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HomeMy WebLinkAboutContract 45642CITYSECRETARYLJIIVL CONTRACT Ho. EASEMENT ENCROACHMENT LICENSE AGREEMENT Commercial THIS AGREEMENT is made and entered into by and between THE CITY OF FORT WORTH, a home rule municipal corporation of Tarrant County, Texas ("City"), acting by and through its duly authorized City Manager or its duly designated Assistant City Manager or Planning and Development Director, and CVS PHARMACY, INC., a Rhode Island Corporation ("License&'), acting by and through its duly authorized representative, owner of the real property located at 8601 and 8777 Boat Club Road, Fort Worth, TX 76179 ("Property"). RECITALS WHEREAS, Licensee is the owner of certain real property described as a 1.723 acre tract of land 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 10 foot wide utility easement (the "Easement") in the Property as shown on the map attached to this Agreement as Exhibit "A" and incorporated herein for all purposes; and WHEREAS, Licensee desires to construct/place and maintain a retaining wall which will encroach onto the Easement; and WHEREAS, to accommodate the needs of the Licensee, the City will allow the encroachment under the terms and conditions as set forth in this Agreement. NOW, THEREFORE, the City and Licensee agree as follows: AGREEMENT 1. The 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 the Licensee, hereby grants permission to the Licensee to encroach upon and occupy a portion of the City's Easement for the purpose of constructing and maintaining a retaining wall (the "Encroachment") as described in and at the location shown on Exhibit "A" but only to the extent shown thereon. Upon completion of the Encroachment, Licensee agrees to be responsible for maintaining the Encroachment within and above the Easement. Licensee shall not expand or otherwise cause the 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road RECEIVED MAY 301014 t ��l-uf 1 T d*PIaiiiii.4'tECORD CITY SECRETARY FT. WORTH, TX Encroachment to further infringe in or on the City's Easement beyond what is specifically described in the Exhibit(s) attached hereto. 2. All construction, maintenance and operation in connection with such Encroachment, use and occupancy shall comply and be performed in strict compliance with the Charter, Ordinances and Codes of the City and in accordance with the directions of the Director of the Transportation and Public Works Department or the Director of the City's Water Department, or his or her duly authorized representative. Prior to the construction of the Encroachment, Licensee shall submit all plans and specifications to the applicable Director or his or her duly authorized representative. Licensee shall not commence construction of the Encroachment until such approval shall be indicated in writing by the Director. However, 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 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 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 2 of 15 Rev. 02/2014 Works or the Director of the Water Department, or said Director's duly authorized representative. 4. 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 Two Hundred Seventy Five and No/100 Dollars (S275.00). 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 5. 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 terms of this Agreement by the Licensee. City shall notify Licensee in writing of the non-compliance and if not cured within thirty (30) days, this Agreement shall be deemed terminated, unless such non-compliance is not susceptible to cure within thirty (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 thirty (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 upon 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 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 3 of 15 Rev. 02/2014 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 SAID ENCROACHMENTS AND USES GRANTED HEREUNDER, WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, ELECTED OFFICIALS OR INVITEES OF THE CITY AND LICENSEE HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY FOR SUCH CLAIMS OR SUITS. LICENSEE SHALL LIKEWISE ASSUME ALL LIABILITY AND RESPONSIBILITY AND SHALL INDEMNIFY CITY FOR ANY AND ALL INJURY OR DAMAGE TO CITY PROPERTY ARISING OUT 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". 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 4 of 15 Rev. 02/2014 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 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 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 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 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 the 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. 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 5 of 15 Rev. 02/2014 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 paragraphs 3 and 4 shall survive the termination of this Agreement. 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 6 of 15 Rev. 02/2014 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. 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. 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 7 of 15 Rev. 02/2014 EXECUTED this City CITY • ^ART By: Randle J-L wood Director Planning and Development RTH ATTEST: STATE OF TEXAS COUNTY OF TARRANT ay of At oo0oa Licensee: CVS PHARMACY, INC. By: Name: Title: Toni A. Motta Assistant Secretary CVS Legal Approval: Dustin Stevens Holland &Knight LLP Approved As To Form and Legality b t tant City Attorney NO hi&C REQUIRED BEFORE ME, the undersigned authority, a Notary Public in and Texas, on this day personallyfor the State of appeared Randall Harwood, known to me to be whose name i s subscribed to the he person foregoing instrument and � acknowledged to me that the same for the u he/she executed purposes and consideration therein herein expressed, City of Fort Worth as the act and deed of the and in the capacitytherein eln stated. GIVEN UNDER Y AND AND SEAL OF OFFICE this 20 004181,44, it':. ?Poet.tninia • CASSANORA F. FOREMAN Notary Public, State of Texas My Commission Expires �- April 26i 2017 N tart' Public State of Texas 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road day • OFFICIAL RECORD Cny SECRETARY ; Page 8 of 15 Fr. WORTH, TX Rev. 02/2014 STATE OF RHODE ISLAND § COUNTY OF BE ,ORE ME, the undersigned authority, a Notary Public in and for the State of Jess, on this daypersonally appeared /dvtt. itt(title) p y PP , 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 CVS Pharmacy, Inc., a Rhode Island corporation, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this -�_ ,Zoe 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Notary Public in and fo the State of Rhode Island day of Susan Dupre Notary Public State of Rhode Island my Commission Expires 06/02/2015 r 5; Page 9 of 15 Rev. 02/2014 ;sb, 7 \1/4 `! • 1 • LEGAL DESCRIPTION OF THE PROPERTY PARCEL 1 BEING a tract of land situated in the D.C. Pace Survey, Abstract No. 1245, City of Fort Worth Tarrant County, Texas and being a portion of Lot 1, Block 1, Lake Country Baptist Church Addition an addition to the City of Fort Worth, Tarrant County, Texas according to the plat thereof recorded in Cabinet B, Slide 2723, P.R.T.C.T.), and being more particularly described as follows: BEGINNING at a. 5/8 inch iron rod found for the southeast corner of said Lot 1, Block 1, Lake Country Baptist Church Addition, said P.K. Nail also being in the west right-of-way line of F M Highway 1220 (Boat Club Road, variable width right-of-way); THENCE South 89 deg 30 min 03 sec West, departing said west right-of-way line and along the south line of said Lot 1, Block 1, a distance of 184.96 feet to a 5/8 inch iron rod found for corner, THENCE South 00 deg 02 min 45 sec East, continuing along said south line, a distance of 13.91 feet to a 5/8 inch iron rod found for corner; THENCE South 89 deg 32 min 57 sec West, continuing along said south line, a distance of 29.90 feet to a 1/2 inch iron rod with red plastic cap stamped "WAI" set for corner, (HENCE over and across said Lot 1, Block 1, Lake Country Baptist Church Addition the following: North 00 deg 28 min 15 sec West, a distance of 248.90 feet to an "X" cut in concrete set for corner; North 89 deg 31 min 45 sec East, a distance of 215.08 feet to an "X" cut in concrete set for corner in the west right-of-way line of aforementioned F.M. Highway 1220 (Boat Club Road); THENCE South 00 deg 26 min 32 sec East, along said west right-of-way line, a distance of 234.91 feet to the POINT OF BEGINNING; CONTAINING within these metes and bounds 1.169 acres or 50,938 square feet of land, more or less. Bearings shown hereon are based upon an on -the -ground Survey performed in the field on the 3rd day of July, 2013, utilizing a G.P.S. measurement (WGS 84) of South 89 deg 30 min 03 sec West (plat -North 89 deg 55 min 12 sec West), along a south line of Lot 1, Block 1, Lake Country Baptist Church Addition, recorded in Cabinet B, Slide 2723, P.R.T.C.T. 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 10 of 15 Rev. 02/2014 PARCEL 2 BEING a tract of land situated in the D.C. Pace Survey, Abstract No. 1245, City of Fort Worth, Tarrant County Texas and being all of Lot 1, Block 1, LD.I Addition, an addition to the City of Fort Worth, Tarrant County, Texas according to the plat thereof recorded in Volume 388-122, Page 83, Plat Records, Tarrant County, Texas (P.R.T.C.T.) and being all of the same -tract of land as described in deed to Pioneer Grocery #One, Inc., recorded in County Clerk's File No. D213000660, Deed Records, Tarrant County, Texas (D.R.T.C.T.), and being more particularly described as follows: BEGINNING at a P.K. Nail set for the most southerly southeast corner of said Lot 1, Block 1, I.D.I. Addition, said P.K Nail also being in the north right-of-way line of Lake Country Drive (variable width right-of-way); THENCE South 89 deg 32 min 46 sec West, along the north right-of-way line of said Lake Country Drive, a distance of 99.99 feet to a 1/2 inch iron rod found for corner, THENCE North 85 deg 09 min 57 sec West, continuing along said north right-of-way line, a distance of 25.11 feet to a 1/2 inch iron rod with plastic cap stamped "ALS" found for corner, said iron rod being the southwest corner of aforementioned Lot 1, Block 1, I D I Addition; THENCE North 00 deg 28 min 44 sec West, departing the north right-of-way line of said Lake Country Drive, a distance of 132 01 feet to a 5/8 inch iron rod found for the northwest corner of said Lot 1, Block 1, I.D.I Addition; THENCE North 00 deg 02 min 45 sec West, a distance of 13.91 feet to a 5/8 inch iron rod found for the northwest corner of aforementioned Pioneer Grocery #One, Inc. tract; THENCE North 89 deg 30 min 03 sec East, along the north line of said Pioneer Grocery tract, a distance of 184.96 feet to a 5/8 inch iron rod found for corner in the west right-of- way line of F.M. Highway 1220 (Boat Club Road)(variable width right-of-way) THENCF, along said west right-of-way line of F.M. Highway 1220 (Boat Club Road), the following: South 00 deg 26 min 32 sec East, a distance of 14.07 feet to a P.K. Nail set for corner, said P.K. Nail being the northeast comer of aforementioned Lot 1, Block 1, I.D.I. Addition; South 89 deg 31 min 45 sec West, along the north line of said I.D.I. Addition, a distance of 9 98 feet to a P.K. Nail set for corner; South 00 deg 28 min 15 sec East, a distance of 95.79 feet to a P.K. Nail set for corner; 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 11 of 15 Rev. 02/2014 South 89 deg 31 min 15 sec West, a distance of 50.08 feet to a P.K. Nail set for corner, THENCE South 00 deg 28 min 15 sec East, continuing along the west right-of-way line of said F.M. Highway 1220, a distance of 38.50 feet to the POINT OF BEGINNING; CONTAINING within these metes and bounds 0 554 acres or 24,147 square feet of land, more or less. Bearings shown hereon are based upon an on -the -ground Survey performed in the field on the 3rd day of July, 2013, utilizing a G.P.S. measurement (WGS 84) of South 89 deg 30 min 03 sec West (plat -North 89 deg 55 min 12 sec West), along a south line of Lot 1, Block 1, Lake Country Baptist Church Addition, recorded in Cabinet B, Slide 2723, P.R.T.C.T. 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 12 of 15 Rev. 02/20 I 4 N ¢ lc 7C Seas = n L6 [§3 Pn 10' UTILITY ESMT EX UNDERGROUND TELEPHONE & OVERHEAD POWET LINES ALONG OR WEST OF PROPERTY LINE tr//////// / OWNS RETAINING WALL N ce z / 5 4'-5 7' , 6 33' ,3 33 ', 2' 1 ENCROACHMENT AREA CVS DRIVE PROP LINE } I 1 1 U G TELE 2' WIDE FLUME W/2" INVERT TYPICAL CROSS SECTION NTS WALL Winkelmann & Associates, Inc. cCHAienect cam a,OI'W= ■ SVPUEYORS OSO ,*n.a, NM tad Al.[ /)i AMA TOYS/ 76/34 R.ea kng.,.enr ,e/.I,roL An AOTOMSS_. �, No. LIGOC . C6^n74ID,7 c Ot& T%Mn'enarn ! icy.c,retl. b.a Scale NOTED Dote 04— I-2G'4 rynP F ,r /I:%qe—G`it' tl*g P,o eci V., 70006 NG-TJIa NOS d/ MY / TO ORAIN WALL iL EXHIBIT A N894jl '14 "E L 1 80' s „I,0 ER ail 3,1 .-rn CJ rrn E+ec31 / ./////I / f//1 10 JTaL,T' r ASLMENT VOt 388- t PAGE 8J \. 2' WIDE FLUME W/2" INVERT /9 TI /. i N o / z /r, .e,'///%/ 1 6e POINT OF-- BEGINNING ^``� -- s89 31'16"W 533' LAKE COUNTRY bR1VL RETAINING WALL WITH 2 FT WIDE x 2 IN. INVERT FLUME AT BOTTOM OF WALL TO NORTH INTO EXISTING SWALE AT BACK OF GAUNTT PROPERTY ENCROACHMENT EXHIBIT CVS BOAT CLUB ADDITION ADJACENT TO GAUNTT PROPERTY 4) I S24 40'27 E 10951 p�F tApGf r a 7 J `J. 1 PROPERTY LINE RETAINING WALL C D• / to 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 13 of 15 Rev 02/2014 METES AND BOUNDS WALL EtvC'ROCHMENT BEGIN A PORTION OF 1 OT 1, 81 OCK 1, I D.;. ADDJTION, PER PIA T RECORD!: D IN VOI HMI: 388—I22 PAGE 8.5, DEED RECORDS TARKANT COUNTY, TEXAS (DRTCT), AND A PORTION Of LOT 1 8e OCK 1 LAKE CUNT!?Y L3APTIST CHURCH ADDITION, PER PLA T F.'ECORDED tN COUNTRY ^LEPKIS DOC NO 0204025306, AND YEING MORE PA RTICULARIY DESCRIBED AS FOLLOWS; fit GINNING AT A ROLA:T ON THt LAST LINL Of A TPA CT 1)ESCN'h'L& DLLD TO TURNER PnAURICE GAUNT T 111, AS RECORDED IN VOLUME 1.5 / PAGE 349 OR TOT, SAID POINT P.EING NORTH 00 DEG 28 MIN 44 SEC WEST, A DI STANCE OF 12.43 FT FROM THE SOUTHEAST CORNER OF SAID OAUNTT TRACT' THENCt NORTH 00 DEC 28 'v.tN 44 SEC `>T, ALONG THE EAST LINE OF SAID GAUNTT ?TACT, PASS./NG .4T 119.59 FT 77-ME NORTHEAST CORIVE:? Of SAID GAUNTT TRACT AND CONTINUING FOR A TOTAL DISTANCE GE 12 9. 48 FT TO A POINT FOR CORNER ON THE NORTH 1INE OF A RR'1PO.SED 10 FI. W/Dr ()111 / EASE/E:VT/ T:-IrNCE NORTH 89 OEG 311 MIN 14 SEC EAST ALONG SAID NOR TH ONE, FOR A DISTANCE OF 1.80 FT TO A POINT FOR CORNER ON THE 8A.CK OF A PROPOSED RETAINING NA; 1; MILNCt SOUTH if DEG 40 MIN 2 SEC EA`_>T ALONG THE HACK Of SAID WALL, FOR A DISTANCE OF 10.96 FT TO A POINT FOR CORNER; THENCE SOUTH .06 DEG 28 MIN 15 SEC EA ST, CON77NUtNG AL ONG THE SACK OF SAID %/A , FOR A DISTANCE OF 779 48 FT. TO A POINT FOR CORN,- R; THENCE SOUTH 89 DEG 31 16 SEC //c S T, DEPARTLAIC TkE BACK OF SAID WALL, FOR A DISNCc OF 6.3.3 FT. TO THE POINT OF BEGII:NING AN;) CONTAINING 0.18.5 ACRES ON /98 SO I T. OF 1 AND, MORE OF I E:iS. Winkelmann & Associates, Inc. cee4Tp.R civil. cr+cnos ■ sililygyilitil AMA la.rccn KVJ/. W4[, %Mt Sit r( x) sIg-7 o MIA. WAS MIN t�TJ) saran PM Mintzt LIOrttists Vq.stit.4a. Pa &9 Tors. SL Y s A IMMC-Co ceFnCAr r Jets, .W.Ywm,m ! Assoctoln. tic Score. I & Quin •04-1f-20T4 age. 71/94V:—Get> tav nrn.eer ND 70908 WALL ENCROACHMENT EXHIBIT CVS BOAT CLUB ADDITION ADJACENT TO GAUNTT PROPERTY 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 14 of 15 Rev. 02/2014 EXHIBIT B 2012 Easement Encroachment Agreement -Commercial CVS Boat Club Road Page 15 of 15 Rev. 02/2014 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/21/2014 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 MARSH USA, INC. 99 HIGH STREET BOSTON, MA 02110 Attn: CVSCaremark.CertRequest@marsh / Fax: 212-948-5338 S02406-GL-GL-14-15 INSURED CVS CAREMARK CORPORATION AND ITS SUBSIDIARIES AND AFFILIATES ONE CVS DRIVE WOONSOCKET, RI 02895 CONTACT NAME: PHONE I FAX INC. No. Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A: New Hampshire Ins Company INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-006868533-03 REVISION NUMBER:4 NAIC # 23841 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 LTRINSR wvn POLICY NUMBER IMM/DD/YYYY) IMM/DD/YYYYt A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X SIR: $500,000 X LIQUOR LIABILITY INCLUDED GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY I PE I LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS UMBRELLA LIAB EXCESS LIAB DED I RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below OCCUR CLAIMS -MADE Y/N N N/A GL6819521 01/01/2014 01/01/2015 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 TORY LIA ITS I IOER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 4,500,000 1,000,000 4,500,000 28,000,000 INCLUDED DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: #10489 — FT WORTH (BOAT CLUB); AS IT PERTAINS TO THE PROPOSED USE AND OCCUPANCY OF PUBLIC PROPERTY AS LOCATED AND DESCRIBED IN EXHIBIT A OF AN EASEMENT ENCROACHMENT LICENSE AGREEMENT BETWEEN THE CITY OF FORT WORTH AND CVS PHARMACY, INC. REGARDING THE REAL PROPERTY LOCATED AT 8601 AND 8777 BOAT CLUB ROAD, FORT WORTH, TX 76179 CERTIFICATE HOLDER CITY OF FORT WORTH, A HOME RULE MUNICIPAL CORPORATION OF TARRANT COUNTY, TEXAS 1000 THROCKMORTON STREET FORT WORTH, TX 76102 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 of Marsh USA Inc. Yevgeniya Muyamina petrni f t& %nLlga/►2c./7ct 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACOREP AGENCY MARSH USA, INC. POLICY NUMBER CARRIER AGENCY CUSTOMER ID: S02406 LOC #: Boston ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMED INSURED CVS CAREMARK CORPORATION AND ITS SUBSIDIARIES AND AFFILIATES ONE CVS DRIVE WOONSOCKET, RI 02895 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance COMMON POLICY CONDITIONS A. Cancellation 2. We [Carrier] may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for non payment of premium 1) General Liability Additional Insured - Where Required Under Contract or Agreement language per endorsement 61712 (12/06): Page 2 of 2 SECTION II- WHO IS AN INSURED, is amended to include as an additional insured: Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: • The coverage and/or limits of this policy, or • The coverage and/or limits required by said contract or agreement. 2) General Liability Earlier Notice of Cancellation Provided By Us language per endorsement CG 02 2410 93: Number of Days' Notice 90 For any statutorily permitted reason other than nonpayment of premium, the number of days required for notice of cancellation, as provided in paragraph 2. of either the CANCELLATION Common Policy Condition or as amended by an applicable state cancellation endorsement, is increased to the number of days shown in the Schedule above. 3) General Liability Advance of Cancellation to Entities Other The Named Insured Limited to E-Mail Notification per Chartis Manuscript endorsement: In the event that the Insurer cancels this policy for any reason other than non payment of premium, and 1. The cancellation effective date is prior to this policy's expiration date; 2. The First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is cancelled (hereinafter, the °certificate Holder(s)°); and has provided to the Insurer, either directly or through its broker of record, the email address of the contact at such entity, and the Insurer received this information after the First Named Insured received notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the °Advice°) via e-mail to such Certificate Holders. Proof of the Insurer emailing the Advice, using the information provided under this policy by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations Page of this policy. All other terms, conditions and exclusions shall remain the same. ACORD 101 (2008/01) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD