HomeMy WebLinkAboutContract 60425Date Received:
11/07/2023
Time Received: 8:17 a.m.
Record Number: PN23-00095
City Secretary No.: 60425
PUBLIC PROPERTY EASEMENT ENCROACHMENT LICENSE AGREEMENT
TIER //
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 HCA Health Services of Texas,
Inc, a(n) a Delaware corporation ("Licensee"), acting by and through its duly authorized
Vice President.
RECITALS
WHEREAS, Licensee is the owner of the real property located at 8500 North
Freeway, Fort Worth, Texas 76177 ("Property"), being more particular described as,
being a tract of land situated in the William Mc Cowen Survey, Abstract Number 999, as
recorded in Deed Records, by Instrument Number D203047768, in Tarrant County,
Texas, and;
WHEREAS, the City owns a water easement (the "Public Property") adjacent to
the Property, recorded in the deed records of Tarrant County by instrument number
D223168009 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 "A," but only to the extent shown thereon, for the purpose of constructing,
installing, and maintaining a private sewer (the "Encroachment"). Upon completion of
the Encroachment, Licensee agrees to be responsible for maintaining the Encroachment
Tier II Easement Encroachment Agreement OFFICIAL RECORD Page 1 of 12
CITY SECRETARY Revised 12/2022
FT. WORTH, TX
within the Public Property. Licensee shall not expand or otherwise cause the
Encroachment to further infringe in or on the Public Property beyond what is specifically
described in Exhibit "A."
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
Tier II Easement Encroachment Agreement Page 2 of 12
Revised 12/2022
the Water Department, the Director of the Development Services Department or their
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 Nine Hundred Dollars ($900.00).
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.
9.
Tier II Easement Encroachment Agreement Page 3 of 12
Revised 12/2022
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
Certificate of Insurance naming City as certificate holder 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 "A."
The amounts of such insurance shall be not less than
$1,000,000
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 "B" 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 12
Revised 12/2022
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.
Tier II Easement Encroachment Agreement Page 5 of 12
Revised 12/2022
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.
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
Tier II Easement Encroachment Agreement Page 6 of 12
Revised 12/2022
[SIGNATURES APPEAR ON FOLLOWING PAGE]
Tier II Easement Encroachment Agreement Page 7 of 12
Revised 12/2022
City: Licensee:
CITY OF FORT WORTH HCA Health Services of Texas, Inc.
a Texas orporatio
By: DJ Harrell (Nov 6, 2023 15:09 CST) By
D.J. Harrell, Director of the Name: Nicholas L. Paul
Development Services Department Title: Vice President
Date: Nov 6, 2023 Date: / — �� 3
ATTEST
Jannette Goodall,
City Secretary
Date: Nov 7, 2023
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Approved As To Form and Legality
Jeremy Anato-Mensah
Assistant City Attorney
Date: Nov 6, 2023
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.
-, J,n
Rebecca Diane Owen (Nov 6, 202310:02 CST)
Date: Nov 6, 2023
Rebecca Owen
Development Services
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Tier II Easement Encroachment Agreement Page 8 of 12
Revised 12/2022
111L3lWW 1!BLI1t1*0NS"A 1108LI1:4K:7 ltlNOki D111►1A"'
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 6th day of
November , 2023
o,�pRY Pve/ KATHLEEN BRADFORD ,
z Notary Public
* * STATE OF TEXAS
NT GV P Notary I.D. 12197197
9�oF My Comm. Exp. Apr. 12, 2027 '
Notary Public in and for the State of Texas
After recording return to:
Development Services Department
Development Coordination Office
200 Texas Street
Fort Worth, Texas 76102
Tier II Easement Encroachment Agreement Page 9 of 12
Revised 12/2022
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
Tennessee , on this day personally appeared Nicholas L. Paul, Vice President (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 deed of HCA Health Services of Texas, Inc., a Texas
corporation (entity type), and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of October,
2023
Notary Public in and for the
State of Tennessee
Tier II Easement Encroachment Agreement
Page 10 of 12
Revised 12/2022
EXHIBIT A
Depiction and description of the Encroachment
Tier II Easement Encroachment Agreement Page 11 of 12
Revised 12/2022
FORTWORTH.
www.fortworthtexas.gov
DECISION LETTER OF THE CITY OF FORT WORTH PLAN
COMMISSION
IPRC22-0180R5
This letter serves as official notice under Texas Local Government Code Section
212.001, et. seq., that your CONSTRUCTION PLANS for IPRC22-018OR5 were
reviewed on the 12th DAY OF JULY, 2023 and were APPROVED.
07/12/2023 C+ I : C.
Date Andrew Goodman, PE
On Behalf of.
Victor V. Tornero Jr., P.E.
Director's Designee for Construction
Plan Approval
Development Services Department, 200 Texas Street, Ft. Worth, TX 76102, (817) 392-7830
(INST. NO. D221371174) 1/2—INCH IRON CD=374.17'
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DEVELOPED BY:
HCA HEALTH SERVICES OF TEXAS
RYAN MCVEY, CONSTRUCTION MANAGER
2545 PARK PLAZA, NASHVILLE, TN 37203
(615) 344-2339
HCA BEHAVIORAL HEALTH HOSPITAL
VICINITY MAP EXHIBIT
CITY PROJECT #104380
LOCATED IN THE CITY OF FORT WORTH, TEXAS
AND BEING OUT OF THE WILLLW MCCOWEN SURVEY,
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ENCROACHMENT
AGREEMENT
PART OF HCA HEALTH SERVICES OF TEXAS, INC.
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
PAGE 2 OF 2
EXHIBIT "A"
EASEMENT ENCROACHMENT NO. 1
Part of Lot 4 HCA Health Services Addition
William McCowen Survey, Abstract No. 999
City of Fort Worth, Tarrant County, Texas
DESCRIPTION, of a 150 square foot (0.003 acre) tract of land situated in the William McCowen Survey,
Abstract No. 999, City of Fort Worth, Tarrant County, Texas; said tract being part of Lot 4, HCA Health Services
Addition, an addition to the City of Fort Worth according to the plat recorded in D223168009 of the Official
Public Records of Tarrant County, Texas; said tract also being part of that tract of land described in Special
Warranty Deed to HCA Health Services of Texas, Inc. recorded in Volume 16373, Page 418 in the Deed records
of Tarrant County, Texas; said 150 square foot (0.003 acre) tract being more particularly described as follows
(bearing System for this survey is based on the Texas Coordinate System of 1983 (2011 adjustment), North
Central Zone 4202, based on observations made on December 12, 2021 with a combined scale factor of
1.0012);
COMMENCING, at a 1/2-inch iron rod with "PACHECO KOCH" cap found for the northeast corner of said HCA
Health Services of Texas, Inc. tract in the south right-of-way line of Alliance Town Center (a variable width right-
of-way) an addition to the City of Fort Worth according to the plats recorded in Instrument No. D220286814 and
D209119495 of the Official Public Records of Tarrant County, Texas;
THENCE, South 64 degrees, 01 minutes, 37 seconds West, along said south line of Alliance Town
Center and the north line of said HCA Health Services of Texas, Inc. tract, a distance of 77.52 feet to
the northeast corner of a future 15-foot wide water easement; from said point a 1/2-inch iron rod with
"PACHECO KOCH" cap found for an angle point in said north line of HCA Health Services of Texas,
Inc. tract bears South 64 degrees, 01 minutes, 37 seconds West, a distance of 532.58 feet;
THENCE, South 25 degrees, 58 minutes, 23 seconds East, departing said south line of Alliance Town
Center and the north line of said HCA Health Services of Texas, Inc. tract and along the east line of
said future 15-foot wide water easement, a distance of 14.16 feet to the POINT OF BEGINNING;
THENCE, South 25 degrees, 58 minutes, 23 seconds East, continuing along said east line of future 15-foot
wide water easement, a distance of 10.00 feet to a point for corner;
THENCE, South 64 degrees, 01 minutes, 37 seconds West, departing said east line of future 15-foot wide water
easement, a distance of 15.00 feet to a point for corner in the west line of said future 15-foot wide water
easement;
THENCE, North 25 degrees, 58 minutes, 23 seconds West, along said west line of future 15-foot wide water
easement, a distance of 10.00 feet to a point for corner;
THENCE, North 64 degrees, 01 minutes, 37 seconds East, departing said west line of future 15-foot wide water
easement, a distance of 15.00 feet to the POINT OF BEGINNING;
CONTAINING: 150 square feet or 0.003 acres of land, more or less.
(A survey plat of even survey date herewith accompanies this description.)
The undersigned, Registered Professional Land Surveyor, hereby certifies that the foregoing description
accurately sets out the metes and bounds of the easement encroachment tract described.
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DUSTIN C. PUSIEJOVSKY
Dustin C. Pustejovsky Date
Registered Professional Land Surveyor No. 6690
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5202-21.747EX4.doc
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The undersigned, Registered Professional Land Q��:••�T••TFf
Surveyor, hereby certifies that this plat of survey
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Y Y P Y �,; Q �Q-, o •�c�
accurately sets out the metes and bounds of �(
the easement encroachment tract described. DUSTINC,•PUSTEJOVSKY
••6690 •�
9:9pF a -A
tiREss�°�
-2Q?3-09-19 s U R,4
Dustin C. Pustejovsky Date
Registered Professional TX REG. ENGINEERING FIRM F-469
Land Surveyor No. 6690
TX REG. SURVEYING FIRM LS-10008001
Pacheco Koch 1 4060 BRYANT IRVIN ROAD
J4 FORT WORTH, TX 76109
a Westwood company 817.412.7155
DRAWN BY I CHECKED BY SCALE DATE JOB NUMBER
MMJ DCP 1 "=20' FEB. 2023 1 5202-21.747
1. A metes and bounds description of even
survey date herewith accompanies this plat
of survey.
2. Bearing system for this survey is based on a
bearing of 1983 (2011 adjustment), North
Central Zone 4202, based on observations
made on December 12th, 2021 with a
combined scale factor of 1.00012.
EASEMENT
ENCROACHMENT
NO. 1
PART OF LOT 4, HCA HEALTH SERVICES ADDITION
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
PAGE 2 OF 2
EXHIBIT "A"
EASEMENT ENCROACHMENT NO. 2
Part of Lot 4, HCA Health Services Addition
William McCowen Survey, Abstract No. 999
City of Fort Worth, Tarrant County, Texas
DESCRIPTION, of a 150 square foot (0.003 acre) tract of land situated in the William McCowen Survey,
Abstract No. 999, City of Fort Worth, Tarrant County, Texas; said tract being part of Lot 4, HCA Health Services
Addition, an addition to the City of Fort Worth according to the plat recorded in D223168009 of the Official
Public Records of Tarrant County, Texas; said tract also being part of that tract of land described in Special
Warranty Deed to HCA Health Services of Texas, Inc. recorded in Volume 16373, Page 418 in the Deed records
of Tarrant County, Texas; said 150 square foot (0.003 acre) tract being more particularly described as follows
(bearing System for this survey is based on the Texas Coordinate System of 1983 (2011 adjustment), North
Central Zone 4202, based on observations made on December 12, 2021 with a combined scale factor of
1.0012);
COMMENCING, at a 1/2-inch iron rod with "PACHECO KOCH" cap found for the northeast corner of said HCA
Health Services of Texas, Inc. tract in the south right-of-way line of Alliance Town Center (a variable width right-
of-way) an addition to the City of Fort Worth according to the plats recorded in Instrument No. D220286814 and
D209119495 of the Official Public Records of Tarrant County, Texas;
THENCE, South 64 degrees, 01 minutes, 37 seconds West, along said south line of Alliance Town
Center and the north line of said HCA Health Services of Texas, Inc. tract, a distance of 77.52 feet to
the northeast corner of a future 15-foot wide water easement; from said point, a 1/2-inch iron rod with
"PACHECO KOCH" cap found for an angle point in said north line of HCA Health Services of Texas,
Inc, tract bears South 64 degrees, 01 minutes, 37 seconds West, a distance of 532.58 feet;
THENCE, South 25 degrees, 58 minutes, 23 seconds East, departing said south line of Alliance Town
Center and the north line of said HCA Health Services of Texas, Inc. tract and along the east line of
said future 15-foot wide water easement, a distance of 128.51 feet to an angle point;
THENCE, Due South, continuing along said east line of future 15-foot wide water easement, a distance
of 307.41 feet to the POINT OF BEGINNING;
THENCE, Due South, continuing along said east line of future 15-foot wide water easement, a distance of 10.00
feet to a point for corner;
THENCE, Due West, departing said east line of future 15-foot wide water easement, a distance of 15.00 feet
to a point for corner in the west line of said future 15-foot wide water easement;
THENCE, Due North, along said west line of future 15-foot wide water easement, a distance of 10.00 feet to a
point for corner;
THENCE, Due East, departing said west line of future 15-foot wide water easement, a distance of 15.00 feet to
the POINT OF BEGINNING;
CONTAINING: 150 square feet or 0.003 acres of land, more or less.
(A survey plat of even survey date herewith accompanies this description.)
The undersigned, Registered Professional Land Surveyor, hereby certifies that the foregoing description
accurately sets out the metes and bounds of the easement encroachment tract described.
2023-09-19
Dustin C. Pustejovsky Date
Registered Professional Land Surveyor No. 6690
Westwood Professional Services, Inc.
4060 Bryant Irvin Road, Fort Worth, TX 76109
(817) 412-7155
TX Reg. Surveying Firm LS-10008001
5202-21.747EX5_Legal.doc
5202-21.747EX5.dwg GAL
%OF
ST TF
bill Ii *E,PUSTEJOVSKY
q 90 6690
.yo.lesS%11�N
SUiI
PAGE 1 OF 2
LEGEND [ENNO 0 0Ir W o W
- - - - PROPERTY LINE LSIn�Ull
EASEMENT LINE O 10 20 40
O POINT FOR CORNER
(UNLESS OTHERWISE NOTED)
(C.M.) - CONTROLLING MONUMENT GRAPHIC SCALE IN FEET
IRF - 1/2-INCH IRON ROD WITH
"PACHECO KOCH" CAP FOUND / O P. O71RF
C.
P■ O. /B�� POINT OF BEGINNING
VIn
P. O■ / POINT OF COMMENCING .tic
P S, A� ILn
�/� �22 1�g��2 � z
a 13 No Zog �/ 0 w
< Lio
LOT 4 0- z
�C HCA HEALTH SERVICES - I_
\ ADDITION
v1 Q z
(INST. NO. D223168009) .�
1 HCA HEALTH SERVICES
1.\ OF TEXAS, INC.
10
(VOL. 16373, PG. 418)
3 IRF \ \ \ I
0 \
x (C.M.) \\ 1
15—FOOT WIDE
N WATER EASEMENT
o (INST. NO. D223168009)
n 26' PUBLIC I C'n
ACCESS EASMENT L p =
N (INST. NO. D219038787)In
I o
DUE EAST
15.00' IN P■ ��B■ EASEMENT
ENCROACHMENT NO. 2
9 LOT 4 DUE NORTH 150 SF
HCA HEALTH SERVICES 10.00' (0.003 ACRES)
ADDITION DUE SOUTH
N (INST. NO. D223168009) DUE WEST 10.00'
a
N 15.00'
NOTES:
aThe undersigned, Registered Professional Land OF
i Surveyor, hereby certifies that this plat of survey P-,t'�SrETFi 1. A metes and bounds description of even
accurately sets out the metes and bounds of �;Q�G RFo 9J, survey date herewith accompanies this plat of
the easement encroachment tract described. survey.
DUSTIN.C. PUSTEJOVSKY 2. Bearing system for this survey is based on a
a ; 9 6690 bearing of 1983 (2011 adjustment), North
q'•.o,�B `off: o Central Zone 4202, based on observations
2023-09-19 made on December 12, 2021 with a combined
Dustin C. Pustejovsky Date S U Ft scale factor of 1.00012.
N Registered Professional
C Land Surveyor No. 6690 TX REG. ENGINEERING FIRM F-469 EASEMENT
TX REG. SURVEYING FIRM LS-10008001 ENCROACHMENT
Pacheco Koch 1 4060 BRYANT IRVIN ROAD NO.
x FORT WORTH, TX 76109 L
o a Westwod company 817.412.WestwoodPART OF LOT 4, HCA HEALTH SERVICES ADDITION
DRAWN BY CHECKED BY SCALE DATE JOB NUMBER WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
GAL I DCP I 1 "=20' I FEB. 2023 I 5202-21.747 CITY OF FORT WORTH, AGE 2AROF 2
RANT COUNTY, TEXAS
o ■
EXHIBIT "A"
EASEMENT ENCROACHMENT NO. 3
Part of Lot 4, HCA Health Services Addition
William McCowen Survey, Abstract No. 999
City of Fort Worth, Tarrant County, Texas
DESCRIPTION, of a 150 square foot (0.003 acre) tract of land situated in the William McCowen Survey,
Abstract No. 999, City of Fort Worth, Tarrant County, Texas; said tract being part of Lot 4, HCA Health Services
Addition, an addition to the City of Fort Worth according to the plat recorded in D223168009 of the Official
Public Records of Tarrant County, Texas; said tract also being part of that tract of land described in Special
Warranty Deed to HCA Health Services of Texas, Inc. recorded in Volume 16373, Page 418 in the Deed records
of Tarrant County, Texas; said 150 square foot (0.003 acre) tract being more particularly described as follows
(bearing System for this survey is based on the Texas Coordinate System of 1983 (2011 adjustment), North
Central Zone 4202, based on observations made on December 12, 2021 with a combined scale factor of
1.0012);
COMMENCING, at a 1/2-inch iron rod with "PACHECO KOCH" cap found for the northeast corner of said HCA
Health Services of Texas, Inc, tract in the south right-of-way line of Alliance Town Center (a variable width right-
of-way) an addition to the City of Fort Worth according to the plats recorded in Instrument No. D220286814 and
D209119495 of the Official Public Records of Tarrant County, Texas;
THENCE, South 64 degrees, 01 minutes, 37 seconds West, along said south line of Alliance Town
Center and the north line of said HCA Health Services of Texas, Inc. tract, a distance of 77.52 feet to
the northeast corner of a future 15-foot wide water easement; from said point, a 1/2-inch iron rod with
"PACHECO KOCH" cap found for an angle point in said north line of HCA Health Services of Texas,
Inc. tract bears South 64 degrees, 01 minutes, 37 seconds West, a distance of 532.58 feet;
THENCE, South 25 degrees, 58 minutes, 23 seconds East, departing said south line of Alliance Town
Center and the north line of said HCA Health Services of Texas, Inc. tract and along the east line of
said future 15-foot wide water easement, a distance of 128.51 feet to an angle point;
THENCE, Due South, continuing along said east line of future 15-foot wide water easement, a distance
of 412.05 feet to the POINT OF BEGINNING;
THENCE, Due South, continuing along said east line of future 15-foot wide water easement, a distance of 10.00
feet to a point for corner;
THENCE, Due West, departing said east line of future 15-foot wide water easement, a distance of 15.00 feet
to a point for corner in the west line of said future 15-foot wide water easement;
THENCE, Due North, along said west line of future 15-foot wide water easement, a distance of 10.00 feet to a
point for corner;
THENCE, Due East, departing said west line of future 15-foot wide water easement, a distance of 15.00 feet to
the POINT OF BEGINNING;
CONTAINING: 150 square feet or 0.003 acres of land, more or less.
(A survey plat of even survey date herewith accompanies this description.)
The undersigned, Registered Professional Land Surveyor, hereby certifies that the foregoing description
accurately sets out the metes and bounds of the easement encroachment tract described.
2023-09-19
Dustin C. Pustejovsky Date
Registered Professional Land Surveyor No. 6690
Westwood Professional Services, Inc.
