HomeMy WebLinkAboutContract 48437 CITY SECTARY pj5`7
FORTWORTH., CO14TUCT 140.
Temporary Street Encroachments
Permit: PC16-00017 Application Date: 11/10/2016
Status: Issued Expiration Date: 12/05/2016
Permit Technician: Linda Pedroza Date Issued: 11/11/2016
Address: 2401 NW MAIN ST
Legal Description:
Mapsco: undefined Insp District: undefined Zoning: undefined
Description of Work: OCCUPYING NW 24TH ST LANE SPACE AND GRASSY RIGHT OF WAY AND SIDEWALK
.FOR TRASH CONTAINERS
Proj/Business Name: HERO RE CONSTRUCTION LLC
Applicant: DARYL WINDLAND,
Property Owner:
Contractor: ,
Occ Class Const Type Square Feet Occ Load Use Description
Temporary Encroachment 473 $472.50
Total Fee $472.50
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, I
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 company to schedule inspection
OFFICIAL-RE�00
CITY SECRETARY
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CONSENT AGREEMENT
FOR 1
TEMPORARY USE OF PUBLIC PROPERTY
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STATE OF TEXAS
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COT JNTY OF TARRANT
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THIS 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, bard 1 I ,U I n d I AND
Hereinafter referred to as"Grantee".
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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:
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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 f
and in accordance with the directions of the Building Official and the Director of Transportation
and Public Works of City,
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CONSENT ACREEPAENTfor Temporary use of pubVc propertyl.doc ,
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Upon expiration of this agreement and the privileges granted hereunder, there shall be no
encroachment by Grantee in,under,on or above the surface of the public rights-of-way involved. ( €
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Grantee agrees to pay in advance an encroachment fee for the temporary privilege of F
encroaching upon a portion of the public rights-of-way as described in Exhibit"B". Said fee is
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calculated in the manner and amounts prescribed by the Building Code of the City of Fort Worth l
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for temporary use or occupancy of public pis rty. The estimated total amount of said fee is: ! t
5o AIL 6 ,15 x xi2-) 3&oya 1 113 �
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Grantee, at no expense to City, shall make proper provision for the relocation and/or
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installation of any existing or future traffic control devises or other improvements affected by 1
such encroachment, use and occupancy, including the securing of approval and consent from the E{{rf
appropriate agencies of the State and its political subdivisions. In the event that any installation,
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reinstallation, relocation or repair of any existing or future traffic control device or improvement E
owned or constructed by or on behalf of the public or at public expense is made more costly by
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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. _ _ 4�
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The term of this agreement shall be for_jt_ days,from to 10c_ S lAa
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Provided, however, should the need for the encroachments granted hereunder at any time cease, {
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Grantee agrees to immediately notify City of such condition; and, upon receipt of such notice by
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the Building Official of the City of Fort Words,this agreement shall terminate.
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It 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
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CONSENT AGREEMFNTrnr Temporary use of public propertyl.doc
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"B". This agreement shall not be construed as the granting of a permanent easement,
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encroachment or license upon City's public streets,alleys, sidewalks,or other rights-of-way.
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City, through its duly authorized representatives, shall have the full and unrestricted right to
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enter upon all public rights-of-way for the purpose of making inspections to determine
compliance with the terms, covenants and conditions herein. In the event that any inspection j
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should reveal a breach of any terms, covenants or conditions herein, City shall give Grantee
notice of such breach. Should such breach not be corrected by Grantee within twenty-four (24)
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hours of receipt of the notice, or within such shorter period of time as deemed necessary by the
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Building Official for the protection of public health or safety, City may terminate and cancel this
agreement.
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Upon expiration or termination of this agreement for any reason whatsoever, Grantee shall, at j
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no expense to City, restore the public rights-of-way and adjacent supporting structures to a
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condition acceptable to the Director of Transportation and Public Works or his duly authorized
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representative and in accordance with then existing City specifications, and Grantee shall remove
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all barricades, equipment, supplies, materials or other property from said location. Grantee i
further covenants and agrees that for a period of one (1)year after the termination of this Consent
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Agreement, Grantee will repair all conditions or damages to the streets and sidewalks or other j
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
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designee. Grantee agrees to begin such repairs within thirty (30) days of receipt of notice from 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,
ordinances and City specifications.
fn 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,
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CONSENT AGREEMENTfor Temporary use of public properbft.doc
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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
encroachment upon the public rights-of-way following termination of this Consent Agreement.
