Loading...
HomeMy WebLinkAboutContract 50915 CITY SECRETARY, CONTRACT NO. Z� EASEMENT ENCROACHMENT LICENSE 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 by and through its duly authorized City Manager, its duly designated Assistant City Manager or Planning and Development Director, and Danone US, LLC [full legal name], a(n) Limited Liability Company [type of entity] ("Licensee"), acting by and through its duly authorized Alfred Lechner [title], owner of the real property located at 1300 W. Peter Smith Street , Fort Worth, TX 76 104 ("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 Sanitary Sewer 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. Al NOW, THEREFORE, the City and Licensee agree as follows: RECEIVED JUN 2 6 2018 AGREEMENT CITY Or FORT WORTH CITY SECRETARY I' 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 Dannon Facilty Expansion(Loading Docks) (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 Easement Encroachment Agreement—Commercial Page 1 of 11 Ej PN 18-00059 - 7 infringe in or on City's Easement beyond what is specifically described in the Exhibit(s) attached hereto. 2. 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. Easement Encroachment Agreement—Commercial Page 2 of I I PN 18-00059 _ Rev. 10/2017 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 ANY AND ALL INJURY OR DAMAGE TO CITY PROPERTY ARISING OUT Easement Encroachment Agreement—Commercial Page 3 of 11 PN 160006" Rev. 10/2017 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. 8. 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. Easement Encroachment Agreement—Commercial Page 4 of 11 PN 18-mm - Rev. 10/2017 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 default or otherwise shall not require City approval provided that Easement Encroachment Agreement—Commercial Page 5 of 11 PN 184= - Rev. 10/2017 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] Easement Encroachment Agreement—Commercial Page 6 of 11 PN iB-0— - Rev. 10/2017 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: CITYOF FOR WOR (Entity) By: By: $✓! Randle Harwoo Name: Alfred Lechner Director Title: Senior Plant Director Planning and Development Date: , 20 Date: D 6 -I 20 g EST: ' ;,''7 Approved As To Form and Legality n City Secretary ��` a `" Assistant Ny Attorney 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. Janie S. Morales Development Manager OFFICIAL RECORD CITY SECRETARY Easement Encroachment Agreement—Commercial Page 7 of 11 PN 1"005e _ RKr,,lW HTX r m-:= . STATE OF TEXAS § COUNTY OF TARRANT § i . This instrument was acknowledged before me on , 201 '�%_ by Randle Harwood, Director of the Planning and Development Department of the City of Fort Worth, on behalf the City of Fort Worth. V ` ,unip opva�G, JENNIFcR L(tUlS[EZLRNACK =Notary Put Gr •i retas +.;6 Comm.Expire;u3•G i 2020 4 vl• . 6i Notary Notary ir) 130561630LLr '� o n (PL— Notar Public, Sate of Texas Easement Encroachment Agreement—Commercial Page 8 of 11 PN 18-00059 - Rev. 10/2017 STATE OF § COUNTY OF § BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas, on this day personally appeared i Sy Pto6g+ D%✓to,, (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 l JtlYLoyle (�S, L`. a L,`m;typal Lj'1zA11 f�, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of I"it , 20 . ;air►��a% MICHELLE A. SOUM 0 Z&sa -Notary Public, state of Texas Notary Public in and for the .