HomeMy WebLinkAboutContract 44315 (2)CITY SECRETARY /12 16
CONTRACT Na
RIGHT OF WAY
ENCROACHMENT AGREEMENT
(COMMERCIAL)
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 its duly authorized Assistant City Manager or
Planning and Development Department Director, hereinafter referred to as the "City", and
The Starr Conspiracy, LLC , acting herein by and through its duly authorized
Limited Liability Company, Vice President hereinafter referred to as "Licensee", Owner of the
property located at 122 S. Main St., Ft. Worth, Tx 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,
Improvement(s) ("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 Improvement(s) are described as follows:
Right of Way Encroachment Including Door Swing,
Ramp/Guardrail, and Awning
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
2012 ROW Encroachment Agreement -Commercial
RECEIVED MAR 27 20413
OFFICIAL RECORD
CITY SECRETARY
011 WORTH, TX
Page 1 of 10
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.
2012 ROW Encroachment Agreement -Commercial Page 2 of 10
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 Two
Hundred and Seventy Five Dollars ($275.00). 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 terms 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
2012 ROW Encroachment Agreement -Commercial Page 3 of 10
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.
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,
2012 ROW Encroachment Agreement -Commercial Page 4 of 10
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.
2012 ROW Encroachment Agreement -Commercial Page 5 of 10
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
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.
2012 ROW Encroachment Agreement -Commercial Page 6 of 10
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 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.
20.
This Agreement shall be binding upon the parties hereto, their successors and
assigns.
i
EXECUTED this 1iday of Mat
20q
2012 ROW Encroachment Agreement -Commercial Page 7 of 10
City
City of Fort Worth
By:
LE HARWOOD
DIRECTOR
PLANNING & DEVELOPMENT
ATTEST:
City Secreta
Licensee
TYPE :The Starr Conspiracy, LLC
By:
Name: B ret Starr
Title: Vice President
Approved As To Form and Legality
,v4�font �4., Assistant City Attorney
A'b�°°°cpc
klazetworstrA3e
2012 ROW Encroachment Agreement -Commercial
OFFICIAL RECORD
CITY SECRETARY
FT. WORTN, TX
Page 8 of 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 (9% 43 day of
•
, 20
`7
•
. 1 1 .li 1 • . •I-
IRMA SAENZ
Notary Public
STATE OF TEXAS
My Comm. Exp. Jan. 28, 2016
..1 1 .1 1 •I •.. . I o Y IL• • 1104 1 • 1 • .1 r eves . • / • . i . •. 1 1 • n 1 i .44 V \
keit a
Notary Public in and for the
State of Texas
2012 ROW Encroachment Agreement -Commercial Page 9 of 10
STATE OF TEXAS
COUNTY OF TA RANT
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
Texas, on this day personally appeared Bret Starr, 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 The Starr Conspiracy, LLC and in the capacity therein
stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this 1 > day of
(44ica ,20 i`5.
•
•
KEN EVANS
Notary Public
STATE OF TEXAS
My Comm. Exp. Aug. 45, 2015
eerrcite_
Notary Public in and for the
State of Texas
2012 ROW Encroachment Agreement -Commercial Page 10 of 10
Exhibit A —Location and
Description of Improvement
101
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CONFERENCE
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FACE OF CURB
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ARCHITECTS + PLANNERS ENCROACHMENT AGREEMENT - EXHIBIT #1 0 1°2•
•
ELEVATION KEYNOTES
(3)
(!)
PATCH AND FILL EXISTING OPENINGS IN BRICK AND MORTAR AND
REPAIR OPENINGS WHERE MISCELLANEOUS CLIPS AND HOUSINGS
HAVE BEEN REMOVED
REFURBISH EXISTING GLAZING TO REMAIN
NEW METAL BOX AWNING WITH (2) ROD AND TURNBACK
SUPPORTS REFER 3/A-411
POWER FOR KEYPAD EXACT LOCATION TO BE COORDINATED WITH
ARCHITECT PRIOR TO INSSALLATION
2"X6" STOREFRONT FRAMES IN ANODIZED ALUMINUM WITH NEW 1"
INSULATED GLASS, TINT TBD
ALL NEW STOREFRONT GLAZING SHALL HAVE A MAXIMUM SHGC
OF 0.30 AND A MAXIMUM U-FACTOR OF 0.60.
NEW ALUMINUM WRAPPED SILL TO REPLACE EXISTING
NEW STAINLESS STEEL GUARDRAIL. 42' ABOVE FINISHED LANDING
&RAMP
NEW CONCRETE 1:12 RAMP. 5' LENGTH SHOWN FOR 5" EXISTING
DROP. FIELD VERIFY PRIOR TO CONSTRUCTION.
LARGER MULLION TO ALIGN W/ EXISTING METAL STRAP @ DOOR
HEADER
KNOX BOX LOCATION TO BE COORDINATED WITH ARCHITECT
PRIOR TO INSTALLATION
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COD AND TURNBACK SUPPORTS
TO ALIGN WITH VERTICAL METAL MULLION
IN GLASS BLOCK
AWNING TO BE WRAPPED WITH
PUNCHED -LETTER SIGNAGE BY OTHERS
METAL BOXED AWNING WITH
(2) ROD AND TURNBACK SUPPORTS
CUT OPENING IN UNDERSIDE OF AWNING
TO PROVIDE ILLUMINATION OF STOOP
LIGHTING TO BE PROVIDED BY OTHERS,
OPENING TO HAVE DIFFUSING LENS,
FIXTURES WILL ALSO PROVIDE ILLUMINATION
THROUGH FRONT FACE OF SIGN
................
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14
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BENNE1T• BENNEP • PE1TIT TH E STAR R CONSPIRACY S a March
ARCHITECTS+PLANNERS ENCROACHMENT AGREEMENT -EXHIBIT #2 0 1� 2•
BASIS OF BEARINGS: WEST RIGHT—OF—WAY UNE OF
S. MAIN STREET ACCORDING TO DEED RECORDED IN
VOL 15207. PG. 9, D.R.T.C_T.
1RF DENOTES IRON ROD FOUND
IRS DENOTES IRON ROD SET
HOUSTON
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Coombs Land Surveying, Inc.
itt�,i_ t t. I P. O. Box 11370 Fort Worth, Texas 76110
.fit (817) 920-7600 (817) 920-7617 FAX
CIS JOB No. 12-0048
LOT 1
JACK R. BROWN
VOL 11261, PG. 574
D.R.T.C.T.
EAST 150.11'
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120 S. MAIN, LTD.
VOL. 15207, PCI. 9
D.R.T.C.T.
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S 39°58'43"E 150.11'
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- UNIT "A'
7460 S.F.
LOT 3
39°57'08"W 150.12
39°57'08'E 150.12'
ONE-STORY
BRICK dot CONC. BLOC:CC BLDG.
UNIT "B"
7478 S.F.
S 89057'00"W 150.12'
LOT 4
126 S MAIN, ILC
INST. No. D212035691
T.C.T.
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PLACE OP
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COMMON AREA "A"
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�1�v Exhibit "A"
LOTS 2 & 3, BLOCK 1
DAGGETT'S SECOND ADDITION
to the City of Fort Worth,
Tarrant County, Texas
LEGAL DESCRIPTION
UNIT "A"
BEING a portion of that certain tract of land described in
deed to 120 S. Main, Ltd. recorded in Volume 15207,
Page 9 of the Deed Records of Tarrant County, Texas,
said tract being Lots 2 and 3, Block 1, Daggett's Second
Addition to the City of Fort Worth. Tarrant County, Texas
and more particularly described as follows:
BEGINNING at a point in the East boundary line of said
120 S. Main Tract being the West right—of—way line of
South Main Street and lying SOUTH, 98.98 feet along said
right--of—way line from a Mag nail set at the Northeast
corner of said 120 S. Main Tract and the Northeast corner
of said Lot 2;
THENCE SOUTH, 49.73 feet along said West right —of --way
line to a point at its intersection with the projection of
the interior wall of a building;
THENCE N 89' 57' O8" W, 150.12 feet along interior wall
of said building wall to a point at it intersection with the
East right-of—way line of South Houston Street;
THENCE NORTH. 49.66 feet along said East right--of—way
line to a paint at its intersection with the projection of
the North exterior face of a building;
THENCE S 89' 58' 43" E, 150.11 feet along the North
exterior face of said building to the PLACE OF BEGINNING,
containing 7460 square feet of land.
LEGAL DESCRIPTION
UNIT "B"
BEING a portion of that certain tract of land described in
deed to 120 S. Main, Ltd. recorded in Volume 15207,
Page 9 of the Deed Records of Tarrant County, Texas,
said tract being Lots 2 and 3. Block 1, Daggett's Second
Addition to the City of Fort Worth, Tarrant County. Texas
and more particularly described as follows:
BEGINNING at a 3/8—inch iron rod found at the Southeast
corner of said 120 S. Main Tract and the Southeast
corner of said Lot 3 lying in the West right—of—way line
of South Main Street
THENCE S 89' 57' 00" W 150.12 feet along the South
boundary tine of said 120 S. Main Tract and said Lot 3 to
a 1/2—inch iron rod found at the Southwest corner
thereof lying in the East right—of—way line of South
Houston Street;
THENCE NORTH, 49.94 feet along said East right—of—way
line to a point at its intersection with the projection of
the interior wall of a building;
THENCE S 89' 57' 08" E, 150 12 feet along the interior
wall of said building wall to a point at its intersection with
the West right—of—way line of South Main Street;
THENCE SOUTH, 49.69 feet along said West right —of --way
line to the PLACE OF BEGINNING, containing 7478 square
feet of land.
LEGAL DESCRIPTION
COMMON AREA `A'
BEING a portion of that certain tract of land described in
deed to 120 S. Main, Ltd. recorded in Volume 15207,
Page 9 of the Deed Records of Tarrant County, Texas,
said tract being Lots 2 and 3, Block 1, Daggett's Second
Addition to the City of Fort Worth, Tarrant County. Texas
and more particularly described as follows:
BEGINNING at a Mag nail set in asphalt pavement at the
Northeast corner of said 120 S. Main Tract being the
Northeast corner of said Lot 2 and lying in the West
nght—of—way line of South Main Street;
THENCE SOUTH, 98.98 feet along said West right —of --way
line to a point at its .intersection with the projection of
the exterior face of the North wall of a building;
THENCE N 89' 58' 43" W, 150.11 feet along the exterior
face of said wall to a point at its intersection with the
East right—of—way line of South Houston Street;
THENCE NORTH, 98.93 feet along said East right —of --way
line to a 1-1/2—inch iron stake found at the Northwest
comer of aforesaid 120 S. Main Tract and the Northwest
corner of aforesaid Lot 2;
THENCE EAST, 150.11 feet along the North boundary line
of said 120 S. Main Tract and sand Lot 2 to the PLACE
OF BEGINNING, containing 14,854 square feet of land.
LEGAL DESCRIPTION
COMMON AREA "B"
BEING a portion of that certain tract of land described in
deed to 120 S. Main, Ltd. recorded in Volume 15207,
Page 9 of the Deed Records of Tarrant County, Texas,
said tract being Lots 2 and 3, Block 1, Daggett's Second
Addition to the City of Fort Worth, Tarrant County, Texas
and more particularly described as follows:
BEGINNING at a point in the East boundary line of said
120 S. Main Tract being the West right—of—way line of
South Main Street and lying SOUTH, 148.71 feet along said
right —of --way line from a Mag nail set at the Northeast
corner of said 120 S Main Tract and the Northeast corner
of said Lot 2;
THENCE SOUTH, 0.80 feet along said West right—of—way
line to a point at its intersection with the projection of
the interior wall of a building;
THENCE N 89* 57' 08" W, 150.12 feet along the interior
wall of said building wall to a point at its intersection with
the East right--of--way line of South Houston Street
THENCE NORTH, 0.80 feet along said East right—of—way
line to a point at its intersection with the projection of
the interior wall of aforesaid building;
THENCE S 89* 58' 43" E 150.11 feet along the interior
wall of said building to the PLACE OF BEGINNING.
containing 120 square feet of land.
Exhibit B —Certificate of
Insurance
'`ems?" CERTIFICATE OF LIABILITY INSURANCE
AMPH -1 OP ID: JM
DATE (MM/DD/YYYY)
03/15/13
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 817-514-9520ICONTACT Jo Manske CIC
Hertel McClendon, LLP 817-514-1835 PHONE 817-514-9520 FAX 817-514-1835
1701 River Run, Suite 910 Mall Extl: (AIC. No):
Fort Worth, TX 76107 ai RESS: jmanske@hertelmcclendonc.om
Tim McClendon
INSURED The Amphibian Conspiracy, A
Business Condominium Owners
120 S Main Street
Fort Worth, TX 76104
COVERAGES
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 AN RL SUBR wun IMM/DD/YYYYI (MM/DD/YYVYI
GENERAL LIABILITY
NAIC #
A X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
I POLICY I I rig
I I LOC
AUTOMOBILE LIABILITY
A ANY AUTO
ALL OWNED
_ AUTOS
X HIRED AUTOS
X
INSURER(S) AFFORDING COVERAGE
INSURER A:CNA Insurance Company
INSURER B :
INSURER C :
I INSURER D :
I INSURER E :
I INSURER F :
CERTIFICATE NUMBER: REVISION NUMBER:
SCHEDULED
AUTOS
NON -OWNED
AUTOS
X UMBRELLA LIAB X OCCUR
POLICY NUMBER
B5085079969 05/14/12 05/14/13
B5085079969
A EXCESS LIAR CLAIMS -MADE B5085080006
DED I X I RETENT ON $ 10,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
05/14/12 05/14/13
05/14/12 05/14/13
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requlred)
CERTIFICATE HOLDER
CITYFTW
City of Fort Worth
1000 Throckmorton
Fort Worth, TX 76102
CANCELLATION
LIMITS
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
ITORY LIMITS I 1 ER
$
$
$
$
$
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE' $
E.L. DISEASE - POLICY LIMIT $
1,000,000
300,000
10,000
1,000,000
2,000,000
2,000,000
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
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