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It is further understood and agreed between the parties hereto that City holds the city streets, i
alleys, sidewalks and other public rights-of-way, including the portions of such streets used and j
encroached upon as described herein, as trustee for the public; that City exercises such powers E`
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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
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 daring the term hereof determine in its sole
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discretion to use or cause or permit to be used for any public purpose the said encroached portion i
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of the streets,then this agreement shall be automatically canceled and terminated,
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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
of said encroachments and uses. i
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Grantee agrees to pay promptly when due all fees, taxes or rentals provided for by this f
agreement or by any federal,state or local statue, law or regulation.
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Grantee covenants and agrees that it shall exercise all rights and privileges granted hereunder
as an independent contractor, and not as an officer, agent, servant or employee of City; that
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Grantee shall have exclusive control of and the exclusive right to control the details of its r
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operations and activities on said described public property and all persons performing same, and
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shall be solely responsible for the acts and omissions of its officers, agents, servants, employees,
contractors, subcontractors, licensees and invitces; 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
beriveen City and Grantee.
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CONSENT AGREEMENTfor Temporary use of public prooertyl.doc
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GRANTEE COVENANTS AND AGREES TO INDENINIFY, AND DOES HEREBY
INDEMI MY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS, AGENTS,
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SERVANTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR
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SUITS FOR PROPERTY DAMAGE OR LOSS AND/OR PERSONAL INJURY,
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CNCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN €
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, EIVIPLOYE ES,
CONTRACTORS, SUBCONTRACTORS, LICENSEES OR INVI`T'EES 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 {
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RESPONSIBILITY AND SHALL INDEMNIFY CITY FOR ANY AND ALL INJURY OR i
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DAMAGE TO CITY PROPERTY, ARISING OUT OF OR IN CONNECTION WITH
ANY AND ALL ACTS OR OMISSIONS OF GRANTEE, ITS OFFICERS, AGENTS, {
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SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICESNE ES,
INVITEES OR TRESPASSERS. 1
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15.
Grantee agrees to furnish City with a Certificate of Insurance, naming City as certificate {
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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"B". The amounts of such insurance shall be not less that the following; j
Property damage,per occurrence $100,000.00
Bodily injury, per person $250,000.00
Bodily injury or death,per occurrence $500,000.00 i
With the understanding of and agreement by Grantee that such insurance amounts shalt 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
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CONSENT AGREEMENTfor Tempo,ar/use of public propertyi.dor j
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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
force such public liability insurance at all times during the term of this agreement and until the
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removal of all encroachments and the cleaning and restoration of the city streets. All insurance j
coverage required herein shall include coverage of all Grantee's contractors_ }
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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.
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This agreement shall be binding upon the parties hereto,their successors and assigns.
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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
hereunder,venue for said action shall be in Tarrant County,Texas.
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In any action brought by City for the enforcement of the obligations of Grantee, City shall be 1{
entitled to recover interest and reasonable attorneys' fees.
EXECUTED this day of JAL
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GRANTOR: GRANTEE:
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CITY OF FORT WORTH
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Building Official
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6 CONSENT AGREEMENTfor Temporary use of public properfyt.doe
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APPROVED TO FORMI AND LEGALITY:
Assistant Agtto Date
Ci Seerretar Date
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[OFFICIAL RECORD
CITY
CITY SECRETARY
FT.WORTH,TX
CONSENT AGREEME"or Temporary use of public propertyl.doc
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STATE OF TEXAS
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COUNTY OF TARRANT
BEFORE AIE, the undersigned authority, a Notary Puhlic in and
r l e State of Tex , on this slay personally appeared F
,known to nae to he the person whose €
ne su sca bed Ice fo going instrument, and acknowledged to me
that he/she executed the same for•th purposes anq consideration therein
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expressed, las the act and deed of I J A 4 d,4
and in the capacity therein stated.
,-GLIVEN UNDER /VY MA ND AND SEA L OF 0FFICE this —11 ay
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Affiant
Title
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�,��,pYPUB�, ! OtlLr rallllC i llil fOa' t
"r Notary Public The State of Texas
* * State of Texas
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goFPg Comm.Exp 09.10-2017 }
Notary ID 123982388 €
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STATE OF TEXAS
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COUNTY OF TARRANT
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BEFORE ME, the undersigned authority, a Notary Public in and v
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For the State of Texas, on this day personally appeared D/a ig
4/1//A)0i_A&0 ,known to me to be the person whose f
name is subscriber)to the foregoing instrument, and acknowledged to nae
that he/she executed the sante forthe p rrposes and consideration therein
expressed, as the act and deed of�y 4F cQ,,-!�Aotyc
and in the capacity therein stated.
,�, ��rr rINDE MY HAND AND SEAL OF OFFICE th is day I
of /I.UVV155 g
Affiant
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Title "
Y . Na�1RIfPl�x 1g oTheStat
c n a�r.d for
Texas `
1DTARYDf�89A781� •� �
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ACID ® TIFIT LI ILITY INSU NC oATE(MM/DDIYYYY,
11/08/2016
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: If the certificate holder Is an ADDITIONAL INSURED,the policy(fes)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 endorsemen s.
PRODUCER coNTacT Ed ar Munoz Posadas
Enterprise Insurance Group, LLC PHONE (813)448-9222 Fn X o:(813)448-9244
12320 Racetrack Road IMAIL
ADDRESSV Tampa,FL 33626 alox@ontorprisainsgroup.com
License#- 1767192 INSURER(M AFFORDING COVERAGE MAIC#
INSURER A: Amtrust International Underwriters
INSURED INSURER B
Hero Reconstruction LLC INSURER C:
616 E.Byron Nelson Blvd Ste 66 INSURER 0:
Roanoke,TX 76262 INSURER E:
INSURER :
COVERAGES CERTIFICATE NUMBER: 00000000-34600 REVISION NUMBER: 4
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.
INSR1 ADDL TYPE OF INSURANCE B POLICY NUMBER POLICY EFF POLICY EXP LIMITS
A X COMMERCIAL GENERAL LIABILITY Y DSI 1267861 00 1110412016 11/0412017 EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE ®OCCUR 0 E T R N S 1.000
MED EXP(Any oneperson) S 6,000
PERSONAL BADVINJURY $ 11000,000
GENL AGGREGATE LINT APPLIES PER: GENERAL AGGREGATE $ Z 000 000
X POLICY❑JECT LOC PRODUCTS-COMP/OPAGG 5 2,000,000
OTHER: S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANYAUTO BODILY INJURY(Per person) S
ALLOOSNE0 SCHEDULED BODILYINJURY(Per aoddenq S
OS
NONAVINED PROaPERdTY DAMAGE S
HIREDAUTOS AUTOS
5
UMBRELLA LUIB OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE $
OED I I RETENTIONS $
WORKERS COMPENSATION I PTR DTH•
AND EMPLOYERS'LIABILITY YIN
A UTE I
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? N f A
(MandstoryIn NH) E.L.DISEASE•EA EMPLOYE S
"A
desaibe under
DE CRI ON un OPERATIONS below E.L.DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VENICLES(ACORD 101,Additional Remarks Schedule,may be attached If mora space is required)
City of fort worth Texas its officers and employees are named Additional Insured as respects to the General Liability Policy.
Endorsement is attached.*10 Day Notice in the Event of non-payment of premium.30 day notice for any other reason.
Property damage per occurrence $100,000,Bodily injury per occurrence$250,000,Bodily injury or death per occurrence.$
500,000 limits are included within the$2,000,000 general agregate.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TPW Street Permit Center THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of fort worth ACCORDANCE WITH THE POLICY PROVISIONS.
311 W. 10th St.
Fort Worth,TX 76102 AUTHORIZED REPRESENTATIVE
EMP
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD
Printed by EMP on November 08,2016 at 10:17AM
Contractors Name:
point of Contact:10A 1 WIA)41 LA/U
phone Number: LI
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Building permit Number:
purpose forClos e: 'T �4 ttx �5
Begin Date: III End Date: t l S 1 ri
Type of Taper according to posted speed limit:
Tapers @ 30 NTH,I Oft Offset,150`minimum
coke Tapers @ 35 MRH,1Oft Offset,a05'minimnm
Tapers @ 40 NPH,IOft Offset,ab5'minimum
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Contractors Name:WW M0 ht'q'
Point of Contact:.00 i IN/NO LA/U
Phone Number: 17 Z 3
Building Permit Number:
Purpose forClos . .-IL,4�m CErn 1-CA u.r
Begin Date: _ --___'o_End Date: t L
Type of Taper according to posted speed limit:
`�� Tapers @ 30 MPH.1 Oft Offset, 150'minimum
Tapers @ 35 MPH,loft Offset,2.05'minimum
Tapers @ 40 MPH,l Oft Offset,0-65'minimum
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