HomeMy WebLinkAboutContract 49017 �g10 11
REGEIVED
�= CITY SECRETARY
�-�,
' 1 5 2017 + RIGHT OF WAY CONTRACT N0.
_kl ;ItY OF FORT ENCROACHMENT AGREEMENT
CRY SECRET f' (COMMERCIAL)
Yi 0 THIS AGREEMENT is made and entered into by and between the City of Fort
North, a home 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 4-Eleven Realty
Partners, LLC, a Limited Liability Corporation "Licensee", acting herein by and through
its duly authorized President, the owner of the real property located at 411 South Main
Street, Fort Worth, Texas 76104 ("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 renovation of an existing
building for lease spaces for retail, restaurant, and events (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 Agreement-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
improvements owned by, constructed by or on behalf of the public or at public expense is
2015 ROW Encroachment Agreement-Commercial Page 2 of 12
rev. 02/2015
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.
S.
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
Legislature; and that City cannot contract away its duty and its legislative power to
2015 ROW Encroachment Agreement-Commercial Page 3 of 12
rev.02/2015
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 permitting 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
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 Agreement-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
rev. 02/2015
[SIGNATURES APPEAR ON FOLLOWING PAGE]
2015 ROW Encroachment 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, 4-Elevn Realty Partners,LLC
A
By: i Li By:
Randle Harwood Name: Scott Clark
Director Title: President
1711 5t'Avenue,
Fort Worth, TX 76110
Planning and De elopment Department
Date: , 207
ATTEST: Approved As To Form and Legality
City Sec t y Assistant City Attorney
of FORTS
* OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
2015 ROW Encroachment Agreement-Commercial Page 8 of 12
rev.02/2015
STATE OF TEXAS §
COUNTY OF TARRANT § <
This instrument was acknowledged before me o , 2017
by Randle Harwood, Director of the Planning a evelo meet De artment of the ity
of Fort Worth, on behalf the City of Fort Worth.
"K_� (
tary ublic, State of Texas
?c'•,y(' CASSANDRA F. FOREMAN
PJotcvv Pkjuic,Stote of rex as
Z.`h X My C ernmissfon cxpir eS
f,Frt:i xt, 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
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 Scott Clark, President, 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 4-Eleven Realty Partners, LLC, a Limited Liability Corporation, and
in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of
200 .
CHEREE PENA Notary Public in and for the
%
STATE WA State of Texas My Calm E'q�.may 19,1Qi8
�'of
2015 ROW Encroachment Agreement-Commercial Page 10 of 12
rev. 02/2015
LEGAL DESCRIPTION OF THE PROPERTY
2015 ROW Encroachment Agreement-Commercial Page 11 of 12
— rev.02/2015
EXHIBIT"A"
Location and Description of Encroachment and Improvements
2015 ROW Encroachment Agreement-Commercial Page 12 of 12
rev.02/2015
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9
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411 SOUTH MAIN ST.
FORT WORTH,TX, 76104
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TP:644.48±
(MATCH EX)
PROPOSED 6" DIAMETER 333% TW:647.62/ .', I i /T
PIPE BOLLARD, SET IN { 41 -gW:645.32-
CONCRETE 3' BELOW GRADE. I TP:644.98t(EX)
TW:649.30 v _
' - BW:645.00 ~-
EXTEND 4 ABOVE GRADE +� —I �},�I II, , a � _
PAINTED OSHA YELLOW — (
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T I^ ! tI Iw . CL > o I I B 572
PROPOSED TW:649.47_ illu :645.72t(EX)RETAINING 33.33% BW:645.76- <
WALL TV 648.37
75 SF CONCRETE 7.5' t I MATCH EX m
DUMPSTER PAD ( )
MATCH EXISTING
EXISTING - r ~'°°'"`" 1 GRADE ALONG
- d
RIGHT OF r SAWCUT
WAY EXISTING
CONCRETE PROPOSED GUTTER
RETAINING WALL PAN PER FORT
EXISTING TO REMAIN
VEHICULAR WORTH STANDARDS
ENTRANCE i
1 EXISTING
i f I EDGE OF
ASPHALT
LEGEND:
TP:650.00 PROPOSED TOP OF PAVEMENT ELEVATION
BW:650.00 PROPOSED BOTTOM OF WALL ELEVATION
TN:650.00 PROPOSED TOP OF WALL ELEVATION
ASPHALT SAWCUT & PATCHBACK
5 0 5 10 — 8" PORTLAND CEMENT CONCRETE
3,600 PSI AT 28 DAYS
SCALE: 1"= 5' REINFORCEMENT: #3 @ 18" O.C.E.W.
NO CHANGES ARE TO BE MADE TO THIS DRAWING WITHOUT WRITTEN PERMISSION OF HARRIS KOCHER SMITH.
ISSUE DATE:02-21-2017 PROJECT#:161107
DATE REVISION COMMENTS HARRIS DSN'D BY: ATM
KOCHER CNK'D BY: ATM
ICE&WILLIAMS 411 SOUTH MAIN ST. SMITH DRAWN BY: ATM
SITE GRADING PLAN PO Fort Worth,,T.—61102te 16 �+SaeL No
P:817.769.6279 F:817.7696298 „') 07
Harr"-"herSmith.com v
TBPE FrMrrf'F-15501•TBPLS FimAl:10194105 � 2
PROPOSED
SANITARY II I
CLEANOUT /i l ` -1 -648-
INV = 648.38 / i 50' ROW
5 LF N 6"
N PVC @ 1%
INLET INV = 648.33
PROPOSED PARK GT-3000
GREASE INTERCEPTOR OR
1 l APPROVED EQUIVALENT
TOP OF LID - 649.58± f
MANHOLES SHALL BE 24" BOTTOM OF STRUCTURE = 641.58±
DIAMETER TRAFFIC RATED , , j 4 AREA = 91 SQUARE FEET
CAST IRON PER PARK 1 -_ 6SO,
DETAIL GT-1. MANHOLE
LIDS TO BE BROUGHT TO
EXISTING GRADE i 1 EL:651.84(EX)�
I1 I
EXISTING EL:651.88(EX)
BUILDING
EXISTING I
OUTLET INV = 648.08 + I _Lu EDGE OF
EXISTING 5 LF N 6 1 / I z ASPHALT
RIGHT OF PVC ® 1% EXISTING WATER > o
WAY (TYP)� PROPOSED _ \ METER TO BE Q ! _
SAMPLE WELL = -+-- \� , REMOVED I
:2!
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INV = 648. 03 �� \ EXISTING
w LID = 652.04± \ UTILITY POLE�65z m
c 15 LF - 6" -T0 REMAIN
PVC @ 1% + I \
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PROPOSED "10-O'CLOCK" WYE
CONNECTION TO MAIN
SANITARY SERVICE INV = 647.88
MAIN INV = 646.05±
EXISTING 8" SS @ 3.65%
PER FORT WORTH PROJECT
X-14304
NOTES:
1. ALL EXISTING INFRASTRUCTURE INCLUDING SIDEWALK TO BE
REPLACED AS NEEDED. EXISTING GRADES SHALL BE
10 0 10 20 PRESERVED.
2. CONTRACTOR SHALL BE RESPONSIBLE FOR TAKING NECESSARY
SCALE: 1"= 10' PRECAUTIONS TO PROTECT EXISTING BUILDING FROM DAMAGE
DURING CONSTRUCTION.
NO CHANGES ARE TO BE MADE TO THIS CRAWING WITHOUT WRITTEN PERMISSION OF HARRIS KOCHER SMITH.
ISSUE DATE:02-21.2017 PROJECT#:161107 DSN'D BY: AN
DATE REVISION COMMENTS HARRIS CHK'D BY: ATM
ICE&WILLIAMS 411 SOUTH MAIN ST. M TH R WN BY: AN
GREASE INTERCEPTOR EXHIBIT Fort Worth Texas Suite SNEF7
P.817.769.6279 F:817.769.6298 161107
Harris KocherSmith.com
TBPE Flan,:F45501•TBPLS Fimdf:10194145 2 6 2
T7CANOPY 1 = 110 SF
CANOPY 2 = 32 SF
CANOPY 3 = 29 SF
ELECTRICAL METERS = 3 SF
W I DUMPSTER = 83 SF
uj
GREASE TRAP — 91 SF
Wdd I I TOTAL = 348 SF
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ENCROACHMENT 2/7/17
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FLOOR PLAN
ICE&W-1 OP ID:ES
ATECERTIFICATE OF LIABILITY INSURANCE F °0410512�"I0 7"
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 pollcy(ies) must be endorsed. If SUBROGATION IS WANED, 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 endarsement s.
PRODUCER NONTACT
AME: Elizabeth Sommers
Kilpatrick Insurance PHONE Fax
Agency, Inc. AIC No E.0:817-731-8771 c,No): 817-731-0520
2410 Montgomery Street ADDRESS:elizabeth@kilpatrickinsurance.com
Ft.worth,TX 78107
Alex Marrs INSURER(S)AFFORDING COVERAGE NAIC t
INsuRERA:Evanston Insurance Company 35378
INSURED Ice&Williams, LLC INSURERB:
4-Eleven Realty Partners LLC INSURERC:
James Ice
1700 6th Ave INSURER D:
Fort Worth,TX 76110 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.
CY EFF --P0LfCVfff
LTR TYPE OF INSURANCE POLICY NUMBER MID MfDD LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0
TO RENTED
cLAIMSMADE OCCUR X 3AA129547 03!1712017 03!1712018 PREMISES Ea occurrence $ 100,00
MED EXP(my one person) $ 5,00
PERSONAL&ADV INJURY $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
X POLICY 0 jEa F-1 LOC PRODUCTS-COMP/OP AGG $ Exclude
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
HIRED AUTOS NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS UAB HCLAJMS-MADE AGGREGATE $
DED I I RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE I I ER
ANY PROPRIETORIPARTNERfEXECUTIVE E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? ❑N/A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS b0 ow E.L.DISEASE-POLICY LIMIT 1$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more apace is required)
CERTIFICATE HOLDER CANCELLATION
CITOF-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ci of Fort worth Department THE EXPIRATION DATE THEREOF, NOTICE HALL BE DELIVERED IN
City P ACCORDANCE MIRTH THE POLICY PROVISIONS,
of Development
David Schroeder,Planner AUTHORUED REPRESENTATIVE
1000 Throckmorton
Fort Worth, TX 76102
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014!01) The ACORD name and logo are registered marks of ACORD
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.
ame of Employee
Title
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