= Comm.Expires 03 03 2020 Notary ID 126416047 State of �•n„u. After Recording Return to: City of Fort Worth Planning and Development Department CFA Office 200 Texas Street Fort Worth TX, 76102 Easement Encroachment Agreement—Commercial Page 9 of 11 PN 18-Doo6e _ Rev. 10/2017 LEGAL DESCRIPTION OF THE PROPERTY Easement Encroachment Agreement—Commercial Page 10 of 11 PN 18-Doose _ Rev. 10/2017 EXHIBIT "A" Map of Encroachment and Easement Easement Encroachment Agreement—Commercial Page 11 of 11 PN Rev. 10/2017 EXHIBIT A Encroachment Agreement 8.55 Square Feet Jennings South Addition City of Fort Worth,Tarrant County,Texas BEING a tract of land situated in the Sarah Gray Jennings Survey,Abstract No. 844 and being a portion of Lot 211-111, Block 24,Jennings South Addition, an addition to the City of Fort Worth,Tarrant County,Texas as shown on plat recorded in Document Number 209116171, Plat Records,Tarrant County,Texas(PRTCT),same being a portion of a tract of land described by deed to The Dannon Company Inc. as recorded in Volume 11814, Page 305, Deed Records,Tarrant County,Texas(DRTCT),and being more particularly described by metes and bounds as follows: (Bearings referenced to west line of Lot 211-111, Block 24, said Jennings South Addition, all distances at ground). COMMENCING at a 5/8-inch capped iron rod stamped "BHB INC'found (CIRF)for the most westerly northwest corner of said Lot 211-111,same being for the intersection of the east right-of-way line of South Ballinger Street(a 60' right-of-way)and the south right-of-way line of the Texas& Pacific Railroad (a variable width right-of-way),from which a found Texas Department of Transportation Monument for the northern most corner of said Lot 211-111 bears North 56°37'04" East,a distance of 192.82 feet; THENCE South 31015'23" East,over and across said Lot 211-111, a distance of 145.27 feet to the POINT OF BEGINNING; THENCE continuing over and across said Lot 211-111 the following courses and distances: North 89.58'16" East, a distance of 1.72 feet to a point; South 09047'01"West,a distance of 10.09 feet to a point; THENCE North 00.01'44"West, a distance of 9.94 feet to the POINT OF BEGINNING and containing 8.55 Square Feet of land more or less SURVEYOR'S CERTIFICATION I,John G. Margotta,a Registered Professional Land Surveyor licensed in the State of Texas, do hereby declare that this survey is true and correct and was prepared from an actual survey made under my supervision on the ground. Further,this survey conforms to the general rules of procedures and practices of the most current Professional Land Surveying Practices Act. 0 �P�E• 0 TFC _ *�..��G\STEREO 9•♦r .00%*00000090000006400 JOHN G. MARGOTTA Margotta ...�................:... SS a of Texas Registered Professional Land Surveyor •A 5956 • • • No. 5956 �9•�OFESS\0`:•'O� Date: May 22, 2018 �'O•••••••'�E'� SURA BBAIRD, HAMPTON & BROWN, INC. ENGINEERING & SURVEYING 6300 Ridglea Place, Ste. 700, Ft. Worth, TX 76116 jmorgottafthbinc.com 817-338-1277 www.bhbinc.com BHB Project /2017.145.000 TBPE Firm F-44 TBPLS Firm 10011300 0rawwing: E:\Survey18\013\071 Dannon Yogurt\Dwg\ENCROACHMENT AGREEMENT.dwg EXHIBIT B N Encroachment Agreement 8.SS Square Feet Jennings South Addition City of Fort Worth,Tarrant County,Texas W E TXDOT found `tpo�.`t0 (CM c aLo beg° �cb'1; �� TXDOT found S 0 1� 0 60' o �#01w$ ate SCALE: V'= 60' 6 401P 1016 C� gb POS — (CM) s DETAIL A �.t. SCALE: 1" = 10' CIRF 10'Sanitary Sewer Easement D209116171 � POB PRTCT c L1 L� Lot 2R-1 R,Block 24 a Jennings South Addition m N o� 3 D209116171 c J —+ q PRTCT a SEE DETAIL A ENCROACHMENT $ I E AGREEMENT 8.55 Sq.Ft. 25'Sanitary Sewer Easement Volume 11971,Page 1137 r'v� Found'X' � DUCT I I in Concrete NOTES: LEGEND CIRF.........5/8-Inch Capped Iron Rod 1.Basis of bearing for this survey is the west line of Lot 2R-1R,Block 24,Jennings South Stamped"BHB INC"Found Addition as recorded in Document Number D209116171,Plat Records,Tarrant County, POB..........Point of Beginning Texas. POC..........Point of Commencing 2.All distances shown are at ground. PRTCT..Plat Records Tarrant County,Texas SURVEYOR'S CERTIFICATION I,John G.Margotta,a Registered Professional Land Surveyor licensed in the State of Texas,do hereby declare that this survey is true and correct and was prepared from an actual survey made under my supervision on the ground. Further,this survey conforms to the general rules of procedures and practices of the most current Professional Land Surveying Practices Ad. � 0 F TFT ��.����STERF�•gS Line Table JOHN G. MARGOTTA J Margotta ...�...............�... 5 e of Texas Registered Professional Land Surveyor :�o 5956 v Line# Direction Length No.5956 ` ••'Qp SUR �'• � Date:May 22,2018 q,�0•::S:••'y0 Ll N89058'16"E 1.72 BAIRD, HAMPTON & BROWN, INC. L2 S9'47'01"W 10.09 13 =mBENGINEERING & SURVEYING 6300 Ridglea Place. Ste. 700, Ft Worth, TX 76116 jmargottaobhbinc.com 817-338-1277 www.bhbinc.com L3 NO-01'44"W 9.94 BHB Project /2017.145.000 TSPE Firm F-44 TBPLS Firm 10011300 Drawing: E:\Survey18\013\071 Dannon Yogurt\Dwg\ENCROACHMENT AGREEMENT.dwg CERTIFICATE OF LIABILITY INSURANCE DA ``,18/20` ACORO � e;2o18 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 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). c PRODUCER CONTACT a NAME: Aon Risk Services Northeast, Inc. PHONE (866) 283-7122 FAX 800-363-0105 d New York NY Office (A/C.No.Ext): - wc.No.: .a 199 Water Street E-MAIL New York NY 10038-3551 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: American Zurich Ins CO 40142 The Dannon Company, Inc. INSURER B: Zurich American Ins co 16535 100 Hillside Avenue white Plains NY 10603 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570071207807 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. Limits shown are as requested INSR ADDL SUBR POLICY EF POLICY X LTR TYPE OF INSURANCE INSDPOLICY NUMBER MYYW I LIMITS B X COMMERCIAL GENERAL LIABILITY GLO 1i 01/01/2019 EACH OCCURRENCE $2,000,000 E TOCLAIMS-MACE X❑OCCUR ? ' $2,000,000 ?REMISES(Ea occurrence MED EXP(Any one person.) $10,000 PERSONAL&ADV INJURY $2,000,000 p o3 EN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $2,000,000 r- X PGLIC'% ❑JECT ❑LOC �PODUCTS-COMPrCP AGO i2,000,000 0 OTHER: o B AUTOMOBILE LIABILITY BAP 5096291 00 08;01%2017 01/01/2019 CGMBINEDSINGLE LiM1T $2,000,000 Ea acoder:t� IIX ANY p,Urn BODILY INJURY(Per person.) 0 OWNED SCHEDULED BODILYINJURY(Per accident; AUTOS ONLYAUTOSRO:=ERTY CAMAGEHIRED AUTOS iaCN-CVJNED 1 U ONLY AUTOS ONLY (Per acr_iderq _ I B x UMBRELLA LIAB %< I OC,'UR AUCO23,56S900 U8i01 2017 01;01/2019 EACH OCCURRENCE S10,000,000EXCESS LIAB i V I—�� SIR applies per policy ter s & conditions ACGREATE $10,000,000 CL.+IMS-i•dADE I DED X iRETENTION I A WORKERS COMPENSATION AND Wc509628700 08/0 1,,201.7 O8%01./201.8_TFFER STATUTE 1 CTH- EMPLOYERS'LIABIL)TY y I N AOS ER B ANY PPGPRIETOR!PnRTNER;ExECLT!VP r E,L EACH ACCIDENT $1,000,000 c=PCEPrMEMBEREXCLUDED% JiNIA wcS09628800 081/01;2017 08%01%2018 (Mandatory in NH) Retro E.L DISEASE-EA EMPLOYEE S1,000,000 if yes desc^be under DESCRIPTiCN O=OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— i DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVidence Of InsUrance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE _y POLICY PROVISIONS. _ City of Fort Worth CFA Office AUTHORIZED REPRESENTATIVE CFA Office - PN18-00059 200 Texas Street Fort Worth rx 76102 usa ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000050007 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. The Dannon Company, Inc. F0--ICY NUMBER See Certificate Number: S70071207807 CARRIER MAIC COCE See Certificate Number: S70071207807 EFFECTIVE CATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER rNSURER INSUR-ER ADDITIONAL POLICIES tf a policy betokc does not include Iinlit infunnation,refer to the corresponding police on the ACORD certificate form lol.policy tilnitN. POLICY POLICY INSR ADUL St BR POLICY NL'NIBER FFFF.CTTVF. F.YPIR,ITION LININS LTR TYPE OF INSI'RANCE IVSD Nll'V n.>rF DATE (%IVVD OrVV V Y) 011lrn1);YY\Y) WORKERS COMPENSATION B N/A wc509628900 08/01/2017 08/01/2018 SIR ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD