HomeMy WebLinkAboutContract 32718 Ci i Y SECRETARY r
CONTRACT NO. .�
m/E
CONSENT AGREEMENT
FOR
TEMPORARY USE OF PUBLIC PROPERTY
STATE OF TEXAS
COUNTY OF TARRANT
THIS AGREEMENT is made and entered into by and between the City of Fort Worth, a
municipal corporation of Tarrant County, Texas, acting herein by and through its duly authorized
Building Official, hereinafter referred to as the "City" and
PEAS f�-&AL-
Acting by and through its duly authorized agent, Ply l'1� H �i4�L
Hereinafter referred to as "Grantee".
WITNESSETH:
For and in consideration of the payment by Grantee of charges set out below and the true and
faithful performance of the mutual covenants herein contained, City hereby grants to Grantee
permission to temporarily encroach upon, uses and occupy portion of the space under, on and/or
above the streets, alleys, sidewalks or other public rights-of-way as follows:
A 34 -fit , space YKColmwQ 5+. Dorf wlsr f�
The location and description of said encroachment is more particularly described in Exhibit "B"
attached hereto, incorporated herein and made a part hereof for all purposes.
2.
All use and occupancy of public street, alleys, sidewalks or other public rights-of-way under
this agreement shall be in strict compliance with the Charter, Ordinances and Codes of the City
and in accordance with the directions of the Building Official and the Director of Transportation
and Public Works of City.
CONSENT AGREEMENTfor Temporary u of pyc Qrop`�fTyn
3.
Upon expiration of this agreement and the privileges granted hereunder, there shall be no
encroachment by Grantee in, under, on or above the surface of the public rights-of-way involved.
4.
Grantee agrees to pay in advance an encroachment fee for the temporary privilege of
encroaching upon a portion of the public rights-of-way as described in Exhibit `B". Said fee is
calculated in the manner and amounts prescribed by the Building Code of the City of Fort Worth
for temporary use or occupancy of public property. The estimated total amount of said fee is:
L6 1S 1(P 0
.0 3 X 1 H ' ), 10' z x q � l� - 7 SCQ -(19 a
5.
Grantee, at no expense to City, shall make proper provision for the relocation and/or
installation of any existing or future traffic control devises or other improvements affected by
such encroachment, use and occupancy, including the securing of approval and consent from the
appropriate agencies of the State and its political subdivisions. In the event that any installation,
reinstallation, relocation or repair of any existing or future traffic control device or improvement
owned or constructed by or on behalf of the public or at public expense is made more costly by
virtue of the existence of such encroachment and use, Grantee shall pay to City and additional
amount equal to such additional cost as determined by City.
6.
The term of this agreement shall be for days, from /V V to 23 2po 5
Provided, however, should the need for the encroachments granted hereunder at any time cease,
Grantee agrees to immediately notify City of such condition; and, upon receipt of such notice by
the Building Official of the City of Fort Worth, this agreement shall terminate.
7.
It is expressly understood and agreed that this Consent Agreement is for a temporary
encroachment in, under, over and upon the public property as located and described in Exhibit
2
CONSENT AGREEMENTfor Temporary use of public property
"B". This agreement shall not be construed as the granting of a permanent easement,
encroachment or license upon City's public streets, alleys, sidewalks, or other rights-of-way.
8.
City, through its duly authorized representatives, shall have the full and unrestricted right to
enter upon all public rights-of-way for the purpose of making inspections to determine
compliance with the terms, covenants and conditions herein. In the event that any inspection
should reveal a breach of any terms, covenants or conditions herein, City shall give Grantee
notice of such breach. Should such breach not be corrected by Grantee within twenty-four (24)
hours of receipt of the notice, or within such shorter period of time as deemed necessary by the
Building Official for the protection of public health or safety, City may terminate and cancel this
agreement.
9.
Upon expiration or termination of this agreement for any reason whatsoever, Grantee shall, at
no expense to City, restore the public rights-of-way and adjacent supporting structures to a
condition acceptable to the Director of Transportation and Public Works or his duly authorized
representative and in accordance with then existing City specifications, and Grantee shall remove
all barricades, equipment, supplies, materials or other property from said location. Grantee
further covenants and agrees that for a period of one(1) year after the termination of this Consent
Agreement, Grantee will repair all conditions or damages to the streets and sidewalks or other
rights-of-way that have resulted from Grantee's use or occupancy of the streets and sidewalks or
other rights-of-way, as determined by the Director of Transportation and Public Works or his
designee. Grantee agrees to begin such repairs within thirty (30) days of receipt of notice from
the Director of Transportation and Public Works or his designee. All repairs shall be performed
in an expeditious and workmanlike manner and shall comply with all applicable laws, codes,
ordinances and City specifications.
