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HomeMy WebLinkAboutContract 47626 CITY SECRETARY CONTRACT NO. EASEMENT ENCROACHMENT LICENSE AGREEMENT Commercial THIS AGREEMENT is made and entered into by and between THE CITY OF FORT WORTH, a home rule municipal corporation of Tarrant County, Texas ("City"), acting by and through its duly authorized City Manager, its duly designated Assistant City Manager or Planning and Development Director, and W.R. MEADOWS, Inc., a Corporation ("Licensee"), acting by and through its duly authorized GENERAL MANAGER, owner of the real property located at 1290 Cantrell Sansom Road, Fort Worth, TX 76131 ("Property"). RECITALS WHEREAS, Licensee is the owner of certain real property situated in the City of Fort Worth, Tarrant County, Texas, more particularly described in the attached Legal Description of the Property; and WHEREAS, the City has a water easement (the "Easement") in the Property as shown on the map attached to this Agreement as Exhibit "A" and incorporated herein for all purposes; and WHEREAS, Licensee desires to construct/place and maintain certain improvements which will encroach onto the Easement; and WHEREAS, City will allow the encroachment under the terms and conditions as set forth in this Agreement to accommodate the needs of the Licensee. NOW, THEREFORE, the City and Licensee agree as follows: AGREEMENT 1. City, in consideration of the payment by the Licensee of the fee set out below and covenants and agreements hereinafter contained, to be kept and performed by Licensee, hereby grants permission to Licensee to encroach upon and occupy a portion of the City's Easement for the purpose of gate and fence (the "Encroachment") as described in and at the location shown on Exhibit "A" but only to the extent shown thereon. Upon completion of the Encroachment, Licensee agrees to be responsible for maintaining the Encroachment within and above the Easement. Licensee shall not expand or otherwise cause the Encroachment to further infringe in or on City's Easement beyond what is specifically described in the Exhibit(s) attached hereto. 2. EFT. RECORD RETARY 2015 Easement Encroachment Agreement-Commercial TH T P ge 1 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom RoadR v. 02/2015 All construction, maintenance and operation in connection with such Encroachment, use and occupancy shall be performed in strict compliance with this Agreement and the City's Charter, Ordinances and Codes and in accordance with the directions of the Director of the Transportation and Public Works or the Director of the City's Water Department, or his or her duly authorized representative. Licensee shall submit all plans and specifications to the applicable Director or his or her duly authorized representative prior to the construction of the Encroachment. Licensee shall not commence construction of the Encroachment until receiving written approval by the Director, but such approval shall not relieve Licensee of responsibility and liability for concept, design and computation in the preparation of such plans and specifications. 3. Upon prior written notice to Licensee, except in the case of an emergency, Licensee agrees that City may enter and utilize the referenced areas at any time for the purpose of installing, repairing, replacing, or maintaining improvements to its public facilities or utilities necessary for the health, safety and welfare of the public or for any other public purpose. City shall bear no responsibility or liability for any damage or disruption or other adverse consequences resulting from the Encroachment installed by Licensee, but City will make reasonable efforts to minimize such damage. In the event that any installation, reinstallation, relocation or repair of any existing or future utility or improvements owned by, constructed by or on behalf of the public or at public expense is made more costly by virtue of the construction, maintenance or existence of the Encroachment and use, Licensee shall pay to City an additional amount equal to such additional cost as reasonably determined by the Director of Transportation and Public Works or the Director of the Water Department, or said Director's duly authorized representative. 4. Licensee agrees to pay to City at the time this Agreement is requested an application fee of 5325.00 in order to defray all costs of inspection and supervision which City has incurred or will incur as a result of the construction, maintenance, inspection or management of the encroachments and uses provided for by this Agreement. 