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
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•
1
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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
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ENCROACHMENT EXHIBIT
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ADJACENT TO GAUNTT PROPERTY
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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.
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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
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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