HomeMy WebLinkAboutContract 48860�"I�Y SL��q� ' ���
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CONTRqCT N0.
EASEMENT ENCROACHMENT LIC�NSE AGREEMENT
Commef°cial
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 tivough its duly authorized City Manager, its duly designated Assistant City
Manager or Planning and Developrnent Director, and Tu�per Financial Incorporated_
[f�ull legal name], a Corporation [type of entity] ("Licensee"), acting by and
through its duly authorized President [title], owner of the real property located at
7500 Rosewood Ave , Fort Worth, TX 76116 ("Property").
RECITALS
WHEREAS, Licensee is the owner of certain real property situated in the City of
Fort Worth, Tarrant County, Texas, more particularly described in the attached Legal
Description of the Property; and
WHEREAS, the City has a drainage easement (the "Easement") in the
Property as shown on the map attached to this Agreement as Exhibit "A" and incorporated
herein for all purposes; and
WHEREAS, Licensee desires to constiuct/place and maintain cei�tain
improvements which will encroach onto the Easement; and
WHEREAS, City will allow the encroachment under the terms and conditions as
set forth in this Agreement to accommodate the needs of the Licensee.
NOW, THEREFORE, the City and Licensee agree as follows:
AGREEMENT
�
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 Licensee,
hereby grants permission to Licensee to encroach upon and occupy a portion of the City's
Easement for the purpose of buildinE a fence (the "Encroachment") as described
in and at the location shown on Exhibit "A" but only to the extent shown thereon. Upon
completion of the Encroachment, Licensee agrees to be responsible for maintaining the
Encroachment within and above the Easement. Licensee shall not expand or otherwise
cause the Encroachment to fi,u-ther infringe in or on City's Easement beyond what is
specifically described in the Exhibit(s) attached hereto.
2.
2015 Easement Encroachment Agreement -Commercial
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All construction, maintenance and operation in connection with such
Encroachment, use and occupancy shall be performed in strict compliance with this
Agreement and the City's Charter, Ordinances and Codes and in accordance with the
directions of the Director of the Transportation and Pubiic Works or the Director of the
City's Water Departmant, or his or her duly authorized representative. Licensee shall
submit all plans and specifications to the applicable Director or his or her duly authorized
representative pi�ior to the construction of the Encroachment. Licensee shall not commence
construction of the Encroachment until receiving written approval by the I�irector, but such
approval shall not relieve Licensee of responsibility and liability for concept, design and
computation in the preparation of such plans and specifications.
��
Upon prior written notice to Licensee, except in the case of an emergency, 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 heaith, safety and welfare of the public or for any other public
purpose. City shall bear no xesponsibility 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, or said Director's duly authorized representative.
4.
Licensee agrees to pay to City at the iime this Agreement is requested an application
fee of $325.00 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.
2015 Easement Encroachment Agreement -Commercial Page 2 of 11
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5.
The term of this Agreement shall be for 30 years, commencing on the date this
Agreement is executed by City. However, this Agreement shall terminate upon Licensee's
non-compliance with any af the terms of this Agreement. City shall notify Licensee in
writing of the non-compliance, and if not cured within 30 days, this Agreement shall be
deemed terminated, unless such non-compliance is not susceptible to cure within 30 days,
in which case this Agreement shall be deemed terminated in the event that Licensee fails
to commence and take such steps as are necessary to remedy the non-compliance with 30
days after written notice specifying the same, or having so commenced, thereafter fails to
proceed diligently and with continuity to remedy same.
6.
It is further understood and agreed between the parties hereto that the Easement to
be used and encroached upon as described herein, is heid 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 Texas Legislature; and that City cannot contract
away its duty and its legislative power to control the Easement fox 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
Easement to be used for any other pubiic purpose, that does not preciude the use of the
Encroachment on the Property, including but not being Iimited to underground, surface or
overhead communication, drainage, sanitary sewerage, transmission of natural gas 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 SUITS FOR PROPERTY DAMAGE OR
LOSS AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL
PERSONS, OF WHATSOEVER HIND OR CHARACTER, ARISING OUT OF OR
IN CONNECTION WITH, THE CONSTRUCTION, MAINTENANCE,
�,, OCCUPANCY, USE, EXISTENCE OR LOCATION OF THE ENCROACHMENT
_.Q ��� AND USES GRANTED HEREUNDER, WHETHER OR NOT CAUSED, IN
� 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
2015 Easement Encroachment Agreement -Commercial Page 3 of 11
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IN CONNECTION WITH THE ENCROACHMENTS AND ANY AND ALL ACTS
OR OMISSIONS OF LICENSEE, ITS OFFICERS, AGENTS, SERVANTS,
EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, OR
INVITEES.
E:�
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 af 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
$1,000,000 Cornmercial General Liability
with the understanding and agreement by Licensee that such insurance amounts may be
revised upward at City's option and that Licensee shall so revise such amounts imrnediately
following notice to Licensee of such requirement. Such insurance policy shall not be
canceled or amended without at least 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
"B" and incorporated herein for all purposes. Licensee agrees to submit a similar
Certificate of Insurance annually to City on the anniversary date of tha execution of this
Agreement
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 the Encroachment and the cleaning and restoration of
the Easement. All insurance coverage required herein shall include coverage of all
Licensees' contractors and subcontractors.
9.
Licensee agrees to deposit with City when this Agreement is executed a sufficient
sum of money to be used to pay necessary fees to record this Agreement in the Real
Property Records of Tarrant County, Texas. After being recorded, the original shall be
returned to the City Secretary of the City of Fort Worth.
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 the Encroachment an,d uses.
2015 Easement Encroachment Agreement -Commercial Page 4 of ] 1
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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.
lz.
Licensee cavenants and agrees ihat 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
pertnitting Licensee to construct, maintain and locate the Encroachment over or within the
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 party may have an
interest. Licensee agrees that it will obtain all necessary permissions 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 Sections 3 and 4 shall
survive the termination of this Agreement.
16.
Licensee covenants and agrees that it will not assign all or any of its rights,
privileges or duties under this Agreement without the written approval of City, and any
attempted assignrnent without such written approval shall be void. In the event Licensee
conveys the Property, Licensee may assign all of its rights and obligations under this
Agreement to the new owner of the Property, and Licensee shall be deemed released from
its duties and obligations hereunder upon City's approval in writing of such assignment,
which approval shall not be unreasonably conditioned or withheld. Foreclosure by a
secured lender of Licensee or assignment to a secured lender by Licensee in the event of
default or otherwise shall noi require City approval provided that said lender notifies City
2015 Easement Encroachment Agreement -Commercial Page 5 of 11
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in writing within 60 days of such foreclosure or assignment and assumes all of Licensees'
rights and obligations hereunder. However, no change of oumership due to foreclosure or
assignment to any secured lender of Licensee shall be effective as to City unless and until
written notice of such foreclosure or assignment is provided to City.
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.
SIGNATURES APPEAR ON FOLLOWING PAGE]
ZO 1 S Easement Encroachment Agreement -Commercial Page 6 of 11
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THIS AGREEMENT may be executed in multiple counterparts, each of wl�ich
sl�all be considered an original, but all of which sl�all constitute one instnilnent.
City
Ci'i
By:
Randle Harwood
Dii-ector
P1aiuling and Development
Date: _
ATTEST:
City Serx�
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, 20��
Licensee:
Tu�per Financial Incoi-poi•ated
Name: Raymond V. Tupper
Title: President
Approved As To Fort1� a»d Legality
, `��;�_.' ; ' � � �11�'�-�..
;
Assistant City Attorney
(; �i� ���'���. ������:.; '
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2015 Easement Encroaclmient Agreement -Commercial Page 7 of 11
Rev. 02/2015
Contract Compliance Manager:
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ensuring all performance and reporting requirements.
, ;
�� � . � � }'�� 1 ��L��.�-�
ame of Employee
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C� r� ��Gi�'�T� :"�
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STATE OF TEXAS
COUNTY OF TARRANT
This instrument was acknowledged before me on
by Randle Harwood, Director of the Planning and,�e
Fort Worth, on behalf the City of Fort Worth. � 1
, ,., ;,, .,;y ,,; �iv v�
_ :�� ' JYlt�tt L'xqlr�' ;
:� �}MY A���m�s zdt1 Notaiy Public,
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.,,;o�,�,,,.,
After Recording Return to:
Cassandra Foreman
Planning and Development Department
1000 Throckmorton Street
Fort Worth TX, 76102
2015 Easement Encroachment Agreement -Commercial
,
, 201
of the Gitv o
of Texas
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Page 8 of 11
Rev. 02/2015
STATE OF Texas �
COUNTY OF Tari•ant §
BEFORE ME, the undejsigned authority, a Notaiy Public in and for the State of
Texas, on this day pei•sonally appeared Raymond Tupper (President), known to me to
be the person whose naine is subscribed to the foregoing instrument, and acicnowledged
to me that he/she executed the same for the purposes and consideration therein
expressed, as the act and deed of Tupper Financial Incorporated, a CORPORATION,
and in the capacity therein stated.
GIVEN LINDER MY HAND AND SEAL OF OFFICE this _� � day of
�� �Zp ��
� .�°Pw:�:PJ;.,, MARIA G. GOME1
j��_ • `�: Notory Public, 51ate of Texas
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:yc My Commisslon Explres
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�"';; oF�,,,� Sepfember 16, 2019 �
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Nota�y Public in and for the
State of Texas
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2015 Easement Encroachment Agreement -Conunercial Page 9 of 11
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LEGAL DESCRIPTION OF THE PROPERTY
2015 Easement Encroachrnent Agreement -Commercial Page 10 of 11
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EXHIBIT "A"
Map of Encroachment and Easement
2015 Easement Encroachment Agreement -Commercial Page 11 of 11
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. �. . ,
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P INT OF
COMMENCING
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LOT 9R, BLOCK 10
ALTA MERE ADDITION
D215277298
LOT 21, BLOCK 10
ALTA MERE ADDITION
VOL. 1037, P. 413
I LOT 1
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POINT OF
BEGINNING
^ J
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LINE iABLE
LINE BEARING
L-1 S 60'22�46" E
L-2 N 08'23'55" E
L-3 S 60'22'46" E
L-4 S 08'23'S5" W
L-5 N 65'42'00" W
L-6 S 56' 15�50" W
�-7 N 08'23'S5" E
J /
LOT 21
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CF ��O�r
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r � LOT 9R �e�'�'r �
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� �`s� B�OCK 10
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SEE DETAIL �
ALTA MERE ADD�
C L E R K' S F I L E N 0. D 2 1 5 2 7 7 2 9 8
January 24, 2017
��S
L-6
LENGTH
32.00
16.09
10.73
61.45
9.67
0.95
47.23
DETAIL
SCALE: 1 " = 10'
-�
d'
1
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SCALE: 1 " = 30'
0 10 20 50 100
SHEET 1 OF 2
Grant Engineering, Inc.
Engineete Sotvayoie Plmnaie
3244 AompLill Suaet Fort Woith, Texae 76110-4014 817-923-3131
Fum Registration No. 100919-00
LEGAL DESCRIPTION
A portion of the variable width drainage easement in the northwest corner of Lot 9R,
Block 10, Alta Mere Addition to the City of Fort Worth, Tarrant County, Texas, according to
the plat recorded under Clerk's File Na. D215277298, Real Property Records, Tarrant
County, Texas, and a portion of Lot 21, Block 10, Alta Me�e Addition to the City of Fort
Worth, Tarrant County, Texas, according to the plat recorded in Volume 1037, Page 413,
of said Real Prope►ty Records, being more particularly described by metes and bounds as
followa:
COMMENCING at a found 1/2 inch steal rod at the northwest corner of said Lot 9R, the
westernmost corner of said Lot 21, and in the east right—of—way line of Bonnie Drive, a
50 feet wide public street;
THENCE South 60 degrees 22 minutes 46 seconds East along the north line of said Lot
9R and the south line of said Lot 21, 32.00 feet to the Point of Beginning;
THENCE North 08 degrees 23 minutes 55 seconds East, 16.�9 feet to a point;
THENCE South 60 degrees 22 minutes 46 seconds East, 10.73 feet fo a point;
THENCE South 08 degrees 23 minutes 55 seconds West, at 16.09 feet passing the
common line between said Lots 9R and 21, in all 61.45 feet to a point;
THENCE North 65 deg�ees 42 minutes 00 seconds West, 9.67 feet to a point;
THENCE South 56 degrees 15 minutes 50 seconds West, 0.95 feet to a point;
THENCE North 08 degrees 23 minutes 55 seconds East, 47.23 feet to the Point of
Beginning, and containing 0.0142 acres (620 square feet) of land, more or less, of which
0.0105 acres (459 square feet) lies within Lot 9R and 0.0037 acres (161 square feet)
lies within Lot 21.
The Basis of Bearings for this description and the
accompanying sketch is the plat recorded under Clerk's
File No. D215277298, Real Property Records, Tarrant
County, Texas.
JOffi� A GRAN? III
January 24, 2017
SHEET 2 OF 2
Grant Engineering, Inc.
Snginee�e Surveyo�s rlannars
37A4 Hemphill Street Fort Wo�, Texae 761101�014 817-923-3131
Fiffi Registtation No.100919-00
LINE iABLE
EXHIBIT FOR SPECIAL USE LINE BEARING LENGTH
OF A DRAINAGE SEMENT L-1 N 18'02'11'� W 12.52
L-2 S 74'S1'50" W 19.81
LOT 9R, BLOCK 10 L-3 N 24'00'00" W 10.12
ALTA MERE ADDITION L-4 N 74 51'So" E 20.86
D215277298 L-5 S 1 S'02' 11 " E 10.01
\
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LOT 9R \ � � LOT 12R
BLOCK 10 '� BLOCK 10
A L T A M E R E � D D. A L T A M E R E A D D.
C L E R K� S F I L E N 0. D 2 1 5 2 7� 2 9 8 C L E R K' S F 1 L E N 0. D 2 1 0 2 2 4 5 8 9
\
\ �� � ;
� POINT OF
\� ��2 j BEGINNING
POtNT OF
COMMENCING
R 0 S E W 0 0 D A V E N U E
c so� Riw >
SCALE: 1 " = 30'
`-��� OF
ya���,��b� 0 10 20 50 100
JOHtt A GRANT IIi
�' 4��, SHEET 1 OF 2
�' S��` Grant Engineering, Inc.
g,nginca�s Siuveyom Planneta
January 24, 2017 3?A4 Hempbill Sueet Fort Worth, Texas 76110.4014 817-923-3131
Firm Registcation No.100919-QO
m
LEGAL DESCRIPTION
A portion of the variable width drainage easement in the southeast corner of Lot 9R,
Block 10, Alta Mere Addition to the City of Fort Worth, Tarrant County, Texas� according to
the piat recorded under Clerk's File No. D215277298, Reol Property Records, Tarrant
County, Texas, being more particulariy described by metes and bounds as follows:
COMMENCING at a found 1/2 inch steel rod at the southeast corner of said Lot 9R, at
the southwest corner of Lot 12R, Block 10, Aita Mere Addition to the City of Fort Worth,
Tarrant County, Texas, according to the plat recorded under Clerk's File No. D210224569,
of said Real Property Records, and in the north right—of—way line of Rosewood Street, a
60 feet wide public street;
THENCE North 18 degrees OZ minutes 11 seconds West along the east line of said Lot 9R
and the west line of said Lot 12R, 12.52 feet to the Point of Beginning;
THENCE South 74 degrees 51 minutes 50 seconds West, 19.81 feet to a point;
THENCE No�th 24 degrees 00 minutes 00 seconds West, 1 Q.12 feet to a point;
THENCE North 74 degrees 59 minutes 50 seconds East, 20.86 feet to a point in the east
line of said Lot 9R and in the west line of said Lot 12R;
THENCE South 18 degrees 02 minutes 11 seconds East along the east line of said Lot 9R
and the west line of said Lot 12R, 10.01 feet to the Point of Beginning, and containing
0.0047 acres (2Q3 square feet) of land, more or less.
The Basis of Bearings for this description and the
accomponying sketch is the plat recorded under Clerk's
File No. D215277298, Real Prope�ty Records, Tarrant
County, Texas.
January 24, 2017
SHEET 2 OF 2
Grant Engineering, Inc.
Snginee�s Surveyora Planneca
3244 HempFull Street Fort WorTh, Taxes 76110-4014 817-923-3131
Fixm Regiatretion No. 100919-00
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DA7E (MMIOWYYYY)
q� � CERTIFICATE OF LiAB1�ITY INSURANCE o2,22,Zo„
PaooucEa THiS CERTIFfCA710N IS ISSUED AS A MATTER OF INFORMATtON
ONLY AND CONFERS IJO RIGHTS UPON THE CERTIFICATE
PRINCE, GARDINER & ASS4CIATES HOLDER TH13 CERTIFICATE DOES NOT AMEND, EX7END OR
6300 RIDGLEA PLACE SUITE 307 ALTER THE COVERAGE APFORDER BY THE POUCIES BELOW.
FQRT WORTH, TX 76116 NAIC #
INSUR�RS AFFORDING CQVERAGE � _ __ _ _
INSURED �� � Rea a Covington Speciaity Insurance Campany _�___
Tupper Finanda� Incflrporated I INSURHi 6: _ ___ -
801 Meadow Hiil Ffd �INS�URB2C: � —
FoA Worth TX 7B108 � iNs` UR�R n: _. __ �-- '
— —�---
IN� E:
THE POLIGIES OF INSURANCE LISTED BELOW HAVE BEErv lssutu �u mc nva�n=� �...�.��.-..�,--- •--•- ��---
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W1TH RESPECT 70 WHICH THIS CfRTIFlCATE MAY BE ISSUED Oft
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRI86D HEREIN ISSUBJEC7 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGA7E LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: -, ' --- ----
T�--- ` TPOUCYEFPECTiWE' POUCYD�IRRTION: LIMITS
INS 'A�D' POUCYNUMBER ppTE MM/pp1yy DAIE MMlDD/YY
LTFi 1NS TYPE OF INSURANCE
GE-NErtn�LtAelulv OZ/21l2O77 t�2l21J201$ !������RRe�CE S $1,QDO,OOO
A � X—}}I —COMMERCWL GENERAL LIABIIITY NAUEP-N i PRE�S (Eb a�o�x�re�i�-e �.__ $l 00,000
I I I )�,AIMS MADE r� OCCUR : . MED EXP (Any one petson) I S $�,OQQ
�— ( �PEi2S�NAt BADV INJURY S $1 �OOO,QOO
, � �-- - � ` GENERPIAGGREGA'TE�_ $2.000,000
GEN'l Aa'iREGA1E LIMIT APPLIES PER: i ( �PRODUC7'S -COMP(OP A� . _
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I I� on� icv � I PRO- �� LOC I �
' AUTOMOBILE L1ABItJ'IY
�ANYAUTO
_ ALL OM'NED AUTQS
iSCHEDULE17AUf05
� HIREDAUTOS
I� NON-0WNEDAUT0.S
GARAGE LIABILITY
� ANY AUTO
EICCESfiNM9RELLA UkBWiY
� QCCUR � CWMS MAt�
DEDUCIIBLE
� WORKERS COMPENSATION ANp
� EMPLOYERS UAHIUTY
' pNY PftOPRiETOR/PARTNER/EXECUTIVE
� OFFICF12t1,lEMBER EXCLUQEO?
� (f yes, deaaibe under
I SPECWLPROVISIONSDebar
: OTNER
� GOMBYVED SINGIE L7MfT S
� (Ea scadanQ � _
80�ILY INJURY ` s�
{Perperson)
BODILYINJURY S
� (Per scddenl) ,
j PROP@�TY DAMAGE I E
� (Petacddent)
� AUTO ONLY - EA ACGDEN7 ; S
OTHER THAN EAACC i $ _
AUTO ONLY: AGG S
EACH OCGURRH�ICE S
� AGGREGAIE � 5 __
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S
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E.L EACH ACCDENT� S
E.L. �ISEASE - EA EMPLOY�
E.LDISEASE-POUCYUMIT S
DESCW P'iION OF OPERATIONS ! LOCATIONS 1 VEHICIES 1 E}(CLUSIONS A�DEU BY EN�OftSEMENT! SPECIAL PROVtS�ONS
RE: 7500 Rosewood Ave., Fort Worth, TX 7fi116 City of Fort Worth's Ref # FS-1 �057 Flle #D21577298 Lot 9R, Block 10, Aita Mere Addfilon, Tarrant Couniy,
TX
SHQUtD ANY OF 1HEABOVE DESCRIH£D POLICIES BE CANCELLEO BEFORE THE EXPIRATION
cassandra.forman�fortworth.org pA7E p{EREOF, TFiE ISSUING tNSURER W0.� ENDEI4YOR TO MAIL 30 DAYS WRI7TEN
Ciry of Fort worth
NOTICE TO THE CERTIFlCATE HOLDER NAMED TO YHE L�T, BUT FW IURE TO DO SO SHALL
Cassandra Forman
2O0 T@X3S 5t IMPOSE NO 00LIGATtON OR UABIUTY OP ANY Klt� UPON THE IN5URER, IT3 AGENTS OR
Fort Wor1h, TX iB'I OZ fiEPRESENTATIYES.
AUTHORIZED REPRESENTATIVE �/'