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Contract 50215
CITY SECRETARY Ot-,!TRACT NO. J TEMPORARY OCCUPANCY PROCEDURES FOR STREET, SIDEWALK, & PARKING METER ENCROACHMENTS 1. Applicant receives in triplicate "CONSENT AGREEMENT FORMS" page ten (10) of the Consent Agreement Forms shall be signed (all originals signature ) by the company president or the company vice president. Name of grantee shall be s same as whoever furnishes the insurance certificate. If grantee is a corporation, obtain officer's signature. ****CONSENT AGREEMENTS SHALL BE NOTARIZED**** 2. Applicant shall furnish three (3) copies of a certificate of insurance and three (3) copies of sketch showing the area(s) to be occupied, time to be occupied, area(s) length and width in whole feet, the correct address, and Building Permit #, that applies to the encroachment. If parking meters are involved, applicant furnishes parking meter number to Gordon Alderman with Transportation Public Works Dept. I 3. Insurance Requirements: Property Damage, Per occurrence $100,000 Bodily Injury,per occurrence $250,000 Bodily Injury or Death per occurrence $500,000 4. FEE CALCUALTION; RECORDED ON SKETCH SUBMITTED FOR PERMIT A. If the time does not exceed three (3) days, the fee will be $42.80 per day up to and including the third day, with a minimum of$128.40 if more than 3 days. B. If the time exceeds three (3) days, the fee per day will be $.015 per sq. ft. of sidewalk space and$.03 per sq. ft. of street space used, minimum of$128.40 Formula: Sidewalk : $.015 x Length x Width x Calendar Days Minimum Street: $.03 x Length x Width x Calendar Days $128.40 5. TRANSPORTATION & PUBLIC WORKS APPROVAL REQUIRED Approval in all cases, contact Gordon Alderman, 817-392-6748. The Transportation & Public Works Department is located at 311 W. 10`h Street, ground level. You will need their signatures on all (3) sketches. ay6-7 8 91�r,j a Sic Ai-9�' w OFFICIAL RECORD � 0 CITY SECRETARY FT.WORTH,TX 1 1 i I_ 1 CONSENT AGREEtMENT FOR TEMPORARY USE OF PUBLIC PROPERTY I I i STATE OF TEXAS COUNTY OF TARRANT t $1 THIS AGREEMENT is made and entered into by and between the City of Fort Worth, a I municipal corporation of Tarrant County, Texas, acting herein by and through its duly authorized t Building Official, hereinafter referred to as the"City"and 1. I Acting by and through its duly authorized agent, �� �N f Hereinafter referred to as"Grantee". i I 1 WITNESSETH: j For and in consideration of the payment by Grantee of charges set out below and the true and F faithful performance of the mutual covenants herein contained, City hereby grants to Grantee permission to temporarily encroach upon, uses and occupy portion of the space tinder, on and/or above the streets,alleys,sidewalks or other public rights-of-way as follows: LA r�r ! The location and description of said encroachment is more particularly described in Exhibit "B" _��1 1 1-\7X, attached hereto, incorporated herein and made a part hereof for all purposes. T' 2. All use and occupancy of public street, alleys, sidewalks or other public rights-of-way under this agreement shall be in strict compliance with the Charter, Ordinances and Codes of the City i and in accordance with the directions of the Building Official and the Director of Transportation f and Public Works of City. i t CONSENT AGREEMENTfor Temporary use of public propenyl doc f I i i I I I E I 3. Upon expiration of this agreement and the privileges granted hereunder, there shall be no encroachment by Grantee in,under,on or above the surface of the public rights-of-way involved. I 4. ! 4 Grantee agrees to pay in advance an encroachment fee for the temporary privilege of encroaching upon a portion of the public rights-of-way as described in Exhibit"B". Said fee is calculated in the manner and amounts prescribed by the Building Code of the City of Fort Worth f for temporary use or occupancy of public property The estimated total amount of said fee is: i s. Grantee, at no expense to City, shall make proper provision for the relocation and/or installation of any existing or future traffic control devises or other improvements affected by such encroachment, use and occupancy, including the securing of approval and consent from the appropriate agencies of the State and its political subdivisions. In the event that any installation, reinstallation, relocation or repair of any existing or future traffic control device or improvement owned or constructed by or on behalf of the public or at public expense is made more costly by virtue of the existence of such encroachment and use, Grantee shall pay to City and additional amount equal to such additional cost as determined by City. 6. The term of this agreement shall be for days,from L _(g to y=Z Provided, however, should the need for the encroachments granted hereunder at any time cease, Grantee agrees to immediately notify City of such condition; and, upon receipt of such notice by i the Building Official of the City of Fort Worth,this agreement shall terminate. 7. ft is expressly understood and agreed that this Consent Agreement is for a temporary encroachment in, under, over and upon the public property as located and described in Exhibit 2 CONSENT AGREEMENT?or Temporary use of public propertyl doc l f i I f I "B". This agreement shall not be construed as the granting of a permanent easement, encroachment or license upon City's public streets,alleys,sidewalks,or other rights-of-way. i 8. E i City, through its duly authorized representatives, shall have the full and unrestricted right to f enter upon all public rights-of-way for the purpose of making inspections to determine compliance with the terms, covenants and conditions herein. In the event that any inspection should reveal a breach of any terms, covenants or conditions herein, City shall give Grantee notice of such breach. Should such breach not be corrected by Grantee within twenty-four (24) j hours of receipt of the notice, or within such shorter period of time as deemed necessary by the Building Official for the protection of public health or safety, City may terminate and cancel this I agreement. i 9. ' v Upon expiration or termination of this agreement for any reason whatsoever,Grantee shall, at C no expense to City, restore the public rights-of-way and adjacent supporting structures to a condition acceptable to the Director of Transportation and Public Works or his duly authorized representative and in accordance with then existing City specifications, and Grantee shall remove all barricades, equipment, supplies, materials or other property from said location. Grantee j a further covenants and agrees that for a period of one (1)year after the termination of this Consent 1 Agreement, Grantee will repair all conditions or damages to the streets and sidewalks or other rights-of-way that have resulted from Grantee's use or occupancy of the streets and sidewalks or E other rights-of-way, as determined by the Director of Transportation and Public Works or his i designee. Grantee agrees to begin such repairs within thirty (30) days of receipt of notice from j r the Director of"Transportation and Public Works or his designee. All repairs shall be performed I in an expeditious and workmanlike manner and shall comply with all applicable laws, codes, E ordinances and City specifications. In the event that Grantee fails to comply with the covenants herein contained with respect to such removal or restoration,the City shall have the right to remove or dispose of any barricades, equipment, supplies, materials or other property and repair any conditions which in the opinion of the City are necessary to bring the public rights-of-way to the condition prescribed herein, and City shall not be responsible for trespass or any other damage or liability in connection with such removal or restoration. Grantee shall reimburse City for the cost and expense of such removal and/or repairs immediately following billing for sante by City. i i 3 CONSENT AGR FFMFNTfor Temporary use of public prop"I doc t i i I e Nothing herein shall be construed as a waiver by City to enforce penal sanctions prescribed l by the Code of the City of Fort Worth and the laws of the State of Texas for Grantee's continued i encroachment upon the public rights-of-way following termination of this Consent Agreement. j 10. It is further understood and agreed between the parties hereto that City holds the city streets, alleys, sidewalks and other public rights-of-way, including the portions of such streets used and I encroached upon as described herein, as trustee for the public; that City exercises such powers ` over the streets as have been delegated to it by the Constitution of the State of Texas or by the Legislature; and the City cannot contract away its ditty and its legislative power to control the streets for the use and benefit of the public. It is accordingly agreed that if the governing body of City, to wit, its City Council, shall at any time during the term hereof determine in its sole f discretion to use or cause or permit to be used for any public purpose the said encroached portion of the streets, then this agreement shall be automatically canceled and terminated. i t E 11. Grantee 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 s of said encroachments and uses. j 12. Grantee agrees to pay promptly when due all fees, taxes or rentals provided for by this 1 agreement or by any federal,state or local statue, law or regulation. 13. Grantee covenants and agrees that it shall exercise all rights and privileges granted hereunder I I as an independent contractor, and not as an officer, agent, servant or employee of City; that Grantee shall have exclusive control of and the exclusive right to control the details of its i operations and activities on said described public property and all persons performing same, and i shall be solely responsible for the acts and omissions of its officers, agents, servants, employees, contractors, subcontractors, licensees and invitees; that the doctrine of respondeat superior shall not apply as between City and Grantee, its officers, agents, servants, employees, contractors and subcontractors, and nothing herein shall be construed as creating a partnership or joint enterprise r between City and Grantee. 4 CONSENT AGREEMENTfor Temporary use of pudic propertyl.doc I E 14. GRANTEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY INDEMIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS FOR PROPERTY DAMAGE OR LOSS AND/OR PERSONAL INJURY, CNCLUDING DEATH, TO ANY AND ALL PERSONS, OF WHATSOEVER KIND OR i CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH, DIRECTLY OR INDIRECTLY, THE MAINTENANCE, OCCUPANCY, USE, EXISTENCE OR LOCATION OF SAID ENCROACHMENT AND i k USES GRANTED HEREUNDER, WHETHER OR NOT CAUSE, IN WHOLE OR PART, ' BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES OR INVITEES OF CITY; AND I GRANTEE HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY OF CITY, ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, FOR SUCH CLAIMS OR SUITS. GRANTEE SHALL LIKEWISE ASSUME ALL LIABILITY AND RESPONSIBILITY AND SHALL INDEMNIFY CITY FOR ANY AND ALL INJURY OR r DAMAGE TO CITY PROPERTY, ARISING OUT OF OR IN CONNECTION WITH ANY AND ALL ACTS OR OMISSIONS OF GRANTEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICESNEES, INVITEES OR TRESPASSERS. s a 15. Grantee agrees to furnish City with a Certificate of Insurance, naming City as certificate i 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 i i described in Exhibit"B". The amounts of such insurance shall be not less that the following: Property damage,per occurrence $100,000.00 ' I Bodily injury, per person $250,000.00 Bodily injury or death, per occurrence $500,000.00 With the understanding of and agreement by Grantee that such insurancc amounts shall be revised Eipward at City's option and that Grantee shall so revise such amount immediately following notice to Grantee of such requirement. Such insurance policy shall provide that it cannot be canceled or amended without at least thirty(30)days' prior written notice to the Building Official 5 CONSENT AGREEMENTfor Temporary use of puM C propertyl Anc i t i f of the City of Fort Worth. A copy of such Certificate of Insurance is attached as Exhibit "A". Grantee agrees to submit a similar Certificate of Insurance annually to City on the anniversary date of the execution of this agreement. j Grantee, agrees, binds and obligates itself, it 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 l removal of all encroachments and the cleaning and restoration of the city streets. All insurance coverage required herein shall include coverage of all Grantee's contractors. f 0 16. iGrantee covenants and agrees that it will not assign all or any of its rights,privileges or duties � under this contract without prior written approval of City, and any attempted assignment without k such prior written approval shall he void. j i i 17. This agreement shall be binding upon the parties hereto,their successors and assigns. i 18. Should any action, whether real or asserted, at law or in equity, arise out of the terms and conditions of this agreement or out of the use and occupancy of City property as permitted hereunder,venue for said action shall be in Tarrant County,Texas. 19. i I In any action brought by City for the enforcement of the obligations of Grantee,City shall be t entitled to recover interest and reasonable attorneys' fees. t EXECUTED this day I of� y U ; 3 G If E GRANTOR: GRANTEE: CITY OF FORT WORTH i Building Official l I Title i 6 CONSENT AGREEMENTfor Temporary use of public propenyl.doe E i t i APP VET TO FO AND LEGALITY: Lox pg Assi's4ni-INty Attorney Date a City SecretaryGU ' ,TU. ' ate ��CAS . OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX 7 CONSENT AGREEMERTfor Temporary use of public propoV.dcc S i. f f STATE OF TEXAS COUNTY OF TARRANT i BEFORE ME, the undersigned authority, a Notary Public in and a 'State of Te, oij this day personally appeared ,known to me to be the person whose j name is subscribed to the fo going instrument, and acknowledged to me that he/she executed the same for the putposes ar d considertion therein expressed, as the act and deed of , and in the capacity therein stated i _N UNDER MY NAND AND SEAL OF OFFICE this -6�ay of 20J$. 6 i V Affiant Bu fdiry G!a_ Title f l i I Notary Public in and for The State of Texas i WOF � ` R. G. NAREZ Notary Public-State of Taxes I Notary ID#12398238-8 Commission Exp.SEPT.13,2021 i 8 STATE OF TEXAS COUNTY OF TARRANT BEFORE AAE, lite undersigned aulltority, a Not at Pub "c in a d F he State of Teras, on this day personally appeared"I U WqS " T ,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. air ores and nsaderation therein _ expressed, as the act and deed of t'-..,k s �4 Til '��,LON and in the capacity therein stated. GIVF,N TINDER MY HAND ND Sh,A L OF OFFICE this day of . v bA%*j 20 t '^ Fey 7 APRIL LYNN GIBBON ine _ Notary Public, State of Texas My Commission Expires '%'�7,f'";•' April 09, 2019 Notary Public in and f The State of Texas FN' ��•�5� 8 Contractors Name:-(F-L.-LL kran�" Point of Contact: Phone Number Building permit Number: Purpose for Closure: T _ Begin Date: Z-3—/g. End Date: 4-Z Type of Taper according to posted speed limit: Tapers @ 30 NTH,1 Oft Offset,150'minimtun __ tt _,w Tapes @ 35 NTH.10ft Offset,05'minimum !Cs0- U C r Tapers-@` Q_WH,10ft Offset,a 6.5 minimum act�. � Nockr� fl«owo-- u . Z.z_` Y, ` .O-� /der x 9 onlay , Panic 'e 10Z � CQ® DATE(MMIDD)YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 01/16/2018 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(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 BART TUCKER Roach Howard Smith & Barton - Fort Worth NAME: 1320 South University Drive PHONE (817) 332-1313 FAX No:(817) 332-2956 E-MAIL ADORES : Fort Worth TX 76107 INSURERS AFFORDING COVERAGE MAIC# INSURERA:Texas Mutual Ins Co 22945 INSURED (817) 469-6721 INSURER B.Central Mutual Ins CO 20230 Texas Reconstruction Inc. INSURER C.Crum & Forster Specialty 44520 4708 McNutt Street INSURERD• Fort Worth TX 76117 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 40618 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS POLICYNUMBER MM/DD M(DD C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 D TO RENT CLAIMS-MADE 7 OCCUR EPX119956 10/20/2017 10/20/2018 PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 51000 PERSONAL&ADV INJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY O JPERCoT- ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER I $ AUTOMOBILE UABIUTY COMBINEDSOJGLEUMITEa $ 11000,000 accident B X ANY AUTO BAP9776779 07/13/2017 07/13/2018 BODILY INJURY(Per Person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NO"WNEO PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident s C X UMBRELLALIAa X OCCUR EFX109342 10/20/201710/20/2018 EACH OCCURRENCE $ 1,000,000 EXCESS LIMB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ TH AND EMPLOYERS' OERWORKERS COMPENSATION PER A YIN TATUTE ANYPROPRIkTOPJPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERMEMBEREXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Pollution/Environmental EP&119956 10/20/2017 10/20/2018 $ 1,000,000 Ti 1 1$ DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Romarkn Schedule,maybe attached K more space Is required) General liability and Pollution policies include a blanket automatic additional insured endorsement or provision khat provides additional insured status to certificate holder only when there is a written contract between named insured and certificate holder that requires such status. General liability and Pollution policies contains a special endorsement/provision with `primary additional insured' wording. General liability, Pollution liability and Workers Compensation policies include a blanket automatic waiver of subrogation endorsement/provision that provides this feature only when there is a written contract between named insured and certificate holder that requires it. 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 WITH THE POLICY PROVISIONS. 200 Texas Street AUTHORIZEDREPRESENTATIVE Fort Worth TX 76102 -f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD V- t of t