HomeMy WebLinkAboutContract 50564 City Secretary Contract No. v J
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`Vd ` �� PERSONAL SERVICES AGREEMENT
(Library)
This PERSONAL SERVICES AGREEMENT ("Agreement")is made and entered into by and between
the CITY OF FORT WORTH (the "City"), a Texas home-rule municipal corporation, and Thaddeus Ford
("Musician/Band"), a jazz band. City and Musician/Band are each individually referred to herein as a "party" and
collectively referred to as the"parties."
CONTRACT DOCUMENTS: 01
The Contract documents shall include the following:
1. This Agreement for Personal Services
2. Exhibit"A"—Statement of Work plus any amendments to the Statement of Work
3. Exhibit"B"—Payment Schedule
4. Exhibit"C"—Signature Verification Form
All Exhibits attached hereto are incorporated herein and made a part of this Agreement for all purposes. In the event
of any conflict between the documents, the terms and conditions of this Personal Services Agreement shall control.
The term "Musician/Band" or "Contractor" shall include the Musician/Band or Contractor, and its officers, agents,
employees, representatives, servants, contractors or subcontractors. The term "City" shall include its officers,
employees,agents,and representatives.
1. Scope of Services.
Thaddeus Ford will provide 6 musicians to perform for 90 minutes at 6:30 p.m.Thursday, May 17,2018,for
a jazz performance at the Fort Worth Central Library,which is part of the Library's 3rd Thursday Jazz Series.The fee
is$1800.00 USD and will be presented at the conclusion of the performance.
Specifically, Musician/Band will perform all duties outlined and described in the Statement of Work, which is attached
hereto as Exhibit "A" and incorporated herein for all purposes, and further referred to herein as the "Services."
Musician/Band shall perform the Services in accordance with standards in the industry for the same or similar services.
In addition, Musician/Band shall perform the Services in accordance with all applicable federal, state, and local laws,
rules, and regulations. If there is any conflict between this Agreement and Exhibit A, the terms and conditions of this
Agreement shall control.
2. Term.
This Agreement shall commence upon February 1, 2018, ("Effective Date") and shall expire no later than
October 1, 2019, ("Expiration Date"), unless terminated earlier in accordance with the provisions of this Ai;eement
or otherwise extended by the parties. This Agreement is not renewable.
OFFICIAL RECORD
CITY SECRETARY
FVe WORTH,TX
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3. Compensation.
The City shall pay Musician/Band the amount of$2000.00 USD in accordance with the provisions of this
Agreement and Exhibit "B," Payment Schedule, which is attached hereto and incorporated herein for all purposes.
Musician/Band shall not perform any additional services for the City not specified by this Agreement unless the City
requests and approves in writing the additional costs for such services. The City shall not be liable for any additional
expenses of Musician/Band not specified by this Agreement unless the City first approves such expenses in writing.
City agrees to pay all invoices of Musician/Band within thirty(30) days of receipt of such invoice. Musician/Band
may charge interest on late payments not to exceed one percent(1%).
4. Termination.
4.1. Convenience. Either the City or Musician/Band may terminate this Agreement at any time and for any reason
by providing the other party with 30 days written notice of termination.
4.2 Breach. Subject to Section 29 herein, either party may terminate this Agreement for breach of duty,
obligation or warranty upon exhaustion of all remedies set forth in Section 29.
4.3 Fiscal Funding Out. In the event no funds or insufficient funds are appropriated by the City in any fiscal
period for any payments due hereunder, the City will notify Musician/Band of such occurrence and this Agreement
shall terminate on the last day of the fiscal period for which appropriations were received without penalty or expense
to the City of any kind whatsoever,except as to the portions of the payments herein agreed upon for which funds have
been appropriated.
4.4 Duties and Obligations of the Parties. In the event that this Agreement is terminated prior to the Expiration
Date, the City shall pay Musician/Band for services actually rendered up to the effective date of termination and
Musician/Band shall continue to provide the City with services requested by the City and in accordance with this
Agreement up to the effective date of termination. Upon termination of this Agreement for any reason,
Musician/Band shall provide the City with copies of all completed or partially completed documents prepared under
this Agreement. In the event Musician/Band has received access to City information or data as a requirement to
perform services hereunder, Musician/Band shall return all City provided data to the City in a machine readable
format or other format deemed acceptable to the City.
5. Disclosure of Conflicts and Confidential Information.
5.1 Disclosure of Conflicts. Musician/Band hereby warrants to the City that Musician/Band has made full
disclosure in writing of any existing or potential conflicts of interest related to Musician/Band's services under this
Agreement. In the event that any conflicts of 4interest arise after the Effective Date of this Agreement,
Musician/Band hereby agrees immediately to make full disclosure to the City in writing.
5.2 Confidential Information. The City acknowledges that Musician/Band.may use products, materials, or
methodologies proprietary to Musician/Band. The City agrees that Musician/Band's provision of services under this
Agreement shall not be grounds for the City to have or obtain any rights in such proprietary products,materials,or
methodologies unless the parties have executed a separate written agreement with respect thereto. Musician/Band,
for itself and its officers, agents and employees, agrees that it shall treat all information provided to it by the City
("City Information") as confidential and shall not disclose any such information to a third party without the prior
written approval of the City.
5.3 Unauthorized Access. Musician/Band shall store and maintain City Information in a secure manner and
shall not allow unauthorized users to access, modify, delete or otherwise corrupt City Information in any way.
Musician/Band shall notify the City immediately if the security or integrity of any City information has been
compromised or is believed to have been compromised, in which event, Musician/Band shall, in good faith,use all
commercially reasonable efforts to cooperate with the City in identifying what information has been accessed by
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unauthorized means and shall fully cooperate with the City to protect such information from further unauthorized
disclosure.
6. Right to Audit.
Musician/Band agrees that the City shall, until the expiration of three (3) years after final payment under
this Agreement, have access to and the right to examine at reasonable times any directly pertinent books,
documents, papers and records of the Musician/Band involving transactions relating to this Agreement at no
additional cost to the City. Musician/Band agrees that the City shall have access during normal working hours to
all necessary Musician/Band facilities and shall be provided adequate and appropriate work space in order to
conduct audits in compliance with the provisions of this section. The City shall give Musician/Band not less than
10 days written notice of any intended audits.
Musician/Band further agrees to include in all its subcontractor agreements hereunder a provision to the
effect that the subcontractor agrees that the City shall, until expiration of three (3) years after final payment of the
subcontract, have access to and the right to examine at reasonable times any directly pertinent books, documents,
papers and records of such subcontractor involving transactions related to the subcontract,and further that City shall
have access during normal working hours to all subcontractor facilities and shall be provided adequate and
appropriate work space in order to conduct audits in compliance with the provisions of this paragraph. City shall
give subcontractor not less than 10 days written notice of any intended audits.
7. Independent Contractor.
It is expressly understood and agreed that Musician/Band shall operate as an independent contractor as to
all rights and privileges granted herein, and not as agent, representative or employee of the City. Subject to and in
accordance with the conditions and provisions of this Agreement, Musician/Band shall have the exclusive right to
control the details of its operations and activities and be solely responsible for the acts and omissions of its officers,
agents, servants, employees, contractors and subcontractors. Musician/Band acknowledges that the doctrine of
respondeat superior shall not apply as between the City, its officers, agents, servants and employees, and
Musician/Band, its officers, agents, employees, servants, contractors and subcontractors. Musician/Band further
agrees that nothing herein shall be construed as the creation of a partnership or joint enterprise between City and
Musician/Band. . It is further understood that the City shall in no way be considered a Co-employer or a Joint
employer of Musician/Band or any officers, agents, servants, employees or subcontractors of Musician/Band.
Neither Musician/Band, nor any officers, agents, servants, employees or subcontractors of Musician/Band shall be
entitled to any employment benefits from the City. Musician/Band shall be responsible and liable for any and all
payment and reporting of taxes on behalf of itself, and any of its officers, agents, servants, employees or
subcontractors.
8. LIABILITY AND INDEMNIFICATION.
A. LIABILITY - MUSICIAN/BAND SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL
PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH, TO
ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, TO
THE EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR
INTENTIONAL MISCONDUCT OF MUSICIANBAND, ITS OFFICERS, AGENTS, SERVANTS OR
EMPLOYEES.
B. INDEMNIFICATION - MUSICIANBAND HEREBY COVENANTS AND AGREES TO
INDEMNIFY, HOLD HARMLESS AND DEFEND THE CITY, ITS OFFICERS, AGENTS, SERVANTS
AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR LAWSUITS OF ANY KIND
OR CHARACTER, WHETHER REAL OR ASSERTED, FOR EITHER PROPERTY DAMAGE OR
LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO MUSICIAN/BAND'S BUSINESS, AND ANY
RESULTING LOST PROFITS) PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL
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PERSONS, AND DAMAGES FOR CLAIMS OF INTELLECTUAL PROPERTY INFRINGEMENT,
ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT,TO THE EXTENT CAUSED BY
THE ACTS OR OMISSIONS OF MUSICIANBAND,ITS OFFICERS,AGENTS, SUBCONTRACTORS,
SERVANTS OR EMPLOYEES.
9. Assignment and Subcontracting.
Musician/Band shall not assign or subcontract any of its duties, obligations or rights under this Agreement
without the prior written consent of the City. If the City grants consent to an assignment,the assignee shall execute a
written agreement with the City and the Musician/Band under which the assignee agrees to be bound by the duties
and obligations of Musician/Band under this Agreement. The Musician/Band and Assignee shall be jointly liable for
all obligations under this Agreement prior to the assignment. If the City grants consent to a subcontract, the
subcontractor shall execute a written agreement with the Musician/Band referencing this Agreement under which the
subcontractor shall agree to be bound by the duties and obligations of the Musician/Band under this Agreement as
such duties and obligations may apply. The Musician/Band shall provide the City with a fully executed copy of any
such subcontract.
[Insert language if goal has been set under the Business Diversity Ordinance]
Business Diversity Ordinance does not apply to this contract.
10. INSURANCE.
During the term of this Agreement,Musician/Band shall procure and maintain at all times,in full force and
effect,a policy or policies of insurance that provide the specific coverage set forth in this Section as well as any and all
other public risks related to Musician/Band's performance of its obligations under this Agreement. Musician/Band
shall specifically obtain the following types of insurance at the following limits:
Commercial General Liability:
$500,000 Each occurrence on a combined single limit
Musician/Band shall promptly provide the City with a certificate of insurance that verifies Musician/Band's
compliance with the insurance requirements of this Agreement.The City's Risk Manager shall have the right to review
and evaluate Musician/Band's insurance coverage and to make reasonable requests or revisions pertaining to the types
and limits of that coverage.Musician/Band shall comply with such requests or revisions as a condition precedent to
the effectiveness of this agreement.
11. Compliance with Laws,Ordinances,Rules and Regulations.
r
Musician/Band agrees to comply with all applicable federal, state and local laws, ordinances, rules and
regulations. If the City notifies Musician/Band of any violation of such laws, ordinances, rules or regulations,
Musician/Band shall immediately desist from and correct the violation.
12. Non-Discrimination Covenant.
Musician/Band, for itself, its personal representatives, assigns, subcontractors and successors in interest, as
part of the consideration herein, agrees that in the performance of Musician/Band's duties and obligations hereunder,
it shall not discriminate in the treatment or employment of any individual or group of individuals on any basis
prohibited by law. If any claim arises from an alleged violation of this non-discrimination covenant by
Musician/Band, its personal representatives, assigns, subcontractors or successors in interest, Musician/Band agrees
to assume such liability and to indemnify and defend the City and hold the City harmless from such claim.
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13. Israel
Musician/Band acknowledges that in accordance with Chapter 2270 of the Texas Government Code, the
City is prohibited from entering into a contract with a company for goods or services unless the contract contains a
written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the
term of the contract. The terms"boycott Israel" and"company" shall have the meanings ascribed to those terms in
Section 808.001 of the Texas Government Code. By signing this contract, Musician/Band certifies that
Musician/Band's signature provides written verification to the City that Musician/Band. (1) does not boycott
Israel,and(2) will not boycott Israel during the term of the contract.
14. Notices.
Notices required pursuant to the provisions of this Agreement shall be conclusively determined to have
been delivered when (1)hand-delivered to the other party, its agents, employees, servants or representatives, (2)
delivered by facsimile with electronic confirmation of the transmission, or (3) received by the other party by
United States Mail,registered,return receipt requested,addressed as follows:
TO THE CITY:
City of Fort Worth With Copy to the City Attorney
Attn:Jennifer Demas at same address
1000 Throckmorton
Fort Worth TX 76102
Facsimile: (817)392-7734
TO MUSICIANBAND:
Name:Thaddeus Ford
Address: 6407 Genstar Ln
Dallas,TX 75252
15. Solicitation of Employees.
Neither the City nor Musician/Band shall, during the term of this Agreement and additionally for a period
of one year after its termination, solicit for employment or employ,whether as employee or independent contractor,
any person who is or has been employed by the other during the term of this Agreement, without the prior written
consent of the person's employer. This provision shall not apply to an employee who responds to a general
solicitation or advertisement of employment by either party.
16. Governmental Powers.
It is understood and agreed that by execution of this Agreement,the City does not waive or surrender any of
its governmental powers.
17. No Waiver.
The failure of the City or Musician/Band to insist upon the performance of any term or provision of this
Agreement or to exercise any right granted herein shall not constitute a waiver of the City's or Musician/Band's
respective right to insist upon appropriate performance or to assert any such right on any future occasion.
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18. Governing Law and Venue.
This Agreement shall be construed in accordance with the laws of the State of Texas. If any action,whether
real or asserted, at law or in equity, is brought on the basis of this Agreement,venue for such action shall lie in state
courts located in Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort
Worth Division.
19. Severability.
If any provision of this Agreement is held to be invalid, illegal or unenforceable, the validity, legality and
enforceability of the remaining provisions shall not in any way be affected or impaired.
20. Force Maieure.
The City and Musician/Band shall exercise their best efforts to meet their respective duties and obligations
as set forth in this Agreement, but shall not be held liable for any delay or omission in performance due to force
majeure or other causes beyond their reasonable control (force majeure), including, but not limited to, compliance
with any government law, ordinance or regulation, acts of God, acts of the public enemy, fires, strikes, lockouts,
natural disasters, wars, riots, material or labor restrictions by any governmental authority, transportation problems
and/or any other similar causes.
21. Headings Not Controlling.
Headings and titles used in this Agreement are for reference purposes only and shall not be deemed a part of
this Agreement.
22. Review of Counsel.
The parties acknowledge that each party and its counsel have reviewed this Agreement and that the normal
rules of construction to the effect that any ambiguities are to be resolved against the drafting party shall not be
employed in the interpretation of this Agreement or exhibits hereto.
23. Amendments.
No amendment of this Agreement shall be binding upon a party hereto unless such amendment is set forth in
a written instrument,and duly executed by an authorized representative of each party.
24. Entirety of Agreement.
This Agreement, including any exhibits attached hereto and any documents incorporated herein by
reference, contains the entire understanding and agreement between the City and Musician/Band, their assigns and
successors in interest,as to the matters contained herein.Any prior or contemporaneous oral or written agreement is
hereby declared null and void to the extent in conflict with any provision of this Agreement.
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25. Counterparts.
This Agreement may be executed in one or more counterparts and each counterpart shall,for all purposes,be
deemed an original, but all such counterparts shall together constitute one and the same instrument. An executed
Agreement, modification, amendment, or separate signature page shall constitute a duplicate if it is transmitted
through electronic means, such as fax or e-mail,and reflects the signing of the document by any party.Duplicates are
valid and binding even if an original paper document bearing each party's original signature is not delivered.
26. Warranty of Services.
Musician/Band warrants that its services will be of a professional quality and conform to generally
prevailing industry standards. City must give written notice of any breach of this warranty within thirty(30) days
from the date that the services are completed. In such event,at Musician/Band 's option,Musician/Band shall either
(a)use commercially reasonable efforts to re-perform the services in a manner that conforms with the warranty,or(b)
refund the fees paid by the City to Musician/Band for the nonconforming services.
27. Network Access.
27.1 City Network Access. If Musician/Band, and/or any of its employees, officers, agents, servants or
subcontractors (for purposes of this section "Musician/Band Personnel"), requires access to the City's computer
network in order to provide the services herein, Musician/Band shall execute and comply with the Network Access
Agreement which shall be provided at the start of negotiations and incorporated herein for all purposes.
28. ImmiEration Nationality Act.
The City of Fort Worth actively supports the Immigration & Nationality Act (INA) which includes
provisions addressing employment eligibility, employment verification, and nondiscrimination. Musician/Band shall
verify the identity and employment eligibility of all employees who perform work under this Agreement.
Musician/Band shall complete the Employment Eligibility Verification Form (I-9), maintain photocopies of all
supporting employment eligibility and identity documentation for all employees, and upon request,provide City with
copies of all I-9 forms and supporting eligibility documentation for each employee who performs work under this
Agreement. Musician/Band shall establish appropriate procedures and controls so that no services will be performed
by any employee who is not legally eligible to perform such services. MusirianBand shall provide City with a
certification letter that it has complied with the verif cjtion requirements required,by this Agreement. Musician/Band
shall indemnify City from any penalties or liabilities due to violations of this provision. City shall have the right to
immediately terminate this Agreement for violations of this provision by Musician/Band.
29. SiEnature Authority.
The person signing this agreement hereby warrants that he/she has the legal authority to execute this
agreement on behalf of the respective party, and that such binding authority has been granted by proper order,
resolution, ordinance or other authorization of the entity. This Agreement, and any amendment(s) hereto, may be
executed by any authorized representative of Musician/Band whose name, title and signature is affixed on the
Verification of Signature Authority Form, which is attached hereto as Exhibit "E" and incorporate herein by
reference. Each party is fully entitled to rely on these warranties and representations in entering into this Agreement or
any amendment hereto.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement in multiples this
day of , 20 /.
ACCEPTED AND AGREED: ACCEPTED AND AGREED:
CITY OF FORT WORTH: Name of Mg ' ian/Band:
By: - By: 41
--' N : Thaddeus Ford, II
Assistant Cit M�nager Title
Date: ,Zb//B Date:
ATTEST
® .
Mary J.Kayser * °
City Secretary
M&Q
APPROVED AS TO FORM AND LEGALITY:
1295: (� A
By:
Paige ebane
Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: No M&C Necessary
Date Approved: N/A
1295 Certification: N/A
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 4ii reporting requirements.
Mari4 Marvin
Assistant Library irector
OFFICIAL RECORD
CITY sECRETARY
FT.WORTH,Tx
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EXHIBIT"A"
STATEMENT OF WORK
Scope of Work/Project Deliverables
Thaddeus Ford will provide 6 musicians to perform for 90 minutes at 6:30 p.m.Thursday,May 17,2018,for
a jazz performance at the Fort Worth Central Library,which is part of the Library's 3rd Thursday Jazz
Series.
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EXHIBIT`B"
PAYMENT SCHEDULE
The City of Fort Worth will issue payment of$1800.00 USD at the conclusion of the performance.
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EXHIBIT"C"
VERIFICATION OF SIGNATURE AUTHORITY
Full Legal Name of Company: Thaddeus Ford,II
Legal Address: 6407 Genstar Ln Dallas TX 75252
Services to be provided: Jazz Band for the 31 Thursday Jazz Series
Execution of this Signature Verification Form ("Form") hereby certifies that the following individuals and/or
positions have the authority to legally bind the Company and to execute any agreement, amendment or change order
on behalf of Company. Such binding authority has been granted by proper order, resolution, ordinance or other
authorization of Company. The City is fully entitled to rely on the warranty and representation set forth in this Form in
entering into any agreement or amendment with Company. Company will submit an updated Form within ten (10)
business days if there are any changes to the signatory authority. The City is entitled to rely on any current executed
Form until it receives a revised Form that has been properly executed by the Company.
1. Name:
Position:
Signature
2. Name:
Position:
Signature
3. Name:
Position:
Signature
Name: 1 i
C,).
Signature of President/CEO
Other Title: _
Date:
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ACERTIFICATE OF LIABILITY INSURANCE DA03/13/20D 18)
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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the
terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT Insurance Canopy Program Support
NAME:
Belfast Insurance Group PHONE Exti. 644-520-6993 Fv No: 801-763-1374
PO Box 34833 E-MAULno nsurancecano
ADDRESS: ifI
@ pycom
North Chesterfield VA 23234 INSURER(S)AFFORDING COVERAGE NAIC0
INSURER A: GreatAmerican Alliance Insurance Company 26832
INSURED INSURER B:
Thaddeus Ford INSURER C:
6407 GENSTAR LN INSURER D:
Dallas TX 75252 INSURERE:
INSURER F
COVERAGES CERTIFICATE NUMBER: 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.
MSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OFINSURANCE POLICY NUMBER MMIDDNYYYA (MMI001YYYY1 LIMITS
GENERAL LIABILITY EACH OCCURRENCE E 1,000,000
X COMMERCIAL GENERAL LIABILITY x PREMISES Ea occurrence $ 300'000
CLAIMS-MADE � F OCCUR F' MED EXP(Anyone person) $ 5'000
A PL2253080-CEP15269 5/16/2018 05/18/2018 PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE E 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
–XI POLICY PRO LOC ANIMAL BAILEE $
AUTOMOBILE LIABILITY F Ea aB801SINGLE LIMIT nL $
ANY AUTO BODILY INJURY(Per,Person) S
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) E
HIRED AUTOS NON-OWNED PROPERTYDAMAGE $
AUTOS Per accident
S
UMBRELLA LIAB OCCUR F F EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION I WC STATU- OTH-
AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE F-1 N/A E.L.EACH ACCIDENT $
OFFICEIMEMBER EXCLUDED?
(Mandatory In NN) E.L.DISEASE-EA EMPLOYE $
Il'yes,describe under
E.L.DISEASE-POLICY LIMIT S
F r—
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required)
It is understood and agreed that the Certificate Holder is named as Additional Insured per attached CG 20 26-Additional Insured-
Designated Person or Organization subject to all policy terms,conditions,and exclusions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CI Of Fort Worth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
200 Texas Street
Fort Worth TX 76102 AUTHORIZED REPRESENTATIVE /7 l
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025(201401)
_ b
CG 20 26 (Ed.04 13)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED- DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Schedule
Name of Additional Insured Person(s) or Organization(s):
Per individual Certificate of Coverage.
Information required to complete this Schedule, if not shown above,will be shown in the Declarations.
A. SECTION II- WHO IS AN INSURED is amended to include as an Additional Insured the person(s)or
organization(s) shown in the Schedule, but only with respect to liability for"bodily injury,""property damage"or
"personal and advertising injury"caused, in whole or in part, by your acts or omissions or the acts or omissions of
those acting on your behalf:
1. in the performance of your ongoing operations; or
2. in connection with your premises owned by or rented to you.
However:
1.the insurance afforded to such additional insured only applies to the extent permitted by law; and
2. if coverage provided to the Additional Insured is required by a contract or agreement,the insurance afforded to
such additional insured will not be broader than that which you are required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these Additional Insureds,the following is added to SECTION 111—
LIMITS OF INSURANCE:
If coverage provided to the Additional Insured is required by a contract or agreement,the most we will pay on
behalf of the Additional Insured is the amount of insurance:
1. required by the contract or agreement; or
2.available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
Copyright, ISO Properties, Inc.,2012
CG 20 26(Ed.04/13) PRO (Page 1 of 1)