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HomeMy WebLinkAboutContract 47499 CRY SECT-'GAY COWRACT M 2i ! EASEMENT ENCROACHMENT LICENSE AGREEMENT Commercial THIS AGREEMENT is made and entered into by and between THE CITY OF FORT WORTH, a home rule municipal corporation of Tarrant County, Texas ("City"), acting by and through its duly authorized Planning and Development Director, and Seung Huun Kim, hereinafter referred to as "Licensee", owner of the property located at 2870 Western Center Boulevard("Property"). RECITALS WHEREAS, Licensee is the owner of certain real property described as Lot IA, Block 1 of the Spindor Addition, an addition to the City of Fort Worth, Tarrant County, Texas as recorded in County Clerks Document No. D215006663 or Volume and Page No.NA of the Real Property records of Tarrant County ("Property"); and WHEREAS,the City has a 25 foot wide sewer line easement(the "Easement") in the property as shown on the map attached to this Agreement as Exhibit "A" and incorporated herein; and WHEREAS, Licensee desires to construct/place and maintain private storm, domestic water service, irrigation service, a sanitary sewer service which will be used to serve the proposed facility(the "Encroachment") and which will encroach onto the City's Easement as shown on the attached survey and only to the extent shown thereon; and WHEREAS,to accommodate the needs of the Licensee,the City will allow the Encroachment under the terms and conditions as set forth in this Agreement. NOW, THEREFORE,the City and Licensee agree as follows: AGREEMENT The City, in consideration of the payment by the Licensee of the fee set out below and covenants and agreements hereinafter contained, to be kept and performed by the Licensee, hereby grants permission to the Licensee to encroach upon and occupy a portion of the City's Easement as described in and at the location shown Exhibit A for the purpose of construct private utility services to serve Lot 1A, Block I (the `Encroachment"). Upon completion of the Encroachment, Licensee agrees to be responsible for maintaining any and all structures and buildings within and above the 2014 Easement Encroachment Agreement-Commercial Page 1 of 9 Easement. Licensee shall not expand or otherwise cause the Encroachment to further infringe in or on the City's Easement beyond what is specifically described in the exhibit(s) attached hereto. 2. All construction, maintenance and operation in connection with such Encroachment, use and occupancy shall comply and be performed in strict compliance with the Charter, Ordinance and Codes of the City and in accordance with the directions of the Director of the Transportation and Public Works Department or the Director of the Water Department of City, or his duly authorized representative. Prior to the construction of the Encroachment, Licensee shall submit all plans and specifications to the applicable Director or his duly authorized representative. Licensee shall not commence construction of the Encroachment until such approval shall be indicated in writing by the Director. However, such approval shall not relieve Licensee of responsibility and liability for concept, design and computation in the preparation of such plans and specifications. 3. 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 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 of the City, or his duly authorized representative. 2014 Easement Encroachment Agreement-Commercial Page 2 of 9 4. 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 to City at the time this Agreement is requested an application fee in the sum of Three Hundred and Twenty Five Dollars ($325.00). 5. The term of this Agreement shall be for thirty (30)years, commencing on the date this Agreement is executed by the City of Fort Worth. Provided however, this Agreement shall terminate upon the non-compliance of any of the terms of this Agreement by the Licensee. City shall notify Licensee of the non-compliance and if not cured within thirty days this Agreement shall be deemed terminated. 6. It is further understood and agreed upon between the parties hereto that the easements to be used and encroached upon as described herein, are held by City as trustee for the public; that City exercises such powers over the easement as have been delegated to it by the Constitution of the State of Texas or by the Legislature; and that City cannot contract away its duty and its legislative power to control the easement for the use and benefit of the public. It is accordingly agreed that if the governing body of City may at any time during the term hereof determine in its sole discretion to use or cause or permit the right of way to be used for any other public purpose, that does not preclude the use of the Encroachment on the Property for a office building or activities related thereto, including but not being limited to underground, surface of overhead communication, drainage, sanitary sewerage, transmission of natural or electricity, or any other public purpose, whether presently contemplated or not, that the parties agree to negotiate in good faith in order to accommodate the Encroachment and the public purpose. 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 StiITS FOR PROPERTY 2014 Easement Encroachment Agreement-Commercial Page 3 of 9 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 SAID ENCROACHMENTS 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. 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 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 the following: $1,000,000 Commercial General Liability with the understanding of and agreement by Licensee that such insurance amounts shall be revised upward at City's option and that Licensee shall so revise such amounts immediately following notice to Grantee of such requirement. Such insurance policy shall provide that it cannot be canceled or amended without at least ten (10) days prior written notice to the Building Official of the City of Fort Worth. A copy of such Certificate of Insurance is attached as attached as Exhibit `B". Licensee agrees to submit a similar Certificate of Insurance annually to City on the anniversary date of the execution of this Agreement. 2014 Easement Encroachment Agreement-Commercial Page 4 of 9 Licensee agrees, binds and obligates itself, its successors and assigns, to maintain and keep in force such public liability insurance at all times during the term of this Agreement and until the removal of all encroachments and the cleaning and restoration of the city streets. All insurance coverage required herein shall include coverage of all Licensees' contractors. 9. Licensee agrees to deposit with the City when this Agreement is executed a sufficient sum of money to be used to pay necessary fees to record this Encroachment on Easement Agreement in its entirety in the deed records of Tarrant County, Texas. After being recorded, the original shall be returned to the City Secretary of the City of Fort Worth, Texas. 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 said 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. 2014 Easement Encroachment Agreement-Commercial Page 5 of 9 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 over or within the described Easement and is not a conveyance of any right, title or interest in or to the Easement nor is it meant to convey any right to use or occupy property in which a third parry may have an interest. Licensee agrees that it will obtain all necessary permission 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 paragraphs 3 and 4 shall survive the termination of this Agreement. 2014 Easement Encroachment Agreement-Commercial Page 6 of 9 16. Licensee covenants and agrees that it will not assign all or any of its rights, privileges or duties under this contract without the written approval of City Planning and Development Director, and any attempted assignment without such written approval should be void. 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. EXECUTED this day of /� 20/�? City Licensee: City of Fort Worth Seung Huun Kim By: By: Randle Harwooct, Director Name: Planning and Developme IF ORTitle: ATTEST: ` ved As To Form and Legality City Sec t Assistant City Attorney _ � r r^ 11 O���fl(6Rn �Fc �'�rI 2014 Easement Encroachment Agreement-Commercial b " ��q({, � � Page 7 of 9 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,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 the City of Fort Worth, and in the capacity therein stated. VfENER Y HAND AND SEAL OF OFFICE this da of Y 0 Pq% CASSANDRA F. FO&EMAN Notary Public,Siare of texas taAr�E My Commission Expires April 26, 201 7 otary Public in and for the State of Texas 2014 Easement Encroachment Agreement-Commercial Page 8 of 9 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 before me Seung H. Kim,known to me to be a person whose name is subscribed to the foregoing instrument,and acknowledged to me that he executed the same for the purposes and consideration therein expressed as the act and deed of Q Lava, LLC Britezone Express, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF THE OFFICE this- +� day of 2015. / pV PVA :45 PAMELA PETREY My Commission Expires March 6, 2018 Notary Public in and for the State of Texas NOTES, I I E IMPACT TEES THE ETTYOFFORT WORTH a�cyES° THE AND COOL CTIONN OW TE AND ym , rFEES THE TOTAL NTT ASSESSED IS ESTABLISHED ON THE RUNG DUE Of INS PUT APPLC.4T10N,BASED UPON SCHEDULE I OF THE CURRFNR IMPAC r TEE ORD ANCE1 THE AMOUNT TO BE COLLECTED IS DETERMINED _o (1TLi*y�T "TTS UNDER SCHEDULE A OF BUILDING SPE ORDINANCE,AND R THE C EFFECTIVE AT TW O "_,r-I� ,,7 j jJrjL'(�'- N fLL'YR CONICJPAL TER A TOR WO TEWAE f5 ISSUED,OR THE CONNECTNIN 041E TO THE YUNCWAL WATER AND/OR WASTEWATER SYSIEIN. 1, OZY RK-or wn7 MOTE A ?HE CRY OF FORT NORTH SHALL NOT BE RESPONSIBLE FOR MNH1E1WrX OF PRIVATE I STREETS DRIVES EMERGENCY ACCESS EASWWTS R£CREAOON AREAS.AND OPEN SPACES: I I CURVE DATA L=265.0, R- /1 AND THE OWNERS SHALL BE RESPONSIBLE FOR THE MAINTENANCE Of PRIVATE STREETS, 1404.70 / I OWNERS AAGRRff TO NOW IFY A�ND�H�wMLELE�THE�CRY OOf'(FORT OPEN WromTH,TDCASAND� CHORD=S.88°13'24"E.-2 5.70' / 1 FROM ALL CLAWS BwwES,AND LOSSES ARWNG OUT OF OR RESUI.nNG FROM L=132.85' PERFORMANCE OF THE OBLIGATIONS OF SAID OWNERS SET FORM N TNS PARAGRAPH. ( / —— — TL �32.85' i 9CNDEPARKWAY SAND DRAf9W INUE T CURB N CURER,PAVEMENT nE-IN,ERNE MIT ISSUANCSIDEWALKS AND DRAINAGE IIAEST MAY BE ftE01ARED AT TIME OF BIA.INHK:PERART LSSUAIlCE V/4 A PARKWAY PERNR.RT. EASEMENT NOM. r. ZONING NIN o5E7RCK ONES TO HE ESTABLISHED PER REQUIREMENTS OF CITY OF FORT WO1Z111 CIE ONO E �./ NO SEWER STRUCTURES SHALL BE CONSTRUCTED OVER AN EX/S71NG WATERSANIU , RY SEINER Q4 VTIUiI'EASEYEHf. URUR'PUBLIC FMS CS DO / ANY PUBIIC VE AND UTILITY,INCLUDING THE F OF FORTAILD WORTH &RI HAVE UB, M M OTHER GROWTH MOVE AND KEEP MOVED ALL OR PART OF ANY ANGER C,FENTE 1ERE,SHRUB. OTHER UCTIONOR BVIANC ITEM WHICH N ANY WAY ENDANGERS OR INTERFERES A OF THE CONSTRUCTION SH WN ON REE OR EAND THEY OF RS RESPECTIVE SYSTEMS ALL ANY OF THE M M INGRESS A EGRESS S THE PUT, AND THEY FOR FIVE INC RIGHT AT ALL TWIN TO RECONS AND EGRESS UPON SAID EASEMENTS FOR NNE PURPOSE OF TO CONSTRUCTION OR PART OF ITS E SPEC IVE SYSTEMS WU, UT BIE7NE AND ADDING TU OR OF PROCURING ALL THEPART OF Urs RESPECTNE SYSTEMS fNRIOUT THE NECESSITY AT ANY nME OF PROCUR/fNG IH£PERMIISSxN OF ANYONE ERA NG PERMITS NO BUILDING PERMITS SHALL BE ISSUED FOR ANY LOT W TNS SUBOMSION UNRL APPROPRIATE PRONSIONS ARE MADE FOR THE CONSROUCTKKI OF ANY APPLICABLE WATER. SEWER,STORM DRAW,STREET LIGHTS,SIDEWALKS AND PAYRM IMPROVEMENTS AND O APPROVAL IS OBTAINED FROM INE CRY OF FORT WORTH. Lot IA SIDEWALKS WORTHST SHALL BE REQUIRED FOR L STREETS CONSTRIFCIED ro THE CRY OF FORT W NORM STANOMDS _ Z SRE DRAINAGE STUDY A SITE DRAINAGE SOAPY WHICH WILL S CONFORMANCE WITH HIVE APPROVED ROADWAY DRAINAGE PUN MAY BE REQUIRED BEFORE ANY BUILDING PERMIT WU BE ISSUED ON THIS SITE(A SRE GRADING PLN IN SOME CASES MAY BE ADEQUATE TO SHOW CONFORMANCE). IF THE SITE DOES NOT CONFORM,THIN A DRAINAGE STUDY IA4Y BE REDLINED ALONG AN THE CFA FOR ANY REQUIRED DRAINAGE IMPROVEMENTS AND THE CURRENT OWNER SWILL SUBMIT A LETTER TO PINE TRV DEPT.STATING THAT HE IS AWARE A BRE DRAM STUDY WILL BE REQUIRED BU ME A BUILDING POW WU BE ISSUED AND THE CURRENT OWNER SHALL WOW THE BUYER OF THE SAME now zONE ACCORDING TO THE ROOD INSURM'CE RATE MAP FOR TARRANT COUNTY,TEYAS AND NGORPONATED AREAS,COMMUNRY PANEL N0.48AT9C 0280 J DATED AUGUST 23.2000, EAST THIS LOT is N zoNE x,WHICH Is HOF N THE TOO YEAR FLOOD zo.NE. 12.38' --- Owners: aDO !'10;=� Devoe Enterprises,Inc. P.O.Box No.10008 WEST o 12.38' Z N WEST 1132.76' 4 EAST/132.76' LOT 1 /2. ED ro �OOOLRI � O0+ T.�WE+ W ECU atiQ I\ �D' 50 0 50 f50 � 1 E; O OU a z )I 0c, on`aN`sEr a a Scale 1" = 50 ft y 2 0 o iII NOTICE!I! � CITY OF FORT WORTH, TEXAS FOR MULTIPLE ADDRESSES IN THIS CITY PLAN COMMISSION LEGAL DESCRIPTION,CONTACT THE FORTWORTH FIRE DEPARTMENT AT NOTE: TEJS PLAT r.S Y.TLJD ONLY IF 817-392-6797 OR 817-392-693% 2"'I tDED WITNJN(HOJ DAYS AFTER DATE OF APPROPAL. THE FORT WORTH FIRE DEPARTMENT PLAT APPRO;rI ATd MUSTAPPROVE OR ASSIGN ALL ADDRESSES Lot 1B `DEER EIDAE-D DY. AM CllAIRIlA r., SS)"p �i HY � SdCRRT.IR M VICINITY MAP (NOT TO SCALE) FINAL PLAT OF Roos LOTS 1A AND 1B, BLOCK 1, SPINDOR ADDITION, AN ADDITION TO THE CITY OF FORT WORTH, TARRANT COUNTY, TEXAS, BEING A RE-PLAT OF LOT 1, BLOCK 1, D ) SPINDOR ADDITION, AN ADDITION TO THE CITY OF FORT WORTH, TARRANT COUNTY, TEXAS, ACCORDING TO THE PLAT 6 5 E ��50� r RECORDED IN CABINET B, SLIDE 1919, PLAT RECORDS, TARRANT COUNTY, TEXAS AND CONTAINING 5.77 ACRES OF LAND MORE OR LESS. 2Q 'f I� tir ►sR�a 14 P00 OT� C THIS PLAT FILED FOR RECORD IN CADINET�, SLIDE�+ D`, DATE :I O A 6 POINT OF l 7 �. BEGINNING OF 7_1 dn--FASDRNI NN C,B.BB 9-.E T918.PF.T.GT.— �Pj� tt F-I9 F C UR,tT'THAT TENS ISA TRUE AND N89°28'31'TT 265.58' DTA ACCURATN RPPRFSNNTATION OP THINS SUAVRY AS AADR ON TES GROUND. ONNIE-REED KINGSGATE PARTNERS 1*imi SURVEYIN-IIZ VOL. 12796, PG. IfAy�T)127, D.R.T.C.T. 817-248-7766 LONNIR REND Su LOBI Z7-0211661.1 07-07= �' R.P.L.S.No. 4P77 FAR:817-B87-5275 4-16-07 ---- BOULEVARD _ — p (120'R1GHT-OF-WAS lTz 1 • a �tr � Z «<o� .,sum --.. — ri o I I �I m , a ea p a o _ a . p n II II Ij = II _ II I � , II I i ij I - •• _ N�i�j - �I �8 �m a c f _L_ F � I N DRAINAGE PLAN BRITS ZONE ] _ EXPRESS ;,a 4 v - € m ,TeM z � o s s C=asiy tA car I s - = p, uCo X4.0 ;mm - =gF. ____ -� I iT g- ug a = wl ds mw ' a i I i i I o > a . � m I ♦___-_ egon 1 , em z ' 0 '� I --• ___- aZn_ 'o , z A ' N I I El g yHo } !po Oy tt f1A0 °.Y� Ft� NAE 1� y�grz. H G� 6 F i i uoRni O o � lil I n m BRITE ZONE € at( Kimley>>>Horn wo @ UTILITY PLAN EXPRESS s a,E AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �.�►� 11/03/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES 140T 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: Myung Park _ Greenhill Insurance Group PHONE -3598 _ ._ FAX972-243-8415-__--�AciNo Ex (972)243 n/C o -_"—___--- 11494 Luna Road Suite 275 E-MAIL un ADDRESS: m Y g@greenhillgroup.net _ INSURER(S)AFFORDING COVERAGE I MAIC k Dallas TX 75234 INsuRERA: Hallmark Specialty_Insurance Company _ "INSURED INSURER B: AWK INVESTMENTS INC INSURER C Britezone Auto Spa INSURER D: 1955 Hwy157 N INSURER E Mansfield TX 76063 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF 114SURANCE 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. lNSR --- -- -ADDL SM.RI � POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD I POLICY NUMBER I MM/DD/YYYY) JMM1DDfYYYYl LIMITS X I COMMERCIAL GENERAL LIABILITY E --___ EACH OCCURRENCE _S 1000000 DAMAGE TO RENTED - -- CLAIMS-MADE X OCCUR I �_ $. 50000 ' PREMISES(Ea occurrence j ( MED EXP(Any.one person) S EXc A X 77GLO15D759 10/05/2015 10/05/2016 PERSONAL&ADV INJURY 1000000 G_EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 POLICY!, JECT PRO- f 0 LOG S 2000000..-. - PRODUCTS,-COtdP10P AGG OTHER: Total Policy Aggregate 4000000 AUTOMOBILE LIABILITY COA181NED SINGLE LIMIT i Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED -- --- AUTOS i BODILY INJURY(Per accident) AUTOS _ _ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS - jPer accident) is UMBRELLA LIABI OCCUR EACH OCCURRENCE LABEXCESS LB J--]CLAIMS_ h4ADEI � � AGGREGATE I$ �1-----;T—TRETENTIONS j S WORKERS COh1PENSATIONSTATUTE OERH AND EMPLOYERS'LIABILITY y/N I --.. _- 1� _--- ---- ANY PROPRIETOR/PARTNER/EXECUTIVE I E L EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? �j N!A — - ---- -- ----.- (Mandatory in NH) i j E.L.DISEASE-EA EMPLOYEE S If yes,describe under – DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT(S i I i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. AUTHORIZED REPRESENTATIVE 1000 Throckmorton Street Fort Worth TX 76102 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD