HomeMy WebLinkAboutContract 43860 CITY SECRETARY / -7 ,
CONTRACT NO, fI
STATE OF TEXAS
KNOW ALL MEN BY THESE PRESENTS
COUNTY OF TA RRANT
THIS AGREEMENT is made and entered by and between the City of Fort Worth, Texas, a municipal
corporation situated in Tarrant County, Texas, hereinafter called "CITY", acting herein by and through its
duly authorized Assistant City Manager, and Kinsman and Associates, hereinafter called "ENGINEER" for
the purpose of providing professional services for the third-party independent review of the Phase VII
Energy Savings Performance Contract(ESPQ proposal of Johnson Controls, Inc(JCI)
WITNESSETH
That for and in consideration of the mutual covenants and agreements herein contained, the parties hereto
do hereby covenant and agree as follows:
SECTION I: SERVICES OF THE ENGINEER
1. CITY hereby contracts with ENGINEER as an independent contractor, and ENGINEER hereby agrees
to perform, within the professional standards normally accepted in the State of Texas, the following
professional services:
I.I. Proposed project descriptions are accurate and correlate with on-site observation.
1.2. Proposed projects are appropriate solutions to existing conditions.
1.3. Methods of calculating savings are reasonable and accurate to acceptable standards.
1.4. Project savings estimates are obtainable.
1.5. Project costs are reasonable and cost/benefits are in balance.
1.6. The measurement and verification method proposed is applicable and adequate.
1.7. Proposed financial plans meet applicable state code and other applicable guidelines.
1.8. The technical interest of the CITY is protected in the contract documents.
1.9. Report of findings.
2. Project scope of work for the above professional services, is defined by JCI's Utility Assessment
Report (UAR) and in accordance with Texas State Energy Conservation Office (SECO)
recommendations.
3. CITY facilities count and department distribution for the above professional services, as defined by
JCIs UAR_
SECTION II: PERSONNEL
1. The following personnel wi 11 be assigned to this Project:
I.I. Samuel Gunderson, Conservation Specialist, City of Fort Worth
1.2. Sam Steele, Administrator of Sustainability Programs, City of Fort Worth
1.3. Frank Kinsman, President, Kinsman&Associates
r 1.4. Charles Clark,Vice President, Kinsman&Associates
-� 1.5. Thomas Congdon, Engineer in Training, Kinsman&Associates
2. Neither party may change key personnel without agreement by the other party.
CD
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, Tip
C:\Users\CRC4\AppData\Local\Microsoft\Windows\Temporary Internet
Files\Content.Outlook\JZEK7ALE\Kinsman Phase 7 Contract 10-12-12 CFW.docx 10/17/2012 Page 1 of 8
SECTION III: CHARACTER&. EXTENT OF ENGINEER'S SERVICES
1, Perform services as outlined in ENGINEER's letter dated 29 August 2012, which is attached to and
made a part of this Agreement. ENGINEER shall consult with CITY to clarify and define CITY's
requirements relative to the assignments and review available data.
2. The schedule for the Project is:
2.1. Complete all services within 30-working days of receipt of the referenced contract documents,
.ICI reports, and other supporting documentation. ENGINEER with contact the CITY if project is
inactive for more than three business days because of delayed response from third party.
3. ENGINEER agrees to commit the personnel to each assignment as necessary in order to complete the
assignment in an expeditious manner.
4. ENGINEER shall advise CITY as to the necessity of CITY's providing or obtaining from others
services and data required in connection with the Assignment at CITY's cost and expense (which
services and data ENGINEER is not to provide hereunder but on which ENGINEER may rely in
performing services hereunder), and act as CITY's representative in connection with any such services
of others.
5. ENGINEER shall pay for the printing of documents as a part of the proposed fee.
SECTION IV: SPECIAL SERVICES OF ENGINEER
1. If authorized in writing by CITY, ENGINEER shall furnish or obtain from others Special Services
necessary to complete the assignments at a cost stated by the Facility Manager by letter.
SECTION V: COMPENSATION TO ENGINEER
1. The total compensation for all of the assignments to be performed by ENGINEER as described in
SECTION III, CHARACTER & EXTENT of ENGINEER'S SERVICES hereof shall be a fixed
amount of$18,000.00,As stated in Attachment A dated 29 August 2012.
SECTION VI: METHOD OF PAYMENT
1. ENGINEER shall be paid not more frequently than once per month on the basis of statements prepared
from the books and records of account of ENGINEER, such statements to be verified as to accuracy
and compliance with the terms of this Agreement by an officer of ENGINEER. Payment according to
statements will be subject to certification by the Director, Transportation and Public works
Department or his duly authorized representative that such work has been performed.
2. The above charges are on the basis of prompt payment of bills rendered and continuous progress of the
work on the Assignment until completion. If CITY fails to make any agreed to payment due
ENGINEER for services and out-of-pocket expenses within sixty-days after approval of ENGINEER's
statement thereof, ENGINEER may, after giving seven-days'written notice to CITY, suspend services
under this Agreement until ENGINEER has been paid in full all amounts due for services actually
performed and out-of-pocket expenses actually incurred.
C:\Users'CRC4\AppData\Local\M icrosoft!windows\Temporary Internet
Fi les\Content.Outlook\JGEK7ALE\K ins man Phase 7 Contract 10-12-12 CFW.docx 10l 1712012 Page 2 of 8
SECTION Vll: CITY RESPONSIBILITIES
I. Provide criteria and information as to CITY's requirements and designate a person with authority to act
on CITY's behalf on aft matters concerning the Assignment.
2. Assist ENGINEER in obtaining existing studies,reports and other available data and services of others
pertinent to the Assignment and in obtaining additional reports and data as required.
3. Upon reasonable notice arrange for access to and make all provisions for ENGINEER to enter upon
public and private property as may be required for ENGINEER to perform services hereunder.
4. Designate in writing qualified persons who will act as CITY's representatives with respect to the
Assignment for the purposes of transmitting instructions, receiving information, interpreting and
defining CITY's policies and decisions with respect to ENGINEER's services.
S. Review all reports, recommendations and other documents and provide written decisions pertaining
thereto within a reasonable time.
6. Upon reasonable notice provide labor and safety equipment to expose structural elements, to make
temporary repairs, and to operate mechanical and electrical systems as required by ENGINEER in the
services.
7. Provide such legal, accounting, insurance and other counseling services to CITY as may be required
for the Assignment.
8. Bear all costs incident to compliance with this Section.
SECTION VIII: TERMINATION
1. CITY may terminate this Agreement at any time for convenience or for any cause by notice in writing
to ENGINEER. Upon receipt of such notice, ENGINEER shall immediately discontinue all services
and work and the placing of all orders or the entering into Contracts for supplies, assistance, facilities
and materials in connection with the performance of this Agreement and shall proceed to cancel
promptly all existing contracts insofar as they are chargeable to this Agreement.
2. If CITY terminates this Agreement under the foregoing paragraph, CITY shall pay ENGINEER for
services performed in accordance herewith prior to such termination, less such payments having been
previously made. Such payment shall be based upon the work completed up to the date of termination
of the Agreement in accordance with the method of compensation prescribed in Sections V and V1
hereof. ENGINEER shall also be compensated for all termination-related expenses such as meeting
attendance,document reproduction,transfer of records.
3. Upon early termination or conclusion of this Agreement, ENGINEER shall provide CITY reproducible
copies of all completed or partially completed engineering documents prepared under this Agreement
that shall become the property of CITY and may be used by CITY in any manner it desires.
ENGINEER shall not be liable for the use of such materials for any project other than the project
described in this Agreement.
C:\Users\CRC4\AppData\Local\Microsoft\Windows\Temporary Internet
Files\Content.OutlooklJZEK7AZE'\Kinsman Phase 7 Contract 10-12-12 CFW.docx 10117!2012 Page 3 of 8
SECTION IX: INDEMNITY AND INSURANCE
1. Approval by CITY of contract documents shall not constitute or be deemed to be a release of the
responsibility and liability of ENGINEER, its officers, agents, employees and Subconsultants, for the
accuracy and competency of the services performed under this Agreement, including but not limited to
surveys, location of subsurface investigations, designs, working drawings and specifications and other
engineering documents.
2. Such approval shall not be deemed to be an assumption of such responsibility and liability by CITY for
any negligent act, error or omission in the conduct or preparation of the subsurface investigations,
surveys, designs, working drawings and specifications and other documents by ENGINEER, its
officers,agents,employees and Subconsultants, it being the intent of the parties that approval by CITY
signifies CITY's approval of only the general design concept of the improvements to be constructed.
3. In this connection ENGINEER shall indemnify and hold CITY and all its officers, agents, servants
and employees harmless from any loss, damage, liability or expenses, on account of damage to
property and injuries,including death,to all persons, including but not limited to officers,agents,or
employees of ENGINEER or Subcontractor, and all other persons performing any part of the work
and improvements, which may arise out of any negligent act, error or omission in the performance
of ENGINEER's professional services. In no event shall ENGINEER be liable for consequential
damages.
4. ENGINEER shall defend at its own expense any suits or other proceedings brought against CITY, its
officers, agents, servants and employees,or any of them on account thereof, and shall pay all expenses
and satisfy all judgments which may be incurred by or rendered against them arising out of the
indemnification; provided and except, however, that this indemnification provision shall not be
construed as requiring ENGINEER to indemnify or hold CITY or any of its officers, agents, servants
or employees harmless from any loss, damages, liability or expense, on account of damage to property
or injuries to person caused by defects or deficiencies in design criteria and information furnished
ENGINEER by CITY,or any deviation in construction from ENGINEER's designs, working drawings,
specifications or other documents.
5, Without limiting the above indemnity, ENGINEER shall maintain a policy of comprehensive general
liability insurance coverage with carriers acceptable to CITY in at least the following amounts:
Commercial General Liability: $1,000,000 Per occurrence
$2,000,000 Aggregate Limit
Workers Compensation:
Coverage A: Statutory limits
Coverage B: Employers Liability Insurance
$100,000 Each Accident/Each Occurrence
$100,000 Disease--per each employee
$500,000 Bodily Injury/Disease--Policy Limit
Automobile Liability: $1,000,000 each accident on a combined single basis
OR
$250,000 Property Damage
$500,000 Bodily Injury per person per occurrence
Professional Liability Insurance
Errors and Omissions: $1,000,000 Per occurrence
$2,000,000 Project aggregate
11Fs 100\Lawl Black lConstructionlTPW-GenerallTPW-Architectural ServiceslKinsman Johnson Controls
ReviewlKinsman Phase 7 Contract 10-12-12 CFW(dwb 11.05.12).docx 11/5/2012 Page 4 of 8
6. ENGINEER shall furnish CITY a Certificate of Insurance In at least the above amounts. Certificate
shall contain a provision that such insurance cannot be canceled without 30-days prior written notice to
CITY. CITY reserves the right to revise insurance requirements specified in this agreement to the best
interests of CITY.
7. General Insurance Requirements
7.1. Commercial General Liability coverage shall be endorsed to name CITY an Additional Insured
thereon, as its interests may appear. The term CITY shall include its employees, officers, officials,
agents,and volunteers as respects the contracted services.
7.2. Certificate(s) of insurance shall document that insurance coverage specified are provided under
applicable policies documented thereon.
7.3. Any failure on part of CITY to request required insurance documentation shall not constitute a
waiver of the insurance requirements.
7.4. A minimum of forty-five days notice of cancellation, non-renewal or material change in coverage
shall be provided to CITY. A ten (10) days notice shall be acceptable in the event of non-payment
of premium. Such terms shall be endorsed onto ENGINEER's insurance policies. Notice shall be
sent to the Facilities Manager, Transportation and Public Works Department, 1000 Throcklnorton,
Fort Worth,TX 76102.
7.5. CITY shall not be responsible for the direct payment of any insurance premiums required by this
agreement. It is understood that insurance cost is an allowable component of ENGINEER's general
overhead.
7.6. CITY reserves the right to revise insurance requirements specified in this agreement according to
the best interests of CITY.
7.7. Insurers for ail policies must be authorized to do business in the state of Texas or be otherwise
approved by CITY; and, such insurers shall be acceptable to CITY in terms of their financial
strength and solvency.
7.8. Deductible limits, or self-insured retentions, affecting insurance required herein may be acceptable
to CITY at its sole discretion; and, in lieu of traditional insurance, any alternative coverage
maintained through insurance pools or risk retention groups must be also approved. Dedicated
financial resources or letters of credit may also be acceptable to CITY.
7.9. CITY shall be entitled, upon its request and without incurring expense, to review ENGINEER's
insurance policies including endorsements thereto and, at CITY's discretion, ENGINEER may be
required to provide proof of insurance premium payments.
7.10.CITY shall not be responsible for the direct payment of any insurance premiums required by this
agreement. It is understood that insurance cost is an allowable component of ENGINEER's indirect
overhead.
7.11.A l l insurance, except for the Professional Liability insurance policy, shall be written on an
occurrence basis.
7.12.The Professional Liability Policy shall be written on a"claims made"and shall be in effect for the
duration of this agreement and for 12 months following ENGINEER's issuance of the of a Final
Report. ENGINEER'S current insurer shall list CITY as a certificate holder for a period of two
(2)years following the delivery of a Final Report to the CITY by the ENGINEER(see SECTION
III above for defined deliverables). CITY shall be notified at least 30-days prior to cancellation
or substantial change in coverage.
C:1Users\CRC41AppData\Local\Microsoft\Windows\Tetziporary Internet
Files!Content.Gutlook\JZEK7AZE1Kinsman Phase 7 Contract 10-12-12 CFW.docx 10/1712012 Page 5 of 8
7.13.Subconsultants to ENGINEER shall be required by ENGINEER to maintain the same or reasonably
equivalent insurance coverage, except for Professional Liability Insurance, as required for
ENGINEER. ENGINFER shall provide CITY with documentation thereof on certificates of
insurance. The ENGINEER shall assure that Subconsultants provide acceptable and appropriate
levels of Professional Liability coverage or that ENGINEER"s coverage provides coverage for the
work of the Subconsultant. Notwithstanding anything to the contrary contained herein, in the event
a subconsultant's insurance coverage is canceled or terminated, such cancellation or termination
shall not constitute a breach by ENGINEER of the Agreement,
SECTION X: INDEMNITY PERTAINING TO HAZARDOUS MATERIALS
1. CITY acknowledges ENGINEER will perform part of the work at CITY's facilities that may contain
hazardous materials, including asbestos containing materials, or conditions, and that ENGINEER had
no prior role in the generation, treatment, storage, or disposition of such materials. In consideration of
the associated risks that may give rise to claims by third parties or employees of CITY, CITY agrees in
so far as permitted by law, to indemnify ENGINEER from any and all losses, damages, claims, or
actions brought by third party or employees of CITY against ENGINEER or ENGINEER's employees,
agents, officers, or directors, in any way arising out of the presence of hazardous materials or
conditions at CITY's facilities, except for claims shown by final judgment to arise out of the sole
negligence of ENGINEER. CITY shall defend at its own expense any suits of other proceedings
brought against ENGINEER and its officers, agents, servants, and employees or any of them on
account thereof. Nothing herein shall be construed so as to require CITY to levy or assess any tax.
2. In connection with hazardous waste, including petroleum products, CITY agrees to the maximurn
extent permitted by law to defend,hold harmless and indemnify ENGINEER from and against any and
all claims and liabilities resulting from CIr1'Y's violation of any federal, state or local statute, regulation
or ordinance relating to the disposal of hazardous substances or constituents. Nothing herein shall be
construed so as to require CITY to levy or assess any tax.
3. The requirements contained in this Section shall not apply if ENGINEER introduces the hazardous
materials or conditions.
C:1 Usersl CRC41 AppData\Loca llNlicrosoft\Windows\Temporary Internet
Files\,Content_Gutlook\JZEK7AZE\Kinsman Phase 7 Contract 10-12-12 C.FW.docx 10/1712012 Page 6 of 8
SECTION XI: RIGHT TO AUDIT
I. ENGINEER agrees that CITY shall, until the expiration of three (3) years after final payment under
this Agreement, have access to and the right to examine any directly pertinent books, documents,
papers and records of ENGINEER involving transactions relating to this Agreement. ENGINEER
agrees that CITY shall have access during normal working hours to all necessary ENGINEER facilities
and shall be provided adequate and appropriate workspace in order to conduct audits in compliance
with the provisions of this section. CITY shall give ENGINEER reasonable advance notice of
intended audits.
2. ENGINEER further agrees to include in all its subcontracts hereunder a provision to the effect that the
subconsultant agrees that CITY shall, until the expiration of three (3) years after final payment under
the subcontract, have access to and the right to examine any directly pertinent books, documents,
papers and records of such subconsultant, involving transactions to the subcontract, and further, that
CITY shall have access during normal working hours to all subconsultant facilities, and shall be
provided adequate and appropriate work space, in order to conduct audits in compliance with the
provisions of this article. CITY shall give subconsultant reasonable advance notice of intended audits.
3. ENGINEER and Subconsultants agree to photocopy such project-related documents as may be
requested by CITY. CITY agrees to reimburse ENGINEER and Subconsultant for the costs of copies
at the rate published in the Texas Administrative Code.
SECTION XII: SUCCESSORS AND ASSIGNS
1. CITY and ENGINEER each bind themselves, their successors and assigns, to the other party to this
Agreement and to the successors and assigns of each other party in respect to all covenants of this
Agreement.
SECTION XIII: ASSIGNMENT
I. Neither party hereto shall assign, sublet or transfer its interest herein without prior written consent of
the other party, and any attempted assignment, sublease or transfer of all or any part hereof without
such prior written consent shall be void.
SECTION XIV: INDEPENDENT ENGINEER
I. ENGINEER shall perform all work and services hereunder as an independent Engineer, and not as an
officer, agent, servant or employee of CITY. ENGINEER shall have exclusive control of, and the
exclusive right to control the details of the work performed hereunder, and all persons performing
same, and shall be solely responsible for the acts and omissions of its officers, agents, employees and
Subconsultants. Nothing herein shall be constrried as creating a partnership or joint venture between
CITY and ENGINEER, its officers, agents, employees and Subconsultants, and doctrine of respondent
superior has no application as between CITY and ENGINEER.
SECTION XVI: OBSERVE AND COMPLY
I. If permitting authorities require design changes so as to comply with published design criteria and/or
current engineering practice standards which. ENGINEER should have been aware of at the time this
Agreement was executed, ENGINEER shall revise plans and specifications, as required, at its own cost
and expense. However, if design changes are required due to the changes in the permitting authorities'
published design criteria and/or practice standards criteria which are published after the date of this
Agreement which ENGINEER could not have been reasonably aware of, ENGINEER shall notify CITY
of such changes and an adjustment in compensation will be made through an amendment to this
Agreement.
C:\Users!CRC4\AppData\Local\Microsoft\windows\Temporary Internet
Files\Content.Outlook\JZEK7AZE\Kinsman Phase 7 Contract 10-12-12 CFw.docx 1411 712012 Page 7 of 8
SECTION XVII: VENUE
1. Venue of any suit or cause of action under this Agreement shall lie in Tarrant County,Texas.
IN TESTIMONY THEREOF, CITY has caused this instrument to be signed in triplicate in its name and on
its behalf, by its City Manager and attested by its City Secretary, with the Corporate Seal affixed; and
ENGINEER has also properly executed this instrument in triplicate copies, each of which is deemed an
original.
EXECUTED CLT
1
ED IN THE CITY OF FORT WORTH TEXAS T�IIS day of C.E.)
X y
B Y: APPROVED:
Frank E. Kinsman
Principal's Name
Kinsman& Associates Consultin g Engineers
Company
President X-0/
Office(President or Vice President) By.
Assistant City Manager
*Fe Y o cos
APPROVAL RECOMMENDED: RECORDED:
(j, �- B B
avi�
y. s �'
Director,Transportation and Publics Works City Secreta r 4k- -'000000
n
[� p' o
APPROVED O FORM AND LEGALITY:
0
--
o a �
Date:
By: �
Ci Attorney 00C)DOao
OFFICIAL RECORD
CITY SECRETARY
FT. WORTHS T
_j
C:IUsersl CRC41 AppDatal Loca]\Microsoft\Windows\Temporary Internet
F Iles\Content.Out look\JZEK7AZE\K1nsman Phase 7 Contract 10-12-12 CF W.docx 10117/2012 Page 8 of 8
KINSMAN&ASSOCIATES, Consulting Engineers
Systems Analysis and Design
August 29, 2012
Mr. Samuel Gunderson
Conservation Specialist
City of Fort worth
401 west 13th Street
Fort Worth, TX 76102-6311
Dear Mr. Gunderson:
We are proposing to perform a third-party review of a new proposed performance contract
(Phase VII) between the City of Fort Worth and Johnson Controls, Inc.
Our third-party review of Phase VII will include verification of the following:
1. Proposed project descriptions are accurate and correlate with on-site observation.
2. Proposed projects are appropriate solutions to existing conditions.
3. Methods of calculating savings are reasonable and accurate to acceptable standards.
4. Project savings estimates are obtainable.
5. Project costs are reasonable and cost/benefits are in balance.
6. The measurement and verification method proposed is applicable and adequate.
7. Proposed financial plans meet applicable state code and other applicable guidelines.
g. The technical interest of the owner is protected in the contract documents.
9. Report of findings.
This review will also include review of the composite cost, savings, payback, and cash flow of
previous Phases I, II, III, IV, VIb, and this Phase VII as they are rolled into one project.
8533 Ferndale Road•Suite 102 Dallas,Texas 75238 Ph.(972)644-7876 Fax (972)644-3355
www.kinsmanengineering.com
Mr. Samuel Gunderson
Page 2
August 29, 2012
Our proposed fixed fee for this work is $18,000.00.
If there are any questions regarding this proposal, we will be pleased to respond. Thank you for
this opportunity to be of service.
Sincerely,
Frank E. Kinsman
President
/Pt
Attachment
cc: Mr. Sam Steele
KINSMAN & ASSOCIATES, Consulting Engineers
Systems Analysis and Design
CONFIDENTIAL
STANDARD RATE SCHEDULE
CLASSIFICATION HOURLY RATE
Principal $130
Senior Engineer $115
Engineer $90
Junior Engineer $75
Senior Technician/Senior Draftsman/Program Coordinator/ $60
Executive Assistant
Technician/Draftsman/Technical Administrator $50
Administrative Assistant/Sr. Secretary/Junior Technician $40
Secretary $30
Clerk/Receptionist $23
Rates Effective: July 2011
8533 Ferndale Road * Suite 102 • Dallas,Texas 75238 • Ph. (972)644-7876 9 Fax: (972)644-3355
� DATE(M MIDDIYYYY)
AC"R" CERTIFICATE OF LIABILITY INSURANCE
10/18/2612
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 ��
NAME:
Higginbotham Insurance Agency, Inc. (A/C-,�u:Ext):8Q0-247-_0712 FAX No:817-347-6981 _- -
12726 Hillcrest Road, Suite 450 E-MAIL
TX 75230 Av�ESS:bmiranda hi in otham.net
INSURER(S)
AFFORDING COVERAGE NAIC#
INSURER AVaryland Casualty QDmipany
INSURED KINSM INSURER B:Sentinel Insurance Com an LTD _ - _.11000
Kinsman&Associates, Consulting Engine INSURER C:Ha f r Und rwriters Ins Co 30164
8533 Ferndale Rd. INSURER D:Conversion Code
Suite 102
- -� -
Dallas TX 75238 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:829205120 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.
_FN_SR_ A SUBR POLICY EFF POLICY EXP
LTR TYPE of INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
A GENERAL LIABILITY PASO42635384 9/2512012 /2612013 EACH OCCURRENCE $1,000,000
x DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000,000
CLAIMS-MADE KI OCCUR MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
i
POLICY PRO- LOC $
COMBINED SINGLE LIMIT
B AUTOMOBILE LIABILITY 46UEOPN1417 212312012 /23/2013 Ea accident $1,000,000
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED x SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS X AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DE❑ RETENTION$ $
C WORKERS COMPENSATION 6WF-CDW7796 10/1812012 0/18/2013 X WC TA iT OTRN-
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $500,000
T
OFFICERIMEMBER EXCLUDED? N/A
(Mandatory in NHS E.L.DISEASE-EA EMPLOYEE $500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000
D Professional Liability AEA1006640001 43/1312012 113/2013 $2,000,000 Each Claim
1$2,000,000 Aggregate
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if mare space is required)
The General Liability policy includes a blanket automatic additional insured provision that provides additional insured status and a blanket
waiver of subrogation provision to the certificate holder only when there is a written Contract between the named insured and the certificate
holder that requires such status.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Fort Worth ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Conservation Specialtist
401 W. 13th Street AUTHORIZED REPRESENTATIVE
Fort Worth TX 76162
Y
®'1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD