.7. 8.All contractors and subcontractors shall have a valid City of Temecula business license and valid Certificate of Liability prior to start of work. 9.Should there be any claim against the City and the property owner with the encroachment being the proximate cause, the property owner shall be notified in writing to remove the encroachment within 30 days or the City will remove and bill the owner. 10.Permission is hereby requested to encroach into public right of way to perform work as set forth above. It is understood that this permit is limited to the work described herein and that all work is to be done in compliance with the provisions attached to this permit and with all other applicable rules. Permittee shall be responsible for said compliance, for acceptability of the work, for repair or replacement thereof if defective, and for repair or replacement of any existing improvement damaged by the doing of the work I hereby certify and agree on behalf of the Permittee that all laws, regulations and ordinances of the City of Temecula and the State of California and the terms and conditions of the Permit shall be complied with whether herein stated or not. 11. 12.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. ******Contractor and all subcontractors shall be present at the pre-construction meeting; otherwise, the meeting will be rescheduled to a later date****** Any work commencing within the City right-of-way before permit issuance or a pre-construction meeting shall be subject to a 72-Hour suspension of said work and an assessment of double permit fees.13. Permitee Date Page 2 of 3 Permit Number: LD24-4145 LD - Utilities/ Excavation - Parallel City Engineer or Authorized Representative Date 11/06/2024 Page 3 of 3 W5-1 ROAD NARROWS W5-1 12 ' M I N . 100'**TO BE DETERMINED BY THE CITY OF TEMECULA** RE V ' D 0 4 / 0 3 / 23 ENTERPRISE CIR S (25 MPH) N PID# 5587346 100'100'100'97' SHOULDER TAPER 100' WORK HOURS: 9:00AM TO 3:00PM 31 ft 7 11/16 in1,062' TO ENTERPRISE CIR W P C/L CENTER LINE C&G CURB & GUTTER R/W RIGHT OF WAY SHEET 01 OF 02 PROJECT: PID# 5587346 CITY OF TEMECULA WORK LOCATION: ENTERPRISE CIR S SE/O WINCHESTER RD CONCRETE PAVING INLAND ENGINEERING SERVICES, INC.CITY BOUNDARY TARGET/SERVICE ADDRESS: 27371 JEFFERSON AVE STE T, TEMECULA, CA 925901373 OLD TEMESCAL RD, CORONA, CA 92881 TEL: 951.277.0800 FAX: 951.277.5300 DESIGNER OWNER 1-800-422-4133 AT LEAST TWO DAYS BEFORE YOU DIG UNDERGROUND SERVICE ALERT OF SOUTHERN CALIFORNIA TICKET# DIGALERTEXCAVATION LEGEND - GENERAL PROP. VAULTV PROP. BORE PROP. BORE PIT PROP. TRENCH PROP. POTHOLE PROP. PEDESTALP EX. HANDHOLE / SCE VENT EX. UTILITY MANHOLE EX. LIGHT POLE EX. TREE EX. VAULT / PEDESTAL / CABINET COMPASS EXCAVATION PLAN DESIGNED BY:INLAND ENGINEERING SERVICES DRAFTED BY:INLAND ENGINEERING SERVICES TEL. NUMBER:(951) 277-0800 PERMIT COORDINATOR: EMAIL: DATE: 09/17/2024EX. TELEPHONE POLE EX. FIRE HYDRANT ANCHOR THOMAS GUIDE PG GRID #XXXXXXXXXX SUBSTRUCTURE MAP #XXXXXXXXXX CADASTRAL MAP #XXXXXXXXXX PLANS & PROFILES #XXXXXXXXXX SEWER INDEX #XXXXXXXXXX DRAINAGE MAP #XXXXXXXXXX REFERENCES VICINITY MAP N.T.S. NORTH TOTAL WORK DURATION: 3 DAYS EX. VAULTV 1"=20'SCALE: agrim@inland-engineering.com AMBER GRIM - INTERSECTION STA:10+00 WINCHESTER RD 10+00 ENTERPRISE CIRCLE S ENT E R P R I S E C I R C L E S WIN C H E S T E R R D E N T E R P R I S E C I R C L E N - INTERSECTION STA:9+86 WINCHESTER RD 10+00 ENTERPRISE CIRCLE N 41 5 3 0 E N T E R P R I S E C I R S 41 5 9 3 W I N C H E S T E R R D 41 6 1 5 W I N C H E S T E R R D 41 6 3 0 E N T E R P R I S E C I R S 27363 JEFFERSON AVE 27349 JE F F E R S O N A V E TIE INTO EXIST. PEDESTAL 14+50 TIE INTO EXIST. MANHOLE 15+82 3 2 CONSTRUCTION NOTES: 1. BORE TO PLACE PVC (SCH-40) CONDUIT. COUNT AND SIZE PER CONDUIT DATA BLOCK ................................ 155 L.F. 2. TIE INTO EXISTING PEDESTAL ............................................................... 1 EA. 3. TIE INTO EXISTING MANHOLE................................................................. 1 EA. 4. PLACE 3'x5' BORE/RECEIVING PIT ......................................................... 3 EA. CONDUIT DATA BLOCK 1 4 4 4 CONSTRUCTION NOTES: 1. BORE UNDER ALL CURBS & GUTTERS. 2. EXISTING TV VAULTS ARE TO REMAIN IN PLACE. 3. USE 1 SACK SLURRY IN STREETS. USE NATIVE SOIL IN PKWY. 4. ALL CONDUITS SHALL BE SCH-40 UNLESS OTHERWISE SPECIFIED, ALL SWEEPS TO POLES SHALL BE SCH-80. 5. CONTRACTOR TO POT HOLE FOR EXISTING DEPTH OF UTILITIES CONDUIT PRIOR TO START OF CONSTRUCTION. 6. CONTRACTOR TO REMOVE & REPLACE DAMAGED CONCRETE MATCH EXISTING LANDSCAPE TO THE SATISFACTION OF THE SATISFACTION OF THE CITY RESIDENT ENGINEER. PRIVATE ENGINEER'S NOTICE TO CONTRACTORS: THE EXISTENCE AND LOCATION OF ANY UNDERGROUND UTILITIES OR STRUCTURES SHOWN ON THESE PLANS ARE OBTAINED BY A SEARCH OF AVAILABLE RECORDS DONE BY THE CONTRACTOR ON USA, AND TO THE BEST OF OUR KNOWLEDGE. THERE ARE NO EXISTING UTILITIES EXCEPT THOSE SHOWN ON THESE PLANS. THE CONTRACTOR IS REQUIRED TO TAKE ALL PRECAUTIONARY MEASURES TO PROTECT THE UTILITIES SHOWN AND ANY OTHER LINES OR STRUCTURES NOT SHOWN ON THESE PLANS. THE CONTRACTOR IS REQUIRED TO POT HOLE THE EXISTING UTILITIES AND VISUALLY LOCATE THE LINE OR STRUCTURE WHILE PERFORMING THE JACK AND BORE OPERATION AND IS RESPONSIBLE FOR THE PROTECTION AND ANY DAMAGED TO THE THESE LINES OR STRUCTURES. CONSTRUCTION CONTRACTOR AGREES THAT IN ACCORDANCE WITH GENERALLY ACCEPTED CONSTRUCTION PRACTICES, CONSTRUCTION CONTRACTOR WILL BE REQUIRED TO ASSUME SOLE AND COMPLETE RESPONSIBILITY FOR THE JOB SITE CONDITION DURING THE COURSE OF CONSTRUCTION OF THE PROJECT, INCLUDING SAFETY OF ALL PERSONS AND PROPERTY; THAT THIS REQUIREMENT SHALL BE MADE TO APPLY CONTINUOUSLY AND NOT BE LIMITED TO NORMAL WORK HOURS, AND CONSTRUCTION CONTRACTOR FURTHER AGREES TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE PRIVATE ENGINEER FORM ANY AND ALL LIABILITY, REAL OR ALLEGED, IN CONNECTION WITH THE PERFORMANCE OF WORK ON THIS PROJECT. THE CONTRACTOR SHALL BE RESPONSIBLE TO REPORT DISCREPANCIES IN PLANS AND/OR FIELD CONDITIONS IMMEDIATELY TO THE DESIGN ENGINEER FOR RESOLUTION PRIOR TO CONSTRUCTION, AND SHALL BE RESPONSIBLE FOR DISCREPANCIES NOT SO REPORTED AND RESOLVED TRAFFIC CONTROL NOTE: CONTRACTOR SHALL SET UP TEMPORARY TRAFFIC CONTROL SHOWN ON ACCOMPANYING TRAFFIC CONTROL PLAN PER MUTCD AND/ OR WATCH MANUAL (LATEST EDITIONS). PREFERENCE AT THE DISCRETION OF THE GOVERNING MUNICIPALITY. R A I S E D M E D I A N R A I S E D M E D I A N LD24-4145 CLEARED BY CITY OF TEMECULA PUBLIC WORKS Tricia.ortega 10/14/2024 10/14/2024 10/14/2024 10/14/20 C/L CENTER LINE C&G CURB & GUTTER R/W RIGHT OF WAY SHEET 02 OF 02 PROJECT: PID# 5587346 CITY OF TEMECULA WORK LOCATION: ENTERPRISE CIR S SE/O WINCHESTER RD CONCRETE PAVING INLAND ENGINEERING SERVICES, INC.CITY BOUNDARY TARGET/SERVICE ADDRESS: 27371 JEFFERSON AVE STE T, TEMECULA, CA 925901373 OLD TEMESCAL RD, CORONA, CA 92881 TEL: 951.277.0800 FAX: 951.277.5300 DESIGNER OWNER 1-800-422-4133 AT LEAST TWO DAYS BEFORE YOU DIG UNDERGROUND SERVICE ALERT OF SOUTHERN CALIFORNIA TICKET# DIGALERTEXCAVATION LEGEND - GENERAL PROP. VAULTV PROP. BORE PROP. BORE PIT PROP. TRENCH PROP. POTHOLE PROP. PEDESTALP EX. HANDHOLE / SCE VENT EX. UTILITY MANHOLE EX. LIGHT POLE EX. TREE EX. VAULT / PEDESTAL / CABINET COMPASS EXCAVATION PLAN DESIGNED BY:INLAND ENGINEERING SERVICES DRAFTED BY:INLAND ENGINEERING SERVICES TEL. NUMBER:(951) 277-0800 PERMIT COORDINATOR: EMAIL: EX. TELEPHONE POLE EX. FIRE HYDRANT ANCHOR THOMAS GUIDE PG GRID #XXXXXXXXXX SUBSTRUCTURE MAP #XXXXXXXXXX CADASTRAL MAP #XXXXXXXXXX PLANS & PROFILES #XXXXXXXXXX SEWER INDEX #XXXXXXXXXX DRAINAGE MAP #XXXXXXXXXX