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HomeMy WebLinkAboutContract 46957 (2)V t3*CGS: < 967 compeer � • CFIVE5 AUG 2 6 201E RIGHT OF WAY �� , ENCROACHMENT AGREEMENT f1 �' �� t.. O U ij (COMMERCIAL) I _; !,,t . eH L I _ 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 Planning and Development Department Director, hereinafter referred to as the "City", and COOK CHILDREN'S MEDICAL CENTER, acting herein by and through its duly authorized Vice President hereinafter referred to as "Licensee", Owner of the property located at 801 West 7th Avenue, Fort Worth, Texas 76104 ("Property"). AGREEMENT 1. For and in consideration of the payment by Licensee of the fee set out below and the true and faithful performance of the mutual covenants herein contained, City hereby grants to Licensee permission to construct/ install and/or allow to remain, Improvements) ("Improvement") that encroaches upon, uses and/or occupies portions of the space under, on and/or above the streets, alleys, sidewalks and other public rights -of - way, such Improvements) are described as follows: Request is being made to install and operate 23 street lights (max height of 12'-4 ") and 28 irrigation heads along Seventh Ave. 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 2014 ROW Encroachment Agreement -Commercial 11 «��1� ;4f1�r;11/-'\r'_, ritUqvrAIRD Lf' tia '+1v,1i 11;\\ 1 if 1tcn Page 1 of 11 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 Licensee 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. Licensee, at no expense to the City, shall make proper provisions for the relocation and installation of any existing or future utilities affected by such encroachment use and occupancy, including the securing of approval and consent from 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, Licensee 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, Licensee understands and agrees that City shall bear no responsibility or liability for damage or disruption of improvements installed by Licensee or its successors, but City will make reasonable efforts to minimize such damage. 2014 ROW Encroachment Agreement -Commercial Page 2 of 11 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, Licensee agrees to pay to City at the time this Agreement is requested an application fee in the sum of Three Hundred and Twenty -Five Dollars ($325.00). Upon execution of this Agreement and annually thereafter, Licensee agrees to pay a fee in the amount of $.56 per square/linear foot of the encroachment area. 7. The term of this Agreement shall be for thirty (30) years, commencing on the date this Agreement is executed by the City of Fort Worth. Provided however, this Agreement shall terminate upon the non-compliance of any of the teens of this Agreement by the Licensee. City shall notify Licensee of the non-compliance and if not cured within thirty days this Agreement shall be deemed terminated. 8. Upon termination of this Agreement, Licensee 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 Licensee that if this Agreement terminates and Licensee 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 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 2014 ROW Encroachment Agreement -Commercial Page 3 of 11 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 team 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. Licensee agrees and acknowledges that this Agreement is solely for the purpose of permitting Licensee to construct, maintain and locate the Improvements over or within the described public right of way and is not a conveyance of any right, title or interest in or to the public right of way nor is it meant to convey any right to use or occupy property in which a third party may have an interest. Licensee agrees that it will obtain all necessary permission before occupying such property. 11. Licensee agrees to comply fully with all applicable federal, state and local laws, statutes, ordinances, codes or regulations in connection with the construction, operation and maintenance of said Improvement, encroachment and uses. 12. Licensee agrees to pay promptly when due all fees, taxes or rentals provided for by this Agreement or by any federal, state or local statute, law or regulation. 13. Licensee covenants and agrees that it shall operate hereunder as an independent contractor as to all rights and privileges granted hereunder and not as an officer, agent, 2014 ROW Encroachment Agreement -Commercial Page 4 of 11 servant or employee of City and Licensee shall have exclusive control of and the exclusive right to control the details of its operations, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers, agents, servants, employees, contractors, subcontractors, licensees and invitees. The doctrine of respondeat superior shall not apply as between City and Licensee, its officers, agents, servants, employees, contractors and subcontractors, and nothing herein shall be construed as creating a partnership or joint enterprise between City and Licensee. 14. LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY INDEMNIFY, 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, INCLUDING DEATH, TO ANY AND ALL PERSONS, 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 OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES OR INVITEES OF THE CITY; AND LICENSEE HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY FOR SUCH CLAIMS OR SUITS. LICENSEE SHALL LIKEWISE ASSUME ALL LIABILITY AND RESPONSIBILITY AND SHALL INDEMNIFY CITY FOR ANY AND ALL INJURY OR DAMAGE TO CITY PROPERTY ARISING OUT OF OR IN CONNECTION WITH ANY AND ALL ACTS OR OMISSIONS OF LICENSEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, INVITEES, OR TRESPASSERS. 2014 ROW Encroachment Agreement -Commercial Page 5 of 11 15. While this Agreement is in effect, Licensee agrees to furnish City with a Certificate of Insurance, naming City as certificate holder, as proof that it has secured and paid for a policy of public liability insurance covering all public risks related to the proposed use and occupancy of public property as located and described in Exhibit "A". The amounts of such insurance shall be not less than the following: $1,000,000 Commercial General Liability with the understanding of and agreement by Licensee that such insurance amounts shall 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 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" 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 all encroachments and the cleaning and restoration of the city streets. All insurance coverage required herein shall include coverage of all Licensees' contractors. 16. Licensee 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 2014 ROW Encroachment Agreement -Commercial Page 6 of 11 17. In any action brought by the City for the enforcement of the obligations of Licensee, City shall be entitled to recover interest and reasonable attorney's fees. 18. Licensee covenants and agrees that it will not assign all or any of its rights, privileges or duties under this contract without the prior written approval of the Director of Planning and Development. 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. 20. This Agreement shall be binding upon the parties hereto, their successors and assigns. EXECUTED this r day of �- frior 2014 ROW Encroachment Agreement -Commercial Page 7 of 11 City City of Fort Worth CENTER By: Randle Harwoo: , Director Planning and Development ATTEST: r / City Secrelatiy 1118-KC REQUIRE ttg 7-6 re9 �• ociltict coo Go©0fcs k; . SAS I Licensee TYPE: COOK CHILDREN'S MEDICAL r By: Name: Stanley E. Davis Title: Vice President Approved As To Form and Legality Wrouvvs,„ Assistant CiAttorney OFFICIAL RECORD CITY SECRETARY F% WORTPI, TX • 2014 ROW Encroachment Agreement -Commercial Page 8 of 11 2014 ROW Encroachment Agreement -Commercial Page 9 of 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 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. AND SEAL OF OFFICE thi ‘N•4? ge4W4(4 %144 $r �� CASSANDRA F. FOREMAN Notary Public, State of Texas My COMMISCI0ti expires April 26, 201/ inarsgamoseigninlaellairlaltlaSk 1141# Gday of Notary Public in and for the State of Texas OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX 2014 ROW Encroachment Agreement -Commercial Page 10 of 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 Stanley E. Davis, Vice President, 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 Cook Children's Medical Center, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this I `O day of A3Lik_s 24c • *1 1 ff • • site ' of... DIONNIA TEUTSCH Notary Public 1 STATE OF TEXAS My Comm. Exp. 10-23-2018 • -037o),L91c: Notary Public in and for the State of Texas OFFICIAL RECORD CITY SECRETARY Ft WORTH, TX 2014 ROW Encroachment Agreement -Commercial Page 11 of 11 LUMINAIRE SCHEDULE h Ave SL IRR LS Exhibits\L PROPOSED I IRRI GA Tl N I LINE I �EX'SS DUNAWAy 550 Bailey Avenue • Suite 400 • Fort Worth, Texas 76107 Tel: 817.335.1121 (TX REG. F-1114) DESCRIPTION METAL HALIDE ACORN STYLE SITE LIGHTING. PROVIDE POLE FOR PGT (MANF: ANTIQUE STREET LAMPS, MODEL: P1FW19-14A-XX) * I * # PROPOSD IRRIGATION LINE # SOUTH TOWER - ALL PROPOSED STREETLIGHTS TO BE PRI VA TEL Y OWNED AND MAINTAINED BY ENCROACHMENT AGREEMENT WITH A PLAQUE LABELED "PRIVATE LIGHT" ON A 4"x2" METALLIC COVER EXHIBIT A VOLTS MANUFACTURER) MODEL SHERIDAN L-SA-H-15M-4LV-C-NF LEGEND — — — PROPERTY BOUNDARY ADJOINERS — EASEMENT PROPOSED ELECTRIC CONDUIT PROPOSED CURB STREETLIGHT NOTE: 1. TOTAL PROPOSED LIGHTPOLES=23 EA 2. TOTAL IRRIGATION HEADS=28 EA 0 60 120 a3 ARCHITECT OP RECORD D vacs OOa Woe a A <.S —a —a 1V w Proposed 2' Masks Valve raft r addicts c.r+np r InIgaean Malec /•\ /A% Q 4 211 6 a- 13.8 n% r i 6 Presesm meets and valves b tie ptaosd IneMle boundary MMs In landscape ewes, bp. 16.3 COOPER STREET 6 • 11 2'1> 51, 0 • '� 14"'!--.I . pi 0 IN 0 0 114- 131 • • • .. 1O... • •-14• I 1►Y 11 11 41 11 4°4 I tl .1_ Cxwbr pedeeeM mane aontreesr at *salon at owner RawVleen senor lo be mauled on rat, wen or IbM polo stein 300'ofcontrol* • PROPOSED SOUTH TOWER MATCHLINE AREA 3 (SEE SHEET IR 1.03) • • 0 1" 4 00 A • 2.97 DRIOCP 1N' 22.6 5.00 11 r9 11 u 11 ip 11 • 1' n i i i i i i J i i i ` I/7. 1 C hp;ls.' rAREA 1 y i AREA 2 _ KEY MAP r. I -r AREA r — J J 1 !FOR IPRICAPON SCHEDULE SEE SHEET IPI.04. FOR IRRICARON NOTES & DETAILS SEE SHEETS IP2.OI & IR2.02 NORTH a GRAPHIC SCALE In ;n I' - 10'-0' WIT PI !ma FKP Architects Haws, I Des oriinu ARCHITCCT DAVID M. SCHWARZ AACHI1LCTS GENERAL CONTRACTOR v LINBECK CONT.UI IANI DUNAWAy nru.s OVPARTUEHT WW1" CONSTRUCTION FACILTPCS AND PLANNING RCVICW TNs donmrd replan ee alnduslon or Po lmdslrrhLIlon Dolmens for Ma goofed Inc brow and w s wooed as Wows. CPaP Rep. IRSNe01 PROJECT NAIL Des As Ohms As Nab 7127ne CookChil dren'1 Medical Center ►•OR1 wtNTiI. IESAs SOUTH TOWER EXPANSION & BACKFILL RENOVATION PROJECT NUMRI.R 10-13059.40 00 !RUE SOUTH TOWER INTERIOR CONSTRUCTION IMPLEMENTATIC DOCUMENTS -ISSUED FOR CONSTRUCTION DATA 12/23/14 DRAWINO Tmr IRRIGATION PLAN AREA 1 DRAWING NUW%rR IR1.01 ARCHITECT OF RECORD 4, - c — 0. --CI a —0 —C2/ 13.3 IrApen marlins u,d vibes to be plead hwds banduy *mils In Isndsaps ow lyp. T7• 24.7 DRIP 014 ec 0— C/� MATCHL NE AREA 1 (SEE SHEET IR1.01) 0— A o- 1`— o— M) c) a Rarl/Fiasae smear !DM mashed on a.lsrbr rad a Opt pole sAINn 300' of oalydbr &P rbrpsdestalmount twitch/ of dr.Won sfamsr PROPOSED SOUTH TOWER WEST TERREL AVENUE i pat • J AREA 4 FOR IRRIGATION SCHEDULE WE 24EET IRI.04. FOR IRRIGATION NOTES k DETAILS SEE SHEETS IR2.01 & IR2.02. NORTH GRAPHIC SCALE n to 1'-10-0' WITH FKP Architects Hannon I Door DCn.GN ARCHITECT DAVID M SCHWARL A4L'H:TECTS orNrRAL CONTRACTOR LINBECK CONf1Ul I ANt DUNAWAy nP Ain OrPARTurNT RCVIrW CONSTRUCTION PACIUTICO AND PLANNING REVIEW TNs document rspnnsnb In conclusion of tie ImplsrnsnrlWn Documents for the poled pled Soo end is *wowed as taloa a CPLP Rao. Data As atssn NNW, PROJDCT NMAC ❑ ❑ ❑ ❑ O CookChil dren'h Medical Center cnINI thr',k:ll. II.S\S SOUTH TOWER EXPANSION & BACKFILL RENOVATION PROJECT NUMBra 10-13059.40 00 ni1UF SOUTH TOWER INTERIOR CONSTRUCTION IMPLEMENTATIC DOCUMENTS -ISSUED FOR CONSTRUCTION DA71 12/23/14 oRAWINn TlTln IRRIGATION PLAN AREA 3 DRAWING NUWIFR IR1.03 4 14'-6" n 13-2' FORT WORTH Series 12'-0" 9'6" Cast Iron Posts 18" sq. base 7'-0' SPECIFICATIONS DESCRIPTION The lighting post shall be all cast iron construction, massively tapered with a deep, 16-flute pattern on the shaft and a classic square base. The post shall be Antique Street Lamps' catalog number PI FW18 XX finish. MATERIALS The post material shall be ASTM A48, Class 30 cast iron, formed true to the pattern with complete detail. All exposed hardware shall be tamper resistant stainless steel. Anchor bolts to be completely hot dip galvanized. Partially galva- nized bolts are not acceptable. DIMENSIONS The post shall be X'- XX"in height with an 18" square base. The post shall taper from a 7" diameter at the top of the base to a 4.5" dia- meter at the post top. An integral 3" O.D. x 3" tenon shall be provid- ed at the top for luminaire mount- ing. The post top shall include a transitional donut between the fluted shaft and the tenon. INSTALLATION The post shall be provided with four 3/4" diameter, L type anchor bolts, 55K psi, to be installed on a 15" diameter bolt circle. Two 6-0" doors shall be provided in the base for anchorage and wir- ing access. A grounding screw shall be provided inside the base accessible from one door. II If II II I( PI FW18 15 finish PI FW18 13 finish PI FW18 12 finish PI FW18 10 finish PI FW18 7 finish PI FW18 6 finish For finish specifications and color options see "Finish" section in catalog. ANTIQUE Street Lamps 2011 W Runctoerg Ln. •Ausfh,1X 78758 Ph(800)410-8899•Fox (512)977-9622 FORT WORTH Series Cast Iron Posts • 18" sq base 3" O.D. x 3" High Tenon —Th I 5.5°x4.5"H. Door Opening for Anchorage and Wiring Access (2 per post) 18" Sq. 1 '=-E- 4.5"0 Post Height 22" V Y ANTIQUE Street Lampsiv 2011 W. Rundberg Ln. •Austin, TX 78758 • Ph (800) 410-8899• Fax (512) 977-9622 ORDERING INFORMATION Choose the boldface catalog nomenclature that best suits your needs and write it on the appropriate line. Example: PI FW18 12 ANPP Options PI FW18 Post Series pPI FW18 1 Post, Cast Iron FORT WORTH 18" base Paint finish to be PPG DTM # 90 475 B140 Z5 C1Y35 M42 10 ANCM 1 Height 6 13 15 Finish' ANPP Prime Painted ANBK Black ANDB Dark Bronze ANDG Dark Green ANVG Verde Green CM Custom Matcn RAL colors 1 1 Options Receptacles Banner Arms Flagpole Holders Custom Logos Signage (see Signage & Accessories section in the catalog or con- tact Antique Street Lamps) NOTES: 1. For finish specifications and color options see Finish section in catalog or contact Antique Steet Lamps. ANCHORAGE GUIDE 13" Dia. Opening cz 15" Dia. Bolt Circle 3" o• o • o •' 00Q 3/4" O, 55K psi, Hot Dip Galvanized L type Anchor Bolts (4 per Post) DS4 WITH LUMINAIRE BASE CHOICE A 16'w 31.5h 9'bd DS4 B 16'w 415'h '4"bd DS4 A ORDE ING GUIDE DS4 E Senes DS4 Bs DS4 X S4 t DS4 C DS4 P DS4 K DS4 M DS4 A DS4 R DS4 L DS4 W DS4 S3 DS4 N3 DS4 Alt 1.1111 Wattage/Lamp Meta! Halide 50M MED 70M MED 1 IUUM mho High Pressure Sodium 35S MED 50S MED 70S MED 100S MED 150S MED 16-:v 37"h '3.5'bd DS4 X 6"w 42-h '4"bd DS4 R 16'w 33"h '3.75 bd DS4 E DS4 L FINIAL Cast alurninurn CUTOFF REFLECTOR i Anodized and segmented with porcelain socket — PORCELAIN SOCKET Medium base i REFRACTIVE GLOBE Clear acrylic 45 bd DS4 D DS4 W BALLAST HOUSING With factory prew'red N.I.D. ballast assembly GLOBE SCREWS (4) 1 /4" stainless steel, socket set screws LUMINAIRE BASE Cast aluminum in a variety of styles BASE SCREWS (6) 1 /4' stainless steel. socket set screws for fastening to 3"O.D, post tenon QUICK DISCONNECT PLUGS ARF SR4SC TB4 'S'bd DS4 C '4.5"bd DS4 P 16-w d2.5'h •4.5"bd DS4 S bd dimensions are the diameter of the base 7 39-h 16 DS4 K 1 16"w 13.5'h '3.5"bd DS4 N '6 bd DS4 M 1315.1 DS4 AU Twist & Lock photoelectric cell options available with luminaire bases S N and AU only. TOOL -LESS BALLAST HOUSING To access ballast assem- bly, release spring tab and rotate housing cover. Lens Material Distribution Voltage' ARF Acrylic. Refractive SR2 les Distribution SR3 IES Distribution ISR4SC IES Distribution I okoa ico LDmLunOn LUMINAIRE BASE WITH BALLAST HOUSING TB1 120 volt TB2 208 volt TB3 240 volt ITB4 277 volt 347 347 volt 480 480 volt NOTES: I. Multi -top Ballast (12Q 208, 240, 277v), (120, 277, 347v In Canada). For wattages under 70S or 70M contact ASL for voltage availabtity. 2. HS option is not avaitabfe with distribution option SR5S or SR4SC. 3, Twist & Lock Photo Control only available with N, S and AU bases. 4. For finish and odor options see Fn'sh sectan In catabg or contact ASL. 5. Consult factory for wattages for B Series Luminaire Base. Litt out txilic's' assembly, REMOVING BALLAST ASSEMBLY Note: Lamp is not furnished with the luminaire. Sample Catalog no: DS4 D 150S MED ARF SR2 TB1 PEB1 ANBK ANCM Options Finish° HS2 SF DF PEBI PEB2 PER' PE1' PE33 PE4' PE73 House Side Shield Single Fusing Double Fusing Photoelectric cell button120v Photoelectric cell button 208, 240, 277v Twist -Lock Photocontrol Receptacle NEMA Twist & Lock PE 120 208, 240v NEMA Twist & Lock PE 347v NEMA TwISt & Lock PE 480v NEMA Twist & Lock PE 277v ANBK ANDB ANDG ANPP L �M 85 Block Dark Bronze Dark Green Prime Pointed 1,Us10n1 MO1Cn Cot.,... 3.,:eeh RAL cdas Paint finish to be PPG DTM # 90-475; B140; Z5; C1Y35; M42 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 W1TH 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, ILTR I TYPE OF INSURANCE N6R I WVD POLICY NUMBER I POLICY FF POLICY EXP MM/DD EIYYYYS MM/DDIYYYY) LIMITS IGENERAL LIABILITY 1 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I X I OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: I POLICY t L PROJECT I I LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON•OWNED AUTOS EXCESS LIAB DEDUCTIBLE I OCCUR CLAIMS -MADE JRETENTION I S WORKERS COMPENSATION AND EMPLOYERS• LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandaton±In NH) It yes, describe under DESCRIPTION OF OPERATIONS below City of Fort Worth 1000 Throckmorton Fort Worth, Texas 76102 P.O. Box 1159 Grand Cayman KY1-1102 Cayman Islands INSURED Cook Children s Health Care System 801 Seventh Avenue Fort Worth, Texas 76104 - 2796 E CERTIFICATE OF LIABILITY INSURANCE I DATE:10/1/14 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 CONTACT Strategic Risk Solutions (Cayman) Ltd NAME: 878 West BayRoad PHONE FAX LAIC, No. EMI: tAlC, Nol: EMAIL ADDRESS: PRODUCER CUSTOMER ID #: INSURER A: INSURER B: INSURER C: INSURER D: INSURER Et INSURER F: INSURER(S) AFFORDING COVERAGE Cook Children's Indemnity Company NAIC # A X CCICHPGL1415 10/1/2014 10/1/2015 IYIN I I 1• I 1 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORJ 101, Additional Remarks Schedule, If more space Is raquhcd) Certificate Holder is an additional insured as required by written contract. Waiver of subrogation as required by written contract. This certificate does not amend, extend or alter the coverage afforded by this policy EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $ $ MED EXP (Any 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 I $ $ 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 POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE $ IroRY UM LIMITS I IERH EL EACH ACCIDENT $ E.L. DISEASE EA EMPLOYEE $ E.L. DISEASE • POLICY LIMIT $ 1,0001000 50,000 0 1,000,000 5,000,000 5,000,000 ACORD 26 (2010/06) The ACORD name and logo are registered marks of ACORD 01988-2009 ACORD CORPORATION. All rights reserved.