4060 Bryant Irvin Road, Fort Worth, TX 76109
(817) 412-7155
TX Reg. Surveying Firm LS-10008001
5202-21.747 EX6_Legal. doc
5202-21.747EX6.dwg GAL
PAGE 1 OF 2
LEGEND
— — — PROPERTY LINE
EASEMENT LINE O 10 20 40
0 POINT FOR CORNER
(UNLESS OTHERWISE NOTED)
fltA
(C.M.) - CONTROLLING MONUMENT GRAPHIC SCALE IN FEET O
IRF - INCH IRON ROD WITH / P. O■ C.
"PACHACHECO KOCH" CAP FOUND //►_
PO B- POINT OF BEGINNING N�
PO C- POINT OF COMMENCING 1 681 i4) ,r,
i
IRF
(C.M.)
`C/ TI 5i I R F
00 709 1152 N
a. ��5,' 00.0 v�/ I O w N
' ( S� �'I_- I � � o
Z ��N s 6��� HCA HEALTH SERVICES <> o
/ ADDITION z z
(INST. NO. D223168009) J
HCA HEALTH SERVICES Q Z
OF TEXAS, INC.
(VOL. 16373, PG. 418)
26' PUBLIC
ACCESS EASMENT )
/\ c^ (INST. NO. D219038787
15-FOOT WIDE
WATER EASEMENT
(INST. NO. D223168009)
x
� 1n
00
N N
W
D
DUE EAST II
15.00'
LOT 4 DUE NORTH
HCA HEALTH SERVICES 10.00'
ADDITION
(INST. NO. D223168009) DUErW:ST
15.00'
i I
The undersigned, Registered Professional Land
Surveyor, hereby certifies that this plat of survey OF.,lF
accurately sets out the metes and bounds of
the easement encroachment tract described. CO. CxS7E � AFC qJ,
EASEMENT
OMB■ ENCROACHMENT NO. 3
150 SF
(0.003 ACRES)
DUE SOUTH
10.00'
I
NOTES:
1. A metes and bounds description of even
survey date herewith accompanies this plat of
survey.
U01IN,U. PUSTEJOVSKY
..'
.6690 •.;•
2. Bearing system for this survey is based on a
a o
2023-09-19 q'-;OFfSs%o*'JO
bearing of 1983 (2011 adjustment), North
Central Zone 4202, based on observations
o Dustin C. Pustejovsky Date
��••BURN�
made on December 12, 2021 with a combined
M Registered Professional
scale factor of 1.00012.
Cq
04 Land Surveyor No. 6690 TX REG.
ENGINEERING FIRM F-469
EASEMENT
o
TX REG.
SURVEYING FIRM LS-10008001
ENCROACHMENT
Pacheco Koch
4060 BRYANT IRVIN ROAD
NO.
Y
FORT WORTH, TX 76109
En
oIN a W@StVMOOd company
817.412.7156
PART OF LOT 4, HCA HEALTH SERVICES ADDITION
WILLIAM MCCOWEN SURVEY, ABSTRACT N0. 999,
DRAWN BY CHECKED BY SCALE
DATE JOB NUMBER
CITY OF FORT WORTH, COUNTY, TEXAS
GAL I DCP I 1"=20' I FEB. 2023 I 5202-21.747
AGE 2ARORANT
F 2
o
�
EXHIBIT "A"
EASEMENT ENCROACHMENT NO.4
Part of Lot 4, HCA Health Services Addition
William McCowen Survey, Abstract No. 999
City of Fort Worth, Tarrant County, Texas
DESCRIPTION, of a 150 square foot (0.003 acre) tract of land situated in the William McCowen Survey,
Abstract No. 999, City of Fort Worth, Tarrant County, Texas; said tract being part of Lot 4, HCA Health Services
Addition, an addition to the City of Fort Worth according to the plat recorded in D223168009 of the Official
Public Records of Tarrant County, Texas; said tract also being part of that tract of land described in Special
Warranty Deed to HCA Health Services of Texas, Inc. recorded in Volume 16373, Page 418 in the Deed records
of Tarrant County, Texas; said 150 square foot (0.003 acre) tract being more particularly described as follows
(bearing System for this survey is based on the Texas Coordinate System of 1983 (2011 adjustment), North
Central Zone 4202, based on observations made on December 12, 2021 with a combined scale factor of
1.0012);
COMMENCING, at a 1/2-inch iron rod with "PACHECO KOCH" cap found for the northeast corner of said HCA