In the event that Grantee fails to comply with the covenants herein contained with respect to
such removal or restoration, the City shall have the right 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 bring the public rights-of-way to the condition prescribed herein, and
City shall not be responsible for trespass or any other damage or liability in connection with such
removal or restoration. Grantee shall reimburse City for the cost and expense of such removal
and/or repairs immediately following billing for same by City.
3 -
CONSENT AGREEMENTfcr Temporary use of public properly
Nothing herein shall be construed as a waiver by City to enforce penal sanctions prescribed
by the Code of the City of Fort Worth and the laws of the State of Texas for Grantee's continued
encroachment upon the public rights-of-way following termination of this Consent Agreement.
10.
It is further understood and agreed between the parties hereto that City holds the city streets,
alleys, sidewalks and other public rights-of-way, including the portions of such streets used and
encroached upon as described herein, as trustee for the public; that City exercises such powers
over the streets as have been delegated to it by the Constitution of the State of Texas or by the
Legislature; and the City cannot contract away its duty and its legislative power to control the
streets for the use and benefit of the public. It is accordingly agreed that if the governing body of
City, to wit, its City Council, shall at any time during the term hereof determine in its sole
discretion to use or cause or permit to be used for any public purpose the said encroached portion
of the streets, then this agreement shall be automatically canceled and terminated.
11.
Grantee 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 said encroachments and uses.
12.
Grantee agrees to pay promptly when due all fees, taxes or rentals provided for by this
agreement or by any federal, state or local statue, law or regulation.
13.
Grantee covenants and agrees that it shall exercise all rights and privileges granted hereunder
as an independent contractor, and not as an officer, agent, servant or employee of City; that
Grantee shall have exclusive control of and the exclusive right to control the details of its
operations and activities on said described public property 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; that the doctrine of respondeat superior shall
not apply as between City and Grantee, its officers, agents, servants, employees, contractors and
subcontractors, and nothing herein shall be construed as creating a partnership or joint enterprise
between City and Grantee.
4
CONSENT AGREEMENTfor T4 rnporar'. use o6 public propft
14.
GRANTEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY
INDEMIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS, AGENTS,
SERVANTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR
SUITS FOR PROPERTY DAMAGE OR LOSS AND/OR PERSONAL INJURY,
CNCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR
CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN
CONNECTION WITH, DIRECTLY OR INDIRECTLY, THE MAINTENANCE,
OCCUPANCY, USE, EXISTENCE OR LOCATION OF SAID ENCROACHMENT AND
USES GRANTED HEREUNDER, WHETHER OR NOT CAUSE, IN WHOLE OR PART,
BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS, SUBCONTRACTORS, LICENSEES OR INVITEES OF CITY; AND
GRANTEE HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY,
ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, FOR SUCH CLAIMS OR
SUITS. GRANTEE 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
ANY AND ALL ACTS OR OMISSIONS OF GRANTEE, ITS OFFICERS, AGENTS,
SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICESNEES,
INVITEES OR TRESPASSERS.
15.
Grantee 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 located and
described in Exhibit "B". The amounts of such insurance shall be not less that the following:
Property damage,per occurrence $100,000.00
Bodily injury, per person $250,000.00
Bodily injury or death, per occurrence $500,000.00
With the understanding of and agreement by Grantee that such insurance amounts shall be revised
Upward at City's option and that Grantee shall so revise such amount immediately following
notice to Grantee of such requirement. Such insurance policy shall provide that it cannot be
canceled or amended without at least thirty(30) days' prior written notice to the Building Official
5 -.
CONSENT AGREEMENTfor Temporar,use of public property:. ...
of the City of Fort Worth. A copy of such Certificate of Insurance is attached as Exhibit "A".
Grantee agrees to submit a similar Certificate of Insurance annually to City on the anniversary
date of the execution of this agreement.
Grantee, agrees, binds and obligates itself, it 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 city streets. All insurance
coverage required herein shall include coverage of all Grantee's contractors.
16.
Grantee covenants and agrees that it will not assign all or any of its rights, privileges or duties
under this contract without prior written approval of City, and any attempted assignment without
such prior written approval shall be void.
17.
This agreement shall be binding upon the parties hereto, their successors and assigns.
18.
Should any action, whether real or asserted, at law or in equity, arise out of the terms and
conditions of this agreement or out of the use and occupancy of City property as permitted
hereunder, venue for said action shall be in Tarrant County,Texas.
19.
