Loading...
HomeMy WebLinkAboutContract 49699 CITY SECRETARY C CONTRACT NO. ROW ENCROACHMENT LICENSE AGREEMENT THIS AGREEMENT is made and entered into by and between THE CITY OF FORT WORTH, ("City") and American Airlines, Inc. ("Licensee"), lessee of the real property located at 13951 Trinity Blvd., Fort Worth, Texas 76155 ("Property"). RECITALS WHEREAS, Licensee entered into a lease agreement (the "Lease") with Dallas/Fort Worth International Airport Board (the "Airport Board"), the owner of the Property, and Licensee must encroach under City's right-of-way in order to construct electrical improvements on the Property; WHEREAS, Licensee's encroachments includes two (2) steel encased electrical conduits in Trinity Boulevard, and a steel encased electrical conduit in American Boulevard (American Boulevard and Trinity Boulevard collectively referred to as «ROW"); WHEREAS, Licensee has authority under the Lease to enter into this Agreement; WHEREAS, the City and Licensee enter into this Agreement to allow Licensee to construct/place and maintain certain improvements which will encroach into the ROW as shown on the map attached to this Agreement as Exhibit "A" and incorporated herein for all purposes; and WHEREAS, City will allow the Encroachment under the terms and conditions as �1 8 9 10; r rth in this Agreement to accommodate the needs of the Licensee. 4►5 � 9 W, THEREFORE, the City and Licensee agree as follows: N AGREEMENT tieJ\\ cu )l. 2`1' 016 8 9� City, in consideration of the payment by the Licensee of the fee set out below and venants and agreements hereinafter contained, to be kept and performed by Licensee, hereby grants permission to Licensee to encroach upon and occupy a portion of the City's ROW for the purposes of installing, maintaining, repairing, and replacing two (2) steel encased electrical conduits in Trinity Boulevard and a steel encased electrical conduit in American Boulevard (collectively the "Encroachment") as described in and at the location within the ROW shown on Exhibit "A" but only to the extent shown thereon. Upon completion of the Encroachment, Licensee agrees to be responsible for maintaining the Encroachment within the ROW. Licensee shall not expand or otherwise cause the Encroachment to further infringe in or on City's RO ecifiically described in Exhibit"A" attached hereto. OFFICIAL RECORD CITY SECRETARY ROW Encroachment Agreement-Commercial Page 1 of 8 FTS WORTH,TX R[,. 8/31/17 2. All construction, maintenance and operation in connection with such Encroachment, use and occupancy shall be performed in strict compliance with this Agreement and the City's Charter, Ordinances and Codes and in accordance with the directions of the Director of the Transportation and Public Works or the Director of the City's Water Department, or his or her duly authorized representative. Licensee shall submit all plans and specifications to the applicable Director or his or her duly authorized representative prior to the construction of the Encroachment. Licensee shall not commence construction of the Encroachment until receiving written approval by the Director, but such approval shall not relieve Licensee of responsibility and liability for concept, design and computation in the preparation of such plans and specifications. 3. Upon prior written notice to Licensee, except in the case of an emergency, Licensee agrees that City may enter and utilize the referenced areas at any time for the purpose of installing, repairing, replacing, or maintaining improvements to its public facilities or utilities necessary for the health, safety and welfare of the public or for any other public purpose. City shall bear no responsibility or liability for any damage or disruption or other adverse consequences resulting from the Encroachment installed by Licensee, but City will make reasonable efforts to minimize such damage. In the event that any installation, reinstallation, relocation or repair of any existing or future utility or improvements owned by, constructed by or on behalf of the public or at public expense is made more costly by virtue of the construction, maintenance or existence of the Encroachment and use, Licensee shall pay to City an additional amount equal to such additional cost as reasonably determined by the Director of Transportation and Public Works or the Director of the Water Department, or said Director's duly authorized representative. 4. Licensee agrees to pay to City at the time this Agreement is requested an application fee of$325.00 in order to defray all costs of inspection and supervision which City has incurred or will incur as a result of the construction, maintenance, inspection or management of the encroachments and uses provided for by this Agreement. Licensee agrees to pay a fee in the amount of$.56 per square/linear foot of the encroachment area upon execution of this Agreement and annually thereafter. 5. The term of this Agreement shall be for the duration of the Lease, 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 ROW Encroachment Agreement-Commercial Page 2 of 8 Rev. 8/31/17 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. 6. It is further understood and agreed between the parties hereto that the ROW 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 ROW as have been delegated to it by the Constitution of the State of Texas or by the Texas Legislature; and that City cannot contract away its duty and its legislative power to control the ROW for the use and benefit of the public. 7. LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, AND ELECTED OFFICIALS FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS FOR PROPERTY DAMAGE OR LOSS AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR CHARACTER, ARISING OUT OF OR IN CONNECTION WITH, THE CONSTRUCTION, MAINTENANCE, OCCUPANCY, USE, EXISTENCE OR LOCATION OF THE ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, ELECTED OFFICIALS, OR INVITEES OF THE CITY; AND LICENSEE HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY FOR SUCH CLAIMS OR SUITS. LICENSEE SHALL LIKEWISE ASSUME ALL LIABILITY AND RESPONSIBILITY AND SHALL INDEMNIFY CITY FOR ANY AND ALL INJURY OR DAMAGE TO CITY PROPERTY ARISING OUT OF OR IN CONNECTION WITH THE ENCROACHMENTS AND ANY AND ALL ACTS OR OMISSIONS OF LICENSEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, OR INVITEES WITH RESPECT THERETO. THE FOLLOWING INDEMNITY SHALL NOT APPLY WITH RESPECT TO MATTERS ARISING OUT OF THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT BY THE CITY'S OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES,ELECTED OFFICIALS OR INVITEES. 8. While this Agreement is in effect, Licensee agrees to furnish City with a Certificate of Insurance naming City as certificate holder, as proof that it has secured and ROW Encroachment Agreement-Commercial Page 3 of 8 Rev. 8/31/17 paid for a policy of public liability insurance covering all public risks related to the proposed use and occupancy of public property as located and described in Exhibit"A". The amounts of such insurance shall be not less than $1,000,000 Commercial General Liability with the understanding and agreement by Licensee that such insurance amounts may be reasonably revised upward at City's option and that Licensee shall so revise such amounts immediately following notice to Licensee of such requirement. Such insurance policy shall not be canceled or amended without at least 30 days prior written notice to the Building Official of the City of Fort Worth. Within in 30 days of execution of this Agreement, Licensee agrees to submit a copy of such Certificate of Insurance. Licensee agrees to submit a similar Certificate of Insurance annually to City on the anniversary date of the execution of this Agreement. Licensee agrees, binds and obligates itself, its successors and assigns, to maintain and keep in force such public liability insurance at all times during the term of this Agreement and until the removal of the Encroachment and the cleaning and restoration of the ROW. All insurance coverage required herein shall include coverage of all Licensees' contractors and subcontractors. 9. At Licensee's expense, Licensee shall file this agreement in the Real Property Records of Tarrant County, Texas within fifteen (15) days of its full execution. After being recorded, the original shall be returned to the City Secretary of the City of Fort Worth. 10. Licensee agrees to comply fully with all applicable federal, state and local laws, statutes, ordinances, codes or regulations in connection with the construction, operation and maintenance of the Encroachment and uses. 11. Licensee agrees to pay promptly when due all fees, taxes or rentals provided for by this Agreement or by any federal, state or local statute, law or regulation. ROW Encroachment Agreement-Commercial Page 4 of 8 Rev. 8/31/17 12. Licensee covenants and agrees that it shall operate hereunder as an independent contractor as to all rights and privileges granted hereunder and not as an officer, agent, servant or employee of City, and Licensee shall have exclusive control of and the exclusive right to control the details of its operations, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers, agents, servants, employees, contractors, subcontractors, licensees and invitees. The doctrine of respondeat superior shall not apply as between City and Licensee, its officers, agents, servants, employees, contractors and subcontractors, and nothing herein shall be construed as creating a partnership or joint enterprise between City and Licensee. 13. Licensee agrees and acknowledges that this Agreement is solely for the purpose of permitting Licensee to construct, maintain and locate the Encroachment within the ROW and is not a conveyance of any right, title or interest in or to the ROW nor is it meant to convey any right to use or occupy property in which a third party may have an interest. Licensee agrees that it will obtain all necessary permissions before occupying such property. 14. In any action brought by the City for the enforcement of the obligations of the Licensee, City shall be entitled to recover interest and reasonable attorney's fees. 15. The parties agree that the duties and obligation contained Sections 3 and 4 shall survive the termination of this Agreement. 16. Licensee covenants and agrees that it will not assign all or any of its rights, privileges or duties under this Agreement without the written approval of City, and any attempted assignment without such written approval shall be void. The foregoing prohibition shall not prohibit Licensee from collaterally assigning this Agreement in connection with any financing, upon receiving written approval as outlined in the foregoing sentence. 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. ROW Encroachment Agreement-Commercial Page 5 of 8 Rev. 8/31/17 However, no change of ownership due to foreclosure or assignment to any secured lender of Licensee shall be effective as to City unless and until written notice of such foreclosure or assignment is provided to City. 17. Any cause of action for breach of this Agreement shall be brought in Tarrant County, Texas. This Agreement shall be governed by the laws of the State of Texas. 18. This Agreement shall be binding upon the parties hereto, their successors and assigns. THIS AGREEMENT may be executed in multiple counterparts, each of which shall be considered an original, but all of which shall constitute one instrument. AGREED: LICENSEE: A RI AIRLINES, INC. a-RandleHa JORT WO H 1�2 Timoth Skipworth Vice President Airport Affairs and Facilities Planning & ve!opment Director APPRO E AS ORMA LEGALITY J�F` FO�, y Jessic svan Assistant ity Attorney ATTEST- U; * By: % .I Mary ayser * City Secretary Acs No M&C Required Form 1295 Certification No. N/A 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. OFFICIAL RECORD CITY SECRETARY FT.WORTH, TX me: r y� Title: d��'f ,� / ROW Encroachment Agreement-Commercial Page 6 of 8 Rev. 8/31/17 ACKNOWLEDGEMENT 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 Timothy Skipworth, Vice President Airport Affairs and Facilities, known to me to be the same person whose name is subscribed to the foregoing instrument, and acknowledged to me that the same was the act of American Airlines, Inc. and that he/she executed the same as the act of said American Airlines, Inc. for the purposes and consideration therein expressed and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this 1 day of 20�2. 1bA'AWANPJ /"��j�'� Brittany Carter Notary Public in a o t e State f Texas t; �INaf\ 1'u1dN. %laieorTr.a. a Expires 10-17-2018 CKNOWLEDGEMENT 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 Randle Harwood, Planning & Development Director of the City of Fort Worth, known to me to be the same person whose name is subscribed to the foregoing instrument, and acknowledged to me that the same was the act of the City of Fort Worth and that he/she executed the same as the act of the City of Fort Worth for the purposes and consideration therein expressed and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this_ c � day of 20 1 `/ krn. X__' 6 Notary Public in and for the tate of Texas After Recording Return to: IRMA SAENZ City of Fort Worth City Attorney's Office ;_,' .;@ Notary Public, scare of Texas 200 Texas Street Comm Expires 01-28-2020 'o't•�� ``4�`` Notary ID 2724984 Fort Worth TX, 76102 "" ROW Encroachment Agreement-Commercial Page 7 of 8 Rev. 8/31/17 EXHIBIT"A" Map of Encroachment ROW Encroachment Agreement-Commercial Page 8 of 8 Rev. 8/31/17 a F ENCROACHMENT ITEMS 6HHMIlHHfIHHD ITEM DESCRIPTION 1 DUCT BANK BORING UNDER TRINITY BLVD }i 2 DUCT BANK BORING UNDER TRINITY BLVD 3 3 DUCT BANK BORING UNDER AMERICAN BLVD n c 3 c m h � R h a �v o � � r f 0 In O ✓ vi Sop • 2 ar EXHIBIT A 0.0 '%QDUN OVERALL EXHIBIT 0 500 1000 i it 550 Bailey Avenue•Suite 400•Fort Worth,Texas 76107 AMERICAN AIRLINES CAMPUS 9 Tel:817.M.1121 RIGHT-OF-WAY ENCROACHMENTS 0 PAGE 1 OF 7 aEG F 1„41 FORT WORTH,TX SCALE; V= 500 ft. I o IIS EX.6'CONC WA 7V? u W LU I 3 ' ! o 1 Z i 4 w c I � ! � w ! v II O a ~ / Qom i / o UCC m r H z p LLJ I = ate '1 � I X � / 1 1� W U_ LL O W I w 2 (7 Y 1 3 I � 1 140 i I C I tQ N 1 1 I 1 CI 1 I 3 n 1 t I I I I I W fir. ® HO HO I J m O 114- L.Lj - Jib ° (u )NON3)(NVG i:)na\sl!q!4xa luawLp—ua ZZLO-L[\sl!4!4x3\s6u!—a\900\u6.-a\994[\009100\OOSuo!3L-Pad\walsM ay\LWOM 1\\:H1tldgllA Wd 8Z:S:ltl L[OZ'bZ lsn6ntl'AWr+n41:NO s!PPeE)A4go9:A9 0311O1d ay <X r h t b .or f o f h Ln h F- # Z LU p m n y h u H Q ro Q q w h z TSC + Q f— oC V CC m _ tl / K w O I yco J o = Q F- F- CC X 3: O Z T � L1J O + , p h f � kq ti ---_ — ———— —-------- --- —� -- ---- -- --- h o a � 0 3 Z �_w 5 m� r d C Q m Q 41 m V Lo ADN3)INV9 IDM\s!q!4-IuawrpeO—ZICO•LI\sl!q!4x3\s6uwLja\go0\ul i�\999T\Oogloo\ooSuorpnpajd`walsM a!y\43pm:U\\:H.LVd3lH Wd BT:S:ltl ZIOZ'bZ 3sn6nV'AepsintLL:NO s!PPe9 MgoB:AS OIUOld O Ln u L w Q U V) �5 woo 0 0 HO 0 HO— LIP) Z W N \\ O U x M,91-X3 N Q 2 \\ O = v W \\ Q U w cr- \\ X O o \\ W LLLL. \\ O -- ---------------- - ��C3————— aavAnnos Aim= p = L Ho rr • W N Li 0 n s NLi- • �; \\ Z &ALL \ I � Op mC / j� a • )VOaON3)INV917110\s3i.q!4)(0 TuawiPV0Dw ZTLO-LT\s1!Q!4X3\s6u!MelO\900\u6!sao\9991\009TOO\OOSuo!Mp(ud\waTsls a!y\43-MU\\:HUVd3lTd WV 6T:8 UV LTOZ'SZ Tsn6nV'AeppA:NO s!PM)AQQ09:AS 03UO-ld O Lo Lo ;II ,II p A + r r C4 t■ e �W --------------- -- -- ----- --- --------------------------- Ln ----- --------- ---------- Q l7 z 2w LU ZO yd I eW O N Q W a � !!1 �� m + Q O � w O~C 0 e N + W LL ci o �O NFL o = a C7 ----- l ------ -- ---------- ---------- -- --- ---------- o 0 0 h h (06 C v 0 0 ,o PPM ^ 0 Fo m t t 0 3 a �N^ �LL z F_� yyA N HF1 m Q C O m )tl02i7N3)INtl91Jf10\Syq!4xa auawLpeonua ZTLO LT\Sl!q!4x3\s6w 0\900\uBL-01999T\009T00\OOSuo4xipad\ways Cs aly\4NoM11\\ FLLtld3lld WV 61:8 ltl LTOZ'S21Sn6n4'AeP.J:NO S!PPe9 AQQoB:AB 03110ld 0 0 f O Ln 0 \ Lndi .-! \� Q V O LU 1 'i Z Oux i M o = Q U - F— Z © LLI Clb"MO8 NV:)lkl3VYV a�a/ w Q w j o m W J J 0 \ Z cLoa W J . r • \ ' 7 m rrl � Q NOIDN3 mNVS i-M\s!Q!4xa Tuaw4xlcn a ZTLO-LT\s7!q!4x3\s60!Awl©\900\u6mBC\499T\009T00100SU0WPad\wglsk e!9\4V0M4\\:Hltld3lL3 WV 6T:9 UV LTOZ'SZ Isnbny'Aepuy:NO spM AQQoB:A9 031101d � O h o II II W 4'Q ti S y � 3 ui �I , ui ------ -- -- -- --- — -- — - = ------ — t� u X (n hI 0 0 � � ~ I N LU I— hW Tm Q — F (Y I y'� w o --- -- ----- LL ------ ---4---- ---------- g 2 W u, 3 0 ,o O m tt O 3 t_ Q LLQ^ �LL ZDW N 0 7 Q C O 0 A m „ NOIDN3>INVG J:)no\s7!Q!4Xa auawyoeojoua ZZLO-LI\sl!9!4X3\s6u!MeiO\goo\u6!saO\gggt\oogloo\oOSuol:pnpad\wags/s a!y\yyom3J\\:H1Vd3-TL4 WV EZ:B:1V LZOZ'SZ 7sn6nV'Aepud:NO s!ppeE)AQQog:A6 O311Old Page 1 of. 1 CERTIFICATE OF LIABILITY INSURANCE DATE 07/3 /2017 07/31/2017 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 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 NAME: Willis of Arizona, Inc. PHONE . 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd AIC No E-MAIL certificates@willis.com P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAICS INSURER A: Illinois National Insurance Company 23817 INSUREDINSURER B: Insurance C®pany Of the stat-of P-nn-yl—lia 19429 American Airlines Group Inc. 4333 Amon Carter Boulevard INSURER C: New Hampshire Insurance Company 23841 Fort Worth, TX 76155 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W3153411 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP /YLIMITS LTR POLICY NUMBER MWD YYY M OD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE Fx-]OCCUR PREMISES Ea occurrence) $ 1,000,000 A MED EXP(Any one person) $ 10,000 Y N 6938940 07/01/2017 07/01/2018 PERSONAL dADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 POLICY JE T LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea acadenl X ANY AUTO BODILY INJURY(Per Parson) $ 8 OWNED SCHEDULED N N 2867439 07/01/2017 07/01/2018 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident b UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER C ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICE 4lMEMBER EXCLUDED? ❑ N/A N 063724507 07/01/2017 07/01/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If ves.cescnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Automobile Coverage applies only to vehicles off of the restricted airport premises. Re: Project IOC/SRO New Garage 13801 FAA Blvd. Fort Worth, TX 76155 City of Fort Worth is included as an Additional Insured as respects to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Fort Worth 200 Texas Street Fort Worth, TX 76102 C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 14899543 BATCH: 399749 American Airlines Group Inc. Named Insured Schedule for Certificates Named Insured American Airlines Group Inc. American itroes, nc. Admirals Club, Inc. American Airlines Marketing Services LLC American Airlines Vacations LLC American Aviation Supply LLC Envoy Aviation Group Inc. Eagle Aviation Services, Inc. Envoy Air Inc. (operates under the trade name "American Eagle") Executive Airlines, Inc. Executive Ground Services, Inc. Piedmont Airlines, Inc. (operates under the trade name "American Eagle") PSA Airlines, Inc. (operates under the trade name"American Eagle") Material Services Company, Inc. AWHQ LLC(real estate holding company) (99%) PMA Investment Subsidiary, Inc. AAG Private Placement-1 Parent LLC AAG Private Placement-1 LLC Americas Ground Services, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 07/01 /2016 forms a part of Policy No. WC 020-68-1978 Issued to AMERICAN AIRLINES GROUP INC. By NEW HAMPSHIRE INSURANCE COMPANY LIMITED ADVICE OF CANCELLATION TO SCHEDULED ENTITIES (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder(s) when this policy is canceled (hereinafter, the "Certificate Holder(s)") and the Named Insured has provided the Insurer, either directly or through its broker of record, either: (a) the name of the entity shown on the certificate, a contact name at such entity and the U.S. Postal Service mailing address of each such entity; or (b) the email address of a contact at each such entity; and 3. prior to the effective date of cancellation, the Named Insured confirms to the Insurer, either directly or through its broker of record, that the persons or organizations set forth in the Schedule below, as well as their respective addresses listed, should continue to be a part of the Schedule and, if not, the names of the persons or organizations that should be deleted, the Insurer will provide advice of cancellation (the "Advice") to each such Certificate Holder(s) confirmed by the Named Insured in writing to be correctly a part of the Schedule within 30 days after the Named Insured confirms the accuracy of the Schedule below with the Insurer, provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the Named Insured confirms the accuracy of the Schedule below with the Insurer. Proof of the Insurer emailing the Advice, using the information provided and subsequently confirmed by the Named Insured in writing, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement: 1 Named Insured means the first named employer in Item 1 of the Information Page of this policy. 2. Insurer means the insurance company shown in the header on the Information Page of this policy. WC 99 00 58 Page 1 of 2 (Ed. 04/11) SCHEDULE NAME OF PERSON OR ORGANIZATION E-MAIL OR U.S. POSTAL SERVICE ADDRESS All other terms, conditions and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE WC 99 00 58 Page 2 of 2 (Ed. 04/11)