HomeMy WebLinkAboutContract 51235 CITY SECRETARY
CONTRACT NO.
l�
EASEMENT ENCROACHMENT LICENSE AGREEMENT
C�c��ySE 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 TEXAS HEALTH RESOURCES,
a not for profit corporation ("Licensee"), acting by and through its duly authorized Vice
President of Real Estate Operations, Jon M. Sullivan Jr., owner of the real property
described in the attached Legal Description and located in Fort Worth, TX
("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 15' Sewer Facility easement(the "Easement") in the
Property as shown on the maps attached to this Agreement as Exhibits "A" and "B"
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:
AGREEMENT
1.
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 constructing, maintaining, modifying, and replacing
Private Storm Drain lines (the "Encroachments") as described in and at the locations
shown on Exhibits "A" and "B" but only to the extent shown thereon. Upon completion
of each Encroachment, Licensee agrees to be responsible for maintaining each
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.
OFFICIAL RECORD
2015 Easement Encroachment Agreement-Commercial CITY SECRETARY Page i of l 1
WORTH,TX Rev. 10/2017
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.
2015 Easement Encroachment Agreement-Commercial Page 2 of 1 l
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
2015 Easement Encroachment Agreement-Commercial Page 3 of 11
Rev. 10/2017
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.
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.
2015 Easement Encroachment Agreement-Commercial Page 4 of i 1
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11.
Licensee agrees to pay promptly when due all fees, taxes or rentals provided for
by this Agreement or by any federal, state or local statute, law or regulation.
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 l l
Rev. 10/2017
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
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:
CITY OF FORT WORTH TEXAS HEALTH RESOURCES,
A Texas not for profit corporation
By: Z By:
Randle Harwood Jon M. SulliT
Director Vice Preside , Estate Operations
Planning and Development
Date: 2018
ATTEST: A proved As To Form and Legality
oqT
City Secreta 0 Assistant Ci Attorney
V' '0Aj
rac mpliance 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 RICORD
CITY SIDR rARY
2015 Easement Encroachment Agreement-Commercial . R #Pa'g'e 7 f l 1
�- - 017
THIS PACE FOR OFFICIAL CITN' OF FORT WORTH tT SE ONLY!
STATE OF TEXAS §
COUNTY OF TARRANT §
This instrument was acknowledged before me oqSj Ckofy�ty/) (� , 201?
by Randle Harwood, Director of the Planning and Development Department of the City
of Fort Worth, on behalf the City of Fort qaNNo
Publi , State o T as
JENNIFER LOUISE EZERNACK
i6$Notary Pubiic, State of Texas
Comm. Expires 03-01-2020
Notary ID 130561630
After Recording Return to:
Planning& Development
Development Coordination Office
200 Texas Street
Fort Worth TX, 76102
2015 Easement Encroachment Agreement-Commercial Page S of 1 1
Rev. 10/2017
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 Jon M. Sullivan Jr.,Vice President,Real Estate
Operations, 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 Texas Health Resources,a Texas
not for profit corporation and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this - day of
2018.
da
iWr
LONNIE MCKAY L
Notary ID# 126521352
My Commission Expires
�..,�a,�.o May 15,2020 Notary Public in and for the
State of Texas
2015 Easement Encroachment Agreement-Commercial Page 9 of I 1
Rev. 10/2017
EXHIBIT A
KELLER
I I
PROPOSED 15 ' HICKS RD. BLV
SANITARY SEWER 3 `� HICKS RD
EASEMENT 15 0 ' P.0.B. = M w w
o >
ROPOSED PRIVAT N75.12 58�:`..:; TRIANGLE
15' STORM DRAI 1349 BLVD. Q TRIANGLE
Z 3 A BLVD.
I LF OF SANITAR HEAL PRESTIGE
SEWER EASEMENT OSH RD PROJEC F RD.
KirC W LOC TI N
a-
0
a
PROPOSED PUBLIC }� LEGEND
8' SANITARY SEWER
0) 15 0 ' - - SS EASEMENT
: 0
.� ►, ss
SAN. SEWER LINE
STORM DRAIN PIPE
ENCROACHMENT
790 790 EASEAENT L# E TABLE
SANIT RY LW BMW DIST
EX. SEW LI S01.46'I5'E 28.28'
GRADE EASEMENT L2 N46.4623'W 21.21'
L3 NOI'46'15'W 28.28'
L4 S46*46'08'E 21.21'
PROP. 21 .2 '
780 GRADE 780
15' PRIVATE-
STORM
RIVATE STORM DRAIN 21 L .F.
ENCROAC HMEN
8' PUBLIC 0 20
SANITARY
SEWER EXHIBIT A
-0+25 0+00 0+50 SEWER ENCROACHMENT
PRNTED, 8/22/2018 STB FILE, WIER—PAVING.STB ALLIANCE MEDICAL PARK
FILE, EXHBIT A — 17091.DWG LOT 4, BLOCK A, THR TARRANT
LAST SAVED 1 8/22/2018 10 143 AM SAVED BY 1 TOBYR
W.A. NO. 17091 ' SHEET I OF 2
.1��1 WIER & ASSOCIATES, IHC.
EXHIBIT A
METES & BOUNDS DESCRIPTION
SEWER ENCROACHMENT—ALLIANCE MEDICAL PARK
LOT 4, BLOCK A, THR ADDITION
BEING A TRACT OF LAND LOCATED IN THE WILLIAM McCOWEN SURVEY, ABSTRACT
NO. 999, TARRANT COUNTY,TEXAS, BEING A PORTION OF A TRACT OF LAND
DESCRIBED IN THE DEED TO TEXAS HEALTH RESOURCES (THR), RECORDED IN
INSTRUMENT NUMBER D209326476, OFFICIAL PUBLIC RECORDS, TARRANT COUNTY,
TEXAS (O.P.R.T.C.T.), AND BEING MORE PARTICULARLY DESCRIBED BY METES AND
BOUNDS AS FOLLOWS:
BEGINNING AT A POINT, FROM WHICH A 5/8" IRON ROD FOUND BEARS N 75°12'58" E,
1349.58 FEET, SAID IRON ROD BEING THE SOUTHEAST END OF A RIGHT-A-WAY
CORNER CLIP AT THE INTERSECTION OF THE SOUTH RIGHT-OF-WAY LINE OF GOLDEN
TRIANGLE BOULEVARD (A VARIABLE WIDTH RIGHT-OF-WAY)WITH THE WEST RIGHT-
OF-WAY LINE OF OLD DENTON ROAD(A VARIABLE WIDTH RIGHT-OF-WAY)AND BEING
THE MOST EASTERLY NORTHEAST CORNER OF LOT 1, BLOCK A, THR TARRANT, AN
ADDITION TO THE CITY OF FORT WORTH, TARRANT COUNTY, TEXAS, ACCORDING TO
A PLAT RECORDED IN INSTRUMENT NUMBER D211075699, O.P.R.T.C.T.;
THENCE S 01046'15" E, 28.28 FEET TO A POINT;
THENCE N 46046'23"W, 21.21 FEET TO A POINT, FROM WHICH A 5/8" ROD FOUND IN
THE EAST RIGHT-OF-WAY OF FOUNDERS WAY (AN 85-FOOT WIDE PUBLIC RIGHT-OF-
WAY) BEARS S 24013'27"W, 583.89 FEET, SAID ROD BEING THE MOST SOUTHWESTERN
CORNER OF LOT 1, BLOCK A, THR TARRANT, AN ADDITION TO THE CITY OF FORT
WORTH, TARRANT COUNTY, TEXAS, ACCORDING TO A PLAT RECORDED IN
INSTUMENT NUMBER D211075699, O.P.R.T.C.T.;
THENCE N 01046'15"W, 28.28 FEET TO A POINT;
THENCE S46046'08" E, 21.21 FEET TO THE PLACE OF BEGINNING AND CONTAINING 424
SQUARE FEET OF LAND, MORE OR LESS.
W&A 17091_20180822
EXHIBIT B IKELLER -111 TIMRFF(
o HICKS RD. BLVD.
` A 0 3 o ELLER -
/
Z2 _ HICKS RD
.. ai h
EE
ROPOSED PRIVATE ALTJ- _ z
15' STORM DRAIN :'.a`r� G N o
TRIANGLE
BLVD. a TRIANGLE
5 LF OF SANITARY A BLVD.
..
SEWER EASEMENT C's , RD o HEAL PRESTIGE
C ACH / OSH
� PROJEG RD.
�.� 1 L LOCkTIIPN
PROPOSED 15 Q
SANITARY SEWE
E��
.................. .............. . .
EASEMEN Nes 04 '34•C \ 1117.41'
��-1\
CIS
Q/ P.0.B. LEGEND'
141 SS EASEMENT
PROPOSED PUBLIC ss SAN. SEWER LINE
8' SANITARY SEWER[ _ STORM DRAIN PIPE
ENCROACHMENT
SANI ARY EASE WT LIE TABLE
SE ER LW REARM DIST
PROP . EASE ENT LI S57.40'10'W 20.33'
780 GRADE 780 L2 W42.41'35'W 15.25'
EX .
15 .3 L3 tZ7'40'10'E 20.33'
GRAD L4 S42'41'35'E 15.25'
.O 15' PRIVATE
STORM DRAIN
770 770
15 L F.
ENCROACHMENT 8' PUBLIC
SA ITARY SEWER 0 20
EXHIBIT B
0+00 0+75 SEWER ENCROACHMENT
ALLIANCE MEDICAL PARK
ME, EXW T 9 - 1709TED, 8/22/2018 1.DWTIB FILE, WIER-PAVING.STB LOT 4, BLOCK A, T H R TA R RA N T
LAST SAVED 1 8/22/2018 10 144 AM SAVED BY 1 TOBYR
W.A. NO. 17091 ' SHEET 2 OF 2
���OR WIEA & ASSOCIATES, MmmmoO
EXHIBIT B
METES & BOUNDS DESCRIPTION
SEWER ENCROACHMENT—ALLIANCE MEDICAL PARK
LOT 4, BLOCK A, THR ADDITION
BEING A TRACT OF LAND LOCATED IN THE WILLIAM McCOWEN SURVEY, ABSTRACT
NO. 999, TARRANT COUNTY, TEXAS, BEING A PORTION OF A TRACT OF LAND
DESCRIBED IN THE DEED TO TEXAS HEALTH RESOURCES (THR), RECORDED IN
INSTRUMENT NUMBER D209326476, OFFICIAL PUBLIC RECORDS, TARRANT COUNTY,
TEXAS (O.P.R.T.C.T.), AND BEING MORE PARTICULARLY DESCRIBED BY METES AND
BOUNDS AS FOLLOWS:
BEGINNING AT A POINT, FROM WHICH A 5/8" IRON ROD FOUND BEARS N 86004'34" E,
1117.41 FEET, SAID IRON ROD BEING THE SOUTHEAST END OF A RIGHT-A-WAY
CORNER CLIP AT THE INTERSECTION OF THE SOUTH RIGHT-OF-WAY LINE OF GOLDEN
TRIANGLE BOULEVARD (A VARIABLE WIDTH RIGHT-OF-WAY)WITH THE WEST RIGHT-
OF-WAY LINE OF OLD DENTON ROAD (A VARIABLE WIDTH RIGHT-OF-WAY)AND BEING
THE MOST EASTERLY NORTHEAST CORNER OF LOT 1, BLOCK A, THR TARRANT, AN
ADDITION TO THE CITY OF FORT WORTH, TARRANT COUNTY, TEXAS, ACCORDING TO
A PLAT RECORDED IN INSTRUMENT NUMBER D211075699, O.P.R.T.C.T.;
THENCE S 57040'10"W, 20.33 FEET TO A POINT;
THENCE N 42041'35"W, 15.25 FEET TO A POINT;
THENCE N 57040'10" E, 20.33 FEET TO A POINT, FROM WHICH A '/z" IRON ROD FOUND IN
THE WEST RIGHT-OF-WAY OF FOUNDERS WAY (AN 85-FOOT WIDE PUBLIC RIGHT-OF-
WAY) BEARS N 31041'59"W, 584.78 FEET, SAID IRON ROD BEING THE NORTHEASTERN
CORNER OF LOT 1, BLOCK 1, ALLIANCE TOWN CENTER NORTH, AN ADDITION TO THE
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS, ACCORDING TO A PLAT
RECORDED IN INSTUMENT NUMBER D215035449, O.P.R.T.C.T.;
THENCE S42041'35" E, 15.25 FEET TO THE PLACE OF BEGINNING AND CONTAINING 305
SQUARE FEET OF LAND, MORE OR LESS.
W&A 17091_20180822
A� CERTIFICATE OF LIABILITY INSURANCE 8128/2018
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 pollcy(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 WA NAME.'
Strategic Risk Solutions(Cayman)Ltd.
For questions related to this certificate contact: PHONE
Strategic Risk Solutions(Cayman)LTD (Ar.No,EX* �2 11 (Ar.NoFAXr
345-&t6-6612
Caribbean Plaza,2nd Floor,North Building AE4111AL It:
878 West Bay Rd PRODUCER
P.O.Box 1159 CUSTOMER IDIII:
Grand Cayman KY1-1102 Cayman Islands IMWROR(S)AFFORDING COVERAGE NAIC0
INSURED MSURER A. Grace Indemnity Company SPC,Ltd.for and on behalf of Grace 1 SP
Texas Health Resources INSURER B:
Attn: Liz Spurgeon INSURER C:
612 E Lamar Blvd,11th Floor INSURER D:
Arlington,Texas 76011 INSURER E:
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 A]OL SU9R POLICY EFF POLICY EJP
LTR TYPE OF INSUUNCE MSR WVD POLICY NUMBER MID LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea occurrence $ Included
CLAIMS-MADE X I OCCUR MED EXP(Any one Person) $ 5,000
A GICHPL-6-18 08/01/2018 06/01/2019 PERSONAL&ADV INJURY $ Included
GENERAL AGGREGATE $ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS/COMP/OPAGG $ Included
X I POLICY I I PROJECT LOC $
AUTOMOBILE LIABflIrY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per $
person)
ALL OWNED AUTOS BODILY INJURY(Per $
accident
SCHEDULED AUTOS PROPERTY DAMAGE(Per $
accident
HIRED AUTOS $
NON-OWNED AUTOS $
LUA�LU OCCUR EACH OCCURRENCE $
EXCESS LUW CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $ $
RETENTION $ $
WORKERS COMPENSATION ANDC STATU- TH-
EIPLOYERS'LL*MU Y YIN ORY LIMITS R
ANY PROPRIETOR/PARTNER/EXECUTNE
E.L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDED?
E.L.DISEASE-EA
atory In NN EMPLOYEE
If yes,describe under E.L.DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEIMICI.ES(Adach ACORD 101,Addidonal Remarks Schedule,Y mon apace In requked)
Re:
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Worth ACCORDANCE WrTH THE POLICY PROVISIONS.
Planning&Development-CFA Office AUTHORIZED REPRESENTATIVE
PN 18-00079
200 Texas Street
Fort Worth,TX 76102
ACORD 25(2010106) The ACORD name and logo are reekxwed marks of ACORD 0 1SSS-2008 ACORD CORPORATION.AN rights reset vad.