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HomeMy WebLinkAboutContract 48547 ro7 89 ly r CITYSECRETARY VL b 9 CONTRACT No. r JAN a y RIGHT OF WAY y CI;ryoFr� �j ENCROACHMENT AGREEMENT �IiYS�� frARR%l (COMMERCIAL) v w py AGREEMENT is made and entered into by and between the City of Fort ome rule municipal corporation of Tarrant County, Texas ("City"), acting herein by and through its duly authorized City Manager, its duly authorized Assistant City Manager or Planning and Development Department Director, and The Southwestern Baptist Theological Seminary, a Texas not for profit "Licensee", acting herein by and through its duly authorized Vice President for Business Admininstration[title], the owner of the real property located at 2001 W Seminary Drive, Fort Worth, Texas 76115 ("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 street, alley, sidewalk, and/or other public right-of- way (individually or collectively, the"Public Right-of-Way") adjacent to 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 Public Right-of-Way; 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: OFFICIAL.RECORD AGREEMENT CITY SECRETARY 1 FT.WORTH,TX City, in consideration of the payment by 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, use and/or occupy portions of the space under, on, and/or above the City's Public Right-of-Way to construct/install and/or allow to remain, certain improvements for the purpose of constructing a concrete block retaining wall (whether one or more, the "Improvements") as described in and at the location shown on Exhibit "A" but only to the extent shown thereon. Upon completion of the Improvements, Licensee agrees to be responsible for maintaining the Improvements. Licensee shall not expand or otherwise cause the Improvements to further infringe in or on City's Public Right-of-Way beyond what is specifically described in the Exhibit(s) attached hereto. 2015 ROW Encroachment Agre e -Commercial Page 1 of 12 rev. 02/2015 2. All construction, maintenance and operation in connection with such Improvements, 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 City's Director of Transportation and Public Works, 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 Improvements. Licensee shall not commence construction of the Improvements 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 completion of the construction and installation of the Improvements, there shall be no other encroachments in, under, on or above the surface area of the Public Right-of-Way, except as described herein and depicted on Exhibit"A". 4. Licensee, at no expense to the City, shall make proper provisions for the relocation and installation of any existing or future utilities affected by such encroachment, use and occupancy, including the securing of approval and consent from any affected utility companies and the appropriate agencies of the State of Texas and its political subdivisions. 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 such encroachment and use, Licensee shall pay to City an additional amount equal to such additional cost as determined in the reasonable discretion of the Director of Transportation and Public Works, or his or her duly authorized representative. 5. 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 Improvements 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 2015 ROW Encroachment Agreement-Commercial Page 2 of 12 rev. 02/2015 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 Improvements 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. 6. Licensee agrees to pay to City at the time this Agreement is requested an application fee of$325.00 in order to defray all costs of inspection and supervision which City has incurred or will incur as a result of the construction, maintenance, inspection or management of the encroachments and uses provided for by this Agreement. Licensee agrees to pay a fee in the amount of$.56 per square/linear foot of the encroachment area upon execution of this Agreement and annually thereafter. 7. 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 within 30 days after written notice specifying the same, or having so commenced,thereafter fails to proceed diligently and with continuity to remedy same. 8. Upon termination of this Agreement, Licensee shall at no expense to City remove the Improvements encroaching into the Public Right-of-Way, and restore the Public Right-of-Way to a condition acceptable to the Director of Transportation and Public Works, or his or her duly authorized representative, in accordance with then-existing City specifications. It is understood and agreed by Licensee that if this Agreement terminates and Licensee fails to remove the Improvements and restore the Public Right-of-Way, Owner hereby gives City permission to remove the Improvements along with any supporting structures, restore the Public Right-of-Way, and assess a lien on the Property for the costs expended by the City in taking such actions. 9. It is further understood and agreed between the parties hereto that the Public Right-of-Way 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 public right-of way as have been delegated to it by the Constitution of the State of Texas or by the Texas 2015 ROW Encroachment Agreement-Commercial Page 3 of 12 rev. 02/2015 Legislature; and that City cannot contract away its duty and its legislative power to control the Public Right-of-Way 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 Public Right-of-Way to be used for any other public purpose, including but not 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 this Agreement shall terminate upon 60 days' written notice to Licensee. In the event this Agreement is terminated under this Section 9, Licensee shall perform the obligations regarding removing the Improvements and restoring the Public Right-of-Way described in Section 8. 10. Licensee agrees and acknowledges that this Agreement is solely for the purpose of pennitting Licensee to construct, maintain and locate the Improvements over or within the described Public Right-of-Way and is not a conveyance of any right, title or interest in or to the Public Right-of-Way nor is it meant to convey any right to use or occupy any property in which a third party may have an interest. Licensee agrees that it will obtain all necessary permissions before occupying such property. 11. 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 Improvements, encroachment and uses. 12. 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. 13. 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. 14. 2015 ROW Encroachment Agreement-Commercial Page 4 of 12 k-15— rev. 02/2015 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 IMPROVEMENTS AND ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY ALLEGED 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 ANY AND ALL INJURY OR DAMAGE TO CITY PROPERTY ARISING OUT OF OR IN CONNECTION WITH THE IMPROVEMENTS AND ANY AND ALL ACTS OR OMISSIONS OF LICENSEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, INVITEES, OR TRESPASSERS. 15. 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 described or depicted 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 promptly 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 all encroachments and the cleaning and restoration of the Public Right-of-Way. All insurance coverage required herein shall include coverage of all Licensees' contractors and subcontractors. 2015 ROW Encroachment Agee -Commercial Page 5 of 12 rev. 02/2015 16. Licensee agrees to deposit with the City when this Agreement is executed a sufficient sum of money to be used to pay the 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. 17. 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. 18. Licensee covenants and agrees that it will not assign all or any of its rights, privileges or duties under this Agreement without the prior written approval of the 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 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. 19. THE PARTIES AGREE THAT THE DUTIES AND OBLIGATIONS CONTAINED IN PARAGRAPH 8 SHALL SURVIVE THE TERMINATION OF THIS AGREEMENT. 20. 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. 21. This Agreement shall be binding upon the parties hereto, their successors and assigns. 2015 ROW Encroachment Agreement-Commercial Page 6 of 12 1� rev. 02/2015 [SIGNATURES APPEAR ON FOLLOWING PAGE] 2015 ROW Encroaclunent Agreement-Commercial Page 7 of 12 " ,; 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 OF FORT WORTH, SOUTHWESTERN BAPTIST THEOLOGICAL SEMINARY By: By: �.t..� Randle Harw od Kevin D. Ensley Director Vice President Planning and Development Department Business Administration Date: lei , 2011 ATTEST: Approved As To Form and Legality City Secreta i OF PAssistant City Attorney Al O � OFFICIAL RECORD CITY SECRETARy Ft WORrNP rX 2015 ROW Encroachment Agreement-Commercial Page 8 of 12 ,r" rev.02/2015 Contract Compliance Manager: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. D e: J ie Wdsternian Development Manager STATE OF TEXAS § COUNTY OF TARRANT § This instrument was acknowledged before me o�-rmv ' 201r7 by Randle Harwood, Director of the Planning an evelopment De rtment f the City of Fort Worth, on behalf the City of Fort Worth. CASSANDRA F. FOREMAN N ublic State o exas r'-01 �= Notary Public,State of Texas ' My Commission Expires April 26, 2011 After Recording Return to: Cassandra Foreman Planning and Development Department 1000 Throckmorton Street Fort Worth TX, 76102 2015 ROW Encroachment Agreement-Commercial Page 9 of 12 TI�S" rev. 02/2015 — STATE OF TEXAS § COUNTY OF TARRANT § BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas, on this day personally appeared Kevin D. Ensley, Vice President of Business Administration, 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 Southwestern Baptist Theological Seminary, a Texas not for profit, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this z 8 'day of C-42016. ,a""�., SANDY D. MANN �O re��Fr lue'% 3e; CS Notary Public,State of texas comrfl.Expires 02-01.2019 Notary Publi and for the ofo� `;s`°' Notary I® 12E50969! ,g. State of Texas 2015 ROW Encroachment Agreeme`ntt-Commercial Page 10 of 12 �,G rev. 02/2015 LEGAL DESCRIPTION OF THE PROPERTY BEING Lot 1, Block 8R, Seminary Hill Addition, an addition to the City of Fort Worth according to the plat recorded in Instrument No. D210203297 of the Official Public Records of Tarrant County, Texas. 