HomeMy WebLinkAboutContract 50587 CITY SECRETARY77--
CONTRACT N0.�
RIGHT OF WAY
ENCROACHMENT AGREEMENT
(COMMERCIAL)
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
herein by and through its duly authorized City Manager, its duly authorized Assistant
City Manager or Planning and Development Department Director, and
Sangalli Real Estate [full legal name], a Limited Partnership [type of entity]
"Licensee", acting herein by and through its duly authorized General Partner, VP [title],
the owner of the real property located at 816 W Daggett Ave , Fort Worth,
Texas 76104("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 street, alley, sidewalk, and/or other public right-of-
way (individually or collectively,the"Public Right-of-Way") adjacent to 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 Public Right-of-Way; 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 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, use and/or occupy portions of the
space under, on, and/or above the City's Public Right-of-i yl y to cons—LI ct/install and/or
allow to remain, certain improvements for the purpose of access stairs (whether
one or more, the "Improvements") as described in and at the location shown on Exhibit
"A" but only to the extent shown thereon. Upon completion of the Improvements,
Licensee agrees to be responsible for maintaining the Improvements. Licensee shall not
expand or,ptherwise cause the Improvements to further infringe in or on City's Public
Right-of-Vy beyond what is specifically described in the Exhibit(s) attached hereto.
OFFICIAL,RECORD
2015 R Iw Encroachment Agreement X-oiiirnercial CITY SECRETARY Page 1 of 12
rev. 02/2015
ffY WORTH,TX
2.
All construction, maintenance and operation in connection with such
Improvements, 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 City's Director of Transportation and Public Works, 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 Improvements. Licensee shall not commence construction of the Improvements
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 completion of the construction and installation of the Improvements, there
shall be no other encroachments in, under, on or above the surface area of the Public
Right-of-Way, except as described herein and depicted on Exhibit"A".
4.
Licensee, at no expense to the City, shall make proper provisions for the
relocation and installation of any existing or future utilities affected by such
encroachment, use and occupancy, including the securing of approval and consent from
any affected utility companies and the appropriate agencies of the State of Texas and its
political subdivisions. 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 such encroachment and use, Licensee shall pay
to City an additional amount equal to such additional cost as determined in the reasonable
discretion of the Director of Transportation and Public Works, or his or her duly
authorized representative.
5.
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 Improvements installed by
Licensee, butty rill make reasonable efforts to minimize such damage. In the event
that any install0ml preinstallation, 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
2015 RQWEncroachment ng,eement-Commercial Page 2 of 12
4�7 — rev. 02/2015
made more costly by virtue of the construction, maintenance or existence of the
Improvments and use, Licensee shall pay to City an additional amount equal to such
additional cost as reasonably detennined by the Director of Transportation and Public
Works or the Director of the Water Department, or said Director's duly authorized
representative.
6.
Licensee agrees to pay to City at the time this Agreement is requested an
application fee of$325.00 in order to defray all costs of inspection and supervision which
City has incurred or will incur as a result of the construction, maintenance, inspection or
management of the encroachments and uses provided for by this Agreement. Licensee
agrees to pay a fee in the amount of$.56 per square/linear foot of the encroachment area
upon execution of this Agreement and annually thereafter.
7.
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 within 30 days after written notice specifying the same, or having so
commenced,thereafter fails to proceed diligently and with continuity to remedy same.
8.
Upon termination of this Agreement, Licensee shall at no expense to City remove
the Improvements encroaching into the Public Right-of-Way, and restore the Public
Right-of-Way to a condition acceptable to the Director of Transportation and Public
Works, or his or her duly authorized representative, in accordance with then-existing City
specifications. It is understood and agreed by Licensee that if this Agreement terminates
and Licensee fails to remove the Improvements and restore the Public Right-of-Way,
Owner hereby gives City permission to remove the Improvements along with any
supporting structures, restore the Public Right-of-Way, and assess a lien on the Property
for the costs expended by the City in taking such actions.
9.
It is further understood and agreed between the parties hereto that the Public
Right-of-Way 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 public right-of way 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
2015 ROW"Encroachment Agreement-Ccinmercial Page 3 of 12
rev. 02/2015
control the Public Right-of-Way 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 Public Right-of-Way to be
used for any other public purpose, including but not 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 this
Agreement shall terminate upon 60 days' written notice to Licensee. In the event this
Agreement is terminated under this Section 9, Licensee shall perform the obligations
regarding removing the Improvements and restoring the Public Right-of-Way described
in Section 8.
10.
Licensee agrees and acknowledges that this Agreement is solely for the purpose
of permitting Licensee to construct, maintain and locate the Improvements over or within
the described Public Right-of-Way and is not a conveyance of any right, title or interest
in or to the Public Right-of-Way nor is it meant to convey any right to use or occupy any
property in which a third party may have an interest. Licensee agrees that it will obtain
all necessary permissions before occupying such property.
11.
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 Improvements, encroachment and uses.
12.
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.
13.
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.
14.
2015RO"'—ncroac'nment Agreement-Commercial Page 4 of 12
rev. 02/2015
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
IMPROVEMENTS AND ENCROACHMENT AND USES GRANTED
HEREUNDER, WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY
ALLEGED 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 IN
CONNECTION WITH THE IMPROVEMENTS AND ANY AND ALL ACTS OR
OMISSIONS OF LICENSEE, ITS OFFICERS, AGENTS, SERVANTS,
EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES,
INVITEES,OR TRESPASSERS.
15.
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 described or depicted 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 promptly
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 an&until the removal of all encroachments and the cleaning and restoration of
the Public Right-of-Way. All insurance coverage required herein shall include coverage
of all Licensees' contractors and subcontractors.
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16.
Licensee agrees to deposit with the City when this Agreement is executed a
sufficient sum of money to be used to pay the 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.
17.
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.
18.
Licensee covenants and agrees that it will not assign all or any of its rights,
privileges or duties under this Agreement without the prior written approval of the City,
andany 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 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.
19.
THE PARTIES AGREE THAT THE DUTIES AND OBLIGATIONS
CONTAINED IN PARAGRAPH 8 SHALL SURVIVE THE TERMINATION OF
THIS AGREEMENT.
20.
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.
21.
This Agreement shall be binding upon the parties hereto, their successors and
assigns.
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[SIGNATURES APPEAR ON FOLLOWING PAGE]
;' le
2015 n.OW Encroachment Agreement-Cor rnercial Page 7 of 12
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F
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,
By: By:
Randle Harwood Name: Michael Sangalli
Director Title: VP Sangalli Holdings,
the General Partner
Planning and Develop ent Department
Date: , 200
ATTEST: Approved As To Form and Legality
%%
City Secretary 3: Assistant City Attorney
XAS y
M&Q
1295:
FOFFICIAL REcom
SECRETARY
FT.WORTH,TX
2015 ROW Encroachment Agreement-i o�mercial Page 8 of 12
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 report requirements.
Janie Scarlett Morales
Development Manager
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
STATE OF TEXAS §
COUNTY OF TARRANT § C,�
This instrument was acknowledged before me on , 201'*Q
by Randle Harwood, Director of the PI d Deve opment Department of the City
of Fort Worth, on behalf the City of Fort orth.
Not Public, t#e o e s
JENNIFER LOUISE EZER
Notary Publie,Stete of 7mxas
�Z Expires ires 03 01-2020
Comm. P
Notary ID 130561630
After Recording Return to:
Cassandra Foreman
Planning and Development Department
1000 Throckmorton Street
Fort Worth TX, 76102
S M
r`
2015��trncroachment Agreement-Commercial Page 9 of 12
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STATE OF §
COUNTY OF r §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
Texas, on this day personally appeared Michael Sangalli ,
VP Sangalli Holdings, (title), known to me to be the person whose name is
the General Partner
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
Sangalli Real Estate , a Limited Partnership , and in the capacity therein
stated.
D
GIVEN UNDER MY HAND AND SEAL OF OFFICE this O day of
of ,Zo
BURKE THOMAS TAYLOR
A e Note Public,
Notary State of Texas Notary Public in and for the
+� Comm.Expires 03-30-2021
Notary ID 131066335 State of �S
2015 ROW ncroachment ArreV-mM1Lt-^o�;�,—,�ercial Page 10 of 12
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LEGAL DESCRIPTION OF THE PROPERTY
r
2015 ROW Encroachment Agreement-Commercial Page 11 of 12
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EXHIBIT"A'•
Leg ig_Desodmion
Tract I:
All of Lots 1 and 2,the West 1/2 of Lot 3,and all of Lots 4,5&6,Block 16,Jennings South
Addition, an unrecorded addition to the City of Fort Worth, Tarrant County, Texas, being
more particularly described by metes and bounds as follows:
BEGINNING at a found 5/8" steel rod at the northwest corner of said Block 16, and at the
intersection of the south right-of-way line of Jarvis Street,a 40 foot wide public street with
the east right of way line of College Avenue,a 60 foot wide public street;
THENCE East along the north line of said Block 16 and the south right-of-way line of said
Jarvis Street, 150.00 feet to a found 5/8" steel rod at the northeast comer of the west 1/2 of
Lot 3 of said Block 16;
THENCE South along the east line of the west 1/2 of Lot 3 of said Block 16, 101.00 feet to a
found P.K.nail at the southeast comer of the west 1/2 of Lot 3 of said Block 16;
THENCE East along the south line of the east 1/2 of Lot 3 of said Block 16,50.00 feet to a
found P.K. nail at the southeast corner of Lot 3 and the southwest corner of Lot 2 of said
Block 16;
THENCE North along the east line of Lot 3 and the west line of Lot 2 of said Block 16,
101.00 feet to a found 5/8"steel rod at the northeast corner of Lot 3 and the northwest comer
of Lot 2 of said Block 16,and in the south right-of-way line of said Jarvis Street;
THENCE East along the north line of said Block 16 and the south right-of-way line of said
Jarvis Street,200.00 feet to the northeast comer of said Block 16,and the intersection of the
south right-of-way line of said Jarvis Street with the west right-of-way line of Lipscomb
Street,a 60 foot wide public street;
THENCE South along the east line of said Block 16 and the west right-of-way line of said
Lipscomb Street,202.00 feet to a found"X"in concrete at the southeast comer of said Block
16, and at the intersection of the west right-of-way line of said Lipscomb Street with the
north right-of-way line of West Daggett Avenue,a 40 foot wide public street;
THENCE West along the south line of said Block 16 and the north right-of-way line of said
West Daggett Avenue,400.00 feet to a found 5/8" steel rod at the southwest corner of said
Block 16,and at the intersection at the south right-of-way line of said West Daggett Avenue
with the east right-of-way line of said College Avenue;
THENCE North along the west line of said Block 16 and the east right-of-way line of said
College Avenue,202.00 feet to the Point of Beginning and containing 1.7390 acres(75,750
square feet)of land,more or less.
Tract Il:
The East 1/2 of Lot 3,Block 16,Jennings South Addition,an unrecorded addition to the City
of Fon Worth, Tarrant County, Texas, being more particularly described by metes and
bounds as follows:
COMMENCING at a found 5/8"steel rod at the northwest comer of said Block 16,and at the
intersection of the south right-of-way line of Jarvis Street,a 40 foot wide public street with
the east right-of-way line of College Avenue,a 60 foot wide public street;
THENCE East along the north line of said Block 16 and the south right-of-way line of said
Jarvis Street, 150.00 feet to a found 5/8"steel rod at the northwest comer of the east 1/2 of
Lot 3 of said Block 16,and the Point of Beginning;
THENCE East,continuing along the north line of said Block 16 and the south right-of-way
line of said Jarvis Street, 50.00 feet to a found 5/8" steel rod at the northeast comer of the
east 1/2 of Lot 3 and the northwest corner of Lot 2 of said Block 16;
THENCE South along the east line of the east 1/2 of Lot 3 and the west line of Lot 2 of said
Block 16, 101.00 feet to a found PK.nail at the southeast comer of the east 1/2 of Lot 3 and
the southwest comer of Lot 2 of said Block 16;
THENCE West along the south line of the east 1/2 of Lot 3 of said Block 16,50.00 feet to a
found P.K,nail at the southwest comer of the east 1/2 of Lot 3 and the southeast comer of the
west 1/2 of Lot 3 of said Block 16;
THENCE North along the west line of the east 1/2 of Lot 3 and the east line of the west 1/2
of Lot 3 of said Block 16, 101.00 feet to the Point of Beginning and containing 0.1159 acres
(5,050 square feet)of land,more or less.
i��j
EXHIBIT"A"
Location and Description of Encroachment and Improvements
S M
201 RG�w Encreaci�mer�t Agreement-Commercial Page 12 of 12
rev. 0212015
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PROPOSED
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CONSULTANTS EXHIBIT
1601 E.Lamar Blvd,Suite 111 N
Arlington, 76011 816 W DAGGETT AVE,
817.230.17.230.477 77 SCALE 1"=30'
TBPE No. 17261 FEBRUARY 20,2018
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3 R EA-01 CYI
ACORO CERTIFICATE OF LIABILITY INSURANCE
FDATE 031081201 YY)
03!08!2018
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 have ADDITIONAL INSURED provisions or 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 NRW4CT
Gus Bates Insurance&Investments
3221 Collinsworth St (AHIc°,No, Ext):(817)335-9547 (A/C No):(817)338-1422
Fort Worth,TX 76107 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAICf
INSURERA:Evanston Insurance Company
INSURED INSURERS:
Sangaill Real Estate. Ltd. INSURERC:
1620 Wabash Ave INSURER D:
Fort Worth,TX 76107
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE DL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD M!D MIDD
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADEOCCUR AA123589 12/15/2016 06/15/2017 DAMAGE ( RENTED 100,000
D4 AG ESSEa occurrence) $
MED EXP(Any one arson $ 5,000
PERSONAL&ADV INJURY 1,000,000
GEN'L AGGREGATE L IMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY 7 weT FILOC PRODUCTS-COMP/OP AGG $ Excluded
OTHER S
AUTOMOBILE LIABILITY (CE
OMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY Per arson $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
AUEED� pp EE (P OPE T t MAGE $
70S ONLY rTGS OIJL�
UMBRELLA,LIAS OCCUR EACH OCCURRENCE $
EXCESS LIAR iCLAIMS-MADE AGGREGATE $
DEG I I RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STAT UT _ ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICEWMEMBEREJCCLUDED? 7 NIA
(Mandatory In NH) E.L DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more apace Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
cl Fort worth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of ACCORDANCE WITH THE POLICY PROVISIONS.
CFA Office-PN18-00027
200 Texas Street
Fort Worth,TX 76102 AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD