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HomeMy WebLinkAboutContract 48924 ITY ETARY C RAC NO EASEMENT ENCROACHMENT LICENSE AGREEMENT Conzniercial 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 City Manager, its duly designated Assistant City Manager or Planning and Development Director, and Prime Rail Interests, LLC, a Domestic Limited Liability Company (LLC) ("Licensee"), acting by and through its duly authorized Michael Rader, President, owner of the real property located at Meacham Blvd, Fort Worth, TX 76106 ("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 Public Access and Utility 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 construct/place and maintain certain 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: --- OFFICIAL RECORD AGREEMENT CITY SECRETARY 1 FT.WORTH,TX 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 Public Access (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 further infringe in or on City's Easement beyond what is specifically described in the Exhibit(s) attached hereto. 2. 2015 Easement Encroachment Agreement-Commercial Page 1 of 11 Transload Drive Rev. 02/2015 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 Public Works or the Director of the City's Water Department, 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 prior to the construction of the Encroachment. Licensee shall not commence construction of the Encroachment until receiving written approval by the Director, but such approval shall not relieve Licensee of responsibility and liability for concept, design and computation in the preparation of such plans and specifications. 3. 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 health, safety and welfare of the public or 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, or said Director's duly authorized representative. 4. Licensee agrees to pay to City at the time 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 Transload Drive Rev.02/2015 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 of 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 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 Texas 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 Easement to be used for any other public purpose, that does not preclude the use of the Encroachment on the Property, including but not being limited 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 KIND OR CHARACTER, ARISING OUT OF OR IN CONNECTION WITH, THE CONSTRUCTION, MAINTENANCE, OCCUPANCY, USE, EXISTENCE OR LOCATION OF THE ENCROACHMENT 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 2015 Easement Encroachment Agreement-Commercial Page 3 of 11 Transload Drive Rev.02/2015 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. S. 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 $1,000,000 Commercial 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 immediately 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 the 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 and uses. 2015 Easement Encroachment Agreement-Commercial Page 4 of 11 Transload Drive Rev.02/2015 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. 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 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 assignment 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 2015 Easement Encroachment Agreement-Commercial Page 5 of 11 Transload Drive Rev. 02/2015 default or otherwise shall not require City approval provided that said lender notifies City in writing within 60 days of such foreclosure or assignment and assumes all of Licensees' rights and obligations hereunder. However, no change of ownership 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] 2015 Easement Encroachment Agreement-Commercial Page 6 of 11 Transload Drive Rev. 02/2015 THIS AGREEMENT may be executed in multiple counterparts, each of which shall be considered an original, but all of which shall constitute one instrument. City Licensee: CITY OF FORT WORTH Prime Rail Interests, LLC By: l� �� By: Randle Ha ood Name: Michael Rader Director Title: President Planning and Development Date: ?jl , 20 1 ATTEST: Approved As To Form and Legality 1 r City Secretary Assistant Cit Attorney U A * �2 �XAS OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX 2015 Easement Encroachment Agreement-Commercial Page 7 of 11 Transload Drive 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. IVB �S ame of Employee Title STATE OF TEXAS § COUNTY OF TARRANT § This instrument was acknowledged before me on , 201 by Randle Harwood, Director of the Planning a d Dev op ent epartme t of the City of Fort Worth, on behalf the City of For Wort CASSANDRA F. FOREMAN .z Notary Public,State of Texas My commissionExpiresNiD April 266,, 2017 ary Public, State o Texas --+. ;ti;.•' 2 After Recording Return to: Cassandra Foreman Planning and Development Department 1000 Throckmorton Street Fort Worth TX, 76102 2015 Easement Encroachment Agreement-Commercial Page 8 of 11 Transload Drive Rev. 02/2015 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 Michael Rader, President (title), 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 Prime Rail Interests, a Domestic Limited Liability Company (LLC), and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of 20,/_ PATTI A. HOLLOWAY �z Notary Pub11C,State of Texas ++y My Commission Expires August 24, 2019 Notary Public in d for the State of 2015 Easement Encroachment Agreement-Commercial Page 9 of 11 Transload Drive Rev. 02/2015 LEGAL DESCRIPTION OF THE PROPERTY 2015 Easement Encroachment Agreement-Commercial Page 10 of 11 Transload Drive Rev. 02/2015 9 EXHIBIT "A" LEGAL DESCRIPTION EASEMENT ENCROACHMENT LICENSE AGREEMENT BEING a tract of land situated in the S.A. & M.G. Railroad Co. Survey, Abstract No. 1464, the W.B. Tucker Survey, Abstract No. 1515, Tarrant County, Texas, being a part of that called E 31.082 acre tract of land described in Special Warranty Deed to Prime Rail Interests, Inc., as recorded in Volume 13052, Page 140 in the Official Records of Tarrant County, Texas (O.R.T.C.T.), being a part of those tracts of land described in Tax Resale Deed to Prime Rail Interest, Inc., as recorded in County Clerk's Document No. D204189724 O.R.T.C.T., and being more particularly described as follows: COMMENCING at a 1/2-inch found iron rod for the common corner between the northwest corner of Lot 2, Block 1 Central Industrial Park, an addition to the City of Fort Worth, as recorded in Volume 388-141, Page 76 of the Plat Records of Tarrant County, Texas (P.R.T.C.T.) and the northeast corner of said 31.082 acre tract and the most easterly corner of said tracts to Tax Resale Deed to Prime Rail Interest, Inc., said iron rod also being on the south right of way line of Meacham Boulevard, a variable width right of way, dedicated by plat recorded in Cabinet A, Page 5688 P.R.T.C.T.; I THENCE North 81 degrees 52 minutes 56 seconds West, along said south right of way line, a distance of 214.09 feet for the point of a circular curve to the right, having a radius of 1,572.93 feet, whose chord bears North 77 degrees 46 minutes 42 seconds West, a distance of 235.24 j feet; 4 { THENCE Northwesterly, along said right of way line and along said circular curve through a central angle of 08 degrees 34 minutes 37 seconds, an arc length of 235.46 feet to the POINT OF BEGINNING; THENCE South 16 degrees 30 minutes 37 seconds West, departing said right of way line, a distance of 24.43 feet for the point of curvature of a circular curve to the right, having a radius of 200.00 feet, whose chord bears South 37 degrees 44 minutes 46 seconds West, distance of 144.88 feet; THENCE Southwesterly, along the arc of said circular curve through a central angle of 42 degrees 28 minutes 19 seconds, an arc length of 148.25 feet for the point of curvature of a circular curve to the left, having a radius of 200.00 feet, whose chord bears South 37 degrees 31 minutes 16 seconds West, a distance of 146.35 feet; THENCE Southwesterly, along the arc of said circular curve through a central angle of 42 degrees 55 minutes 20 seconds, an arc distance of 149.83 feet to a point for corner; THENCE South 16 degrees 03 minutes 36 seconds West, a distance of 125.46 feet for the point of curvature of a circular curve to the right, not being tangent to the preceding course, having a radius of 50.00 feet, whose chord bears North 60 degrees 58 minutes 03 seconds West, a distance of 22.45 feet; THENCE Northwesterly, along the arc of said circular curve through a central angle of 25 degrees 56 minutes 42 seconds, an arc length of 22.64 feet to a point for corner; 1of3 THENCE North 16 degrees 32 minutes14 seconds East, a distance of 14.74 feet for the point of curvature of a circular curve to the left, having a radius of 4.50 feet, whose chord bears North 07 degrees 39 minutes 57 seconds West, a distance of 3.69 feet; THENCE Northwesterly, along the arc of said circular curve through a central angle of 48 degrees 26 minutes 02 seconds, an arc length of 3.80 feet for the point of curvature of a circular curve to the right, having a radius of 35.50 feet,whose chord bears North 09 degrees 20 minutes 01 second West, a distance of 47.86 feet; THENCE Northeasterly, along the arc of said circular curve through a central angle of 84 degrees 46 minutes 15 seconds, an arc length of 52.52 feet for the point of curvature of a circular curve to the left, having a radius of 44.50 feet, whose chord bears North 33 degrees 53 minutes 22 seconds East, a distance of 27.25 feet; THENCE Northeasterly, along the arc of said circular curve through a central angle of 35 degrees 39 minutes 33 seconds, an arc length of 27.70 feet to a point for corner; THENCE North 16 degrees 03 minutes 36 seconds East, a distance of 28.82 feet for the point of curvature of a circular curve to the right, having a radius of 220.50 feet, whose chord bears North 37 degrees 31 minutes 16 seconds East, a distance of 161.35 feet; THENCE Northeasterly, along the arc of said circular curve through a central angle of 42 degrees 55 minutes 20 seconds, an arc length of 165.18 feet for the point of curvature of a circular curve to the left, having a radius of 179.50 feet, whose chord bears North 43 degrees 32 minutes 47 seconds East, a distance of 95.55 feet; THENCE Northeasterly,along the arc of said circular curve through a central angle of 30 degrees 52 minutes 17 seconds, an arc length of 96.72 feet for the point of curvature of a circular curve to the left, having a radius of 59.50 feet, whose chord bears North 05 degrees 41 minutes 24 seconds West, a distance of 66.20 feet; THENCE Northwesterly, along the arc of said circular curve through a central angle of 67 degrees 36 minutes 06 seconds, an arc length of 70.20 feet for the point of curvature of a circular curve to the left, not being tangent to the preceding course, having a radius of 1,572.93 feet, whose chord bears South 72 degrees 35 minutes 38 seconds East, a distance of 49.19 feet; THENCE Southeasterly, along the arc of said circular curve through a central angle of 01 degree 47 minutes 30 seconds, an arc length of 49.19 feet to the POINT OF BEGINNING Containing 10,304 square feet or 0.2366 acres of land, more or less. Basis of Bearing is the Texas Coordinate System NAD 83, North Central Zone(4202), observed by GPS using Western Data Systems Dallas/Fort Worth area RTK Cooperative Network on 7/06/2012. Distances shown are surface distances, scale factor of 1.00012. 2 of 3 EXHIBIT "A" Map of Encroachment and Easement 2015 Easement Encroachment Agreement-Commercial Page 11 of 11 Transload Drive Rev.02/2015 — ——— — — — ——— — — — — — — — — M � a eOUAc/lA44 y r _ u a SITE 1AEACHAM FORT NORTH ;L DEPoD EMACHAM AIRPORT A a 1 PRIME- RAIL AL INTERESTS, INC. • HE 38TH S P &O CO DOC. NO. D204189724 !/ LOCATION MAP „ROPO O.R.T.C.T. / NOT TO SCALE �`SVRVE 1464 I N PBS�RAc� - - - - - - ----- RdXIMATE --7P SURVEY LINE -�— – � i ABS�R515 // PRIME RAIL INTERESTS,E 2 C. 0 25 50 100 // // PG. 140 SCALE:V=50' / / / O.R.T.C.T. 0.0143 ACRES S73'56'24'E / 625 SQ. FT. 25.00 , / POINT OF 25.N1603'36'E / POINT OF BEGINNING I 25.00' BEGINNING S74'28'44'W / S16'03'36'W 650.34' N73'56'24'W / / / 25.00' 1/2•FIR I 25.00' / -- --� -� /�—30' SANITY ( POINT OF SE EASMENT I COMMENCING / 1/2'FOUND IRON ROD PARENT TRACT \\/ NOT TO SCALE EXHIBIT "A" WW/SD CROSSING __ __ __ ENCROACHMENT AGREEMENT i -- -- -- TRANSLOAD DRIVE DATE:10/2016 AVO:28949 LEGENDOEM HALFF POINT FOR CORNER 4000 FOSSIL CREEK BLVD.FORT WORTH,TX 76137(817)847-1422 2 2 TBPLS FIRM NO.10029605 ( ACOR" CERTIFICATE OF LIABILITY INSURANCE °� r 9�22�20 6 ' 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 endorsement(s). PRODUCER CONTACT Natalie McCalment NAME: DFB Insurance Group of DEW, LLC PH/c°Nr o.ext): (817)261-1101 lac,Nol:(a17>z61-1120 ---- --- AIL 700 Highlander Blvd. , Ste. 340 ADDRESS:nmccalment@dfbinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Arlington TX 76015 INSURER A:Seneca Specialty Insurance Com INSURED --- _-- --- INSURER B Michael Rader, Prime Rail, DBA: Interest LLC, INSURER c: PO Box 249 - -- - INSURER D: INSURER E: Colleyville TX 76034 1 INSURER F: COVERAGES CERTIFICATE NUMBER:1617 LIAB 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 ADDL'SUBRi POLICY EFF j POLICY EXPI LIMITS LTR O WVD POLICY NUMBER MM/DDIYYYY MMIDD/YYYY l X COMMERCIAL GENERAL LIABILITY 3 EACH OCCURRENCE $ 1,000,000 ---DAMAGE TORENTED - �- -- A _- CLAIMS-MADE X_' OCCUR PREMISES(Ea occurrence) '_$- 100,000 X RAG1046161 4/27/2016 4/27/2017 MED EXP(Any one person) _$ 5,000 =PERSONAL&ADVINJURY ?$ 1,000,000 X GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIM� POLICY IT APPLIES PER: - PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER:- - - - LOC AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ (Ea accident) — ANY AUTO ! �BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS t1pDILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE Is AUTOS HIRED AUTOS AUTOS _(Per accident) I � I $ UMBRELLA LIAR —i OCCUR EACH EACH OCCURRENCE $ - - EXCESS LIAR �, E - $ AGGREGAT DED ! RETENTION$ f J $ WORKERS COMPENSATION '..� PER OTH I AND EMPLOYERS'LIABILITY 1 --.- STATUTE i _ER_ Y/N _.. -- -___-------- i I i ANY PROPRIETOR/PARTNER/EXECUTIVE —�,N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? —_ -- -- -- (Mandatory in NH) E.L.DISEASE EA EMPLOYEE$ _. If yes,describe under ��— ____-- __--- ----- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I i II 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 City of Fort Worth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: David Schroeder ACCORDANCE WITH THE POLICY PROVISIONS. 1000 Throckmorton Street Fort Worth, TX 76102 AUTHORIZED REPRESENTATIVE Mark Bridges/KSI tv� - ITIJ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSn25 i9n14n1)