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HomeMy WebLinkAboutContract 48274 FORTWDRTH,." CITU g GRT Y L �� CONTRACT . - Temporary Street Encroachments Permit: PC16-00016 Application Date: 09/27/2016 Status: Issued Expiration Date: 08/28/2017 Permit Technician: Linda Pedroza Date Issued: 10/04/2016 Address: 815 N COMMERCE ST Legal Description: NORTH FORT WORTH Block 35 Lot41 Mapsco: 62V Insp District: 23 Zoning: TU N-2 Description of Work: SIDEWALK CLOSED TO INSTALL EXTERIOR CONSTRUCTION ELEVATOR, HAVE 2 DUMPSTERS ON THE STREET AND USE FOR APROX 1 YEAR. Proj/Business Name: SHELL CRAFT Applicant: GREG MILLS, Property Owner: SELLERS, JUDY 4112 BIG BEND TRL FORT WORTH, TX 76135 2406 Contractor: Occ Class Const Type Square Feet Occ Load Use Description Temporary Encroachment 10129 $10,128.75 Total Fee $10,128.75 Balance $0.00 1 hereby affirm that the information contained herein is true and correct to the best of my knowledge, and agree to conform to all regulations of the City of Fort Worth as described in the Fort Worth Municipal Code. I understand that failure to comply with these provisions may result in the revocation of this permit. In accordance with the State of Texas Underground Facility Damage Prevention and Safety Act(Utilities Code Chapter 251), 1 hereby affirm that before performing any excavation 16" or deeper using mechanical equipment, have or will have contacted 1-800-545-6005 for proper identification and location of underground utilities in the area. Signed: Date: Sexually Oriented Business (Initials) Yes No Under the Penalty of Law and Pursuant to Senate Bill 509 of the 77th Legislature of the State of Texas, I hereby certify that an asbestos survey has, when applicable, been done in accordance with the Texas Asbestos Health Protection Act(see Texas Occupations Code Section 1954.259)and the National Emission Standards for Hazardous Air Pollutants for the area(s) being renovated and/or demolished. I understand that substantial penalties may result from failure to conduct a proper asbestos survey. All driveway access or street cuts require a separate permit and inspection from the Transportation and Public Works Department (817-392-6526). Signed: Date: TO SCHEDULE INSPECTIONS CALL (817)392-6370 (If Permit is 3rd Party Inspections, contact your designated 3rd Party compan to schedule inspection) OFFICIAL RECORD CITY 3ECRET ARY FX MOI TMT Y X CONSENT AGREEMENT FOR TEMPORARY USE OF PUBLIC PROPERTY STATE OF TEXAS COUNTY OF TARRANT TI-ITS AGREEMENT is made and entered into by and between the City of Fort Worth, a municipal corporation of Tarrant County,Texas, acting herein by and through its duly authorized Building Official, hereinafter referred to as the"City"and Acting by and through its duly authorized agent, G re 1' ,j r Hereinafter referred to as"Grantee". WITNESSETH: For and in consideration of the payment by Grantee of charges set out below and the true and faithful performance of the mutual covenants herein contained, City hereby grants to Grantee permission to temporarily encroach upon, uses and occupy portion of the space under, on and/or above the streets,alleys,sidewalks or other public rights-of-way as follows: CG =4--, o 4 h W� l t- The location and description of said encroachment is more particularly described in Exhibit`B" attached hereto, incorporated herein and made a part hereof for all purposes, 2. All use and occupancy of public street, alleys,sidewalks or other public rights-of-way under this agreement shall he in strict compliance with the Charter, Ordinances and Codes of the City and in accordance with the directions of the Building Official and the Director of Transportation and Public Works of City, i CONSUrr AGREE"EMfer Temporary use of pubic propertyi Coc i i i � r I I 3. i Upon expiration of this agreement and the privileges granted hereunder, there shall be no encroachment by Grantee in, tinder,on or above the surface of the public rights-of-way involved. 4. j Grantee agrees to pay in advance an encroachment fee for the temporary privilege of I encroaching upon a portion of the public rights-of-way as described in Exhibit"B". Said fee is I I calculated in the manner and amounts prescribed by the Building Code of the City of Fort Worth ! I for temporary use or occupancy of public property. The estimate([total amount of said fee is: I dill dolls -- t©� LZ� •�t s i 5. Grantee, at no expense to City, shall make proper provision for the relocation and/or installation of any existing or future traffic control devises or other improvements affected by such encroachment, use and occupancy, including the securing of approval and consent from the appropriate agencies of the State and its political subdivisions. In the event that any installation, }1 i reinstallation, relocation or repair of any existing or future traffic control device or improvement i owned or constructed by or on behalf of the public or at public expense is made more costly by I virtue of the existence of such encroachment and use, Grantee shall pay to City and additional amount equal to such additional cost as determined by City. # i 4 b. The term of this agreement shall be for days,from to�_ 1�, f Provided, however, should the need for the encroachments granted hereunder at any time cease, Z Grantee agrees to immediately notify City of such condition; and, upon receipt of such notice by j the Building Official of the City of Fort Worth,this agreement shall terminate. I 7' ft is expressly understood and agreed that this Consent Agreement is for a temporary encroachment in, under, over and upon the public property as located and described in Exhibit i 2 CONSFNTAGRFFMF.NTrorTemporary use ofpublic propertyt.doc i I I r i i i 3 "B". This agreement shall not be construed as the granting of a permanent easement, encroachment or license upon City's public streets,alleys,sidewalks,or other rights-of-way. S. I City, through its duly authorized representatives, shall have the full and unrestricted right to enter upon all public rights-of-way for the purpose of making inspections to determine I compliance with the terms, covenants and conditions herein. .In the event that any inspection k should reveal a breach of any terms, covenants or conditions herein, City shall give Grantee t notice of such breach. Should such breach not be corrected by Grantee within twenty-four (24) hours of receipt of the notice, or within such shorter period of time as deemed necessary by the i Building Official for the protection of public health or safety, City may terminate and cancel this i agreement. I 9• Upon expiration or termination of this agreement for any reason whatsoever, Grantee shall, at no expense to City, restore the public rights-of-way and adjacent supporting structures to a condition acceptable to the Director of Transportation and Public Works or his duly authorized representative and in accordance with then existing City specifications, and Grantee shall remove all barricades, equipment, supplies, materials or other property from said location. Grantee s further covenants and agrees that for a period of oite(1)year after the termination of this Consent Agreement, Grantee will repair all conditions or damages to the streets and sidewalks or other rights-of-way that have resulted from Grantee's use or occupancy of the streets and sidewalks or other rights-of-way, as determined by the Director of Transportation and Public Works or his designee. Grantee agrees to begin such repairs within thirty(30) days of receipt of notice froin j i the Director of Transportation and Public Works or his designee. All repairs shall be performed in an expeditious and workmanlike manner and shall comply with all applicable laws, codes, If ordinances and City specifications. In the event that Grantee fails to comply with the covenants herein contained with respect to such removal or restoration, the City shall have the right to remove or dispose of any barricades, equipment,supplies, materials or other property and repair any conditions which in the opinion of the City are necessary to bring the public rights-of-way to the condition prescribed herein, and City shall not be responsible for trespass or any other damage or liability in connection with such removal or restoration. Grantee shall reimburse City for the cost and expense of such removal and/or repairs immediately following billing for same by City. It i i 3 MNSENT AGREEMENTfor Tempwry use of PtIUic propenyl AOC '+ i i f I Nothing herein shall be construed as a waiver by City to enforce penal sanctions prescribed by the Code of the City of Fort Worth and the laws of the State of Texas for Grantee's continued j I encroachment upon the public rights-of-way following termination of this Consent Agreement. 10. I It is further understood and agreed between the parties hereto that City holds the city streets, alleys, sidewalks and other public rights-of-way, including the portions of such streets used and encroached upon as described herein, as trustee for the public; that City exercises such powers ! over the streets as have been delegated to it by the Constitution of the State of Texas or by the ! Legislature; and the City cannot contract away its duty and its legislative power to control the 1 streets for the use and benefit of the public. It is accordingly agreed that if the governing body of City, to wit, its City Council, shall at any time during the term hereof determine in its sole discretion to use or cause or permit to be used for any public purpose the said encroached portion of the sheets, then this agreement shall be automatically canceled and terminated. 11. Grantee 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 , ofsaid encroachments and uses. 12. Grantee agrees to pay promptly when due all fees, taxes or rentals provided for by this agreement or by any federal,state or local statue, law or regulation. f i 13. t Grantee covenants and agrees that it shall exercise all rights and privileges granted hereunder i as an independent contractor, and not as an officer, agent, servant or employee of City; that Grantee shall have exclusive control of and the exclusive right to control the details of its operations and activities on said described public property 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; that the doctrine of respondeat superior shall not apply as between City and Grantee, its officers, agents, servants, employees, contractors and subcontractors, and nothing herein shall be construed as creating a partnership or joint enterprise I between City and Grantee. 4 CONSENT AGREEMENTfor Temporary use of public propertjl.doc i I I I I i t 14. l GRANTEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY INDEMIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS FOR PROPERTY DAMAGE OR LOSS AND/OR PERSONAL INJURY, f CNCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN f CONNECTION WITH, DIRECTLY OR INDIRECTLY, THE MAINTENANCE, OCCUPANCY, USE, EXISTENCE OR LOCATION OF SAID ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT CAUSE, IN WHOLE OR PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES OR INVITEES OF CITY; AND GRANTEE HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY, ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, FOR SUCH CLAIMS OR SUITS. GRANTEE SHALL LIKEWISE ASSUME ALL LIABILITY AND RESPONSIBILITY AND SHALL INDEMNIFY CITY FOR ANY AND ALL INJURY OR C DAMAGE TO CITY PROPERTY, ARISING OUT OF OR IN CONNECTION WITH I ANY AND ALL ACTS OR OMISSIONS OF GRANTEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICESNEES, l INVITEES OR TRESPASSERS. j i i l 15. E Grantee agrees to fiu'nish City with a Certificate of Insurance, naming City as certificate i holder, as proof that it has secured and paid for a policy of public liability insurance covering all I public risks related to the proposed use and occupancy of public property as located and described in Exhibit"13". The amounts of such insurance shall be not less that the following; i Property damage, per occurrence $100,000.00 ! Bodily injury, per person $250,000.00 i r Bodily injury or death, per occurrence $500,000.00 With the understanding of and agreement by Grantee that such insurance amounts shall be revised upward at City's option and that Grantee shall so revise such amount immediately following notice to Grantee of such requirement. Such insurance policy shall provide that it cannot be canceled or amended without at least thirty(30) days' prior written notice to the Building Official i I 5 CONSENT AGREEMENTfor Temporary use of public prope0/1 doc i l f t r i I of the City of Fort Worth. A copy of such Certificate of Insurance is attached as Exhibit "A". Grantee agrees to submit a similar Certificate of Insurance annually to City on the anniversary date of the execution of this agreement. Grantee, agrees, binds and obligates itself, it successors and assigns, to maintain and keep in I force such public liability insurance at all times during the term of this agreement and until the removal of all encroachments and the cleaning and restoration of the city streets. All insurance coverage required herein shall include coverage of all Grantee's contractors. I 16. Grantee covenants and agrees that it will not assign all or any of its rights, privileges or duties under this contract without prior written approval of City, and any attempted assignment without such prior written approval shall he void. I� f , 17. This agreement shall be binding upon the parties hereto,their successors and assigns. 4 18. Should any action, whether real or asserted, at law or in equity, arise out of the terms and conditions of this agreement or out of the use and occupancy of City property as permitted f hereunder, venue for said action shall be in Tarrant County, Texas. i { 19. In any action brought by City for the enforcement of the obligations of Grantee, City shall be I entitled to recover interest and reasonable attorneys' fees. 1 . EXECUTED thisda of Q 'x.�— , 200`f f Y 11_ _ i r GRANTOR: GRANTEE: III CITY OF FORT WORTH S hal C4: ding Official 1 Title I I 1 6 CONSENT AGREEMENTfor Temoerary use of public propeW.doc ' I � I r APPROVED TO FORivt AND I RCYA LITY: A)NQ I leo Assistant City Attorne Date i ity Secr t y Date I j g ®( . 00 d� o 0 a 0, A� i i i ti I ; i i i i l ' I i ' FOFFICIALRECORDARY TX ► f 7 CONSENT AGREEMENTfcr Temporary use of public properfyl.coc i i i STATE OF TEXAS COUNTY OF TARRANT I BEFORE ME, the undersigned authority, a Notary Public in and F r the State of Texas on this clay personally appeared LP-4-Nsa ,Icnojvn tome to be the person whose name is su scribed to the foregoing instrument, and acknowledged to me that he/she executed the same for the purposes rind consideration therein i expressed, as the act and deed of i and in the capacity therein stated. GIVEN NDER MY HAND ND SEAL OF OFFICE this o�& day ? of ��t f , 20 , I C� I I Affiant I Title �� y ..E.Gy ftp<wy PLlel/•G(�9/// l otary Publi in and fo f { The State of Texas i i 8 } e (; i i i I i i f t i i 1 I � 4 STATE OF TEXAS COUNTY OF TARRA NT E � BEFORE 11NIE, the undersigned authority, a Notary Public in and FLnthe Stateis clay personally appeared �j�.&J gutw ,known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to file i that he/she executed the same for the purposes and considerattop therein expressed, as the act and deed of and in the capacity therein stated. i &iY7 ER MYHANDtVD SEAL OF OFFICE this day 0j, f ff( I e II Plant 1 �U ll.t�tw+G. � �MlwltST�.q"IDIZ '+ Title I� I No ar �Iic �andfo �� ! j The State of Texas j i R G NAREZ PUg�, NotaryPublic State of Texas 1�OF Pg Comm.Exp W10.2017 Notary ID 123982388 ! i if 9 I E r Contractors Name: Point of Contact: Phone Number: Building Permit Number: Purpose for Closure: Begin Date: _ End Date: Type of Taper according to posted speed limit.- Tapers imit:Tapers @ 30 NTH.1Oft Offset,150'minimum Tapers @ 35 MPH,loft Offset,aO5'minimum Tapers @ 40 MPH,IOfft Offset,a65' urn 1 i W d i _r� FFZ —` Z77 JI X l �n� i (pt S t4c\OtL`� Ni i A16. 08/03 R CERTIFICATE OF LIABILITY INSURANCE D /DD/YIYY) 08/03/2016 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 FBELOW. 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 endorsement(s). PRODUCERNCONAMENracr DAVID P.REED SIG/BRIDIE&ASSOCIATES PHONE IA/4sNe,E&I940 668-0436 FAX NO: 940-668-0469 305 EAST CALIFORNIA STREET,SUITE A — - E-MAIL DAVID.REED S ADDRESS: ._. _ � IG4YOU.COM GAINESVILLE,TX 76240 940-668-0436 INSUR_ERf S)AFFORDING COVERAGE NAIC# _- - -INSURER A-:--COLONY INS.CO. INSURED - - ___ INSURERS: NATIONAL GENERAL SHELL CRAFT, LLC —_-,_ -INSURER-C:ERC ASSOCIATED INTERNATIONAL INSURANC 2445 STADIUM PLACE -- INSURER D ARLINGTON,TX 76006 __ INSURERE:_ INSURER F COVERAGES CERTIFICATE NUMBER: 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. INSRADDL SU- BR7 ---- _ _ LTR TYPE OF INSURANCE POLICY NUMBER MMD Y imminnivywi LIMITS A }( I COMMERCIAL GENERAL LIABILITY 103GL00678601 110/21/2016110/21/20161 EACHOCCURRENCE S 1,000,000 CLAIMS-MADE X OCCURI DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 — -- I ED EXP(Any one person) s 10,000 "— — PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE s 2,000,000 �l POLICY I X PRO-- r LOC JECT PRODUCTS-COMP/OP AGG $ 2,000,000 ^~OTHER: S B AUTOMOBILE LIABILITY - 2002937729 12/14/2015 2/14/2016 COMBINED SINGLE LIMIT ANY AUTO I ' Ea accident) $ 1 r000,O00 AALL UTOS OWNED X SCHEDULED 4 I I BODILY INJURY(Per person) $ AUTOS ( BODILY INJURY(Per accident) S NON-OWNED I ( --- X HIREDAUTOSAUTOS I PRO 'X+t PERTY DAMAGE (LPeraccident) $ $ C X UMBRELLA LIAB EACH OCCURRENCE $ 5,000,000 � � � X09/05/2016 i EXCESS LIAB - -------- OCCUR OBW6103415 09/05/2015 AGGREGnTE $ 5,000,000 CLAIMS-MADE DED RETENTION$ $ — WORKERS COMPENSATION PER OTH- j AND EMPLOYERS'LIABILITY Y!N I I i �_ STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEtE.L.EACHACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑I N/A _ (Mandatory in NH) LE.L DISEASE-EA EMPLOYEE $ If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I i i DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT,SUBJECT TO THE POLICY TERMS,CONDITIONS AND EXCLUSIONS PER BLANKET ADDITIONAL INSURED ENDORSEMENT CERTIFICATE HOLDER CANCELLATION CITY OF FORT WORTH P&D PARKWAY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 THROCKMORTON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FORT WORTH,TX 76102 AU THORZED"REPRESS NTATI VE "` ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AC40R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DO(YYYY} 09/19(2016 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: H the certificate holder Is an ADDITIONAL INSURED,the policy(Les)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). PRODUCER CONTACT DAVID P. REED NAME: SIG/BRIDLE&ASSOCIATES PH ryo,Ext}; 940-668-0436 (AA,No}; 940-668-0469 305 EAST CALIFORNIA STREET,SUITE A ADDRESS: DAVID,REED@SIG4YOU,COM GAINESVILLE,TX 76240 INSURER($)AFFORDING COVERAGE NAICp 940-668-0436 INSURER A: COLONY INS,CO. INSURED INSURER B: NATIONAL GENERAL SHELL CRAFT, LLC INSURER I- ASSOCIATED INTERNATIONAL INSURANCE 2445 STADIUM PLACE INSURER D: ARLINGTON,TX 76006 INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 1 H INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT" TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THF TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR',. TYPE OF INSURANCE ADOL,W D POLICY NUMBER MMtDD(YYYY MM DDIYYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY 103GL000678602 10/21/2016'10/21/2017. EACH OCCURRENCE '..$ 1,000,000 DAMAGE IORENIED 100,000 C�.1:�r5 MADE OCCUR PREMISES(Ea occurrence). $ MEC EXP{Any one person) $ 10,000 PERSONAL s ADV INJURY S 1,000,000 CEN',AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PO:.EGY X PE T LOC PRODUCTS COMP�OP AGG S 2,000,000 _ OTHER' B AUTOMOBILELIABILITY 2002937729 12/1412015,12/14/2016:co"BINED1 SINGLE LIMIT $ 1,000 000 _.,ANY AUTO BODILY INJURY(Per person,) ,..5 _ OWNED xSCHEDULED Boni:Y INJURY(Per accidcnQ S AUTOS ONLY ;AUTOS X EARED x. NON-OWNED PROPERTY DAMAGE -,, -- AUTOS ONLY _ AUTOS ONLY ',.(Per accidrrd) C X UMBRELLA LIAR OCCUR XOBW6753916 09/05/2016 09/051201 7'.EACH OCCURRENCE 5 5,000,000 :f EXCESS LIAB CLAIMS MADE AGGREGATE $ 5,000,000.._ DED RETENTION$ $ WORKERS COMPENSATION PER : OTH- _AND EMPLOYERS`LIABILITY YIN STATUTE ER ANl'PROPRiETORIPARTNER/EXECtJTIVF [:] NlA: E EACHAGG,!DF,NT $ C,PFICER%hdE61EEREXCLUDED; -_.. -. !,(Mandatory in NH) E.L DISEASE-EA EMPLOYEE S It yes describe un<:er _.... DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS i LOCATIONS(VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT,SUBJECT TO THE POLICY TERMS, CONDITIONS AND EXCLUSIONS PER BLANKET ADDITIONAL INSURED ENDORSEMENT CERTIFICATE HOLDER CANCELLATION CITY OF FORT WORTH P&D PARKWAY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1000 THROCKMORTON ACCORDANCE WITH THE POLICY PROVISIONS. FORT WORTH,TX 76102 AUT HOBFZECI'RPRESgNTATIVE _ r Oc 1988-2015 ACORD CORPORATION. Ail rights reserved, Arnon-,tz r,)naelnot Tt. Arnon „,. L. „t:Arnon