2015 Easement Encroachment Agreement-Commercial Page 2 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom Road Rev. 02/2015 5. The term of this Agreement shall be for 30 years, commencing on the date this Agreement is executed by City. However, this Agreement shall terminate upon Licensee's non-compliance with any of the terms of this Agreement. City shall notify Licensee in writing of the non-compliance, and if not cured within 30 days, this Agreement shall be deemed terminated, unless such non-compliance is not susceptible to cure within 30 days, in which case this Agreement shall be deemed terminated in the event that Licensee fails to commence and take such steps as are necessary to remedy the non-compliance with 30 days after written notice specifying the same, or having so commenced, thereafter fails to proceed diligently and with continuity to remedy same. 6. It is further understood and agreed between the parties hereto that the Easement to be used and encroached upon as described herein, is held by City as trustee for the public; that City exercises such powers over the Easement as have been delegated to it by the Constitution of the State of Texas or by the Texas Legislature; and that City cannot contract away its duty and its legislative power to control the Easement for the use and benefit of the public. It is accordingly agreed that if the governing body of City may at any time during the term hereof determine in its sole discretion to use or cause or permit the Easement to be used for any other public purpose, that does not preclude the use of the Encroachment on the Property, including but not being limited to underground, surface or overhead communication, drainage, sanitary sewerage, transmission of natural gas or electricity, or any other public purpose, whether presently contemplated or not, that the parties agree to negotiate in good faith in order to accommodate the Encroachment and the public purpose. 7. LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, AND ELECTED OFFICIALS FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS FOR PROPERTY DAMAGE OR LOSS AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR CHARACTER, ARISING OUT OF OR IN CONNECTION WITH, THE CONSTRUCTION, MAINTENANCE, OCCUPANCY, USE, EXISTENCE OR LOCATION OF THE ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, ELECTED OFFICIALS, OR INVITEES OF THE CITY; AND LICENSEE HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY FOR SUCH CLAIMS OR SUITS. LICENSEE SHALL LIKEWISE ASSUME ALL LIABILITY AND RESPONSIBILITY AND SHALL INDEMNIFY CITY FOR 2015 Easement Encroachment Agreement-Commercial Page 3 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom Road Rev. 02/2015 ANY AND ALL INJURY OR DAMAGE TO CITY PROPERTY ARISING OUT OF OR IN CONNECTION WITH THE ENCROACHMENTS AND ANY AND ALL ACTS OR OMISSIONS OF LICENSEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, OR INVITEES. 8. While this Agreement is in effect, Licensee agrees to furnish City with a Certificate of Insurance naming City as certificate holder, as proof that it has secured and paid for a policy of public liability insurance covering all public risks related to the proposed use and occupancy of public property as located and described in Exhibit "A". The amounts of such insurance shall be not less than $1,000,000 Commercial General Liability with the understanding and agreement by Licensee that such insurance amounts may be revised upward at City's option and that Licensee shall so revise such amounts immediately following notice to Licensee of such requirement. Such insurance policy shall not be canceled or amended without at least 30 days prior written notice to the Building Official of the City of Fort Worth. A copy of such Certificate of Insurance is attached as Exhibit "B" and incorporated herein for all purposes. Licensee agrees to submit a similar Certificate of Insurance annually to City on the anniversary date of the execution of this Agreement Licensee agrees, binds and obligates itself, its successors and assigns, to maintain and keep in force such public liability insurance at all times during the term of this Agreement and until the removal of the Encroachment and the cleaning and restoration of the Easement. All insurance coverage required herein shall include coverage of all Licensees' contractors and subcontractors. 9. Licensee agrees to deposit with City when this Agreement is executed a sufficient sum of money to be used to pay necessary fees to record this Agreement in the Real Property Records of Tarrant County, Texas. After being recorded, the original shall be returned to the City Secretary of the City of Fort Worth. 10. Licensee agrees to comply fully with all applicable federal, state and local laws, statutes, ordinances, codes or regulations in connection with the construction, operation and maintenance of the Encroachment and uses. 2015 Easement Encroachment Agreement-Commercial Page 4 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom Road Rev. 02/2015 11. Licensee agrees to pay promptly when due all fees, taxes or rentals provided for by this Agreement or by any federal, state or local statute, law or regulation. 12. Licensee covenants and agrees that it shall operate hereunder as an independent contractor as to all rights and privileges granted hereunder and not as an officer, agent, servant or employee of City, and Licensee shall have exclusive control of and the exclusive right to control the details of its operations, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers, agents, servants, employees, contractors, subcontractors, licensees and invitees. The doctrine of respondeat superior shall not apply as between City and Licensee, its officers, agents, servants, employees, contractors and subcontractors, and nothing herein shall be construed as creating a partnership or joint enterprise between City and Licensee. 13. Licensee agrees and acknowledges that this Agreement is solely for the purpose of permitting Licensee to construct, maintain and locate the Encroachment over or within the Easement and is not a conveyance of any right, title or interest in or to the Easement nor is it meant to convey any right to use or occupy property in which a third party may have an interest. Licensee agrees that it will obtain all necessary permissions before occupying such property. 14. In any action brought by the City for the enforcement of the obligations of the Licensee, City shall be entitled to recover interest and reasonable attorney's fees. 15. The parties agree that the duties and obligation contained Sections 3 and 4 shall survive the termination of this Agreement. 16. Licensee covenants and agrees that it will not assign all or any of its rights, privileges or duties under this Agreement without the written approval of City, and any attempted assignment without such written approval shall be void. In the event Licensee conveys the Property, Licensee may assign all of its rights and obligations under this Agreement to the new owner of the Property, and Licensee shall be deemed released from its duties and obligations hereunder upon City's approval in writing of such assignment, which approval shall not be unreasonably conditioned or withheld. Foreclosure by a secured lender of Licensee or assignment to a secured lender by Licensee in the event of 2015 Easement Encroachment Agreement-Commercial Page 5 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom Road Rev. 02/2015 default or otherwise shall not require City approval provided that said lender notifies City in writing within 60 days of such foreclosure or assignment and assumes all of Licensees' rights and obligations hereunder. However, no change of ownership due to foreclosure or assignment to any secured lender of Licensee shall be effective as to City unless and until written notice of such foreclosure or assignment is provided to City. 17. Any cause of action for breach of this Agreement shall be brought in Tarrant County, Texas. This Agreement shall be governed by the laws of the State of Texas. 18. This Agreement shall be binding upon the parties hereto, their successors and assigns. SIGNATURES APPEAR ON FOLLOWING PAGE 2015 Easement Encroachment Agreement-Commercial Page 6 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom Road Rev. 02/2015 THIS AGREEMENT may be executed in multiple counterparts, each of which shall be considered an original, but all of which shall constitute one instrument. City Licensee: CITY F LORTH W.R. MEADOWS, INC. Randle lurwood Name: ANDREW TAM Director Title: GENERAL MANAGER Planning and Development Date: 2016 ATTEST: Approved As To Form and Legality City re4� Assistant City Attorney ®� FO , ;. �� f f' OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX 2015 Easement Encroachment Agreement-Commercial Page 7 of 12 W.R.MEADOWS Inc. 1290 Cantrell-Sansom Road Rev.02/2015 STATE OF TEXAS § COUNTY OFT NT § This ins was acknowledged before me on , 2016 y all H7on ood, Director of the Planning Development epartment of the City of Fort Worthbehalf the City of Fort Worth. Notary Public, State of Texas CASSANDRA F. FOREMAN Notary Public SQA} f9xa5 My Comm;.,,,..- :saes Aptii kk6 After Recording Return to: Cassandra Foreman Planning and Development Department 1000 Throckmorton Street Fort Worth TX, 76102 2015 Easement Encroachment Agreement-Commercial Page 8 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom Road Rev.02/2015 STATE OF "" - MELN§ � COUNTY OF 1eEs -.. BLE err coMM►ssO�oN ri May 8,2016 BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas, on this day personally appeared AhAULO r " (title), known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he/she executed the same for the purposes and consideration therein expressed, as the act and deed of LO.i 1 � du�� , . ;, a c `1n and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of , 2016. 44,4�.'z���/'4�3 a Notary Public in and for the State of 2015 Easement Encroachment Agreement-Commercial Page 9 of 12 W.R.MEADOWS Inc. 1290 Cantrell-Sansom Road Rev.02/2015 LEGAL DESCRIPTION OF THE PROPERTY Being a 1,177,457 Square Feet (27.031 acres) tract of land situated in the David Odum Survey, Abstract No. 1184, City of Fort Worth, Tarrant County, Texas as shown in a Special Warranty Deed to Adder Minnis Limited Partnership, and recorded as Instrument Number D213105276 of the Official Public Records of Tarrant County, Texas (O.P.R.T.C.T.), and being more particularly described as follows: BEGINNING at a cotton spindle found (CM) at the northwest corner of said Adder Minnis Limited Partnership tract and the northeast corner of that certain tract of land as described in a deed to the City of Fort Worth, recorded in Volume 7394, Page 2156, of the Deed Records of Tarrant County, Texas (D.R.D.C.T.), said point also being in the south right of way line of Cantrell Sansom Road (a variable width right of way); THENCE North 89 degrees 39 minutes 07 seconds East, with the north line of said Adder Minnis Limited Partnership tract and the south right of way line of said Cantrell Sansom Road, a distance of 764.58 feet to a cotton spindle found (CM) for the northeast corner of said Adder Minnis Limited Partnership tract and an angle point in the south right of way line of said Cantrell Sansom Road; THENCE South 00 degrees 46 minutes 06 seconds East, with the east line of said Adder Minnis Limited Partnership tract and the south right of way line of said Cantrell Sanson Road, at 60.00 feet passing an angle point in the south right of way line of said Cantrell Sansom Road and the northwest corner of Lot 1, Block 1 of NAFX Addition as recorded in Cabinet A, Slide 8657, of the Plat Records of Tarrant County, Texas, and continuing with the west line of said Lot 1, a total distance of 1,538.22 feet to a 5/8" capped iron rod found (CM) for the southeast corner of said Adder Minnis Limited Partnership tract and an ell corner of a called 65.660 acre tract of land to Madison Decker, Limited, recorded in Instrument Number D206407165 (O.P.R.T.C.T.); THENCE South 89 degrees 22 minutes 18 seconds West, with the south line of said Adder Minnis Limited Partnership tract and the north line of said Madison Decker, Limited tract, a total distance of 764.56 feet to a 1/2" capped iron rod found (CM) for the southwest corner of said Adder Minnis Limited Partnership tract and an ell corner of said Madison Decker, Limited tract, said point also being in the east line of that certain tract of land as described in a deed to Miller Distributing Fort Worth, Incorporated, recorded in Instrument Number D210032445 (O.P.R.T.C.T.); THENCE North 00 degrees 46 minutes 06 seconds West, with the west line of said Adder Minnis Limited Partnership tract and the east line of said Miller Distributing Fort Worth, Incorporated tract, at 1,381.88 feet passing a City of Fort Worth monument found for the southeast corner of said City of Fort Worth tract of land, at 1,481.78 feet passing a concrete monument found (disk missing) for reference, continuing for a total distance of 1,541.88 feet to the POINT OF BEGINNING and containing 1,177,457 Square Feet (27.031 acres) of land, more or less. 2015 Easement Encroachment Agreement-Commercial Page 10 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom Road Rev. 02/2015 EXHIBIT "A" Maps of Encroachment and Easement 2015 Easement Encroachment Agreement-Commercial Page 11 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom Road Rev. 02/2015 P o P_ HP OHP g 1I NOW d * Allllll,01 Legend g —Ex. SS -- EXISTING SANITARY SEWER LINE Ex• W EXISTING WATER LINE (DOM.) Gx EXISTING GAS LINE '� x — OUL EXISTING OVERHEAD UTILITY LINE i x ' ' ' — OHP PROPOSED OVERHEAD POWER — SS PROPOSED SANITARY SEWER — -EAST ENCROACHMENT AREA N to ,Q; LL E �' X r ` Y 55 rnn VJ �P WWV'IAW 2 ,3 T, jll R.ss� 60 n 1 Mf j V S m M.N.. 4 301dd0 {7 i; w A I • z I 00 ' o M fa F G G G C)s 0 �aar�i IL N .Y j3 Y i F 'v ISIvHa WEST sass ort ENCROACHMENT es 3\ AREA N OO bL• a O jiS u Qa d dH0 dH0 dH0 dH0 PROJECT W.R. MEADOWS EXHIBIT A JASTER-QUINTANILLA DALLAS,LLP OVERALL ENCROACHMENT EXHIBIT 100 CLASS STREET DALLAS,TEXAS 75207 Fj 214.752.4048 JQENG.COM SCALE: REV: 1" = 100' JK,rB NO:311'94 TEXAS REGISTERED ENGINEER FIRM F-1294 Legend EXISTING SANITARY SEWER LINE x. vy ............... EXISTING WATER LINE (DOM.) EXISTING GAS LINE OU- EXISTING OVERHEAD UTILITY LINE 55' R.O.W. OHP — PROPOSED OVERHEAD POWER SS — PROPOSED SANITARY SEWER DEDICATION BY PLAT U-) RklHT OF AfAY EASEMENT ANTERO R"SOURCES PIPELINE, L-P R ;T. NO. 20406-5,917, O.P.R.DJC.T. PROP-6s—E6 EXISTING PROPOSED CHAIN—LINK , CHAIN—LINK FENCE FENCE ENTRANCE 15' 15' SIGN ol R I ncRFH EXISTING 30' PG. b6, t).R.T,C ,k 0 D A I WATER MAIN -F R 4�.8�' 36. 4' 19, 1982 EASEMENT PROPERTY LINE ss— PROPOSED CHAIN—LINKPROPOSED LP/ FENCE STOP SIGN 40' PROP. SANITARY SEWER PROPOSED ESMT 24' SLIDE GATE �Z— Ld PROPOSED GATE CONTROL BOX V) F– UG[—UGE—UGE­ UGE— Elmo PROJECT W.R. MEADOWS Exl-nE�rr F3 JASTER-QUINTANILLA DALLAS,LLP WEST ENCROACHMENT EXHIBIT 100 GLASS STREET DALLAS,TEXAS 75207 P1 214.152.9098 JQENG.COM SCALE: REV: 1" = 40' IQ;06%315M98 TEXAS REGISTERED ENGINEER FIRM F-1294 t Legend EXISTING SANITARY SEWER LINE _ EXISTING WATER LINE (DOM.) j EXISTING GAS LINE EXISTING OVERHEAD UTILITY LINE — OHP — PROPOSED OVERHEAD POWER — SS — PROPOSED SANITARY SEWER EXISTING 55' R.O.W. A DEDICATION CHAIN—LINK 771. BY PLAT N FENCE II EXISTING 30' I % WATER MAIN PROPOSED EASEMENT CHAIN—LINK o FENCE I 4' PP _ � o 1' 4.47' PROPOSED GATE CONTROL BOX I ss ss ss I PROPOSE6 40' PROP. 24' SLIDE GATE1 a- �, I - SANITARY SEWER � o - L_P`EASEMENT PROPOSED ` CHAIN—LINK FENCE7t_ PD . m m PROPERTY I LINE 0 9 15 15' I ■� PROJECT � M � W.R. MEADOWS■r l Oa. 1 XII 1311 C JASTER-QUINTANILLA DALLAS,LLP EAS ENCR� c"��ENr ExH e 100 GLASS STREET DALLAS,TEXAS 75207 P1214.152.9098 1QENG.COM SCAT F. REV: 1" — 40' 1Q:08 N0;3150098 TEXAS REGISTERED ENGINEER FIRM F•1294 EXHIBIT "B" Certificate of Insurance 2015 Easement Encroachment Agreement-Commercial Page 12 of 12 W.R. MEADOWS Inc. 1290 Cantrell-Sansom Road Rev. 02/2015 DATE(MM/DD/YYYY) ,4�®® CERTIFICATE OF LIABILITY INSURANCE 3n12016 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(les) must 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 endomemen s. PRODUCER NAME. Kelly BOrzell0 Arthur J.Gallagher Risk Management Services, Inc. PHONE630-773-3800 FAXNo,,630-285-3922 Two Pierce Place EMAIL .kali borzello a com Itasca IL 60143 y_ @ Jg INSURERS AFFORDING COVERAGE NAIC X INSURERA:LM Insurance Corporation 33600 INSURED WRMEADO-02 INSURER B: W R Meadows, Inc. INSURER C: 300 Industrial Drive Hampshire, IL 60140 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1617776767 REVISION NUMBER: 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR IND WVD POLICY NUMBER MM/DO1YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY TB5Z41437732015 8/1/2015 8/1/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE T RENTED PREMI E Ea occurrence $300,000 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JECT ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ea accident $ ANY OAUTO SCHEDULED BODILY INJURY(Per person) $ ALITSSS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PR PE TY DAMA HIRED AUTOS AUTOS Per acddent $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE ❑NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 1290 Cantrell Sansom Road Fort Worth,TX 76131 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Fort Worth ACCORDANCE WITH THE POLICY PROVISIONS. Planning and Development Department 1000 Throckmorton Street AUTHORIZED REPRESENTATIVE Fort Worth TX 76102 J ( ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD