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HomeMy WebLinkAboutContract 44017 (2)STATE OF TEXAS ENCROACHMENT AGREEMENT COUNTY OF i nRRAN i § CITY ECRETARY CONTRACT P100 THIS AGREEMENT is made and entered into by and between the City of Fort Worth, a municipal corporation of Tarrant County, Texas, acting herein by and through its duly authorized City Manager or duly designated Assistant City Manager, hereinafter referred to as the "City", and FORT WORTH COUNTRY DAY SCHOOL, INC , acting herein by and through its duly authorized PRESIDENT, RUSSELL LAUGHLIN hereinafter referred to as "Grantee", Owner of the property located at 4200 Country Day Ln. ("Property"). WITNESSETH: 1. For and in consideration of the payment by Grantee of the fee set out below and the true and faithful performance of the mutual covenants herein contained, City hereby grants to Grantee permission to construct/ install and/or allow to remain, Improvement(s) ("Improvement") that encroaches upon, uses and/or occupies portions of the space under, on and/or above the streets, alleys, 01- 1 3 P O 1 .1 0 IN 1 OFFICIAL RECORD CITY SECRETAR'Y 1,1 u: WOR'flIU TX sidewalks and other public rights -of -way, such Improvement(s) are described as follows: The requested encroachment is for approximately 123 linear feet of private 6" irrigation line encased with 12" steel casing. This requested line connects a water source from the Trinity River Authority with a private facility on site. No connection to City infrastructure is intended or included. The encroachment is for the portion that crosses under Arborlawn Drive. There is an additional request for approximately 66 linear feet of private 6" irrigation line encased with 12' steel casing pipe. This encroachment is south of Arborlawn Drive over Water Easement #D207435312 and Sanitary Sewer Easement #D207435313. The location and description of said Improvement and the encroachment is more particularly described in Exhibit "A", attached hereto, incorporated herein and made a part hereof for all purposes. 2. All construction, maintenance and operation in connection with such Improvement, use and occupancy shall be performed in strict compliance with this Agreement and the Charter, Ordinances and Codes of the City and in accordance with the directions of the Director of Transportation and Public Works of City, or his duly authorized representative. All plans and specifications thereof shall be subject to the prior written approval of the Director of Transportation and Public Works, or his duly authorized representative, but such approval shall not relieve Grantee of responsibility and liability for concept, design and computation in preparation of such plans and specifications. 3. Upon completion of construction and installation of said Improvement and thereafter, there shall be no encroachments in, under, on or above the surface area of the streets, alleys, sidewalks and other public rights -of -way involved, except as described herein and shown on the hereinabove referred to Exhibit "A". 4. Grantee, 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 the utility companies and 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 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, Grantee shall pay to City an additional amount equal to such additional cost as determined by the Director of Transportation and Public Works of the City, or his duly authorized representative. 5. City may enter and utilize the referenced areas at any time for the purpose of installing or maintaining improvements necessary for the health, safety and welfare of the public or for any other public purpose. In this regard, Grantee understands and agrees that City shall bear no responsibility or liability for 3 damage or disruption of improvements installed by Grantee or its successors, but City will make reasonable efforts to minimize such damage. 6. 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, Grantee agrees to pay to City at the time this Agreement is executed a fee in the sum of two hundred seventy five Dollars ($ 275.00 ). 7. The term of this Agreement shall be for thirty years, commencing on the date this Agreement is executed by the City of Fort Worth. R Upon termination of this Agreement, Grantee shall, at the option of City and at no expense to City, restore the public right-of-way and remove the Improvement encroaching into the public right-of-way, 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. It is understood and agreed to by Grantee that if this Agreement terminates and Grantee fails to remove the Improvement, Owner hereby gives City permission to remove the Improvement and any supporting structures and assess a lien on the Property for the costs expended by the City to remove such Improvement. 4 9. It is further understood and agreed upon between the parties hereto that the public rights -of -way, alleys, sidewalks ("public right-of-way") to be used and encroached upon as described herein, are 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 Legislature; and that City cannot contract away its duty and its legislative power to 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 right of way to be used for any other public purpose, including but not being limited to underground, surface of overhead communication, drainage, sanitary sewerage, transmission of natural or electricity, or any other public purpose, whether presently contemplated or not, that this Agreement shall automatically terminate. 10. Grantee understands and agrees that the granting of any encroachment hereunder is not meant to convey to Grantee any right to use or occupy property in which a third party may have an interest, and Grantee agrees that it will obtain all necessary permission before occupying such property. 5 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 of said Improvement, encroachment and uses. 12. Grantee 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. Grantee 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 Grantee 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 Grantee, its officers, agents, servants, employees, contractors and subcontractors, and nothing herein shall be construed as creating a partnership or joint enterprise between City and Grantee. 14. GRANTEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS 6 OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS FOR PROPERTY DAMAGE OR LOSS AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL P ERSONS, OF WHATSOEVER KIND OR CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH, DIRECTLY OR INDIRECTLY, THE CONSTRUCTION, MAINTENANCE, OCCUPANCY, USE, EXISTENCE OR LOCATION OF SAID IMPROVEMENT AND ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF O FFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, S UBCONTRACTORS, LICENSEES OR INVITEES OF THE CITY; AND GRANTEE HEREBY ASSUMES AlL L (ABILITY AND RESPONSIBILITY FOR S UCH CLAIMS OR SUITS. GRANTEE 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 ANY AND ALL ACTS OR OMISSIONS OF GRANTEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, S UBCONTRACTORS, LICENSEES, INVITEES, OR TRESPASSERS. 15. While this Agreement is in effect, Grantee 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 Tess than the following: $1,000,000 General Liability with the understanding of and agreement by Grantee that such insurance amounts shall be revised upward at City's option and that Grantee shall so revise such amounts immediately following notice to Grantee of such requirement. Such insurance policy shall provide that it cannot be canceled or amended without at least ten (10) days prior written notice to the Building Official of the City of Fort Worth. A copy of such Certificate of Insurance is attached as attached as Exhibit "B". Grantee agrees to submit a similar Certificate of Insurance annually to City on the anniversary date of the execution of this Agreement. Grantee 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 all encroachments and the cleaning and restoration of the city streets. All insurance coverage required herein shall include coverage of all Grantee's contractors. 16. Grantee agrees to deposit with the City when this Agreement is executed a sufficient sum of money to be used to pay necessary fees to record this Consent Agreement in its entirety in the deed records of Tarrant County, Texas. After being recorded, the original shall be returned to the City Secretary of the City of Fort Worth, Texas 17. 8 In any action brought by the City for the enforcement of the obligations of Grantee, City shall be entitled to recover interest and reasonable attorney's fees. 18. Grantee covenants and agrees that it will not assign all or any of its rights, privileges or duties under this contract without the prior written approval of the City Manager or designee. Any attempted assignment without prior written approval will be void. 19. THE PARTIES AGREE THAT THE DUTIES AND OBLIGATION CONTAINED IN PARAGRAPH 8 SHALL SURVIVE THE TERMINATION OF THIS AGREEMENT. 90. This Agreement shall be binding upon the parties hereto, their successors and assigns. 9 EE) =CU T ED this City City of Fort Worth By: RANDLE HARWOOD DIRECTOR PLANNING & DEVELOPMENT ATTEST: Loth City Secretary y day of ccat (6)L ;IN eV. Vcs). 000 # Out° ° eati tgl 1448"S, 0 ?), 00 nt41.1), Grantee FORT WORTH COUNTRY DAY SCHOOL, INC By: Name: Russell Laughli�f 'n Title: President Approved As To Form And Legality k\J\ b) , \(/) Assistant City Attorney 0 '(es 0 p 0000-2 AY ►9 i A 7 OFFICIAL RECORD � CITY SECRETARY FT. WORTHS TX 10 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 Randle Harwood, 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 the City of Fort Worth, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this ' 20_1. CA59; Notary Public in and for the State oflexas day of °o�'�rPt;�% R. G. NAREZ e: = Notary Public, State of Texas %)4'� My Commission Expires #4'9%;;60%yn_?% September 10, 2013 ease 11 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 L,e(SSa( ,0ciicuu , 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 G+foetrliever Al, v crn and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of n Oar, r , 20 Jr' Notary/Public in and for the State of Texas 12 • • • • • • EXISTING 6" PRIVATE IRRIGATION' • • $ , / ' �! /// �// ,/ !//, ! �i! /! / c,//7,11e././°1 0fi1yi/4////{/j//!// J ! • • • ! 4f f/, 'l// y///5- ////!!//141/ / J . % % / EXISTING 1 IIC -L� s � Edwards Meter: Limited 8L#IL17IttG RESTRICTION Volume 12915, Page 394 & LEVEE EASEMENT TARRANT COUNTY WATER CONTROL & IMP(U)VEMF.NT DISTRICT NO. ONE, VOL. 4S59, PACE 9, D,R.T,C.T. iNTAR;i%%�' r 'I 1' V//i//! /' .//. .dam r ;/J!!/lij� F// / /i: I 1 APPROXIMATE LOCA710N OF-' FUTURE WEST BOUND ARBORLAPN DRIVE (NTTA*) APPROXIMATE LOCH TIONn OF FUTURE EAST BOUND ARBORLAWN DRIVE (N7TA#) 61hMSE::RETAIN tYALL (N I I 600 EXIST. '• L, ...._ ..._...fir -FUTUR FINISH -'GRADE 590 NG1-1- 23 1 MCP if —, ARBORLAWN DRIVE VARIABLE WIDTH R.O. W IINSTRUMENT ' [.fiO7214241) • 2.5 1'Y 0+00 -' EXISTING-' 3' - f ..:. GROUND .. . L - — PROPOSED 6" IRRIGATION LINE (SEPARATE CONTRACT) SOUTHWESTERN SELL. EASEMENT t� VOL t �57 PG 652 1 ?I 1 'PO' Zoning Vacant --+�. -_.: /l.. // //�:);;. ryi i1a/�ji /! ;% j%i!i !!!�/!-2 � /// ;/.10?%1;• / %� %! i . •i �� r / j j/fi!!j%!! - /!�!!/ �I/!!�//�l/ '/ j /f //�! f�fill !y/t ///j111�%lljiilj /i%%ijjiii,%%�!%� %%/ / d ! i �%l�:�lf - . • ✓ • i�\ / ! u PERMANENT DRAINAGE FACIL EY EASEMENT (Instrument ?fD21C.0423t7) 1 d35 rt\ Ili t,\ ei to-. L+I : -' 1.1-00 • , PROPOSED 6=•--•, IRRIGATION LINE ' 610 600 13'-MIN.- .10 _..._. _ 590 -INSTALL 1123 L.F. OF 12" DIA. SIttL CASING PIPE & 1129 L.F. OF 6" PVC (PURPLE) ® 1.14X (BY OTHER THAN OPEN CUT) BARNETT GAS - PIPELINE EASEMENT 1\ II; tr\:';tent#D210111 83) l\ t i A• ir =T- Arborlawn Drive A=--. (Variable Width Right -Of -Way) Instrument IID207.214244. t I t • • lb-LI-FILM' EASEMENT (Instrument 4020710 <347 ) EXISTING 10' GAS TP = 577.3 • • • 1 1 1 VARIABLE iS':OTH DRAINAGE EASEMENT (Instrument tt 021`*3429')O) '-••j••_• --1 1 0 (PURPLE) RETAINING WALL--N, FUTURE PARKLAND \\ DEDICATION APPROXIMATE LOCATION OF 1:r--1 GAS PIPELINE E:C`l. = tS: ' AT WL CROSSING / / / / 1123 L.F. OF <2b STEEL --I CASING & 1129 L.F. OF 6" IRRIGATION WATER LINE TO BE INSTALLED BY OTHER THAN OPEN CUT Edwards Geren Limited Yalu fne 1291S, Page 394 1i'7' Zoning Vacant 2Cf SANITARY SEWER E.A_SEMEttT----1 - VOL 3796: PG. 639. U.R.T.C.T. IN i,: .0 1 + „ _=— ��t---- = - #DUNAWAY 550 Bailey Avenue • Suite 400 • Fort Worth, Texas 76107 Tel: 817.335,1121 • Fax 817.335. 743 7 (1X REG. F-1114) • • • • • i r 1 t i 1 /--PERMANENT [3► NNAGE / I / 0 •.•T7 F,'LSEt.'3Efii • tinstrument #021 J03283.3) i1 y • • r . I `'. :I i( l • , i • • i / • i : \ •t f• I / t; ;/I ,—PE RMN ENT DRAINAGE }`i ../' FAX' LITY'EASEMENT it i ,'` (Instr..: E:I #D210042893) res r 4/ I it \ i� --I �•-tr€uTY EASEMENT 't f (fnstr•.irnent 4D20710,347) i `) t • /J t i rnik ,,,; ,,� t h•, ...-1 '�• • • • • i irt • Edwards Gore; Limited Volurne 12915, Page 394 1PD' Zoning Vacant • t • • • • i : i t i , • • • • , ,l !-PERMANENT DRAINAGE .l FACILITY EASEMENT (Instrument #D21OOo42S92) , i i t • • , :, • • • , • , • •' --1' •�z r ��` i i = / ---PERNAIANEUT DRAINAGE ' FACILITY EASEMENT (Instrument en #0210042896) ;t%N (I. t. it WATER EASEMENT (I �:%tlittcrt \ 140207435312) \ SA':T; ARY SEWER EASEMENT •--- -\ (Iresirumen fiD2E1 43S313) :i N. it t •i t `"—PEI:MAt4ESIT DRAINAGE maim/ EASEMENT (Ins:rumeni k0211X1:42S€5) Future State Highway 121T (Variable Width Right -Of -Way) Instrument NO205118475 • \-V ArtIABLE WIDTH DRAINAGE E EASEMENT (Irtz_ru:nen_ #0217542901) 20' t,S'#OE SANITARY SEWER-- N\ EASEMENT VOL. 37S5, PG. 639 `\i & 20' WIDE S 11 EASEMENT VOL 449 . PG. 531 11v -4 11 j -10' W:DE LliltiT Y 4-1 / EASEMENT, CAB. A. 20' WIDE WATER -A" - II fi SLIDE 1924, EASEMENT VOL. 7776, '.R.T.0 T. PG. 636 D.R.T C T. 1 1S' %t^:DE SESC EASENIF: NT, CAB. A, SLIDE 1924, PDTi T 0 300 600 I SCALE: 1"= 300 ft. PER'r1ANEN's DRAINAGE F A; I;rY FASEtrSEPIT (Instrument fD2iC4)4239?) PROPOSE yN IRRIGATION LINE y`'et>.-- tn•. rs �S/ S t 1 -''`' `s`' , tX. 1 jt tN • • • • • , • • • S���y.>\• Jam/ ss•�i_!sb�� 3.z1 �i 4s 1i-cam 1t FORT WORTH COUNTRY DAY IRRIGATION LINE ARBORLAWN DRIVE CROSSING ENCROACHMENT EXHIBIT 10/15/2012 , PAGE 1 OF 2 • 1 f EXISTING 6" PRIVATE —\-, IRRIGATION'" / 405c.r_ / i',//' !, 11p// fit/till /,/. 1� 10cl yv„•a•- r c yfi ///// / //ice.- /r '• != • at 05 in/ //! //' /// // !// ! i pl r, I --EXISTING • Edwards G ren Limited• �r jir, BUILDING RESTRICTION — - � y. Volume 12945, Page 394 INT 1 i.i �,ei ;// //��/; & LEVEE EASEMENT 'FAO` Zoning / /ili//i/y%i/;, TARRANT COUNTY WATER //p iaz Vacant -CV/ ROA / CONTROL & IMPRAVENIENT II'/ii %;:ice DISTRICT NO. ONE, ribP €3,R.T.C.T. • .1 1 s SOUTHWESTERN BELL EASEMENT VOL 6057 PG 652 • • • • • • 1—UTILITY EASEMENT (Instrument NO207103347) ;.r::.r 5 o... RETAINING W`:ALL---� FUTURE PARKLAND \\ DEDICATION `. • WAIT LOCATION OF 1C' —r GAS PIPELINE AT Wt. CROSSING , OF 12'1 / CASING 61 �. O L.F OF 6 ft r iA•. L1i'NETO 'EEk�T}4ttEDDY TILER 4 IRRIGATION IR: b THAN OPE: Edwards Goren Limited Volume 1291 S, Page 394 'PO' Zoning Vacant ii r • 'Y / / / / / .'Y,/%Fl #D • , • • • �—in7rr':ir! j!�'://�.'•1'�lit�%ji%�/rjj'r��j� �%j! jail���/%/�j%�jJ�!%��j/ j%%l j!%%/��i� j% /i/ ////!i! // !.(!!d</!!/ 7 l;•! !J! . ! rJ irr l! /!,/,/ !// !! �J f// /////J/ r/ //1// / ///k/ /e filfififififi . ti • • • •�. 1 r 1 1 f VARIABLE WIDTH DRAINAGE EASEMEIff (Instrument 11021%4h9t!..) • :z • • t• • • •• • ♦ :• t• • :• • • • PERMANENT DRAINAGE FACILITY EASEMENT (Instrument 1;0210032859) 1 : it tic Ltl; 1 7 / • • •• .� ; ,—PERMANENT DRAINAGE ♦t 1 FATALITY t ,Etv ENT (Instrument PLVIO1426921 1 • • 4t' • • • it •' t --PERMANENT DRAINAGE FACtUTY EASEMENT (Instrument #D210042893) • 1 • • ♦ • EASEMENT--\ -: uirrent_ \ 20/ ;5312) \ \ 2C�:43S32�• S ANITARY SEWER EASEM (Instrument ND 2tY WIDE SANITARY SEWER EASEMENT VOL. 3755: PG. 639 & 20' WIDE SWB EASEMENT VOL •t49:0. PG. 531 2r? SANITARY SEWER EASEMENT VOL. 3796: PG. 639, (''10' WIDE LTILI Y G.R.T.C.T- �, !1 E:f SE'y1 N:T. CAR. Et. ,t 11 SLIDE 1024, I; \ 11 P.R.T.0 T. / / PERMANENT DRAINAGE -- FACILITY EAS£I'/MEt1 T (Instrument J021((6423 :7) fX/S77NO TOP r -GROUND E'X1S11NG:24 WATER LINE 1 fL..i=..591.96' QS ;• • PROPOSED tr— =.RRIGATIuN LINE (PURPLE) ... R412. 590: h INSTALL 66.-L.F.-..OF...12' DIA STEEL 'CASING --PIPE- O OX ::.$Y.OPEN_CUT EXIS77NG 12' SANITARY SEWER LINE FL = 582.52' NPR ARNETT GAS EASEMENT ' (l :.'.tni *tent i1D2a Arborlawn Drive (Variable Width Right -Of -Way) --• �, fir _--!S�InstrumentitD2072142.44_-_�_. -- APPR , • 4DUNAWAy 550 Bailey Avenue • Suite 400 • Fort Worth, Texas 76107 Tel: 817.335.1121 • Fwc 817.335,7437 (1X REG, F-1114) --UT€LT Y EASEMENT (Enstruma;t #020710.3347) i t t ter.. tN. ' t t • / • / • it Edwards Geren Limited Vofumen1291t5s�:tnPage 394 r r a, Zoning Vacant • • • • r1 t t • • ♦ :. • : • • • : • :• • : • • • i `--1-PERMANENT DRAINAGE i' N\ ... \`., ' FACItITY EASEMENT :t `,. l \\\' (E.^:Stf:�FT:2:et r-C12iC{b�e2ii`_a6} 't � \� „: 1': �� il\ ta• �•• It `�"`'—P£1:MANT.NT DP,AIN E FACILITY EASEMENT i. • 20' WdDE WATER EASEMENT VC::. 7776, PG. 636 D.R.T C T. 15' WiDE SRC EASE MENT, CAS. A, SLIDE 1924, O D T t T 0 300 600 1 1 I SCALE: 1"= 300 ft. (Instrument nnD21OC'42S4 Future State Highway 121T (Variable Width Right -Of -Way) Instrument #D205118475 \—VARIABLE WIDTH DP•AINAG E EASEMENT (Er: : uinent fiO2IQ-34 901) ._PERMANENT DRAINAGE FACILITY EASEMEIN? (is ist;;inrte:tt14021(;42897) / : i • ='%C=.1SE:: IRRIGATION LINE I ff- ' ,� ,♦• ,•u\ k \ tt ' i?• �. wt✓ f�yv' �/ \•t • • \ • .4 \ i ' �� \• • • • \'n' •. tt t• ▪ \ kt\ ORT FORT WORTH COUNTRY DAY IRRIGATION LINE SANITARY SEWER & WATER EASEMENT ENCROACHMENT EXHIBIT 10/15/2012 PAGE 20F2 4 Ln ACORO THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER HUB International Rigg 777 Main Street, Suite C-50 Fort Worth TX 76102 CERTIFICATE OF LIABILITY INSURANCE INSURED Fort Worth Country Day School, 4200 Country Day Lane Fort Worth TX 76109 Inc. CONTACT NAME: IPHONE INC. No. Ext): IE-MAIL ADDRESS: I Katie Hunt (817) 820-8100 i DATE (MM/DD!YYYY) 9/12/2012 FAX No): (817) 870-0310 katie.hunt@hubinternational.com INSURER(S) AFFORDING COVERAGE NAIC # IINSURERA:Hartford Underwriters Ins. Co. (INSURER B : Sentinel Insurance Co. IINSURERC:Hartford Casualty Insurance Co. IINSURERD:Hartford Accident & Indemnity Co I INSURER E : 1 INSURER F : 30104 11000 29424 22357 COVERAGES CERTIFICATE NUMBER: Cert ID 41301 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 ADDL'SUBR POLICY EFF POLICY EXP LTRINS4 WVD POLICY NUMBER IMM/DD/YYYYI (MM/DD/YYYYI LIMITS TYPE OF INSURANCE GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY 46UUNJD0892 9/1/2012 9/1/2013 CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY I I Ca LOC AUTOMOBILE LIABILITY B X ANY AUTO ALL OWNED AUTOS X HIRED AUTOS C D X UMBRELLA LIAB EXCESS LIAB DED 1 X RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below SCHEDULED AUTOS NON -OWNED AUTOS OCCUR CLAIMS -MADE 10,000 Y/N N N!A 46UUNJD0892 9/1/2012 9/1/2013 46RH1J3D0261 9/1/2012 9/1/2013 46WBZR5390 9/1/2012 9/1/2013 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (My one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE WC STATU- OTH- X TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The General Liability and Automobile Liability policies include a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status subject to policy terms and conditions. The General Liability,Automobile Liability and Workers' Compensation policies include a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the named insured and the certificate holder that requires it subject to policy terms and conditions. CERTIFICATE HOLDER City of Fort Worth Parks and Community Services Department 920 Woodward St. Fort Worth TX 76107 ACORD 25 (2010/05) CANCELLATION $ 1,000,000 $ 300,000 $ 10,000 $ 1,000,000 $ 2,000,000 $ 2,000,000 $ 1,000,000 $ $ $ $ 10,000,000 10,000,000 1,000,000 1,000,000 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 of 1