HomeMy WebLinkAboutContract 26405 CITY SECRETARY
CONTRACT NO.
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, herinafter referred to as the "City"' and
R.J. Miller and Associates, inc.
RJ Miller, President
acting by and through its duly authorizer)
hereinafter referred to as
"Grantee".
WITNESSETH:
1.
For and in consideration of the payment by Grantee of the
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 portions of
the space under, on and/or above the streets, alleys, sidewalks or other
public rights-of-way as follows:
Sidewalk at southwest corner of 1000 Block Houston Street
Sidewalk at southwest corner of 200 Block West 9th Avenue
FROM
OTill, Easff
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 streets, alleys, sidewalks or other
public rights-of-way under this agreement shall be in strict compliance
with the Charter, Ordinances and Codes of City and in accordance with
the directions of the Building Official and the Director of Transportation
and Public Works of City.
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 Sidewalk only
$.Ol x 105 feet x 6 feet x 90 days = $567:-00
I Q/yn I-VA A-yL 0�1 GP
:IJ (U ID Ooo 0o- ���- P
'r MI���!C�5 °Q� 2
Ji 1t 1 '7 1OO
5.
Grantee, at no expense to City, shall make proper provision for
the relocation and/or installation of any existing or future traffic control
devices 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 an additional amount equal to such additional
cost as determined by City.
6.
90 10-23-00
The term of this agreement shall be for days, from
QJ►-zo-off
toprovided, 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 `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 Worksbr-his
duly authorized representative and in accordance with then 9'-,
specifications, and Grantee shall remove all barricades, equipment, y9-1 � o
9
supplies, materials or other property from said location. Grantee further
4
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 too 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.
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
' RKNA HCHD
C Y EEDM k
, rNo Val
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 that 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, should 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 statute,
law or regulation. r1rl
NRCCIA1 p B HCOMOD 6
r��' �tE'GM,V
R Wr,IFINN M
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.
14.
Grantee covenants and agrees to indemnify, and does hereby
indemnify, hold hannless 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, including death, to any and all
persons, of whatsoever kind or character, whether real or asserted,
arising out of or in connection -vvith, directly or indirectly, the
maintenance, occupancy, use, existence or location of said
encroachment and uses granted hereunder, whether or not caused, in .
whole or in part, by alleged negligence of officers, agents, servants,
r0P'N(C-PDMQY
_RG+ � HP FM
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,
licensees, 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 than the following:
Property damage, per occurrence $100,000
Bodily injury, per person $250,000
Bodily injury or death, per occurrence $500,000
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 amounts immediately following notice to grantee of such
requirement. Such insurance policy shall provide that it cannot be cancelled
or amended without at least thirty (30) days' prior written notice to the
Building Official 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, 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 of 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 the 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. OFpRy�1NAk Fr'�SMED
UU
U1l-,E 9
EXECUTED This 20th day of October 2000.
GRANTOR: GRANTEE:
R.J. Miller and Associates,inc.
CITY OF FORT WORTH RJ Miller, President
BY: BY:
BUILDING OFFICIAL
esident
APP VED TO FO AND LEGALITY:
TITLE
ClXk ATTO EY/ DATE:J-4
CITY SECRET Y K DATE:
Contract Authorization
Date
10
FT woo �[ o
STATE OF TEXAS
COUNTY OF TARRANT
BEFORE ME, the undersigned authority, a Notary Public in and
For State of'Texas, on this day personally appeared
wAy-)1'fA ,known tome to be the person whose
name is subscribed to the foregoing instrument, and acknowledged to me
that he/she executed the same or theu.- os s and cons*d ration,therein
expressed, as the act and deed of cp' �
and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this day
of
Affiant
JUANITA JOYCE JEFFERSON
Notary Public �fZ
e State of Texas
'�of Comm. Expires 06-28-2003 Not Public in an for
The State of Texas
k PEG0 D
c�E(I'— ,MA P11
STATE OF TEXAS
COUNTY OF TARRANT
BEFORE ME, the undersigned authority, a Notary Public in and
For a State o Texas, on this day personally appeared
t J MI L ii�f' ,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 thn
expressed, as the act and deed of ✓n' L�l`�. .)g
and in the capacity therein stated
GIVEN UNDER MYMAND AND SEAL OF OFFICE this day
Of , 20-12-0—
Affiant
0 Do .Affiant
Title
Notary ciblic in and for
The State of Texas
-Cc '00000000000000C.X)(xcx.t..
CvW -11A AN TURNER g
Nota; ludic,State of Texas
a, •:'My commission Exp.06-13-20028
1-100''0'00000000000000000000000001-100''0'0000000000000000000000000000§UU000000000000000000000000000§
07-10-2000 01:39PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 971-484-0159 T-466 P.001/001 F-315
i
fit's Heavqout Post Bridges
stem New&
g
contractors With pedestrian overhead protection Canopq Frames
• Meets OSHA and local • The Heavy Duty 300 lbs. Canopy Frames can provide
codes far pedestrian per sq. ft. system (1.456 economical pedestrian pro-
protection. kgs per sq. meter] allows for tection on secondary
• Plain design can aes- use of erected scaffolding streets. Used in-conjunction
thetically blend with any or material storage on with Patent's Heavy Duty
jobsite. top. Post Bridge, a complete
• The standard design • 16 ft. (4.9m) high drive- pedestrian canopy can be
provides 8 ft. wide (2.4m) thru bays available. provided. Canopy Frames
walkway. Other widths can • Fast and efficient erection (Part #O3S) are 76" (2.3m)
be accommodated. and dismantling. high by 6' (1.8m) wide. They
• • Electrical lighting, provide 7' (2.1m) of unob-
structed headroom for
ft. capacity 1732 kgs per sq. parapets and-siding can pedestrian traffic. (See back
meter]. be added to enhance aes- page for illustration.)
thetics and eet safety
W MAW)"We re ent Typical Installation
An"Doty Pest scaRolding ran easily be of the Sidewalk Canopy
Bridoe SidewalN meted atop tanaPies built
y , Frames provides a struc-
frem the 6dte"We Past
Bridges. r ture with a load rating of
150 Ib/sq. ft. (732 kg/sq.m)
�* using single bracing and
r,
y frame spacing up to 10'
aom) on center. A load
+uii of _
L
of 300 Ib/sq. ft.
g/sq. m) can be
ed with double brac-
eel 1-bearns as head-
d frame spacing of
m) on center. Nuts on
ustable legs (02J)
used instead of the
1 handles to maximize
� ,�` clea nce.
07-10-2000 12:48PI1 =FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 972-484-0159
T-461 P.001/001 F-306
E.
,,�avy Duty Post
. .
Canopy
g �� C>
ti
7'6'
T."
of Z. 3
Sidewalk Canopy Frame
Q,S;Height TV (229 m).,56 Ibs. (2.54 V.
4.
ri ;.. .
Heavy Duty Sidewalk Bridge
7'(2.3 m),
8'(2A4 m),
10'(3.05 M)
Diagonal
Brace
7'(2.3 m),8'(2.44 m), 10'(3.05 m)
Horizontal Brace
S_$- 3-H7: 13.4 tbs. (6.08 kg)
15.3 lbs. (6_94 kejS-a 7; 1g.9 lbs.(a57 kd
H1o:19.11 Ins. (8 66 20.3 lbs. (9.21 Wd
"3-01g V.6 Ibs.(10.7 k9)
$'(2.44 m) 16' 141.88 m)
post Post
,�i: 79lbs. 5:M: 142lbs.
(35.8 kph (64.414)
Clamp
IL $4: 2.21bs. (1.0 kO
U Ua UV\�J'�O UP �IS(/Vo
07-10-2000 01:03PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 9T2-484-0159 T-469 P 002/006 F-320
I-
x .3 � BAR 1
�t6 (WELDeP iN PL ACE.J
• ' 1
S-0
• 7-6• .
.3.9 ,
�,� �� srclv,� • •
s 0 .40
Sol
9'
• ' SIL�EWt�'LX CANOPY rRAME
awfi�p j •z T.#7F lIKY om - Few. w a rte.
PRAWN1 -TO 1•J- -�� C !1-
ArPF"M �j, 7v
iCALG •, ".
• THE PATENT SCAFFOLDING CQ. INC' .
poor" a SS•81 SWO NT. L 1.C1TMKN.Y
My
07-10-2000 02:03PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 972-484-0159 T-469 P.003/006 F-320
BUUETIN PSS-50
JIM
1 l�
lip
SIDEWALK CANOP11ts
7
i I
.r
• ^ t ;:►; 4 I�M:�:.:_ ter+. -
Erected
roue aver®
Sectimonal
PATENM
•�NUY1 W I�CUr �\:. IL7 WIVY:II
ar_wCCAl rliw/!J
Iq-
_---------------------9 0
07-10-2000 02:03PM FROWPATENT CONSTRUCTION SYSTEMS DALLAS 972-464-0159 T-469 P.004/006 F-310
I
6'm,Wide Frame
Assures strong,
Easyp4owErect
Sidewalk Canopy
NEW Sidewalk Canopy F;Iamee (Part 0038) for as with
"Trouble Saver" Sectional Scaffolding, are 7'A" high by 6'
wide.They provide 7'of w-tobstructed headroom for pedes-
trian traffic during overhead construction work,repairs or
. _ washing down. Canopies erected with these frames make a
neat installation which.de finitely marks the contractor as
progressive.
Strong yet lightweight, i.hese frames case be greeted to
carry loads up to 300 Iba per square foot. Standard
"Trouble Saver"braces,cdonsion legs and base plates are
used in the erection. For use on narrow sidewalks, PSCo.
can also furnish a 7'6"high by b'-wide frame(Part#03V).
flemoorLINe and alterations on building In Wichita, KanaaB, re• ,
quired the we of now Sidewalk Canopy frames.Atop the canopy
was erected a"Trouble savor"Sectional Scalfold.
TYPICAL Installation of theoe new 81dowaik Canopy frames to
provide a atruotu►e with a toad rating of 300#1aq,ft.Note that;to
achieve this rating, double bracing and 0'or T a" (-beams as
headers, are required. If ho -cad Is to be applied to the Canopy,
single bracing and frames •acino up to 10' may be used. Nuts
on the adjustable lege (02J�, turned by a comendonal spanner
wrench, can be used Instead of Ow handles normally found on
029 extension legs
Le6 J'
�11I C��Iu C�LyWN�Y
ti
OT-10-2000 02:03PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 972-484-0159 T-469 P.005/006 F-320
I
i g
SIDEWALK CANOPY FRAME is W wide and rO'high, providing 7' TYPICAL of the clean. nest Instmilatlons posalble with "Trouble
of headroom for pedestrian& Saver" Canopy trarnes Is this Irietailatlon in Schsnsctedy, N.Y.
Adjustable lug@ compensare for•lope'of eldewalk.
I
i
t
,
SCAFFOLDING can easily be erected atop Canopies bull, 'rum NEW YORKekyecraper oontrectare•also find these frames Maim-
these now W-wide frames.Consult your nearest Patent Scaffolding an Ideal Sidewalk Canopy. On this Installation, part of eldal
Co. office for load factors based on various Jolat spacing and area was walled oft. 'Tubalox"Scaffolding provicaa handrall. k
����I1WUSlf
OT-10-2000 02:04PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 972-464-0159 T-469 P.006/006 F-320
t
e
l
Two FRAMs:-WIDE Sidewalk Canopies,such ae th4 installation In Detroit,are some-
times required In speolal circumstances. In this assay also, a scaffold was readily
erected atop the canopy,for cornice removal operationa.
i�
r ;
f ,
r ,
4
t
+
PITTSBURGH'S famous Gateway Center STEEL I-BFaM In U-head atop frame tap provides rigid aupport for 2"planking which
protects pedestrians by means of this formed the -;rolective cavering over sidewalk on Instal ations In Detroit.Canopy was
small Canopy erected with "Trouble, acclaimed ty contractor,hotel owners and city officials,
Saver"O'-wills frames.caulking work was
being performed overhead.
SALES aENral;s
0MCilTNE OFFICE
ONE 13RMF KAZA,FORT LEE,N.J.USA 07021
TELEPHONE:201-4e1-e7oo • TWX 710991 9500 11Iq,Ap1sOL.DINO
AWam,Y asoom MA 0"zo ll,ON fart 111" Fl &I$"0ty,04MbwAn.I NWdMiw ft ps F1M bas,G TOM FL
r11"Oto11 1117.311-050 716.771-M 111,'7.1712] N i7
9 71t�421-3490 414.272.3121 215.743.6171 41642 0 11M14100
MR"Ck lu •CNR.car WWI 7111 Fat carat,TY has AAWW,CA Nw eN.as,LA rMnp,All #Ica hw,M T"49
sF114"41M W-0-11121,19 114a57-Mol 1717-33"13 213-77•210 5M-733-2111 010.2"in Ie&791�= 1111041tlll
Iw 4wo.no Sbui Na,NC D9asasr,co Nei",cr ud"twl.TN t11~=L w MNIBa1M,PA theft a
301.242.11719 104,MI771 3M477-1001 2M-5M4291 901.398-3233 m1-faz4.1rs12 412.23W;17 mM71IF-02111
GMWML T: CMIMw.I 11ww,w "Mmb%Tx MIUM fl. tNa.Ter1k Ntf w1MsN,all R
4111HO NN 312-171.2625 313$31.3014 713444-171Z 995.75+4.9565212-714-MOD 503.2113.31 15 v U u 1� �)�((�I'�i p
101i�FWNimM CO. KG mn�q,+dp+fuppy Lo 45000 Co. !ri l�V
UI CAM L'CWAWi FO M WAPVpM CL Lie. NYIIO N9,034 W702 =U=514QJ4•Wf TO M 41WUNM CAlrtlatl / N .^ PDJ �
51 NpR,O:aM0111107 Pn urnaal 7.L a t:X NflIICO tali MF515.15rr �:;l'U II'�)��ri�;�W IS IIW��
IM Ia1A11115rL 1N1E1rFi1111I E1Yr1L �N MO+QS- 2 I i. 110 R R W 3 T( of r0 at rAUL1-19 Th.415i r4 )Ili
It�rIM�C a1p0 TIL �N01•a107 i i..Oii�J/iFZrAT 31 AaMw 1fL 5�}137lILal-1301 TM.071172�11,1 I
NW AN Oupnml M WIF MM N*.AN poMtio lnd 111141FwN 0100 to+sd of Wkild la vie only w1wo PNM M IP on Off,
Mp+d11MM.t00111r daha011 ws aa/M
WON ptWY 04 in d11 maw h moved 04WW sonic cal in cordwmily odh wlo prxlsM.Splpkwilm e,1 mo m a am d4+4nwe gem a w WAINg>t tJIM111�daraaMll
Client 30146 RJMIL
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YY)
PRODUCER 0 7/25/00
Higginbotham & Assoc . , IAG. ONLY THIS CEANDFCONFEAS ISSUED
RIGHTS MATTER
THE INFORMATIION
ON
P.O. BOX 908 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Fort Worth, TX 76101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
817 336-2377 INSURERS AFFORDING COVERAGE
-------------
INSURE D
R.J. Miller & Associates, Inc . & INSURER A:Commercial. Union Insurance Company
3624 W. Vickery Blvd. INSURER B:
Fort Worth, TX 76107 INSURER C:
I INSURER D:
I
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REMIREMENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR TYPE OF INSURANCE POLICYNUMBER POLICY EFFECM 10 TIVEPON CYEXPtRAT)0 OMITS
A GENERALLIABILITY GRR694059 07/22/00107/22/01OEAURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY GE(Any one fFre1 32 O O 000CLAIMSMADEa OCCUR ny one person) S10 000A ADV INJURY S1 OOO 000GGREGATE Q non O 0 0 0
GENL AGGREGATE TEL
PROOUCTS-COMP/OP AGG S2 000 , 000
JECT
POLICY PRO- LOC
A AUTOMOBILE LIABILITY GRAS13688 07/22/00 07/22/01 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1, 000, 000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (per person) S
X HIRED AUTOS
BODILY
X NON-OWNED AUTOS (PeraccidenRY
) S
-- PROPERTY DAMAGE S
1(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANYAUTO EAACC $
OTHE R THAN
AUTO ONLY: AGO $
A EXCESSUABIUTY 905X5H 107/22/00 07/22/01 EACH OCCURRENCE s4, 000, 000
X OCCUR D CLAIMS MADE AGGREGATE s4, 000, 000
S
DEDUCTIBLE $
X RETENTION $10000 $
A WORKERS COMPENSATION AND ARH215 3 4 5 07/22/00707/22/01 X UPTATud OTH
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500, 000
I
E.L.DISEASE-EA EMPLOYEE $500, 000
E.L.DISEASE-POLICY LIM17,$5 O O 0 0 0
OTHER �
DESCRIPTION OF OPERATIONS)LOCATIONSIVEH1CLESIEXCLUSIONS ADDED BY EN DORSEMENT/SPECIAL PROVISIONS
Project: Guinn School Business Assistance Center
The City of Fort Worth is named as Additional Insured as respects General
Liability & Automobile Liability. A Waiver of Subrogation is issued in
favor of the City of Fort Worth as respects General Liability, Automobile
Liability and Workers' Compensation policies .
CERTIFICATE HOLDER ADDMONALWsuRED•INsuRE1MTMR: _ CANCELLATION
SHOULD ANYOFTFEABOVE DESCRIBEDPO 9�I rWFWMN
City Of Fort Worth DATE THEREOF,THE ISSUING INSURER W L6At� 11V $�Transportation and Public Works NOTX�TDTHECERTTFtCATEHOLDERNAM D y T1000 Throckmorton St . IMPOSE NOOBUGAMON OR LIABILITY OF r ��Ve��:Ctt
Fort Worth, TX 76102 REPRESENTATIVES. —
AUTHORIZED RESENT
�I
ACORD25-S(7/"l of 2 #S46235/M46234 LLD O ACORD CORPORATION 198
0
� y
0 g
o
Z
a
N A Z
f
r
04
ol
c a
J cc E
ionUJ
QQ
J 0
w � ' E 0s f
d i0o3 = E E E N 9 I y
= > > Q O i
°
cc c vai "' "' n a O Jr
FF
C,3 L p to
O X .� 'O c7 c7 .pa = x X O 1
C 'V C N d o S ri
r 7 � CU O N n-
� N 0000 0 I 1
r CL
pad
Z222
s_ cn
� � m 222 U Q u cy-
Z v Q LU
EUQ a3 � M � � O L,-u, i i� eeln� (�RWil/,�
N C L L a.„� Q. Lv W "� "IFFICO Al u g
L L RS N L Q = Q W S
CU
&5
C .0 O .� O to Z Q.F'^ F- F^ LU p