HomeMy WebLinkAboutContract 48093 t }.
} CI}DECEIVED Y 1f SECRETARY' 0
CONTRACT NO. 0
AUG 16 2016 NON-EXCLUSIVE PRIVILEGE AGREEMENT
C[�YOW,
This Non-Exclusive Privilege Agreement (hereinafter referred to as "Agreement") is
entered into by and between the City of Fort Worth, Texas ("City") a home-rule
municipality located within Tarrant and Denton Counties, acting through Fernando
Costa, its duly authorized Assistant City Manager, and Panther City Rental, LLC dba
Panther City Disposal ("Grantee"), acting through Clark Thompson, its duly authorized
representative.
WHEREAS, the City desires to regulate the business of collecting and transporting
municipal solid waste produced within the City by entering into non-exclusive privilege
agreements with persons engaged in such business; and
WHEREAS, Grantee desires to engage in the business of collecting and transporting
municipal solid waste produced within the City;
NOW THEREFORE, for and in consideration of the mutual promises and agreements
herein set forth, and other good and valuable consideration, the receipt and sufficiency
of which is hereby confessed and acknowledged, the City and Grantee agree as follows:
1. PRIVILEGE: A non-exclusive privilege is hereby granted to use the public streets,
alleys and thoroughfares within the corporate limits of the City of Fort Worth for the
purpose of engaging in the business of collection of solid waste.
2. TERM: The term of this Agreement shall be for a period of five (5) years. This
Agreement shall automatically renew at the end of every five year term of the
Agreement unless notice of termination is provided by one party to the other at least
thirty (30) days prior to the date of renewal.
3. SCOPE AND NATURE OF OPERATION: It is expressly understood and agreed that
the Grantee may collect and deliver for disposal all solid waste, including recyclable
materials, accumulated on premises within the corporate limits of the City, where the
individuals or companies contract with the Grantee for those services excluding
residential service other than apartment complexes and motels. Grantee will, at its
own expense, furnish personnel and equipment to collect solid waste and will
establish and maintain in an efficient and businesslike manner the contracted
services. Grantee will furthermore comply with all pertinent rules, regulations, laws,
and ordinances as directed by the City of Fort Worth and all other governmental
entities having jurisdiction thereupon.
4. REGULATION OF VEHICLES: All vehicles used by the Grantee for the collection
and transportation of solid waste shall be registered with the City, shall have a permit
n attached thereto, and shall be covered at all times while loaded and in transit to
-� prevent the spillage of solid waste onto the public streets or properties adjacent
C) m a thereto. Any spillage will be promptly recovered by the Grantee. All vehicles owned
r by the Grantee shall be clearly marked with the Grantee's name in letters not less
mthan four (4) inches in height. All such vehicles shall be cleaned and maintained by
X 0*, Panther City Rental, LLC Page 1 of 7
Revised by CRL 200208290
Grantee so as to be in good repair and of good appearance and, when idle, free of
solid waste residue as may cause odor or provide a breeding place for vectors.
5. REGULATION OF LEASED CONTAINERS: It is specifically understood and agreed
that the City of Fort Worth shall permit the Grantee to rent or lease containers for
collection purposes to the owner or occupant of any premises within the corporate
limits of the City, excluding residential customers other than apartment complexes
and motels, for collection purposes subject to the following requirements:
(1) ALL such containers shall be constructed according to good industry
practice in the trade;
(2) ALL such containers shall be equipped with suitable covers to prevent
blowing or scattering of solid waste while being transported for disposal of
their contents;
(3) ALL such containers shall be cleaned and maintained by grantee so as to
be in good repair, of a good appearance and free of such solid waste
residues as may cause odor and provide a breeding place for vectors;
(4) ALL such containers used for the disposal of food waste or other
putrescible material shall be serviced no less than two times per week;
and
(5) ALL such containers shall be clearly marked with the grantee's name and
telephone number in letters not less than four (4) inches in height.
The City of Fort Worth and the Grantee expressly agree that regardless of any
responsibility which may be placed on the citizens of Fort Worth or other third parties
for the above five requirements, the Grantee under this contract agrees to be
responsible for each of the five requirements and to fulfill each of them without
asserting they are the responsibility of some third party.
6. DAMAGE TO PUBLIC PROPERTY: Grantee expressly agrees to assume liability for
all costs of repair of public streets, bridges, rights-of-way, and other facilities that are
damaged as a result of negligence by Grantee, its officers, agents, or its employees
during it's operations pursuant to this agreement.
7. DISPOSAL OF SOLID WASTE: It is specifically understood and agreed that Grantee
will comply with all rules, regulations, laws and ordinances pertaining to the disposal
of solid waste as directed by responsible governmental agencies having jurisdiction
thereupon. Disposal of all solid waste collected by the Grantee from premises within
the corporate limits of the City of Fort Worth must be made at a lawfully permitted
sanitary landfill. Grantee's violation of this provision shall be cause for revocation of
this Agreement.
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Revised by CRL 200208290
8. SOLID WASTE COLLECTION: The collection of solid waste between the hours of
11:00 p.m. and 6:00 a.m. shall be prohibited. However, Grantee may seek
permission from the Assistant Director -Solid Waste Services/Code Compliance
Department ("Director") in writing by stating the particular hours Grantee wishes to
collect waste and the reasons necessary for this exception. Upon receiving a written
request, which must be mailed by the US Postal Service, returned receipt requested,
the Director shall have ten (10) days to make a determination and shall notify the
Grantee in writing of the decision within fifteen (15) days of the receiving notice. The
Director reserves the right to review that decision if a complaint is received. The
Director shall notify the Grantee, and the Grantee may present evidence to the
Director or designated representative regarding such complaint. The Director or his
designated representative shall determine (1) whether such collection between the
hours of 11:00 p.m. and 6:00 a.m. did, in fact, occur at that location and was the
cause of such complaint, and if so, (2) whether such collection at those hours and at
that location should be prohibited and the Grantee's exception revoked.
9. FEE: For and in consideration of the covenants and agreements herein contained,
Grantee hereby agrees to pay to the City of Fort Worth a fee of five percent (5%) of
the gross revenues generated from Grantee's operations within the City.
(A) Calculation: The calculation of gross revenues generated from operations
within the City shall include all revenue derived, directly or indirectly by
Grantee from or in connection with its operations within the service area
covered by this agreement, excluding revenues generated from contracts
with the City for residential garbage and recycling services, as determined
in accordance with generally accepted accounting principles. Gross
revenues shall include, but are not limited to, revenues received from the
collection and disposal of all solid waste.
(B) Fee Payment : The fee shall be paid on a quarterly basis no later than
thirty (30) days after the end of each calendar quarter. The payment shall
be made to the City of Fort Worth, Code Compliance Department, Solid
Waste Services Division, 4100 Columbus Trail, Fort Worth, TX 76133.
(C) Delinquent Payments: Fee payments received after the due date shall be
subject to interest at the rate of twelve (12%) percent per annum until the
fees are paid in full.
10. REPORTS: Each quarterly payment shall be accompanied by a financial accounting
report using the form which is attached as Exhibit A, showing the basis for the
computation of the quarterly payment and
a) total estimated volumes of solid waste collected by the solid waste hauler
with separate figures for multi-family living units, and from commercial
accounts;
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Revised by CRL 200208290
b) total estimated volumes of waste material recycled by the solid waste
hauler, with separate figures for multi-family living units and from
commercial accounts; and
c) a description and the total estimated volumes of each type of waste
material recycled by the solid waste hauler.
11. AUDITING BOOKS AND RECORDS: The City shall have the authority to arrange
for and conduct, at the City's expense, an audit of the books and records of the
Grantee at the Grantee's location. The records kept on site by Grantee shall include
at a minimum the list of accounts, the number and size of containers, the frequency
of collection and the revenue generated. The Grantee shall be given at least five (5)
days notice of the audit, a description of and the purpose for the audit, and a
description, to the best of the City's ability of the books, records, and documents the
City wishes to review. Grantee shall pay the costs of audit if the results of the audit
establish that Grantee has underpaid the fees required hereunder in any given year
by 5% or more.
12. FORFEITURE: The failure or refusal of the Grantee to comply with any of the
provisions of this Agreement or any of the provisions of the Code of the City of Fort
Worth, or any other applicable rules, regulations, laws and ordinances shall be
deemed a breach of this Agreement. The Director shall notify the Grantee of such
breach and the Grantee shall have 30 days to cure the breach. If the breach is not
cured within 30 days and no "good faith" effort is being made to cure the breach, the
Director may recommend to the City Council that at a regularly scheduled City
Council meeting it should declare the privilege forfeited and may exclude the
Grantee from further use of the streets of the City under the privilege. The Grantee
shall thereupon immediately surrender all rights in and under the privilege and the
privilege shall be null and void.
13. INDEMNITY INSURANCE: Grantee assumes all risk of loss or injury to property or
persons arising from any of its operations under this Agreement, and agrees to
indemnify and hold harmless the City of Fort Worth from all claims, demands, suits,
judgments, costs or expenses, including attorney's fees, arising from any such loss
or injury. It is expressly understood that the provisions contained herein shall not in
any way limit the liability of the Grantee. Grantee agrees to maintain insurance as
follows:
A. Minimum Limits:
1. Commercial General Liability: $1,000,000.00 per occurrence
$2,000,000.00 aggregate
2. Automobile Liability Insurance: $1,000,000.00 each accident.
Coverage is to include "any auto"
used by Grantee. Coverage
shall include loading and
unloading.
Panther City Rental, LLC Page 4 of 7
Revised by CRL 200208290
3. Workers' Compensation Insurance:
Part A: Statutory limits
Part B: Employer's liability
$1,000,000.00 each accident;
$1,000,000.00 disease - policy
limit; and
$1,000,000.00 disease- each
employee
4. Pollution Liability Insurance: $1,000,000.00 per occurrence
5. Excess Umbrella Liability: $2,000,000.00 per occurrence
B. Other Insurance Terms:
1. The City of Fort Worth shall be endorsed as an additional
insured on each of Grantee's insurance policies.
2. Grantee's insurance shall be endorsed with a waiver of
sub-rogation in favor of the City.
3. Grantee's insurance policies shall be endorsed to provide a
minimum 30 days notice of cancellation, non-renewal, or
material change in coverage, such notice to be sent to the City
at the address set forth below.
4. City of Fort Worth shall receive Certificates of Liability Insurance
prior to Grantee beginning work.
5. Insurers shall be acceptable to the City of Fort Worth and
Insurers shall be duly authorized by the Texas Department of
Insurance.
6. Grantee's insurance policies shall not have a greater than
$50,000.00 deductible per occurrence unless otherwise
approved by City.
7. Insurance agencies used by Grantee shall be duly licensed in
the State of Texas.
14,RETENTION OF RIG"TS BY CITY: The City of Fort Worth, in granting this privilege,
fully retains and reserves all the rights, privileges, and immunities that it now has
under the law to fully patrol and police the streets, alleys and public ways within the
City, and the granting of this privilege shall in no way interfere with the improvements
or maintenance, on any streets, alleys or public ways, and the rights of the Grantee
Panther City Rental, LLC Page 5 of 7
Revised by CRL 200208290
herein to use the streets shall at all times be subservient to the right of the governing
body of the City of Fort Worth to fully exercise its rights of control over streets, alleys
and public ways.
15.AMENDMENTS: The City of Fort Worth expressly reserves the right, after due notice
to Grantee, to modify, amend, alter, change, or eliminate any of the provisions of this
privilege and to impose such additional conditions upon the Grantee as may be just
and reasonable as determined by the City Council, the conditions to be those
deemed necessary for the purpose of insuring adequate service to the public.
16.ASSIGNMENT OF AGREEMENT: This Agreement and any and all rights and
obligations hereunder may be assigned by the Grantee only with the prior written
consent of the City Council. All provisions of this Agreement shall apply to the
Grantee, its successors or assigns.
17.SEVERABILITY: If any section, subsection, sentence, clause, phrase, or other
portion of this Agreement is, for any reason, declared invalid, in whole or in part, by
any court, agency, commission, legislative body, or other authority of competent
jurisdiction, such portion shall be deemed a separate, distinct, and independent
portion. Such declaration shall not affect the validity of the remaining portions herein,
which other portions shall continue in full force and effect.
18.MAILING OF NOTICES: Every notice to be served upon the City or the Grantee shall
be hand delivered or sent by certified mail, return receipt requested. Every such
communication to the City shall be delivered or sent to the Assistant Director of Solid
Waste Services at the following address: 4100 Columbus Trail, Fort Worth, Texas
76133. Every such notice to the Grantee shall be delivered or sent to PO Box
123941, Fort Worth, Texas 76121. The mailing of such notice shall be equivalent to
direct personal notice and shall be deemed to have been given when received.
Either party may, upon written notice to the other party, change the address specified
in this section.
19.APPLICABLE LAW AND VENUE This Agreement shall be deemed to be executed in
the City of Fort Worth, Texas, regardless of the domicile of the Company, and shall
be governed by and construed in accordance with the laws of the State of Texas.
Venue for any legal action or proceeding arising under or relating to this Agreement
shall be in Tarrant County, Texas.
20. EFFECTIVE DATE: This Agreement shall be effective August 1, 2016.
Panther City Rental, LLC Page 6 of 7
Revised by CRL 200208290
IN WITNESS HEREOF, the City and Grantee have executed this agreement by their
authorized representatives:
THE CITY OF FORT WORTH, TEXAS PANTHER CITY RENTAL, LLC
By: By: �-
Fernando Costa Clark Thompson
Assistant CiY Manager Title: Owner
Date: B/t5/tG
APPROVED AS TO FORM AND LEGALITY: WITNESS:
d,—t,k Name: lfj�
Arthur N. Bashor
Assistant City Attorney ,/i
Title: /��
f OR
ATTEST: 0
Mary J. r9ej City Sec ry
G- a� 0 '/
Contract authorization
12Q
Date
M AL RECORD ECRETARY ORTH, TX
Panther City Rental, LLC Page 7 of 7
Revised by CRL 20020829v 1
City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 819/2016
III/II��
DATE: Tuesday, August 9, 2016 REFERENCE NO.: **C-27852
LOG NAME: 23PANTHER CITY NON-EXCLUSIVE
SUBJECT:
Authorize Agreement Granting Non-Exclusive Privilege to Panther City Rental, LLC d/b/a Panther City
Disposal to Collect and Transport Municipal Solid Waste in Fort Worth Pursuant to Section 12.5-850 of the
City Code (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council:
Authorize the execution of an Agreement granting non-exclusive privilege to Panther City Rental, LLC
d/b/a Panther City Disposal to collect and transport municipal solid waste in Fort Worth pursuant to
Section 12.5-850 of the City Code.
DISCUSSION:
Panther City Rental, LLC d/b/a Panther City Disposal, has submitted an application for a non-exclusive
privilege Agreement to collect commercial solid waste generated by businesses and industries in Fort
Worth. The term of the Agreement is for a period of five years and will automatically renew each five year
period unless notice of termination is provided by one party to the other at least 30 days prior to the date
of the renewal. The Director has determined the applicant meets the requirements of the law and the City
Code and recommends that the City Council authorize the privilege Agreement which must be passed by
a two-thirds vote.
In accordance with the terms of the Agreement, Panther City Rental, LLC d/b/a Panther City Disposal,
shall pay to the City a fee of five percent of gross revenues derived from its commercial collection
operations within the City. Such fee shall be paid on a quarterly basis due on April 30, July 31, October 31
and January 31 for the preceding quarter. Panther City Rental, LLC d/b/a Panther City Disposal also
agrees to comply with all other terms such as the condition of the solid waste container used, assumption
of liability for damage caused, collection times and the submission of annual reports.
FISCAL INFORMATION / CERTIFICATION:
The Financial Management Services Director certifies that the Code Compliance Department will be
responsible for collection and deposit of funds due the City under this Agreement.
FUND IDENTIFIERS (FIDs):
TO
Fund Department ccoun Project Program ctivity Budget Refer( kmount
ID 1A ID Year Chartfield 2
540011 0239901 14450006 1 1 1 $0.00
FROM
Logname: 23PANTHER CITY NON-EXCLUSIVE Page I of 2
Fun Department ccoun Project Program ctivity Budget I Reference # �mounj
ID ID Year Chartfield 2
CERTIFICATIONS:
Submitted for City Manager's Office by: Fernando Costa (6122)
Originating Department Head: Brandon Bennett (6345)
Robert Smouse (5153)
Additional Information Contact: Doris Brent (5164)
ATTACHMENTS
1. EPLS Panther City Disposal.pdf (Public)
2. Form 1295 Panther City.pdf (Public)
3. PC Applicaiton.pdf (Public)
Logname: 23PANTHER CITY NON-EXCLUSIVE Page 2 of 2
CERTIFICATE OF INTERESTED PARTIES FORM 1295
Sofl
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 it there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 1 2016-85198
Panther City Rental, LLC dba Panther City Disposal
Fort Worth,TX United States Date Filed-
2 Name of governmental entity or state agency that Is a party tot the contract for which the forms 07/15/2016
being flied.
City of Fort Worth Date Ax/184,wledged:
3 Provide the Identification number used by the governmental entity or state agency to track or Identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
23 PCA
Solid waste hauling
4 Nature of Interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I intermediary
Thompson, Clark Fort Worth,TX United States X
5 Check only If there Is NO Interested Party. ❑
6 AFFIDAVII, I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
qua,P�
r JAMES R 8001yE
Notary ID 0 125382300
My Coniadssion Expires �•.—
�Na�•'' March 21,2018 Z Z=-L,
Signs re of authorized agent of cony cting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said L�'1�il� �/1�1� this the day of Tilt,�
20 _,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of offic administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277
FoRTWORTH. APPLICATION FOR
NON-EXCLUSIVE PRIVILEGE AGREEMENT
(Collection and Transportation of Municipal Solid Waste)
INSTRUCTIONS: Complete form and return to City of Fort Worth, Solid Waste Management Division
4100 Columbus Trail, Fort Worth,TX 76133
Trade Name of Applicant jD9AnMx (Try Physical Address
AAJZkV 6rry 1Z.fNr4, LQ D$R ))rfPofAI 9YW frga. (t Ieofli 7712.0
Contact Name Contact
'4"" Q72 7YT 6gIZ
Mailing Address
�� �ak � /'Z3a1yl Telephone Number � �7 g�C 8`2�f
/—oRT W09711 7'61 Z.\ Fax Number
1. Briefly describe the nature and character of the service the applicant proposes to
render.
Ro l I oFF /q 027Zj,' 60 N rrrVX rXON WA-5[C g'0Zi 61
2. Estimated Number of Vehicles Operating Under this Agreement. A list
of all vehicles must be attached to this application. The list shall
include make, model, year and license plate number of all vehicles to
operate under this Agreement.
3. Do each of the vehicles listed in question 2 above have a current City ND
of Fort Worth Haulina Permit?
4. Applicant has attached Certificated of Liability Insurance as required in Circle One
the Non-Exclusive Privilege Agreement, section 13. QYE.S ) NO
5. Signature of person authorized by the Company to sign this Application
Signatures
Title O Li e1 e r Date
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
For City Use Only
Privilege Agreement Number: Date Approved:
Period Covered: to Approved M&C Number:
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
Distribution: City Secretary, Solid Waste Division,Applicant
AC ® r ATE(MMOD/YYYY)
AC� CERTIFICATE OF LIABILITY INSURANCE 6/13/2016
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(les) 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 andorsement(s).
PRODUCER CONTACT Jessica Cervantes
Crockett Insurance Service PHONE (936)544-2291 FAX (936)541-9732
AiC No
P.O. Box 670 E-MAIL
ADDRESS: canicac @crockettinsurance.com
INSURERS AFFORDING COVERAGE NAIC#
Crockett T$ 75835 INSURERA:SCOTTSDALE INSURANCE
INSURED INSURER B:PROGRESSIVE COUNTY MUTUAL CO.
PANTHER CITY RENTALS LLC INSURER C:
4900 ARBOL CT. INSURER D:
INSURER E:
FORT WORTH T$ 76126 INSURER F:
COVERAGES CERTIFICATE NUMBERi4ASTER 2015-2016 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER MMMiDDNYYY MMMiDD/YYYP LIMITS
LTR
$ COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000
DAMAGE TO IRENTOY-
A CLAIMS-MADE Fj OCCUR PREMISES a occurrence $ 100,000
CPS2312744 9/16/2015 9/16/2016 MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
$ POLICY JPRO-- LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMcci�DS NG M $ 1,000,000
B ANY AUTO BODILY INJURY(Per person) $
$ ALL OWNED SCHEDULED 03817640-0 6/10/201 6/10/2017 BODILY INJURY(Per accident) $
AUTOS AUTOS
HIRED AUTOS AN-OVMED PROPERTY DAMAGE $
(Par accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS'LABILITY STATUTE ER
N
ANY PROPRIETORIPARTNERIEXECU LIVE YIN NIA E.L.EACH ACCIDENT $
OTFlCERIMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE.$
K yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
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.
1000 Throckmorton St.
Fort Worth, T$ 76102 AUTHORIZED REPRESENTATIVE
Carlton Jones
®1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025 rmiAnit