HomeMy WebLinkAboutContract 57385 Date Received: 04/11/2022 Permit Number: PN21-00188
Time Received: 2:17 pm City Secretary No.: 57385
PUBLIC PROPERTY EASEMENT ENCROACHMENT LICENSE AGREEMENT
TIER II
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, Assistant City Manager, or
Director of the Development Services Department, and Ryan M. McCollum and Ashley
M.McCollum,Property owners ("Licensee").
RECITALS
WHEREAS, Licensee is the owner of the real property located at 4245 Ranier
Court, Fort Worth, Texas 76109 ("Property"), being more particularly described in the
attached Exhibit"A"which is incorporated herein for all purposes; and
WHEREAS, the City owns a water and storm drain easement (the "Public
Property") adjacent to the Property as shown in the attached Exhibit "B," which is
incorporated herein for all purposes, and as recorded in the plat records of Tarrant
County as plat number FS-14-059; and
WHEREAS, Licensee desires to construct, place, and maintain certain
improvements which will encroach in, on,above,or below the Public Property; 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 Licensee of the fee set out below
and covenants and agreements hereinafter contained to be kept and performed by
Licensee,hereby grants permission to Licensee to encroach in, on, above, or below and
occupy a portion of the City's Public Property as described in and at the location shown
on Exhibit "C," but only to the extent shown thereon, for the purpose of constructing,
installing, and maintaining fence posts (the "Encroachment"). Upon completion of
the Encroachment, Licensee agrees to be responsible for maintaining the
Encroachment within the Public Property. Licensee shall not expand or
otherwise cause the
OFFICIAL RECORD
Tier II Easement Encroachment Agreement
PN21-00188 CITY SECRETARY
FT.WORTH, TX
Encroachment to further infringe in or on the Public Property beyond what is specifically
described in Exhibit"C."
2.
All construction, installation, maintenance, and operation of the Encroachment
and the use or occupancy of the Public Property shall comply with and be performed in
strict compliance with this Agreement and with the charter, ordinances, codes, and
policies of the City. Prior to the construction or installation of the Encroachment,
Licensee shall submit all plans and specifications to the Director of the Development
Services Department or duly authorized representative. Licensee shall not commence
construction or installation of the Encroachment nor make any use of the Public Property
until after the execution of this Agreement.
3.
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 and the use and occupancy of the Public Property, including the securing
the approval and consent of the appropriate utility companies and agencies of the State of
Texas and its political subdivisions. In the event that any installation, reinstallation,
relocation, or repair of any existing or future utility or improvements owned by or
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 of
Public Property, Licensee shall pay to City an additional amount equal to such additional
cost as determined by the Director of Transportation and Public Works, the Director of
the Water Department, the Director of the Development Services Department, or their
duly authorized representative.
4.
Licensee agrees that City may enter and utilize the Public Property at any time for
any public purpose, including installing, repairing, replacing, or maintaining
improvements to its public facilities or utilities necessary for the health, safety, and
welfare of the public. The City shall have no responsibility or liability for any damages
related to the Encroachment resulting from the City's use of the Public Property;
however,the City shall make reasonable efforts to minimize such damage.
5.
Upon termination of this Agreement, Licensee shall, at the option of and at no
expense to the City, remove the Encroachment and restore the Public Property to a
condition acceptable to the Director of Transportation and Public Works, the Director of
the Water Department, the Director of the Development Services Department or their
Tier H Easement Encroachment Agreement Page 2 of 14
PN21-00188 Revised 11/2020
duly authorized representative. Any such removal of the Encroachment shall be in
accordance with then-existing City regulations and policies. It is understood and agreed
to by Licensee that if this Agreement terminates and Licensee fails to remove the
Encroachment and restore the Public Property, Licensee hereby gives City permission to
remove the Encroachment and any supporting structures from the Public Property, to
restore the Public Property, and to assess a lien on the Property for the costs expended by
the City in taking such actions.
6.
In order to defray all costs of inspection and supervision which the City has
incurred or will incur as a result of the construction, maintenance, inspection or
management of the Encroachment and use of Public Property as 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 Seven Hundred Dollars($700.00).
7.
The term of this Agreement shall be for thirty (30) years, commencing on the
date this Agreement is executed by City. However, the City may terminate this
Agreement upon Licensee's noncompliance with any of the terms of this Agreement.
City shall notify Licensee in writing of any such noncompliance and if Licensee does not
cure the noncompliance within thirty (30) days of notice from City, the City may
terminate this Agreement.However,the City may, at its sole option,allow the Agreement
to remain in effect so long as Licensee has taken reasonable measures to cure the
noncompliance or is continuing to diligently attempt to remedy the noncompliance.
8.
It is further understood and agreed between the parties hereto that the Public
Property to be used and encroached upon is held by City as trustee for the public; that
City exercises such powers over the Public Property 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 Public Property 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 Public Property to be used for any other public purpose, 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 both the Encroachment and the public purpose.
Tier H Easement Encroachment Agreement Page 3 of 14
PN21-00188 Revised 11/2020
9.
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,
WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION
WITH, DIRECTLY OR INDIRECTLY, THE CONSTRUCTION,
MAINTENANCE, OCCUPANCY, USE, EXISTENCE, OR LOCATION OF THE
ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT
CAUSED, IN WHOLE OR IN PART, BY THE ALLEGED 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.
10.
While this Agreement is in effect, Licensee agrees to furnish City with a
homeowner insurance policy for the property as proof that is 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"C." The amounts
of such insurance shall be not less than
$750,000.00
with the understanding 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 thirty(30) days prior written notice to
the Building Official of the City. A copy of such Certificate of Insurance is attached as
Exhibit "D" and incorporated herein for all purposes. Licensee agrees, binds, and
obligates itself and 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 restoration of the Public Property. All insurance coverage
required herein shall include coverage of all Licensee's contractors and subcontractors.
Tier II Easement Encroachment Agreement Page 4 of 14
PN21-00188 Revised 11/2020
11.
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 the county in which the Encroachment is located. After being
recorded,the original shall be returned to the City Secretary of the City of Fort Worth.
12.
Licensee agrees to comply fully with all applicable federal, state, and local laws,
statutes, ordinances, codes, and regulations in connection with the construction,
operation, and maintenance of the Encroachment and use of the Public Property.
13.
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.
14.
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.
15.
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 Public Property and is not a conveyance of any right, title, or interest in or to the
Public Property, 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.
16.
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 attorneys' fees.
Tier H Easement Encroachment Agreement Page 5 of 14
PN21-00188 Revised 11/2020
17.
The parties agree that the duties and obligations contained in Section 5 shall
survive the termination of this Agreement.
18.
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 the 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.
Foreclosure by a secured lender of Licensee or assignment to a secured lender by
Licensee in the event of default or otherwise shall not require City approval provided that
said lender notifies City in writing within sixty (60) days of such foreclosure or
assignment and assumes all of Licensee's rights and obligations hereunder. However, no
change of ownership due to foreclosure or assignment to any secured lender of Licensee
shall be effective as to City unless and until written notice of such foreclosure or
assignment is provided to City.
19.
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.
20.
This Agreement shall be binding upon the parties hereto and their successors and
assigns.
21.
This Agreement may be executed in multiple counterparts,each of which shall be
considered an original,but all of which shall constitute one instrument
[SIGNATURES APPEAR ON FOLLOWING PAGE]
Tier H Easement Encroachment Agreement Page 6 of 14
PN21-00188 Revised 1112020
City: Licensee:
CITY OF FORT WORTH Property Owners
By: Di Harrell 2022 18:03 CDT) B}7�l r
D.J. Harrell, Director of the Name: Ryan M.McCollum
Development Services Department Title: Property Owner
Date: Apr 5,2022 Date: _2,, //, -
By: 1AA r-
Name: Ashed,M.McCollum
a
�� F F OR t dad Title: Property Owner
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ATTEST: �EXASa� Approved As To Form and Legality
.Tannette S. Goodall
Jannette S.Goodall(Apr 8,202215:39 CDT)
Jannette Goodall, Thomas Royce Hansen
City Secretary Assistant City Attorney
Ordinance No.24161-04-2020
Date: Apr 8,2022
Date: Apr5,2022
Contract Compliance Manager:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract,including ensuring all performance
and reporting requirements.
Tanie Morales
Janie Scarlett Morales(Apr S,2022 16:45 CDT)
Janie S.Morales
Development Services
Date: Apr5,2022
Tier II Easement Encroachment Agreement OFFICIAL RECORD
PN21-00188 CITY SECRETARY
FT.WORTH, TX
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 D.J. Harrell, known to me to be the person
whose name is subscribed to the foregoing instrument, and acknowledged to me that he
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 5th day of
April , 2022 .
Wendy L. Digitally 9 y y OgpRYP(iB/ WENDY L BEARDSLEE
signed Wend L. 2 Notary Public
Beardslee * *Beardslee Date:2022.04.0518:34:13-05'00' STATE OF TEXASy
P Notary I.D. 13323719-3
Notary Public in and for the State of Texas 9'�oF�4 My Comm. Exp. July 28, 2025
After recording return to:
Development Services Department
Development Coordination Office
200 Texas Street
Fort Worth,Texas 76102
Tier H Easement Encroachment Agreement
PN21-00188 OFFICIAL RECORD
CITY SECRETARY
FT.WORTH, TX
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
,on this day personally appeared Ryan M. McCollum,property owner(Title)
known to me to be the person whose name is subscribed to the foregoing instrument, and
acknowledged to me that he or she executed the same for the purposes and consideration
therein expressed,as the act and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this ({ day of
20
MANUEL BEDOLLA JR.
Public,5
otaryPsiubi n and for the MYCom .E 10-19-2025
ID No.13340123-7
State of
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
on this day personally appeared Ashely M. McCollum, property owner
(Title) known to me to be the person whose name is subscribed to the foregoing
instrument, and acknowledged to me that he or she executed the same for the purposes
and consideration therein expressed,as the act and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this I day of
20 .
' a+ MANUEL BEDOLLA JR.
)otary and for the Notary Public,State of Texas
My Comm.Exp.10-19-2025
State of -No.13340123-7
Tier H Easement Encroachment Agreement OFFICIAL RECORD
PN21-00188
CITY SECRETARY
FT.WORTH, TX
EXHIBIT A
Legal Description of the Licensee's
Property
Lot 3, Block 44, Westcliff, an addition to the City of Fort Worth, Tarrant County, Texas,
according to the Plat recorded in Volume 388-G, Page 141,Deed Records of Tarrant County,
Texas.
Tier II Easement Encroachment Agreement Page 11 of 14
PN21-00188 Revised 11/2020
EXHIBIT B
Depiction of the Public Property
Tier H Easement Encroachment Agreement Page 12 of 14
PN21-00188 Revised 11/2020
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EXHIBIT C
Depiction and description of the Encroachment
Tier II Easement Encroachment Agreement Page 13 of 14
PN21-00188 Revised 11/2020
Reference No: 213Y09 G.F.No: 09-00434 RH
Title Co: RATTIKIN TITLE COMPANY
Purchaser: . BOLLMAN 356 total LF
PROPERTY DESCRIPTION
Lot 3,Block 44,WESTCLIFF,an Addition to the City of Fort Worth,Tarrant County,Texas,according to the plat
recorded in Volume 388-13,Page 141.Deed Records of Tarrant County,Texas.
FND.CAPPED
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' cedar picket with metal post 226' '> zB•
22660 / � •:�couc.
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31/2'
from corner of wall STONNLE 5 36 09WAL
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/ METAL BLDG.
Post ON DIRT / 130' LOT 1 with metal
3BB-G/ 141
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LOT 4 RUNNER 388-C/ 141
388-G/141 .,. J+ 12�8/ !,: 4 31.9' T
5'DRAINAGE ESNT. ` •~�.!l::i •:. .'Ek•`�.- /
3BB-G/141 •:'7^?::.` '?'�,5 4.6 /
L•• �!�;+� / BRICK & FRAME a1
>,•,'.i=�v n/ RESIDENCE LOT 2
a •T�i•, .:
•Y...,.�:rir i'J. 5.7' 21.7' 388-G/ 141
BRICK
B� {J1`• • PLANTER
--tONC.DRIVE DOES
NOT PROTRUDE OVER '•.•�
PROPERTY LINEN'11
FND. 1/2-IR •'�a��i.i� NO. 1/2-IR
R = 408.00'
L = 125.25'
REC. L = 125.00'
4.245 RANIER COURT
This survey Is hereby
acre 1 and approved-
-_ NOIE:ThY ru M plat Y co"htd. AITy reproduction of
FI - Ta e Plat+�thr srowW..rithi.corwnt W a
Nolotlon of F d d*py�ght 1— Thb—w rar
pxformed srak+MWy tx tM TBM Co porry and PurGgwr
ur I user ht�e_ Morn od Y llowrrd for orr WY1gY uw. TIIY—W
SCALE: 1" = 30' rwnaYw Brr prop4rd of t11I Slrveyor. Po
_ . r—Imdxd aoPYr or IthW., w of LAY doamrnL
SURVEYORS CERTIFICATION Ea
L WILLIAM H.MOSS,REGISTERED PROFESSIONAL LAND SURVEYOR,HEREBY CERTIFY THAT (•,oF.,Tyr
THIS SURVEY WAS MADE ON THE GROUND UNDER MY SUPERASION AND CORRECTLY SHOWS •�P••L 5 T E`.;fq
THE BOUNDARY LINE,AND DIMENSIONS OF THE LAND INDICATED THEREON,AND THAT SAID
PROPERTY HAS ACCESS TO AND FROM A DEDICATED ROADWAY,SAID PROPERTY BEING SUBJECT —T— OVERHEAD UTILITIES r;� p•.t
TO ANY AND ALL EASEMENTS,RESERVATIONS AND RESTRICTIONS THAT MAY BE OF RECORD.AND THAT FENCE ............
ONLY THE EASEMENTS SHOWN ON THE REFERENCED PUT OF RECORD AND THOSE OF WHICH THE WILLIAM H. MOSS
SURVEYOR HAS BEEN GIVEN WRITTEN NOTICE FROM TITLE COMPANY ARE SHOWN ON THIS PUT. BRICK O ...........................
SURVEYOR 040 NOT ABSTRACT THIS PROPERTY AND RELIES SOLELY ON THE TITLE WORK PROVIDED To ® Z
HIM FOR NOTICE OF ANY EASEMENTS WHICH MAY AFFECT THIS PROPERTY. WOOD DECK w '•O 5122CONCRETE
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w <y PR*LINE SURVEYING,LTD. p�y�I�{7�.
P.O.Bo.924 Phone:(817)276-1148
Mington,Teas 76004 Fa.:(817)276-1147 DRAWN BY: UM DATE:02—11—09
SURVEY ONLY VALID WITH ORIGINAL SIGNINWRE
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EXHIBIT D
Certificate of Insurance
Tier II Easement Encroachment Agreement Page 14 of 14
PN21-00188 Revised 11/2020
TRAVELERS
Policy Summary
Homeowners Policy
Named Insured and Mailing Address Your Agency's Name and Address
RYAN MCCOLLUM MARSHAL INS ADVISORS LLC
ASHLEY MCCOLLUM 6300 RIDGLEA PL STE 600
6300 RIDGLEA PL#600 FORT WORTH, TX 76116
FORT WORTH,TX 76116-5732
Residence Premises
4245 RANIER CT
FORT WORTH,TX 76109-5028
Mortgagee Name and Address
1. TRUIST BANK 2. INTERNATIONAL BANK OF COMMERCE
ISAOA/ATIMA ISAOA ATTN: MORTGAGE SERVICING
PO BOX 7952 8998 RESEARCH BLVD
SPRINGFIELD,OH 45501 AUSTIN,TX 78758
LOAN NUMBER: 3005553155 LOAN NUMBER: 80102942
Policy Informativro
Your Policy Number 609000227 633 1 For Policy Service 1.817.731,3771
Your Account Number 609000227 For Claim Service 1.800.252.4633
Your Insurer: TRAVELERS PERSONAL INSURANCE COMPANY
a subsidiary or affiliate of The Travelers Indemnity Company
One Tower Square, Hartford, CT 06183
The policy period is from April 30, 2021 at 12:01 A.M. STANDARD TIME to April 30, 2022 at 12:01 A.M.
STANDARD TIME at the residence premises.
$3,228.00
This is not a bill.You will be billed separately for this transaction.
Discounts
The following discounts reduced your premium:
Multi-Policy Early Quote Loss Free
Good Payer Fire Protective Device
Savings Reflected in Your Total Premium: $1,659.00
Coverages and Limits of Liability
Property Coverage Section Limit
Coverage A—Dwelling $582,200
Coverage B—Other Structures $58,220
Coverage C—Personal Property $436,650
Coverage D—Loss of Use $116,440
PL-50355 TX(05-17) Page D-1
479/ODLN02
TRAVELERS
Liability Coverage Section
Coverage E—Personal Liability-Bodily Injury and Property Damage(each occurrence) $500,000
Coverage F—Medical Payments to Others (each person) $10,000
Deductibles
Peril Deductible Deductible
Property Coverage Deductible(All Other Perils) $1,000
Windstorm or Hail Deductible 1% of Coverage A-Dwelling Limit $5,822
Equipment Breakdown Deductible $500
Buried Utility Lines Deductible $500
In case of loss under the Property Coverage Section,only that part of the loss over
the applicable deductible will be paid(up to the coverage limit that applies).
Special Limits and Additional Coverages The limit shown for each of the
Coverage Level: Travelers Protect® Special Limits of Liability and Additional Coverages
is the total limit for each loss in that category.
Personal Property—Special Limits of Liability Limit
a. Money, bank notes, coins, stored value cards $250
b. Securities, accounts, passports,tickets, stamps $1,500
c. Comic books and trading cards $1,000
d. Collectibles,figurines, glassware, marble, porcelains, statuary $1,000
e. Theft of jewelry, watches, precious stone $1,500
f. Theft of furs $1,500
g. Theft of silverware, goldware, pewterware $1,500
h. Theft of firearms and related equipment $1,500
i. Theft of tools and their accessories $1,500
j. Theft of rugs, tapestries and wall hangings $1,500
k. Business property on the residence premises $3,000
I. Business property away from the residence premises $1,500
m. Trailers or semitrailers not used with watercraft $1,500
n. Motor vehicle parts or equipment not attached to motor vehicle $500
o. Electronic apparatus while in or upon a motor vehicle or watercraft $1,500
The Special Limits of Liability do not increase your Coverage C—Personal Property Limit.
Property—Additional Coverages Limit
Debris Removal (Additional %of damaged covered property limit) 5%
Tree Removal Per Tree$500 Per Loss $1,000
Trees, Shrubs and Other Plants Per Tree$500 Per Loss $29,110
(5% of Coverage A- Dwelling Limit)
Fire Department Service Charge $500
Credit Card, Fund Transfer, Forgery and Counterfeit Money $1,000
Loss Assessment $1,000
Landlord Furnishings $2,500
PL-50355 TX(05-17) Page D-2
479/ODLN02
TRAVELERS ]
Named Insured RYAN MCCOLLUM Policy Number 609000227 633 1
ASHLEY MCCOLLUM
Policy Period April 30,2021 to April 30,2022 Issued On Date December 14,2021
Property—Additional Coverages (continued) Limit
Ordinance or Law(10% of Coverage A- Dwelling Limit) $58,220
Personal Records and Data Replacement $1,500
Limited Fungi or Other Microbes Remediation $5,000
The applicable policy deductible applies unless otherwise noted.
Liability—Additional Coverages Limit
Damage to Property of Others $1,000
Loss Assessment $1,000
Please review your policy for other Personal Property Special Limits of Liability and Additional Coverages that may apply.
Optional Coverages and Packages
Optional Coverages Endorsement Limit Premium
Personal Injury Coverage HQ-082 TX (02-19) $16.00
Personal Property Replacement Cost Loss Settlement HQ-290 CW(05-17) Included*
Windstorm or Hail Percentage Deductible HQ-312 CW(05-17) Included*
Additional Replacement Cost Protection Coverage HQ-420 CW(11-18) $291,100 Included*
50%of Coverage A- Dwelling Limit
Replacement Cost Loss Settlement for Certain Non-Building HQ-443 CW(11-18) $63.00
Structures on the Residence Premises
Foundation Coverage HQ-468 TX (05-17) Included*
Loss Forgiveness Included*
Optional Packages Endorsement Limit Premium
Enhanced Water Package Included*
Water Back Up and Sump Discharge or Overflow Coverage HQ-208 CW(08-18) $582,200
Limited Hidden Water or Steam Seepage or Leakage HQ-209 CW(08-18) $582,200
Coverage
Roof and Siding Matching Package Included*
Matching of Undamaged Roof Surfacing Additional Coverage HQ-700 CW(05-18) $20,000
Matching of Undamaged Siding Coverage HQ-701 CW(05-18) $20,000
Buried Utility Lines and Equipment Breakdown Package $55.00
Equipment Breakdown Coverage HQ-855 CW(05-17) $50,000
Buried Utility Lines Coverage HQ-856 CW(02-19) $20,000
*Note:The additional cost or premium reduction for any optional coverage or package
shown as`Included"is contained in the Total Policy Premium Amount.
Required Forms and Endorsements Included in Your Policy, Form: 633
Policy Quick Reference HQ-T77 CW H2 (05-17)
Agreement, Definitions&Policy Conditions HQ-D77 CW(05-17)
Property Coverage Section HQ-P03 CW(05-17)
Liability Coverage Section HQ-L77 CW(05-17)
Signature Page HQ-S99 CW(05-17)
PL-50355 TX(05-17) Page D-3
479/ODLN02
TRAVELERS
Required Forms and Endorsements Included in Your Policy: (Continued) Form: 633
Special Provisions-Texas HQ-300 TX(05-17)
Additional Benefits HQ-860 CW(08-18)
The Declarations along with the Optional Coverages,Optional Packages and Required Forms and
Endorsements listed above form your Homeowners Insurance Policy.
Please keep these documents for reference.
Information About Your Property
There are many factors that determine the premium on your policy, some of which are displayed below. If you
would like a policy review, please contact your agent or Travelers Representative.
#of Families: 1 Family Year Built: 1953 Construction Type: Frame
#of Stories: 1 Square Footage:3307 Siding Type: Brick/Masonry Veneer
#of Bathrooms: 2 Age of Roof:00 Roof Material Type: Architectural Shingle
Garage-Number of Cars:2 Garage Type:Attached Foundation Type: Slab
#of Employees: 00 Finished Basement: 00
Online Policy Summary as of December 14,2021
PL-50355 TX(05-17) Page D-4
479/ODLN02