Loading...
HomeMy WebLinkAboutContract 34160J..i 4�iB � � / . �.J, . , . .. '. ��a�..l . �-�..���� C�NSENT AGREEMENT FOR TEMI'OT2AR'Y USE OF PUBLIC PROPERTY STf1TE OF TEXAS COTJNTY OF TARRANT THIS AGREFMENT is made and entered into by and behveen the City o� �ort Wo�rth, a �nunicipal corporaiion of Ta�rapt Coanty, Texas, acting herein by and thcough its dEzly authot�ized Building Of�cial, hereinafier reFerred to as the "City" and �"� C�1( ��,! �((. �� �t- �1.j ►'' J��� r C��, � h�. _ Acting byand through its cluly authorized agent, �;�,t____ (��l/ �)�1�5�-� , �Iereinafter r�ferred to as "Grantee". WITIV�S�ETI�: For and in consideration of the payment by Gi•antee of cl�arges set out below ancl fhe ti•ue and faithful pe�fiormance of the rr�utual cc�venants herein contained, Gity iierehy grants ta Grantee permission to femporarily encroach upon, uses and occupy portion of the space under, on and/oi• above the st�•eets, alleys, sidewalks or other public rights-of way as follows; j l��;�`,�aL, �ti �i i?�>� �iz�- ��ts ���' '�to_�.t:cs��a � n,,,, ,� � ,�a', ) //y��\/� �/J _�{7�z'if ii_:�1-�ny1G�iJt� --- ✓ Ulk; � ( � .�'�" The I�cation and description of said encroachment is more pat�ticularly described in Exhibit "B" attached hereto, incorporated heraii-► and mado a part hereof for a!1 pr�iposes. 2. All use and occupancy.of public sh�eet, aIleys, sidewalks or other pu6lic rights-af way tinder this aaree�nent shall be in strict comp[ia�tce with the Charter, Ordi�iances and Coctes of tl�e City anct in aecordance wiYh the directions of the Building Offcial and the Director of Transportation and Public Works of Ciiy, i�, r �'� 1 i�� fj '� f' /� �(� �S ��J�aLJ n ji i I i� 1 10�� �1 �:,' v Ji 1 r, � � 'v � � L� ���1;'�l��f ` I�� 'rfl U' c7I� " l a .��.J1`.��(1�� �SG\�� CONSENT ABREEMfiNTforTemporary usa of pu6Gc�prapsrlyi�.dac �� 3. iTpon expiration of this agreement and the privileges granted hereunder, thei•e shall be no encroachment by �rantee in, under, on or above the surfacE of the public rights-of-way invoi��ed. 4. Grantee agrees to pay in advance an enct•oachment fee For the temporary privilege of encroaching upo�i a portion of the public rights-of was� as described in Bxhibit "B". Said fee is calculated in the manne►• and amounts prescri6ed by tlie Building Code of the City oi Fort Wox�th for temporary use or occupancy of public property. The estinnated total amount of sai�l fee is: 6 ' 1 N--'��—� ' � �[%�� � r �� i � � x �'� �—.l���y r � � � �'� �° ��� . —=-� f1'C`� �j-f �� j( � `c? l,� ��C- a-�� .� _�.� � � � `�;� -���'� __ � � ��� L� C�� �. Grantee, at no expense ta City, shall make proper provision for the relocation ancVor installation of a�ay existing or futu�•e YrafFic control devises or other improvement5 affected hy such encroachmeut, use and occupancy, including ihe securing of approvai and consent from the appropriate agencies of the State �tnd its political subdivisions. In the event that any installation, reinstaltation, reloeation or repair of any existing or fuhn�e t1•affic contro( device or improvement owned or constructed by ar on behalf of the p«blic or at pub(ic expense is mada more costly by virtue of the exisrence of such encroachinent and use, Gt•antee shatl pay tn City and additional amo�int equa[ to such additional cos� as deter,mined by City. . 6. Tha te►•m of tltis agreement shall be for �_�days, from l,� ��}� _ C C��j 1� Provided, however, should the need for the encroachments granted hereunder at auy �rme cease, Grantee agrees to immediately notify City oFsuch condition; and, upon receipt of such notice by the Building Of�cial oC the City oF Fort Wortli, tliis agreement shall termi»ate, '7. Ct is expp•essly understood and agreed that ti�is Consent Agreem�nt is for a temporazy encrolcb�nent in, uncler, over and upon the p��blic property as located and described in Exhibit _,s�- ,_�_t.��a::=. �a ,:.� �, �� l ��r���� �u.���]��1�ti� � Z �' ' S"I'� �' � �''�'� IL, �� GONSFN7'AGRFF4AFNTforTemporaryusaofpubl pro�� tl.�loc�'�'���'�� ��7 ".`�;! �';1: U �1r� � �� �� o "B". This agreemer�t shalt not be construed as the granting of a permanent easernenf, encroacl�ment or license upon City's public streets, alleys, sidewalks, or other rights-of-way. S. City, through its duly authorized representatives, shail have the fuli and unrestricted right to enter upon all public rights-of-way for the purpose of ma(cing inspections to determine conipliance with ihe terms, covenants and cnnditions het•ein. In the event that any inspection should reveal a Ureach of any tet�rns, covenants or conditions herein, City shall give Grantee ttolice of sucli breach. Shoald such breach not be corrected by Grantee within twenty-four (24) hours of reeeipt af the notice, or within such shorter period of time as deemed necessaiy by the Building O�cial foi• the protection of public health or safety, City may terminate and cancel this agreement. 9. llpon expiration or te�•rxtination of this agreement for any reason �vhatsoever, Grantee shall, at no erpense to City, restore the pubiic rights-of-�vay and adjacent supporting structures to a condition acceptlble to the Director of Transpol�t�tion and Public Wo��ks or his duly authorized representative and in accorcEa�Zce witlt then exisiing City specifications, and Grantee shall j-emove all barricades, equipment, supp(ies, materials or other propeity fi�om said location. Grantee fiu-ther covenants and �grees that for a period of one (1) year after the tecmination of this Consent Ageeement, Grantee �vilr repair all conditions oc damages ta the streets and sidewal!