ENCROACHMENT PERMIT APPLICATION - Moval
LAND DEVELOPMENT DIVISION1 4 1 7 7 F r e d e r i c k S t r e e t P . O . B o x 8 8 0 0 5 M o r e n o V a l l e y, C A 9 2 5 5 2 - 0 8 0 5Phone: 951.413.3120 Fax: 951.413.3158 www.moval.org LandDevelopment@moval.orgENCROACHMENT PERMIT APPLICATIONDEVELOPMENT PROJECT (PEN) AND/OR MAP #:UTILITY WORK ORDER NUMBER(S):TYPE OF CONSTRUCTION: [[[[]]]]Street / Storm Drain[ ] Storm Drain (RCFC)[ ] Signing & StripingSewer[ ] Sewer & Water[ ] WaterTraffic Signal / Modification[ ] Utility Place-Holder (for bidding / misc. purposes only)Miscellaneous (please describe below – required)I HEREBY APPLY TO EXCAVATE, CONSTRUCT, INSTALL OR OTHERWISE ENCROACH WITHIN PUBLIC RIGHT-OF-WAY AS FOLLOWS:D URATIONOFW ORK ( NUMBERE VENING W ORK R EQUIRED ?OF DAYS ):N UMBEROFH OURS ( IFONLY1DAY ):[ ] Y ES [ ] N OW HEN ?H OURS(##–##pm) ?W EEKEND W ORK R EQUIRED ? [ ] Y ES [ ] N OW HEN ?H OURS(##–##pm) ?THIS SECTION REQUIRED FOR MISCELLANEOUS / UTILITY PERMITS ONLY:SIDEWALK / CURB & GUTTEREXCAVATION (Crossing)LF CURB CORE (#)LFEXCAVATION (Parallel)SMALL BORE POTHOLES (12” diameter max)L OCATIONPARKWAY DRAINS (#)LFOTHER POTHOLES ( 12” diameter)DRIVEWAYS (#)NEWSPAPER RACK (#)BORE / SPLICE PITS (#)OF WORK [i.e. W/S of Perris Blvd. south of Cactus Ave.] – do not list a street address only :In consideration of the granting of this permit, all applicants (including utility companies) hereby agree .org/city hall/forms.shtml#landdev].a.Typical Application drawing(s) are only accepted from the latest editions of either the California TemporaryTraffic Control Handbook (CATTCH), the Manual on Uniform Traffic Control Devices (MUTCD), the WorkArea Traffic Control Handbook (WATCH) or the Field Guide for Temporary Traffic Control mnify, defend and hold harmless the City, Moreno Valley Community Services District (“CSD”), Moreno ValleyHousing Authority (“Housing Authority”) and each of their officers, officials, employees, agents and volunteers inaccordance with the Indemnification and Hold Harmless Agreement, which is incorporated into and part of theEncroachment Permit Application and the Encroachment Permit, itself.3.Remove or relocate any encroachment installed or maintained under this permit, upon written notice from the City Engineer.4.Maintain a copy of the issued permit at the work site and made available to any authorized City representative upon request.5.Notify the Land Development Division via email (LDInspections@moval.org) at least two (2) workdays prior tobeginning and upon completion of work. The applicant, developer, contractor and/or owner will be responsible for thetimely request of inspections.Revised: 11 / 2021Page 1 of 5W : \ F O R M S \ P E R M IT S \ E n c r o a c h m e n t P e r m i t A p p l i c a t i o n . d o c x
LIABILITY INSURANCE REQUIREMENTSThe “applicant”, whether the developer, general contractor (with appropriate license) or public utility/franchise shall pay forand maintain in full force and effect all insurance as required in Exhibit “A” of the Indemnification and Hold HarmlessAgreement, which is incorporated into and part of the Encroachment Permit Application and Encroachment Permit, itself.The applicant shall be responsible for ensuring that all subcontractors are properly insured. Property owners applying as “owner-builder” may provide their homeowner’s insurance “in-lieu” of the listed requirement. ALL APPLICABLE INFORMATION BELOW MUST BE PROVIDEDOWNER / DEVELOPER / UTILITY [ ] O WNER / B UILDERCONTACT:COMPANY (if applicable):OFFICE #:MOBILE #:EMAIL:MAILING ADDRESS:STATE CONTRACTOR’S LICENSE #:CLASS:GENERAL CONTRACTORCITY BUSINESS LICENSE #:[C LASS “A”CONTACT:COMPANY (if applicable):OFFICE #:MOBILE #:OR APPROPRIATE“C”LICENSE REQUIRED ]EMAIL:MAILING ADDRESS:STATE CONTRACTOR’S LICENSE #:CLASS:APPLICANT S AMECONTACT:COMPANY (if applicable):OFFICE #:MOBILE #:AS :CITY BUSINESS LICENSE #:[ ] O WNER / D EVELOPER / U TILITY[ ] C ONTRACTOREMAIL:MAILING ADDRESS: Will be required to sign the permit once issued.BYSIGNING THEINDEMNIFICATIONAPPLICANT, HEREBY STATE THATIANDHOLD HARMLESS AGREEMENT I,THEAM AUTHORIZED AND HAVE READ AND AGREE TOMEET THE CONDITIONS INCLUDED IN THIS APPLICATION AND ACKNOWLEDGE THATTHIS WILL BE MADE A PART OF THE ENCROACHMENT PERMIT.[ ATTACH NOTARIZED LETTER OF AUTHORIZATION ]Revised: 11 / 2021Page 2 of 5W : \ F O R M S \ P E R M IT S \ E n c r o a c h m e n t P e r m i t A p p l i c a t i o n . d o c x
INDEMNIFICATION AND HOLD HARMLESS AGREEMENTFOR ENCROACHMENT PERMITSIn consideration for the issuance of an Encroachment Permit and to the furthest extent allowed by law, Applicant does herebyagree to indemnify, hold harmless and defend the City of Moreno Valley (“City”), Moreno Valley Community ServicesDistrict (“CSD”), Moreno Valley Housing Authority (“Housing Authority”) and each of their officers, officials, employees,agents and volunteers from any and all loss, liability, fines, penalties, forfeitures, costs and damages (whether in contract, tort orstrict liability, including but not limited to personal injury, death at any time and property damage) incurred by City, CSD,Housing Authority, Applicant, subcontractors or any other person, and from any and all claims, demands and actions in law orequity (including attorney's fees and litigation expenses), arising or alleged to have arisen directly or indirectly out of theissuance of the Encroachment Permit or any work permitted thereunder. Applicant’s obligations under the preceding sentenceshall apply regardless of whether City or any of its officers, officials, employees, agents or volunteers are passively negligent,but shall not apply to any loss, liability, fines, penalties, forfeitures, costs or damages caused by the active or sole negligence, orthe willful misconduct, of City, CSD, Housing Authority or any of their officers, officials, employees, agents or volunteers.Throughout the life of the Encroachment Permit, Applicant shall pay for and maintain in full force and effect all insurance as required in“Exhibit A”, which is incorporated into and part of this Agreement, or as may be authorized or required in writing by City Manager orhis/her designee at any time and in his/her sole discretion. Applicant agrees to require that all parties, including but not limited tosubcontractors or others with whom Applicant enters into contracts or hires or retains pursuant to or in any way related to this permit,provide the insurance coverage required herein, at minimum, including naming City and affiliated agencies as additional insured, as set forthin Exhibit “A”. Applicant agrees to monitor and review all such coverage and assumes all responsibility for ensuring that such coverage isprovided in conformity with the requirements of this Permit. Moreover, Applicant agrees and acknowledges that failure to obtain all of theinsurance required or to ensure that the coverage required herein is maintained by any subcontractors or others involved, will not diminishApplicant’s liability, and Applicant shall be responsible for any losses, claims, suits, damages, defense obligations, or liability of any kind ornature attributable to the City or its officers, employees, servants, volunteers, agents and independent contractors.Applicant shall conduct all defenses at his/her/its sole cost. The fact that insurance is obtained by Applicant shall not bedeemed to release or diminish the liability of Permittee, including, without limitation, liability assumed under thisAgreement. The duty to indemnify shall apply to all claims regardless of whether any insurance policies are applicable. Theduty to defend hereunder is wholly independent of and separate from the duty to indemnify and such duty to defend existsregardless of any ultimate liability of Applicant. The policy limits do not act as a limitation upon the amount of defenseand/or indemnification to be provided by Applicant. Approval or purchase of any insurance contracts or policies shall in noway relieve from liability nor limit the liability of Applicant, its officials, officers, employees, agents, volunteers or invitees.City shall be reimbursed for all costs and attorney’s fees incurred by City in enforcing this Agreement.Applicant shall be fully responsible to the City for all acts or omissions of any subcontractors. Nothing herein shall createany contractual relationship between City and subcontractor nor shall it create any obligation on the part of the City to pay orto see to the payment of any monies due to any such subcontractor other than as may be required by law.This Indemnification and Hold Harmless Agreement shall survive the expiration or termination of the Encroachment Permit.The undersigned acknowledges that he/she (i) has read and fully understands the content of this Indemnification andHold Harmless Agreement; (ii) is aware that this is a contract between the City and Applicant; (iii) has had theopportunity to consult with his/her attorney, in his/her discretion; (iv) is fully aware of the legal consequences ofsigning this document; and (v) is the Applicant or his/her/its authorized signatory.S IG N E DO N T H E F O LLO W IN G D A T E :S IG N A T U R EOFA P P LIC A N T(required).P R IN T N A M EOFA P P LIC A N T[ ATTACH NOTARIZED LETTER OF AUTHORIZATION ]Revised: 11 / 2021Page 3 of 5W : \ F O R M S \ P E R M IT S \ E n c r o a c h m e n t P e r m i t A p p l i c a t i o n . d o c x
STANDARD INSURANCE REQUIREMENTSEXHIBIT “A”The City of Moreno Valley, the City of Moreno Valley Community Services District and the Moreno ValleyHousing Authority require the following minimum limits of insurance:1)General Liability insurance with limits of not less than 1,000,000 for bodily injury and property damage; 1,000,000 for personal and advertising injury; 2,000,000 products and completed operations aggregate;and 2,000,000 general aggregate.2)Auto Liability insurance endorsed for “any auto” with limits of liability of not less than 1,000,000 peraccident for bodily injury and property damage.3)Workers' Compensation insurance as required by law.4)Employer's Liability insurance with limits of liability of not less than 1,000,000, each accident; 1,000,000 disease each employee; and 1,000,000 disease policy limit.In addition, the City of Moreno Valley, the City of Moreno Valley Community Services District and the MorenoValley Housing Authority require the following as evidence of insurance:5)A certificate of insurance, which reads: “The City of Moreno Valley, the City of Moreno Valley CommunityServices District, the Moreno Valley Housing Authority and each of their officers, officials, employees,agents and volunteers are additional insured’s as respects to General Liability and Auto Liabilityinsurance. This insurance is primary, and our obligations are not affected by any other insurance carriedby such additional insured whether primary, excess, contingent, or on any other basis. Waiver ofsubrogation for Workers’ Compensation and Employer’s Liability insurance as respects to the City ofMoreno Valley, the City of Moreno Valley Community Services District, the Moreno Valley HousingAuthority and each of their officers, officials, employees, agents and volunteers.”a. Certificate holder should appear as follows: City of Moreno Valley, City of Moreno Valley CommunityServices District, the Moreno Valley Housing Authority 14177 Frederick Street, Moreno Valley, CA 925536)An Additional insured endorsement, with primary and non‐contributory language or a primary insuranceendorsement, for General Liability insurance. The additional insured endorsement(s) should extend to bothongoing operations and completed operations. The additional insured should read: “The City of MorenoValley, the City of Moreno Valley Community Services District, the Moreno Valley Housing Authority andeach of their officers, officials, employees, agents and volunteers.”a. Examples of primary insurance language are "Such insurance as is afforded by the policy is primary andany other insurance shall be excess and not contribute to the insurance afforded by this endorsement" and"This insurance is primary, and our obligations are not affected by any other insurance carried by suchadditional insured whether primary, excess, contingent, or on any other basis".7)An Additional insured endorsement for Auto Liability insurance. The additional insured endorsementshould read: "The City of Moreno Valley, the City of Moreno Valley Community Services District, theMoreno Valley Housing Authority and each of their officers, officials, employees, agents and volunteers.”8)A Waiver of Subrogation endorsement for Workers’ Compensation and Employer’s Liability insurance asrespects to the City of Moreno Valley, the City of Moreno Valley Community Services District, the MorenoValley Housing Authority and each of their officers, officials, employees, agents and volunteers.Revised: 11 / 2021Page 4 of 5W : \ F O R M S \ P E R M IT S \ E n c r o a c h m e n t P e r m i t A p p l i c a t i o n . d o c x
ENCROACHMENT PERMITLIST OF SUBCONTRACTORS[A VALID C ITY B USINESS L ICENSE IS REQUIRED FOR EACH ]Business Name:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Class:Business Name:Email:City Business License #:Type of Work:Contact Name:Mobile #:State Contractor’s License #:Revised: 11 / 2021Email:Class:Page 5 of 5Email:City Business License #:W : \ F O R M S \ P E R M IT S \ E n c r o a c h m e n t P e r m i t A p p l i c a t i o n . d o c x
14177 Frederick Street P.O. B ox 88005 Moreno Valley, CA 92552-0805 . Phone: 951.413.3120 Fax: 951.413.3158 www.moval.org LandDevelopment@moval.org . . Moreno Valley, the City of Moreno Valley Community Services District, the Moreno Valley Housing Authority and each of their officers, officials, employees, agents and volunteers. .
project, for example, to relocate utilities prior to a Caltrans pavement rehabilitation project. The Oversight Resident Engineer Guidelines does not apply to encroachment permit projects. Use the Encroachment Permit Manual for permit inspection procedures, required forms,
Chapter 500 - Specific Encroachment Permits ENCROACHMENT PERMITS MANUAL CURRENT AS OF
industry concern, in June 2010 ASTM published E 2600-10, Standard Guide for Vapor Encroachment Screening on Property Involved in Real Estate Transactions.3 Vapor Encroachment Screening Under the Newly-Revised ASTM E 2600-10 Standard Rationale for Revising the Standard The original ASTM
IMPERIAL COUNTY PUBLIC WORKS DEPARTMENT 155 South 11th Street El Centro, CA 92243 . Tel: (442) 265-1818 Fax: (442) 265-1858 . icpw@co.imperial.ca.us . ENCROACHMENT PERMIT . APPLICATION (Ordinance No. 1370, adopted August 12, 2003 and effective September 11, 2003) DATE Complete All Numbered Spaces! Please Type or Print! See Additional Handouts
Once a Permit has been cancelled, no work can recommence under that Permit. A new Permit to Work must be completed for the remainder of the work and approved by the Permit Issuer. 5.9 Permit extension In instances where it is necessary to extend a Permit beyond the original expiry time / date e.g. the task has
a permit-required confined space. No permit-required confined space may be entered without a valid entry permit. The entry permit must contain the following informa on: the iden ty of the permit space to be entered and the purpose of the entry, the date and the authorized dura on of the entry permit, a lis ng of authorized
c. For a Revision to an existing permit or shop drawings, select "Application for Revision/shop drawing". d. For Permit Extensions, select "Permit Extension". e. For a Re-issueof an expired permit, select "Permit Reissuance". f. For a Change of Contractor to a permit, select "Change of Contractor".
ASM Handbook Series on Heat Treating Expands to Four Volumes Springer Science Business Media New York and ASM International 2013 The recently-released Steel Heat Treating Fundamentals and Processes is the first of four upcoming ASM Hand-books on Heat Treating. Under the direction of an editorial team, including Jon Dossett and George Totten as Volume Editors, Volume 4A includes extensive .