REFERENCES EX. VAULTV 1"=20'SCALE: agrim@inland-engineering.com AMBER GRIM DATE: 09/17/2024 TOTAL WORK DURATION: 3 DAYS Data current as of 12/27/2023 7:28:30 AM Home | Online Services | License Details Contractor's License Detail for License # 818906 DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. Business Information H H S CONSTRUCTION LLC 2042 S GROVE AVENUE ONTARIO, CA 91761 Business Phone Number:(909) 393-3322 Entity Ltd Liability Issue Date 04/17/2003 Reissue Date 12/20/2019 Expire Date 12/31/2025 License Status This license is current and active. All information below should be reviewed. Classifications CSLB complaint disclosure is restricted by law (B&P 7124.6) If this entity is subject to public complaint disclosure click on link that will appear below for more information. Click here for a definition of disclosable actions. Only construction related civil judgments reported to CSLB are disclosed (B&P 7071.17). Arbitrations are not listed unless the contractor fails to comply with the terms. Due to workload, there may be relevant information that has not yet been entered into the board's license database. A - GENERAL ENGINEERING C31 - CONSTRUCTION ZONE TRAFFIC CONTROL C10 - ELECTRICAL B - GENERAL BUILDING C-7 - LOW VOLTAGE SYSTEMS Copyright © 20232023 State of California Bonding Information Contractor's Bond This license filed a Contractor's Bond with AMERICAN CONTRACTORS INDEMNITY COMPANY. Bond Number: 100565005 Bond Amount: $25,000 Effective Date: 01/01/2023 Contractor's Bond History LLC EMPLOYEE/WORKER BOND This license filed a LLC Employee/Worker Bond with ARCH INSURANCE COMPANY. Bond Number: 1161954 Bond Amount: $100,000 Effective Date: 12/20/2019 Bond of Qualifying Individual Workers' Compensation This license has workers compensation insurance with the ACE AMERICAN INSURANCE COMPANY Policy Number:C55949013 Effective Date: 10/01/2023 Expire Date: 10/01/2024 Workers' Compensation History Liability Insurance Information This license has liability insurance with TWIN CITY FIRE INSURANCE COMPANY Policy Number: 37ECS0L5825 Amount: $1,000,000 Effective Date: 09/30/2023 Expiration Date: 09/30/2024 Liability Insurance History Miscellaneous Information Other This license filed Bond of Qualifying Individual number SU1173178 for DANIEL PATRICK SCANLAN in the amount of $25,000 with ARCH INSURANCE COMPANY. Effective Date: 01/01/2023 BQI's Bond History This license filed Bond of Qualifying Individual number 100473403 for KRISTIN KATHLEEN JIMENEZ in the amount of $25,000 with AMERICAN CONTRACTORS INDEMNITY COMPANY. Effective Date: 01/01/2023 BQI's Bond History 12/20/2019 - LICENSE REISSUED TO ANOTHER ENTITY 12/21/2019 - SECRETARY OF STATE - CONVERSION Personnel listed on this license (current or disassociated) are listed on other licenses. Back to Top Conditions of Use Privacy Policy Accessibility Accessibility Certification ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE Lockton Companies, LLC 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816) 960-9000 kcasu@lockton.com HHS CONSTRUCTION, LLC 2042 S. GROVE AVE. ONTARIO CA 91761 Arch Insurance Company 11150 Hartford Casualty Insurance Company 29424 Hartford Fire Insurance Company 19682 Twin City Fire Insurance Company 29459 X X 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 X X X X $1,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX X X X X 10,000 10,000,000 10,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX C 37 UENOL5831 9/30/2024 9/30/2025 A 37 ECSOL5825 9/30/2024 9/30/2025 B 37XHUOL5832 9/30/2024 9/30/2025 D UXP3000309-01 9/30/2024 9/30/2025 NOT APPLICABLE 9/30/2025 1451971 N N N N N N 9/13/2024 16271358 16271358 XXXXXXX CITY OF TEMECULA 41000 MAIN STREET TEMECULA CA 92590 RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. EXCEPT 10 DAYS NOTICE OF CANCELLATION OF NON-PAYMENT OF PREMIUM; SHOULD THIS POLICY BE CANCELLED BEFORE THE EXPIRATION DATE, LOCKTON COMPANIES WILL MAIL 30 (THIRTY) DAYS WRITTEN NOTICE TO THOSE CERTIFICATE HOLDERS WHICH REQUIRE SUCH ACTION PER CONTRACT OR AGREEMENT. X X © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ACORD 25 (2016/03) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER E-MAIL ADDRESS: FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Acct#:2795388 08/28/2024 LOCKTON COMPANIES, LLC 888-828-83653657 Briarpark Dr., Suite 700 Houston, TX 77042 Indemnity Insurance Company of North America 43575 HHS CONSTRUCTION, LLC 2042 S GROVE AVE ONTARIO, CA 91761-5617 A X C7234828A 10/01/2024 10/01/2025 X 1,000,000 1,000,000 1,000,000 RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. Waiver of Subrogation in favor of Certificate Holder when required by written contract RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. insperitycerts@locktonaffinity.com CITY OF TEMECULA TEMECULA CA 92590 41000 MAIN ST WC 90 03 75 (05/18) Workers' Compensation a nd Employers' Li ability Pol icy Named Insured Endorsement Number Policy Number Symbol: Number: Policy Period TO Effective Date of Endorsement Issued By (Name of Insurance Company) 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 to which it is attached and is effective on the date issued unless otherwise stated. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1.( X ) Specific WaiverName of person or organization: ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2.Operations: 3.Premium: The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4.Minimum Premium: INCLUDED Authorized Agent 10/01/2024 10/01/2025 10/01/2024 C7234828A CITY OF TEMECULA 41000 MAIN ST TEMECULA, CA 92590 RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. WLR HHS CONSTRUCTION, LLC ONTARIO, CA 91761-5617 2042 S GROVE AVE Indemnity Insurance Company of North America Waiver of Subrogation in favor of Certificate Holder when required by written contract RE: ALL OPERATIONS PERFORMED BY THE NAMED INSURED DURING THE CURRENT POLICY PERIOD. Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\Forms\Permit Applications\Word\Encroachment Permit App.docx Page 1 of 2 Revised: 06/16/2020 APPLICATION INFORMATION 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 a set of Construction Drawings, 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 damage to persons or property happening or occurring as a proximate result of any work undertaken 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 ENCROACHMENT PERMIT. Bore to place 122' of PVC (SCH-40) conduit for fiber optic cable. Tie into (1) existing vault. Place (3) bore/receiving pits in the street. Place (1) new PVC conduit stub out. 32769 Tulley Ranch Rd (Rulley Ranch Rd & Pascual Cir) PID 5325679 06/04/2024 06/06/2024 Bore to place 155' of 3" PVC conduit for communication cable. Tie into (1) existing CATV pedestal. Tie into (1) existing manhole. Working Days: 03Tie into (1) existing manhole. Working Days: 03 27371 Jefferson Ave Ste T (Enterprise Cir SE/o Winchester Rd) PID 5587346 10/29/2024 11/01/2024 LD24-4145 CLEARED BY CITY OF TEMECULA PUBLIC WORKS Tricia.ortega 10/14/2024 10/14/2024 10/14/2024 10/14/20 Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\Forms\Permit Applications\Word\Encroachment Permit App.docx Page 2 of 2 Revised: 06/16/2020 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 approac h 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 #: Charter Communications (Marcus/Owner) / Inland Engineering Services (Amber/Applicant) 7337 Central Ave, Riverside, CA 92504 / 1373 Old Temescal Rd, Corona, CA 9288 Amber Grim 951.277.0800 x257 agrim@inland-engineering.com 04/30/2024 H H S Construction 2042 S. Grove Ave., Ontario CA 91761 Michael Sisler (909) 393-3322 818906 A / C31 049178 09/18/2024