In any action brought by City for the enforcement of the obligations of Grantee, City shall be
entitled to recover interest and reasonable attorneys' fees.
EXECUTED thisZ'� day of GC'I 0��r 2005.
GRANTOR: GRANTEE:
CITY OF FORT WORTH
Buil ng Official71—
Title
/v 1
CONSENT AGREEMENTfor Temper ry useof pubftcpropeny
APPRO CORM AND LEGALITY:
Assistant City Attomey Date
f�A
City Secretary Date
'1
NO M&C REQUIRED
I
CONSENT AGREEMENTfor Tempor*-usoofpuWrCprap"
STATE OF TEXAS
COUNTY OF TARRANT
BEFORE ME, the undersigned authority, a Notary Public in and
Fpr,the S ate gf Texas, on this day personally appeared
,known tome to be the person whose
name is subscribed to :e fore ing instrument, and acknowledged to me
that he/she executed the same for thAp`urposes a�jjz consideration therein
expressed, as the act and deed of J-j '5 • T7
and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this V` day
of �� 20 G.Y
Affian
Title
Notary Public in and for
The State of Texas
WY ANGELA ESTRADA
Notary Public
k STATE OF TEXAS r
OF MYCW n.Exp.08/21/2007
8
STA TE OF TEXAS
COUNTY OF TARRANT
BEFORE ME, the undersigned authority, a NotaryXublic in and
For the State of Texas, on this day personally appeared
pt-T L— ,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 C'VA ��r 1-= U ?rl�
and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this day
Of C C 20
RUSHI ARUN DEVANI
Notary Public,State of Texas a
My Commission Expires 1
September 20,2009 1111
Affiant
Title
Notary Public ion and for
The State of Texas
9
Contractors Name:
Point of Contact: S V/U l L LAVA N I
Phone Number: 5-14-781-394-G
?j$uilding Permit Number:-NMP,-T--ER [,C,d M
riupose for Closure: P O D S- 0 437 4-
Begin
Begin Date: A10V Zeal End Date:-L(!( Z3 ZD
- Type of Taper according to posted speed limit:
Tapers @ 30 MPH 1Oft Offset 30ft minimum
Tapers @ 35 MPH loft Offset 35ft minimum
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coke.. Tapers @ 40 MPH 1Oft Offset 40ft minimum
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AN INSPECTI I�1 RR ALL
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09/27/2005 09:13 9162311500 PAGE 02/05
SYNEPRO�01 KAIM
ACORD CERTIFICATE OF LIABILITY INSURANCE �9i 5/2005 Y'
PRODUCER. (916)231-1741 THIS CERTIFICATE.I3ISSUED ASA MATTER OF INFORMATION
Acordia of California Insurance Services, Inc. ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE
CA DOI LIC>A03'32276 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CAD I LIC# 362ock Drive,Suite iQQ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Rancho Cordova,CA 95670 INSURERS AFFORDING COVERAGE NAIC 0
INSURED Pearl Real Estate, Inc INSURERA:American Zurich Insurance Cornpa!!y 40142
Pearl Real Estate, Inc NSURERe American Guarantee&Liability
P.Q. Box 94.265
Lubbock,TX 79493 INSURERG:
INSURER 0'
NSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W FFH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIaED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONSAND CONDITIONS OF SUCH
POLICIES.AGGREGATE LAAFr$SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_
FOIICYNUMeER POIIOYEFFECTIVE POLICY EXPIRATIONTYPE DE INSUffANCE DATE fMMAXVyx1 LIMITS
GENERAL LIAENUTY EACH OCCURRENCE $ 1,000,000
A X X CUMMERCiALGENERALLIABILITY CP037$531200 5!112095 511/2006 P EBOCGUMnC4 s 1,00040
CLAIMS MADE �OCCUR MED'e7iP(Anyone pe Mon) $
X Liquor Liab-$1,000,000 PRRSCNALAAWINJURY s 1100010
OENERAL AGGREGATE g ZOOO,0
OEN1 AGGREGATE LIMITAPPL(ES PER; PRODUCTS-COMPIOP A00 3 znmo
POLY PRC.
ICFKLOC
AUT'MPOILELIABILm COMBINED 91NGLE LIMIT 1.000,000
A X ANY.AU'O AP591563100 511/2005 5/112006 (EsGoddenl)
X ALL MNEO AUTOS
BCOILY INJURY $
SCHEDULED AUTOS (Per perKn)
N IRE D ALI TOS
eaolLY INJURY 2
(Per addtdrrd)
vON-4+VNEOAUT03
PROPERTY CAMAOE g
(Per 9celde r1I)
GARAGE LIABILITY AUTO ONLY.EAACC10ENT S
ANYAUTO OTHERTHAN EAAGC S
AUTO ONLY: AGG S
E7 FSWUkISR£LLA LIABILITY EACH OCCURRENCE $ 25,000,00
B OCCUR CLAIMS MADE 7411100 5/112005 5!112006 AGGREGATE g 25,000,00
DEDUCTIBLE
$
X RETENTION $ 10,000 $
WORKERS COMPENSATION AND WC STATU- OTH-
EMP'LI]YEW LIABILITY
ANY PROPRIETDRIPARTNFPJMCUT NE E.L.EACH ACCIDENT $
OFFICER/ME-\IEER EXCLUOEO? E,L,DISEASE-EAEMPLCYEr eCIa �
9ALRFRavISIIOE.L.ELDISEASE-POLICY LIMIT 3g
GTH W
DESCRIPTION OF OPERATIONS)LOCATION S!VEHICLES I EXCLUSIONS ADDED BY ENDORSELIENT!SPECIAL M"31ONS
Carriers flnanclal strength 19 AX-V
RE: Clarion Hotel in Ft Worth Texas 600 Commerce St, Ft Worth,TX. - trash dumpster located on street In front of this hotel.The certificate
holder IY9 officers and employees are inGluded as additional Insured per CG2010 for this project and waiver of subrogation Is Included
parCG2404.
CERTIFICATE HOLDER CANCELLATION
City of Fort Worth SHOULD ANY Or THE ABOVE DESCRIGEO POLICIES BE CANCELLED 8EFORF THE EXPI RATION
Transportation &Public Works St.Mgmt.Dept DATE THEREOF,rNE I88UINa INSURERIMLL ENWAVORTO MAIL 30 DAYS WIRITTEN
311 W. 10th St. NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LI Fr,OUT FAILURE TO DO SO SHALL,
Fort Worth,TX 76102- IMPOSE NO OBLIGATION OR LIABIL"OF ANY KIND UPON TREINSURER ITS AGENTS Oft
REPRESENTATIvo.
AUTH OI IIED REPREBENTATN E
ACORD 25(2001/06) C ACORD CORPORATION 1988
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09/27/2005 09:13 9162311500 PAGE 04/05
INSURED: Synergy Property Mgmt/Pearl Real Estate /
POLICY NIJMBER:CP00378531200 COMMERCIAL GENERAL LIABILITY
INSURANCE COMPANY:American Zurich Ins. Co.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-OWNERS, LESSEES, OR CONTRACTORS(FORM B)
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: Clty of Ft.Worth
Transportation and Public Works Street Management Dept.
311 W. 10"'St
Ft.Worth,TX 75102
As respects: Trash Removal I Dumpster located at Clarion Hotel 600 commerce St., Ft.Worth,TX
(If no entry appears above,information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.
WHO IS AN INSURED (Section II) Is amended to include as an insured the person or organization
shown In the Schedule, but only with respect to liability arising out of your ongoing operations performed
for that insured.
ACORDIA OF CALIFORNIA INSURANCE SERVICES, INC,
CG 20 10 10 93 Copyright, Insurance services Office, Inc_, 1992
09/27/2005 (39:13 9162311500 PAGE 05/05
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 24 0410 93
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST
OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Endorsement effective Policy Number. CP0378531200
9-26-05 12:01 A.M.standard time
Named Insured: Synergy Property Management/ Countersigned by.
Pearl Real Estate
zed ReprentatJve)
SCHEDULE a9
Name of Person or organization: City of Ft.Worth It's officers and employees
(If no entry appears above, information required to complete this endorsement will be shown in the declarations
as applicable to this endorsement_)
The 'TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV---
COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above
because of payments we make for injury or damage arising out of your ongoing operations or'your work" done
under a contract with that person or organization and included In the 'products-completed operations hazard."
This waiver applies only to ttre person or organization shown in the Schedule above.
CL 675(10-93)
CG 24 04 10 93 Copyright,insurance services Office,IPTG,1892
Page 1 of 1
".itv of Fort Worth Transportation and Public Works Street Use Permit Page 1 of
FORTWORTCITY OF FORT WORTH
TRANSPORTATION AND PUBLIC WORKS
STREET USE PERMIT
)ATE 10/27/2005 PERMIT #79984 MAPSCO 77A D.O.E.# Building Permit# PC05-00023
(if applicable)
STREET BLOCK FROM TO DATE Mon.-Fri.Time TIME TIME
BEGIN END BEGIN END SAT. SUN.
1.COMMERCE ST 600-700 E 5TH ST E 6TH ST 11/7/2005 12/23/2005 24HRS 24HRS 24HRS
YPE OF WORK TO BE PERFORMED:Other-Fee
LANE CLOSURE FOR DUMPSTER PLACEMENT OK PER ATTACHED TRAFFIC CONTROL PLAN. PLYWOOD OR EQUIVALENT
TO BE PLACE UNDER THE DUMPSTER TO PROTECT PAVEMENT FROM MARRING DURING LOADING/UNLOADING, FAILURE
TO DO SO WILL IMMEDIATELY REVOKE PERMIT.
rH/S PERMIT/S GRANTED TO THE CONTRACTOR/APPLICANT UNDER THE FOLLOWING CONDITIONS:
• CONTRACTOR/APPLICANT IS REQUIRED TO HAVE THIS PERMIT AND TRAFFIC CONTROL PLAN AT THE WORK
SITE OR EVENT AT ALL TIMES.
• THIS PERMIT IS ISSUED IN ACCORDANCE WITH AN APPROVED TRAFFIC CONTROL PLAN.
• ALL WORK IS CONSTRUCTED IN ACCORDANCE WITH THE CITY OF FORT WORTH'S "STANDARD
SPECIFICATIONS FOR STREETS AND STORM DRAIN CONSTRUCTION MANUAL".
• ADEQUATE TRAFFIC CONTROL DEVICES ARE INSTALLED AND MAINTAINED AS SHOWN IN THE ATTACHED
TRAFFIC CONTROL PLAN (TCP) SUCH AS SIGNS, STANDARD TYPE I BARRICADES SAFEGUARD THE
PROPERTIES AND PUBLIC.
• CITY TRAFFIC ENGINEER AND/OR INSPECTORS MAY REQUIRE ADDITIONAL TRAFFIC CONTROL DEVICES.
• ALL DAMAGES TO PUBLIC OR PRIVATE PROPERTY, INCLUDING UNDERGROUND FACILITIES, AND FOR ALL
PERSONAL INJURIES ON WORK PERFORMED UNDER THIS PERMIT WILL BE THE RESPONSIBILITY OF THE
CONTRACTOR.
• A 24-HOUR DECISION-MAKING CONTACT REPRESENTATIVE AND PHONE NUMBER IN THE EVENT OF AN
EMERGENCY SHALL BE PROVIDED.
• THIS PERMIT DOES NOT RELIEVE THE CONTRACTOR FROM OBTAINING NECESSARY PERMITS FROM COUNTY
AND STATE ENTITIES WHERE WORK IS ENCROACHING INTO THEIR RIGHT-OF-WAY.
• IT IS UNDERSTOOD THAT VIOLATIONS OF THIS PERMIT MAY RESULT IN THE REVOCATION OF THE
CONTRACTOR'S LICENSE.
PEARL REAL ESTATE AARON LONG 47 OS
CONTRACTOR/APPLICANT CFW CONTACT
EMERGENCY CONTACT NAME NEHAL SHAH
24-HOUR PHONE 866-511-7192 MOBILE 866-511-7192 PGR# FAX#866-511-7192
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT
STREET MANAGEMENT SECTION
311 W 10th STREET
FORT WORTH,TX 76102
(817)392-6594 FAX(817)392-8941
ttp://tpwpermit.cfwnet.org/popup_perm t.asp?perp it_id=79984 10/27/200
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This Ian is submitted for TCP. I certify this plan will be used for the folling location(s):
and that all channelizing devices will conform' to 'General Notes' as shown on the back.
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Signature: Date
CITY OF FORT WORTH TYPICAL LAYOUT FOR DUMPSTER
f L TRANSPORTATION
AND Note:
PUBLIC WORKS See reverse side for Generzl Notes and Device SP?�cinq °LAN `31@'
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"'ity of r-)rt Worth Transportation and Public Works Payment Receipt Page 1 of
FORTW Rflj TRANSPORTATION AND PUBLIC WORKS RECEIPT FOR PAYMENT 311 WEST 10TH STREET
,- FORT WORTH, 7
PH:817-392-6594 F: 817-3939 2-89418941
PAYMENT ID 9352 APPLICANT PEARL REAL DATE 10/27/2005
ESTATE
PAYMENT Credit PAYMENT $50.00
METHOD Card AMOUNT Payment is Verified
PERMIT: 79984 DATE: 10/27/2005 TYPE: Other-Fee LOCATION: 600-700 COMMERCE
ID FEE TYPE FEE AMOUNT AMOUNT APPLIED
21677 Permit $50.00 $50.00
ttp:Htpwpermit.cfwnet.org/popup_receipt.asp?pid=9352 10/27/200