<s or otlier r•ights-oF way that 1��2ve resulted from Grantee's use or occupancy of the st�•eets and sidewallcs or other righTs-of-way, as determined by the Director of Transportatioti 2nd Pub[ic Wocks or his designee. Grantee agrees to begin such repairs within thirty (30) days of receipt oF no[ice from the Uirector of TrZnsporta#ion and Public Works or l�is desigi�ee. All repairs shall be perfoi•med in an expeditious and tivorkman(ike mailner and sha(I co�nply wiih aN app]icable ta�vs;..codes, ardinances and City specifications. Tn the event that Grantee faiis to compty with the covenants he�•ein eontained with respect to such removal or restoration, the City shall have the rigl�t 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 bri��g the public rights-of-�►vay to the condition prescribed herein, and Ciry shall not be responsibie for frespass ar any nther damage or liability ir� connection wiih si�ch remo�val or restoration. Grantee shall reim6urse City for the cost and e:cpet�se of such r�moval atid/or repairs irr►tnediately following biliing for same b}� City. s. �;;����.����`-.!l '���1�!�� � � � ,�rr�, i 3 ,,1�`�� ����;�; ��;�� CONSEM'AGREElhENTforTemporaryuseatpu cpro 1.doc,�� y� 2 q ��, ';';;�'},���fj,� USG�� r Notliing herein shall be construed as a �vaiver by City to enforca penal sanctions prescribed by the Code of the City of Fort Worth and the laws of the State of Texas for Grantee's cc�ntinued encr�oachtnent upon the pubtic rights-of-way folIotiving termination of this Consent Agreement. 10. It is further understood and agreed between the parties hereto that City holds tl�e city streets, alleys, sidewalks and other public right�c-of-way, including tha portions of such streets used and encroached upon as dascribed herein, as trustee for the pnblic; that City exei•cises such powers over the streets as have been delegated to it by the Constitution of the State of Texas or by the Legislatnre; and the City cannot contract away its duty and its legislative power to cont�ol the streefs for the use and benefit of the public. It is accordingly agt�eed that if tlte governing body of City, to wit, its City Council, shall at any time diu•ing the term l�et•eof determine in its sole discretion to nse or cai�se or permit to be used fot� any pub(ic purposa tlle said encroached portion of the streets, then this agrecment shall ba automatically canceled and terit�inated, l.l. Grantee agrees to comply fiilly with all applicahfe fedei'al, state and local laws, stattYYes, ordin�nces, codes or regl�lations in connectiou with the conshuction, operation and n�aintenance of said encroachments arui uses. 12. Grantee lgrees to �ay prnrnptly when due ali fees, taxes or rentals provided for by this agreement or by any federal, state or local stahie, law oi• i•egnlation. 13. Grantee covenants and agrees that it shall execcisa all rights attd privileges granted hereunder as an independent contractor, and not as an officer, agent, se�vant oi• employee of City; that Grantee shall h�,ve exchisive control of and the exclusive right to cont►•ol the details of its operations and activities on said described public property and all persons perforniittg same, and shal( be solely responsible fot• the �cts and omissiotls of its officez•s, agents, servants, employees, contractors, s�tbcontractors, licensees and invitees; that the doctrine of r•espondeat st�perior shaEl tiof app[y as between City and Grantee, i#s officers, ager�ts, servants, empfoyees, contraetors and subcontracfors, and nothing herein shall be construed as creating a partnership or joint enterprise bet��veet� City and Grantee. � :=;���);;)J���,1��;,��r 4 �r�,15I��;�;� �- 1���, �� � �7 CONSENTAGREEMENTfcrTemporaryuseofpublicpropert�t.do �`,7'JUL C���ci'���'l �� . � �'��U � �,;; �, , ��, � '��_ �� �.dt:�Ilp 14. GRANTEE COVENAN3'S A2ViD AGREES TO I1V1DEiVINIFY, AND DOES HE�BY INDEIVIIT'I', HOLID HARMLESS r'�ND DEFEIVD CITY, ITS OTF'ICER�, AG�NTS, SERVAIoIT� AND �1VIPLOYEES, FRONI AI�iD AGATiVST AI�Y f11VD ALL CLAili75 OR SUITS FOR PROP�ItT'Y DA�AGE OR Li)S� AND/OR P�ASONAY, IP�TJ(IRY, CNCLUDING DEATH, T4 A.NY AND ALL PERSONS, OF WI'�ATSOEV�R KII�D OR CHARA,CTJER, W�TT�R REAL OR Ei�SER1`ED, ARISING OUT OF OR Il`i CONNiCTI01>1 WITH, DII2ECTLY OR I1�TDII�CTLY, T]E�E NiAi1v1TENA1�1C�, OCCUPAIVCY, �TSE, EXIST�TVC� OIa LOCATTOI>I OT SAID ENCROACHMENT A.101D USE� G12ANTEb HE1t�UNllER, WHETH�R aR IVOT CAU�E, l�1 WHOLE Ola PA�tT, BY ALLEGED NEGI,iG�1VCE OF OFI+IC�+RS, AG�NTS, S�RVANT�, �MPLOY�ES, COI\TTRACTORS, SUBCONTRACTORS, Li�EN$�+E� OR II�IVITEES OF CITY; AlVD GRAN'T�� H�R�BY ASSUii�S ALL LIAI3II,ITY AIVD R�SPOI�S�ILITY OF CIZ'Y, IT� OFFICERS, AGEI�ITS, SERVAlVTS AloI13 EIVIPLOYE��, FOR SUCH CLAIMS OR SUITS. GRAI�TE� SHALL LII{EWISE ASSUil�IE ALL L1ABtL�7['Y A�ID 12�SPONSIB�LITY AI+�D SHALL INDEMNIFY CITY FOR AI`TY AND ALL INJURY OR DAMA�E TO CITl' 1'ROPERTY, ARISING OUT O� OR IN CONiVECTYON' WTTH AiOTY AND ALL ACTS OR aMISSiOPd� OF GRATVT�E, TT5 OY+'�'YC]CR,S, AG�I�ITS, S�1$'VANTS, EMPI,QY�ES, CONTRA�'I'ORS, SUBCOI�TTRA,CTORS, LIC�SIY��S, INVIT��S OR TR]CSPA�SER�. 15. Geantee agrees to fiirnish City with a Certificate of Insurance, naming City �s certificate holder, as proof that it has secured and paid f�r a policy of public liabilily insurance covering al( public risks i�elated io ihe proposed use aizd occupancy of public property as located and described in �xhibit "B". The amaunts of such insurance shalf ba noi less that the foliowing: Propet�ty damage, per occurrence $1 Q0,000,00 Bodily injury, perpersoii $250,000.00 Bodily injnry or deafh, per occi�rrence $500,000.00 VVith t(ie understanding of and agreement by Grantee that such insurancc amounts shall be revised upward at City's option and that Grantee shall so revise stich amount immec�iately fo[�owing notice to GraTrtee of such requirement. Such insurance policy shall provide t[iat it cannot be canceled or amended rvitl�out at Ieast thirty (30) days' prior wrirten notice to the Builditlg Official 5 � .. r, uv��l'L. �!t '��� � �' �� CONSfNT AGREEMEMTforTemporary use nf public pr erty'rrck� ./ i� ���' ��0� ��j1 �� �/ ;y �,�^ �� � �:: �s`; II� .�. U f�, ..�', ^%t:��11�� �!� 7� of tlie City of Foit Worth. A copy of such Cej�tificate of Insut•ance is attached as Exhibit "A". Grantee agi•ees to submit a si�nilar Certificate of Tns�u�ance ai3n��a11y ta City on tYte anniversary date ofthe execution of this agreement Grantee, agrees, binds and obligales itself, it successors and assigns, to maintain and keep in force such public liability insurance at alt times duxing the te�m o� this agz�eemeni and ui�til the removat of all eneroachments and ihe cleanfng and restoration of the city sn-eets. All insut�ance coverage reqttired herein shall include coverage of aU Grantee's contractors. 16. Grantee covenants and agrees that it will not assign aIl or auy of its rights, privileges or duties under this contract without prior written approv1l of City, and any attempted assignment without siich prior written approv�l shafl he void. 17. Tl�is agreement shall be binding upon the parties hereto, their successors and assigns. 1 �, Shoulct any action, whether rea{ or asserted, at lativ of• in equity, arise o�rt of tl�e terms and conditions of this agreentent or otit of tlie use aRd occupailcy of City prope�ty as permitted hereunder, venue for said action shall be in Tarrant County, Texas. 19. In any actio�a brougl�t by City for the enFoi•cement of the obiigaiions of G�•antee, City shalt be entitled to recover interest and reasonabl� at�orneys' fees, EXECUTED this / �� day of ��� � �, �� — �— ---- GRANTOR: GRA� : � CITY OF FORT WORT�-I ,,�`,� / , � /1C�1�{. -�L �GC'' LCt-� l�� vCf� _� . {�� C � S fi�% - Building Official ✓� I`�� S I Gl-(' h� Tit(e — - —_- _ - ,�,:,^, � �;; � �'�'�, J;ti�� ��� �'��'?'C CONSENT AGREEMENTfar Tempersry use ol public ropq(�ty°�po(l �rs �� I� �I� j�, �� �J G L �� �.`-'Ci �1� L�'1.,�. ^�f�.l:il1���`YYY �'��"� ��) .. `✓ � � APPROV TO � �1�D TAEGALTTY: AsSis ant �it_ AtLorney Date � ��� . Cily Secretar i�C) Ni�cC: ���;C�U��C�fJ � ,� ___.z. �._.,-- ==��oa� A � .�b-'�.o-^z�oc� ll ate CONSFN7 AGREEMENTfor Temporary use of Fublic properlyl.doc STATE OF TEXAS COUNTY OF TARRANT BEFORE ME, tlze ac�zdef�sig�zed autlzority, a Nota�y Public i�: a�zd For tlze State of Texas, o�r tlzis day personally appeared �'=i�� v/ �j�7��iL,`7•`��';/,��?�-������ ,k�zowii to nce to be tlr�e pef�soiz fvliose �zunze is subsc�•ibed to tlze foregoi�tg instrarnte�at, a�id ackfaowledged to me tJzat he/slze executerl tlae sanae for tlr�e purposes a�id coiisi�leratioii tltereiir t, ' - - l%�, -�-r. ; ,.,' _��7C i ri� expresse�l, as tlae act a�:rl rleed of �� �� � ��� , a�trl in tlre capacity tlief�ei�z state� GI i�EN UNDE�Z MY HAND AND SEAL OF OFFICE tIz is %� day o, f C C � C, ��v�;-- :�: Z p��, ,� ;� � 2r� �� � " -LC� f�ff (lll�` � � ��>> ���1�. 0�1�/�z- Title -� `_'� � �S � `�, �_,.: ;�. Notaty Public in� a�ed for ��' Tlze State o Texas ,,,,���,,,,, -.-�� �zot�nrr�e�ni �. i�7. NAREZ , = Notary Public, .Srate nf Texas ; ;�+�,; My Commission Expires ��':;;�;;;�` September 10, 2009 8 — = -._ --_ --, ,.-.. �•r_,, ;� �',:,,^^^i �;��'�1'L�1:�'!t hi5�'J ��J � y� a,r�:�._ ��� � U,'� 1'��;; �t; ��;';! ? � ��� ':'� `<� ��� �'� �'� � � �c � .s��r� a� ���,� C`�UI�T�' Ol� �'ARIPAtV�' BEFOIZEME, f{ie crtacleFsigned rtrtiho��rty, a Notr�ty PtabCic irt �rn�f �'of� tlee tate f Texr�s, on thrs rlay �ersonally a�vpearetl �'f�Y1�Nr� �� Il�ti�r"� q t ���''� "�h� ,known to me to be the pe�son wLiose name i,� srcbscribe�i io tlae faregoing ifzstrac�nent, anrd recknowlerlged to me ilz�ct �ie/sfae executetl tjie .stame foN tlze purpo.�es a�cl consirleYrciinn t{�er�ein expYesserl, as tlae �ct and �leed of Z4+;�'tz�'t! �(���,������ rera�l in the cuprlcity thet�eirt .strePed � G !V III�DER l�YHAIVDAI�ID SLAL OF OFFIC'E this � — rltxy o f �' �'r�� ,� 20� . � A f �cnt . � tG�Jt � itle , IVotrcry Prc6Cic in rcnrl for Tlie State of Texas REBECCFi! .��O�SON Notary Pub�ic, S1a1� of (eSas �ly Co 5m�2S2010 Xp T � � 0 e _.�.._ ._�„"_ ' /` 'l .,. �: %`a„l�'1!I (j I�jr�I���i���117 '%�15"`%V�4� 1 ����� `���RI���'�� � .''' 1 �1�Ui �;���� � �, �';�k,jU �� � - �.� ` ,t . ,. , -� _ .: q'X y d'; �,�.;J Contractors Name: G�r n� f Point of Contact: � � �` Phone Number; s:�;� -i _ �? �� � � , � Building Permit Number: Purpose for Closure: (�yti����,, .,,,,„ �M�?i � Begin Date: i ��/v�� �nd Date:��� Type of Taper according to posted speed limit: Tapers @ 30 iV�H lOft Offset 30R minimu� Tapers @ 35 MPH 1Qft Offset 35ft auni�uum Tapers @ 40 MPH l Oft Offset 40ft minimnum �p 1 �.�� �G � -, ���� .� ,,, � �� � �� �% `',� �\ i ��. _ -. ._ --`� ` .� ~'� l.—� � Z� �'�fiVJb�1�b �1������ 5� � a R �,�I!1��� ;���t-,����5�'�111�1 iii,•(,��2GqG (f8::�i i:-i3. �1'�Y1677�i3 BI��TC'LCrH �JU�)i ��"�"'�+'°' ����"�����l�� (�� L.��l�����T� 1%i����l��� I��. ���` I �a•r� (n�n,voelYVYYJ � y � 10fU3!2U�6 Pt�ouCeR �� iHIS GEkifFiCA7f� i5 lS5UE0 A� A r�ATTER pF 1NFQRMA7IGN ih� ��in Junas r;:,��Gy c�h1LY ANb ct�NFEF�s Nn Rl�w�fS UFON 't'H� �€R71FI��iiE Mindi McFtiniey H��-��R- TH1S GEI2'1'IFIG:4i� GfC��$ NJT AMEfVD, EXTEND qR ALY�Ft Tt�� CdVFFL��� AFFC�RI3E� BY TH� F'91.ICf��u B�L4VV. $52�J Baat Glub r��i. --- �ort Worth, TX 1�'( 79 _ IhlSUREI�$ AFFDRDlN� �Qy��q�',�_ �p,�G y� IN5UR�6 i1JSUK[RA: N;Y�;���v�isi�. I�SUYiiriGU Companias Aj�x Glass & 11,9irror, InG. �i�suR�Re. rex�s t�4cu,�1 Insurancc- C:qm�aany 401 S W, VicKery Blvd uasurz�r�c: Fori Vvprth, TX 7�i1U7 � i�,5����R�; -- —� — I trisuas�F: 'HE POLIGIES UI� :N�:4!R!?��C:G I_ISTEP BEL�W HAVE BEEh! lSSUED 7�] THE INS�iRED NANIr% A�Sb`/G FOF:7hIE POLICv 7=RIOC INGICA7EC. Nr]'r'1n'19'H,�"raN01N� ANY REQUIREfvIEh'", 7ERfv9 OR rp�s�n;riQN p� m�Y �;ON-r,AGT QR CTI•IE� UOGUMENT WI?N R[SPECT T4 WHICH 'I�HIS Cti271�ICn7 : MAY BE ISSUED O�i FAAY PEh^'Pl.11N, 'iH� I�IS,IF:ANGE =.FrCFDEC BY TFIE PGLICIES 17ES�nIBE� HEl��lri IS $UiX,I��Y Tb ALL TrIE TEFf�AS, EiCCLUSIOIVS ANp COVDITIOrJ$ rj� .SUCH POUCIE5 A��GREc.,�i C uh11T5 Shlc��:vN �,a.vv Fi�,vr aG�N REpUGEE� BY PAID G! F,iMS. Ra�'R�atr --- ---- -F'�''( . � . � m'v'�""` �. l.7ft ,fN4rl _ ll rc Or' iNSllieANGE PpI,IGI' NU�7EEfi G;i7 • � �" � t(fJl1� r ���q�rc GEN�Rki,.:Aalll'Pv Ob/3C�/2005 �$/3D/�007 GaGH�GCUR�rvGr ,• �,004,4i�U A +% COMi'��::'�.;C��i.LC7ENERA441A61UTY Q'�p�i'�sJJ�5�3a�� � U0.N1A�`��Tli'��' y, 500,G'�}:J f•i�6MISC3 E� o�cwrn r,� � Gl.a: dS'.li�Dc � CCCUR � NiF,p EYP ;My one patami) 5 5,�Q0 I ✓ <-��'` 3�.'•:U:?I '..It�l;iii;y ' ryE1'iSONAL',S HUV INJJNY S 1 U5U 4hb �=u�� NC-�; .r:wnrE � rnrr �PN�_it� NcH: t Fouc �PRGJECT r� i.nc auramoe� _r tiaeiurv ] 4N� . i i 4 � qU_ i_ .YWcC HL�`G� _j 5CI•11 :4;LnD,iUTCo , J iiIFE lAU?C•.`; � NQh-G{h'Mc?P,UT'05 � —_ _ GAf�q�E Lla aLir ` ^���• nrdv,at „ A ! EXCt35rUt. �FELLAUABILf�-r i� i'+r.{;!. ❑ .,�-, . ; A1NC�C I QFi,1l_ _�flliL'c �✓�� Kcft 1''Q�'V y; 1f,1 .flfi i $ WO iSE4:5 c;UG7r�Nar,T�9N AN� � EhSPLOYEpS' 6�:idiLlll' � aNvrr�ovr;i--ur;�a�c7,u:N�_: =CVT�vE I GFFiC'tF.4�AEb19[F. EY,CLu�=U' i If V?S. JESCitihe und�_ � 'vU j Sf�EC1Ai 'RGVI51: fJ5 tclpw I r� rto�c�R City o? Forr �Na�b► �'uf�lic �Arork., ���p�rl•m�nt 311 V+l . I t�+,h �t Fort'Ndrih,TX�diU2 91 BA�59451:�QQ1 �� cu�5�����aos TSFOGp112�1 iq4 GLNCRALAGGF�EGATE 3 P�cOpIIGTS - GQMP/OI� a,^�,� � q$.r30/'�(7Q� 0$/30,'20D7 �Of�ABINcD SINGLE _I,NIT ; (ea �caae�,t) 3QOILV W,IUR1' � ,Fat Pe:s��n) . �6DILY INJU�Y � t�r� accideni) �ROP�RTY' UAI�iAt`sE r; iPr..r aq�id�nq � AUTO ONLY - EA AGCIUEtJT g OTIdER Th1AN EA A(.� .� ___ AUTQ ONLY; k�� � ��/30(�Qb6 081;�bi2�07 eACli �GCLIRRGH�6 s ,1�Gf:GGATE � I � I u 08!30120f]7 2,o0o,ono 2,409,4U0 i,000,oao ;.��o,�oa 5,OUt],OGO E._ CA•�MIACCI[]ENT 1,���,��� E.L. CISCASE � Eti E�APLtjY�,ti ',�OO,�GO L".;.. C+I�CAS�. P�LICY L1�.11T 3—���fl���C'0 �:;'�'r�Jv]c°?� ar;��"J �!��n�� �{ u i ' ���J�.�J N ' i 7 i"''p I p�. �_:l�u ����t ��!I�� GAIV�ELIJ�7fO1V 9 + �i� �': '� J: u�ar�—vc�aa�- -- S 1 SNOIJLG ANY fjp YHF ABGVE �ESCRI�C U POLICIES 6H CpNC��4ED EEFORE THE tKPIW;T10 C7ATE TN�RE(]F, 7H� 155UING INSUftE% IVILL ENDFAV6R TLY MAII. '� � �iAY9 WRi't7EN ta61'ICE ip YS�M1 G�R7�FlGA7E H+]LAER hl4AiEG 70'fNE �EpY, 8UT FAIIURE TO DD 50 ShIALl �P+1a0,4'� hl�i �iBLiGNiIDN (?R LIABILf'FY t]F r �Y fSIN6 11PpN TH� IN5URER �7S AGEN7S Ok REPRE3EAlL4TlVE5. AUTHO�Z�� REPRE3EN7.QTIUE � Nl�linda i�1c►tir�ley ACOt�D 25 (�Q01lOB) _ — -- Ct1 ACdt2D