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HomeMy WebLinkAbout(Imperial Western Products) Diamond Bar Limited Collection Permit 2026City of Diamond Bar DATE: Environmental Services INVOICE # City Hall BILL TO: Imperial Western Products c/o Building and Safety 4085 Bain Street 21810 Copley Drive Mira Loma, CA 91752 Diamond Bar, CA 91765 760-398-0815 909-839-7015 greendb@diamondbarca.gov LIMITED COLLECTION PERMIT SUBTOTAL TAX RATE SALES TAX OTHER TOTAL Make all checks payable to City of Diamond Bar. THANK YOU FOR YOUR BUSINESS! 12/23/2025 25261 INVOICE 0.00% $314.84 $314.84 $314.84 DESCRIPTION AMOUNT Limited Collection Waste Hauler Permit Fee Valid January 1 - December 31, 2026 Attachment A The State of California mandates that the City of Diamond Bar meet diversion requirements and accurately monitor and report all waste and diversion activities. Per Diamond Bar Municipal Code (DBMC) Section 8.16.460, residents and businesses must utilize one of the City’s two franchise waste haulers or secure a Limited Collection Permit approved by the Program Manager. The City reserves the right to modify the terms and conditions of the permit at any time and may revoke a permit for violation of any permit condition. 1.Application Process Permittees must submit this completed application, including but not limited to the following additional requirements listed in DBMC Section 8.16.540: o Liability Insurance; Workers Compensation Insurance; Indemnify City against liability; Maintain an office for inquiries and complaints; Obtain all applicable permits and licenses required by Federal, State or Local agencies; Responsible for damages caused as a result of its acts or omissions; Maintain records and provide City with inspection authority; Hours of collection requirements; Minimize impacts to noise and public traffic. Certain covered projects must also submit a completed Recycling and Waste Reduction Application as required under DBMC Section 8.16.650. Applications will be reviewed within ten (10) business days. The decision of the Program Manager is final. 2.General Provisions Limited Collection Permits are valid for one calendar year and expire on December 31st. Notification by the City prior to the expiration of the permit will not be provided. Pay Limited Collection Permit Fee of $314.84. Permittee shall not have any past due balances with the City or the City’s franchise waste haulers, or any outstanding violations. Approved permits shall not be transferred, delegated or assigned. No Collection Permittee shall perform Solid Waste Collection Services otherwise provided for in a Solid Waste Franchise Agreement. 3.Waste Containers Containers shall comply with all local, state, and federal health and safety standards. 4.Disposal/Diversion and Reporting Requirements Waste shall be disposed of at least on a weekly basis only at licensed waste disposal facilities, including a landfill, recycling center, recyclable material purchasing center, compostable materials handling facility, transfer station, green material composting facility, or other facility permitted to accept such materials. Permittee is required to recycle at least 75% of all waste generated by the covered construction project as defined in Section 8.16.620. Permittee shall retain and provide documentation, consisting of a completed Recycling and Waste Reduction Compliance Report, gate tickets, receipts for disposal, etc. that proves waste has been disposed in the proper manner and at the required frequency. Documentation shall be provided to the City for verification on a monthly basis no later than the 10th day of each calendar month. Limited Collection Permit Application City of Diamond Bar ~ Environmental Services 21810 Copley Drive ~ Diamond Bar, CA 91765 (909)839-7015 ~ www.DiamondBarCA.gov Attachment A 5.Authorized Vehicles/Transport Permittee shall transport waste only in approved vehicles. Permittee is subject to all local, state, and federal laws related to the transportation of solid waste, as well as storm water discharge regulations. Permittee is responsible for any damages or clean-up costs resulting from its activities. 6.Modification of Limited Collection Permit The City reserves the right to modify the terms and conditions of the permit at any time. 7.Revocation, Suspension, Appeal. The City Manager may revoke or suspend any permit. The applicant may appeal the denial, revocation, or suspension of a permit. Upon revocation of the permit, service must be immediately established with the appropriate franchise waste hauler. It is unlawful for any person to operate under a permit which has been revoked or suspended. Zip Code: Name: APPLICANT INFORMATION Mailing Address (If Different From Above): Business Address: E-mail: City: State: Zip Code: Phone: Print Name: Signature: Date: I agree to the Limited Collection Permit requirements as listed above and declare under penalty of perjury under the laws of the State of California that the information provided in this application is true and correct. STAFF USE ONLY Application Complete If no, explain :____________________________________________________ Approved Denied Revoked (City Manager)— If Revoked, explain:_______________________________________ ____________________________________________________________________________________________________ Signature Print Name Program Manager Date PLEASE READ, SIGN AND DATE Description of vehicle(s) and/or equipment: List of customer(s) to be served: Proposed Rates: Services offered and listing of customer(s) receiving service: Additional information as requested by the City: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 12/19/2025 Arthur J.Gallagher Risk Management Services,LLC1490MarketStreet,Suite 3LakeCharlesLA70601 Lynn Erpelding,CIC,CISR 337-475-7442 lynn_erpelding@ajg.com Nationwide Agribusiness Insurance Co 28223 National Union Fire Insurance Company of Pittsburg 19445ImperialWesternProducts,Inc.220 South Commerce Avenue,1st FloorRussellvilleAR72801 Granite State Insurance Company 23809 Colony Insurance Company 39993 1969377126 A X 1,000,000 X 1,000,000 5,000 1,000,000 2,000,000 X Y Y CPP119003A 11/1/2025 11/1/2026 2,000,000 B 1,000,000 X Y Y 5717880 6/30/2025 6/30/2026 D X 5,000,000 X EXC4279462 6/30/2025 6/30/2026 5,000,000 CC X N Y 9708740997087410 6/30/20256/30/2025 6/30/20266/30/2026 1,000,000 1,000,000 1,000,000 D PollutionLiability Y CPLUS4286768 11/1/2025 11/1/2026 Each Condition $1,000,000 Certificate Holder is included as Additional Insured on the General Liability policy pursuant to and subject to the policy's terms,definitions,conditions andexclusionsasperendorsement#CA2043,edition date 12/19.Certificate Holder is included as Additional Insured on the Automobile policy as per endorsement#87950,edition date 09/14.Waiver of Subrogation applies to Certificate Holder as respects the General Liability,Automobile,Workers Compensation andExcessLiabilitypoliciespursuanttoandsubjecttothepolicy's terms,definitions,conditions and exclusions.General Liability and Automobile policies areprimaryandnoncontributorypursuanttothepolicy's term,definitions,conditions and exclusions.Pollution Liability is on Occurrence Basis while ProfessionalLiabilityisonClaimsMadeBasis.Policies listed above contain a 30 day Notice of Cancellation,except 10 days in the event of nonpayment. Workers Compensation Policy #:97087409 covers State of California only.See Attached... City of Diamond Bar21810CopleyDriveDiamondBarCA91765USA ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: 1 1 Arthur J.Gallagher Risk Management Services,LLC Imperial Western Products,Inc.220 South Commerce Avenue,1st FloorRussellvilleAR72801 25 CERTIFICATE OF LIABILITY INSURANCE Workers Compensation Policy #:97087410 covers all other States. Excess Liability policies follow form of underlying policies as listed below:Policy #:EXC4279462 -6/30/2025-26-Colony Insurance Company -$5,000,000 limit and is excess over General Liability,Pollution Liability and ProfessionalLiabilityonly.NAIC #39993Policy#GVE100272504 -6/30/2025-26 -Gemini Insurance Company -$3,000,000 limit and is access over Automobile and Employer's Liability only.NAIC#10833Policy#EXT30091263400 -6/30/2025-26 -Endurance American Specialty Insurance Company -$2,000,000 xs $3,000,000 over Automobile and Employer'sLiabilityonly.NAIC #41718Policy#140001789 -6/30/2025-26-QBE Specialty Insurance Company -$2,000,000 xs $5,000,000 over Auto and Employer's Liability only.NAIC #39217Policy#TUEF35653100 -6/30/2025-26-Great American Insurance Company -$3,000,000 xs $7,000,000 over Auto and Employer's Liability only.NAIC #16691Policy#ENVX000051325 -6/30/2025-26 -Underwriter's at Lloyd's,London -$15,000,000 xs $5,000,000 over General Liability,Pollution Liability andProfessionalLiabilityonly.NAIC #15792 AUTO COMPREHENSIVIE DED:$100AUTOCOLLISIONDED:$500APDappliestoallrented/leased vehicles with a cost new value greater than or equal to $75,000.Vehicles with a cost new less than $75,000 must be scheduled. Equipment Coverage:Policy #PW00687025Carrier:Certain Underwriter at Lloyd's LondonPolicyDates:06/30/2025-06/30/2026ScheduledTIV:$96,760,641Rented/Leased Limit:Any One Item $1,000,000Deductible:$50,000 Each OccurrenceCertificateholderislistedasLossPayee on Rented/Leased Equipment/Auto as their interest may appear.