2015 ROW Encroaclunent Agreement-Commercial Page 11 of 12 rev. 02/2015 EXHIBIT "A" Location and Description of Encroachment and Improvements i i 2015 ROW Encroachment Agreement-Commercial Page 12 of 12 -- — � rev. 02/2015 EXHIBIT "A" RIGHT-OF-WAY ENCROACHMENT Part of W Spurgeon Street, Seminary Hill Addition Maria Arocha Survey, Abstract No. 1 City of Fort Worth, Tarrant County, Texas DESCRIPTION, of a 221 square foot(0.005 acre) tract of land situated in the Maria Arocha Survey, Abstract No. 1, City of Fort Worth, Tarrant County, Texas; said tract being part of W Spurgeon Street (a 60-foot wide right-of-way) dedicated by the plat of Seminary Hill Addition, an addition to the City of Fort Worth according to the plat recorded in Volume 310, Page 45 of the Map Records of Tarrant County,Texas; said 221 square foot tract being more particularly described as follows (bearing system for this survey is based on the Texas State Plane Coordinate System - NAD 83, North Central Zone 4202, based on observations made on April 26th, 2012 with an applied combined scale factor of 1.00012): COMMENCING, at a 1/2-inch iron rod with "PACHECO KOCH" cap found at the most northerly northeast corner of Lot 1 R, Block 4R, Seminary Hill Addition, an addition to the City of Fort Worth according to the plat recorded in Instrument No. D214159799 of the Official Public Records of Tarrant County, Texas; said point also being at the west end of a right-of-way corner clip at the intersection of the south line of said W Spurgeon Street and the west right-of- way line of Townsend Drive (a 60-foot wide right-of-way); from said point a 1-inch iron rod found bears South 89 degrees, 09 minutes, 14 seconds West, a distance of 155.00 feet; THENCE, North 00 degrees, 50 minutes, 46 seconds West, departing the said north line of W Spurgeon Street, a distance of 60.00 feet to a point in the south line of Lot 1, Block 8R, Seminary Hill Addition, an addition to the City of Fort Worth according to the plat recorded in Instrument No. D210203297of the said Official Public Records, and the north line of said W Spurgeon Street; THENCE, South 89 degrees, 09 minutes, 14 seconds West, along the said south line of Lot 1 and the said north line of W Spurgeon Street, a distance of 53.33 feet to the POINT OF BEGINNING; said point being the beginning of a non-tangent curve to the right; THENCE, in a southwesterly direction departing the said south line of Lot 1 and the said north line of W Spurgeon Street and along said curve, having a central angle of 88 degrees, 19 minutes, 35 seconds, a radius of 9.00 feet, a chord bearing and distance of South 45 degrees, 50 minutes, 13 seconds West, 12.54 feet, an arc distance of 13.87 feet to a point at the end of said curve; THENCE, Due West, a distance of 12.00 feet to a point for the beginning of a curve to the right; THENCE, in a northwesterly direction along said curve, having a central angle of 85 degrees, 30 minutes, 16 seconds, a radius of 9.00 feet, a chord bearing and distance of North 47 degrees, 14 minutes, 52 seconds West, 12.22 feet, an arc distance of 13.43 feet to a point for corner on the said south line of Lot 1 and the said north line of W Spurgeon Street; THENCE, North 89 degrees, 09 minutes, 14 seconds East, along the said south line of Lot 1 and the said north line of W Spurgeon Street, a distance of 29.97 feet to the POINT OF BEGINNING; CONTAINING: 221 square feet or 0.005 acres of land, more or less. (A survey plat of even survey date herewith accompanies this description.) The undersigned, Registered Professional Land Surveyor, hereby certifies that the foregoing description accurately sets out the metes and bounds of the right-of-way encroachment described. 13,V1 G OF Michael Cleo Billingsley Date y Q`�G, SAF ZP Registered Professional Land Surveyor No. 6558 ••:••.•.•••.•..•.•_i••, Pacheco Koch Consulting Engineers, Inc. �11GHAEL CLEO BD LINGSLEY 6100 Western Place, #1001, Fort Worth TX 76107 ........ ' " """"' 6558 817 412-7155 '•90 ���o TX Reg. Surveying Firm LS-10008001 ••S 3139-15.036EX3.doc; 3139-15.036EX3.dwg DCP PAGE 1 OF 2 EXHO o 07 18AW LOT 1, BLOCK 8R SEMINARY HILL ADDITION (INST. NO. D210203297) TRANS RIGHT—OF—WAY PART OF ENCROACHMENT SOUTHWESTERN BAPTIST 221 SF 0 10 20 40 THEOLOGICAL SEMINARY (0.005 ACRES) (VOL. 329, PG. 513) BLOCK RETAINING ' GRAPHIC SCALE IN FEET N 89'09'14" E WALL PO/NT OF 29.97' LO TRANS EG/NN/NG 218.91 S 89'09'14" W 53.33' d=85'30'16" X88'19'35" R=9.00' DUE WEST R=9.00' L=13.4 12.00' L=13.87 T=8.32' T=8.74 CB=N 47'14'52" W CB=S 45'50'13" W CD=12.22' CD=12.54' W SPURGEON STREET CD o (VOL. 310, PG. 45) 1/2-INCH IRON I"�o1 0 ROD W/ "PACHECO KOCH" �p LR�OD CAP FOUND (C.M.) (p (C.M.) I a, Z S 89'09.14" W 155.00' O N LOT 1 R, BLOCK 4R M SEMINARY HILL ADDITION PO/NT OF tWi� � Q) LLJM ( (INST. N0. D214159799) COMMENCING<0C) PART OF Q Of I i~ ( SOUTHWESTERN BAPTIST 1/2-INCH IRON vii ROD W/ -PACHECO KOCH" F z THEOLOGICAL SEMINARY CAP FOUND I (VOL. 329, PG. 513) Z v LEGEND Ui - - - - PROPERTY LINE M ( I EASEMENT LINE NOTES: O POINT FOR CORNER M (UNLESS OTHERWISE NOTED) 1• A metes and bounds description of even (C.M.) - CONTROLLING MONUMENT survey date herewith accompanies this plat The undersigned, Registered Professional Land of survey. Surveyor, hereby certifies that this plat of 2. Bearing system for this survey is based on survey accurately sets out the metes and bounds of the right—of—way encroachment OF the Texas State Plane Coordinate System — qE•....••TF NAD 83, North Central Zone 4202, based on described. P •''%STE'•.;!' �'� G RFa•9�, observations made on April 26th, 2012 with an applied combined scale factor of 1.00012. N MICHAEL CLEO BILLINGSLEY """""""" .. ' RIGHT-OF-WAY ... C ------- - 1 —/r 3o�r� .:90 6558 �pvo o Michael Cleo Billingsley Date 9tio:�Fss�v�� ENCROACHMENT \ Registered Professional S U R Land Surveyor No. 6558 PART OF W SPURGEON STREET Pacheco Koch 6100 WESTERN PLACE, SUITE 1001 SEMINARY HILL ADDITION FORT WORTH, TX 76107 817.412.7155 Aw TX REG. ENGINEERING FIRM F-469 MARIA AROCHA SURVEY, ABSTRACT NO. 1 TX REG. SURVEYING FIRM LS-10008001 CITY OF FORT WORTH, CD DRAWN BY CHECKED BY SCALE DATE JOB NuAIVER TARRANT COUNTY, TEXAS Fn DCP MCB 1"=20' NOV 2016 3139-15.036 PAGE 2 OF 2 DWG FILE: 3139-15.036EX3.DWG CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/10/2016 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(ies) 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). PRODUCER CONTACT Barbara Moyer er Y Insurance One Agency, L.C. PHONE(ALC-ND t (972)223-1700 Nc No:(972)223-8298 712 N Hampton Rd. E-MAIL ADDRESS: er @insuranceonea enc com ADDRESS: �' g Y Suite 180 INSURERS AFFORDING COVERAGE NAIC 4 DeSoto TX 75115 INSURER A:Hanover Insurance Company 22292 INSURED INSURERB:Texas Mutual Insurance Company 22945 Southwestern Baptist Theological Seminary; INSURERC: PO Box 22480 INSURER D: INSURER E: Fort Worth TX 76122 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1621257237 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVQ POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ACLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ LLD7140900-05 2/5/2016 2/5/2017 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO- JECT 0LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY EOMaBI EDtSINGLE LIMIT $ 1,000,000 A 11 ANY AUTO BODILY INJURY(Perperson) $ ALL OWNED SCHEDULED AZD6843254-06 2/5/2016 2/5/2017 BODILY INJURY(Per $ AUTOS AUTOS er accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS per accident PIP-Additional $ 5,000 X I UMBRELLA LIAB LJ OCCUR EACH OCCURRENCE $ 20,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ UHD7140897-6 2/5/2016 2/5/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.LEACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A B (Mandatory in NH) TSF0o01208455 2/5/2016 2/5/2017 E.L.DISEASE-EA EMPLOYE $ 1, )00,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Ft. Worth, its officers & employees shall be named as Additional Insured as required by City Ordinance in regard to General Liability and Auto Liability. Waiver of Subrogation shall apply to General Liability, Auto Liability and Workers Compensation. Policy has 30 day notice of cancellation except for Non-Payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ft. Worth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1000 Throckmorton ACCORDANCE WITH THE POLICY PROVISIONS. Ft. Worth, TX 76102 AUTHORIZED REPRESENTATIVE Rick McCrary/BGM1 lee_ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r9014oTn ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Law Enforcement Liability Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 5,000 Flat Ref# Description Coverage Code Form No. Edition Date Pastoral Counseling Professional Liability PSCPL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref# Description Coverage Code Form No. Edition Date Innocent Party Defense Limit 1Limit 2 Limit 3 Deductible Amount Deductible Type Premium 300,000 Ref# Description Coverage Code Form No. Edition Date Innocent Party Defense Limit 1Limit 2 Limit 3 Deductible Amount Deductible Type Premium 100,000 Ref# Description Coverage Code Form No. Edition Date Sexual/Abuse Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref# Description Coverage Code Form No. Edition Date Underinsured/Uninsured UMUM Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,0001000 Ref# Description Coverage Code Form No. Edition Date Alternate Employer Endorsement Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Waiver of Subrogation WVSUB Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Experience Mod Factor 1 EXP01 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date WC&Employer's liability I WCEL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Waiver of Subrogation WVSUB Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium �OFADTLCV Copyright 2001,AMS Services,Inc.