Health Services of Texas, Inc, tract in the south right-of-way line of Alliance Town Center (a variable width right-
of-way) an addition to the City of Fort Worth according to the plats recorded in Instrument No. D220286814 and
D209119495 of the Official Public Records of Tarrant County, Texas;
THENCE, South 64 degrees, 01 minutes, 37 seconds West, along said south line of Alliance Town
Center and the north line of said HCA Health Services of Texas, Inc. tract, a distance of 77.52 feet to
the northeast corner of a future 15-foot wide water easement; from said point, a 1/2-inch iron rod with
"PACHECO KOCH" cap found for an angle point in said north line of HCA Health Services of Texas,
Inc. tract bears South 64 degrees, 01 minutes, 37 seconds West, a distance of 532.58 feet;
THENCE, South 25 degrees, 58 minutes, 23 seconds East, departing said south line of Alliance Town
Center and the north line of said HCA Health Services of Texas, Inc. tract and along the east line of
said future 15-foot wide water easement, a distance of 128.51 feet to an angle point;
THENCE, Due South, continuing along said east line of future 15-foot wide water easement, a distance
of 614.81 feet to the POINT OF BEGINNING;
THENCE, Due South, continuing along said east line of future 15-foot wide water easement, a distance of 10.00
feet to a point for corner;
THENCE, Due West, departing said east line of future 15-foot wide' water easement, a distance of 15.00 feet
to a point for corner in the west line of said future 15-foot wide water easement;
THENCE, Due North, along said west line of future 15-foot wide water easement, a distance of 10.00 feet to a
point for corner;
THENCE, Due East, departing said west line of future 15-foot wide water easement, a distance of 15.00 feet to
the POINT OF BEGINNING;
CONTAINING: 150 square feet or 0.003 acres of land, more or less.
(A survey plat of even survey date herewith accompanies this description.)
The undersigned, Registered Professional Land Surveyor, hereby certifies that the foregoing description
accurately sets out the metes and bounds of the easement encroachment tract described.
�..� 2023-09-19
Dustin C. Pustejovsky Date
Registered Professional Land Surveyor No. 6690
Westwood Professional Services, Inc.
4060 Bryant Irvin Road, Fort Worth, TX 76109
(817) 412-7155
TX Reg. Surveying Firm LS-10008001
5202-21.747 EX7_Legal. doc
5202-21.747EX7.dwg GAL
OF
DUSTIN�C.�PUSTEJOVSKY
6690
PAGE 1 OF 2
LEGEND
— - - PROPERTY LINE
EASEMENT LINE
O POINT FOR CORNER
(UNLESS OTHERWISE NOTED)
(C.M.) - CONTROLLING MONUMENT
IRF - 1/2-INCH IRON ROD WITH
"PACHECO KOCH" CAP FOUND
P.O.B: POINT OF BEGINNING
P. O. C. POINT OF COMMENCING
0 10 20 40
GRAPHIC SCALE IN FEET ONNtA
�P N� 868�
Z0 4(35) .
r�
v
AO.C.
Ln
711RF CL
LO
I-
?3 1051. NO' 0 �" LOT 4
< <�NS�' HCA HEALTH SERVICES
/ ADDITION
(INST. NO. D223168009)
HCA HEALTH SERVICES
s OF TEXAS, INC.
s \ (VOL. 16373, PG. 418)
C, 6 �SZSa� \ 26' PUBLIC
\ \�-u: ACCESS EASMENT /\ (INST. NO. D219038787)
IRF �\
(C.M.) \\ 1
15—FOOT WIDE
WATER EASEMENT
(INST. NO. D223168009) V) °�°
DUE EASTI
15.00'
LOT 4 DUE NORTH
HCA HEALTH SERVICES 10.00'
ADDITION
(INST. NO. D223168009) DUE WEST
15.00'
The undersigned, Registered Professional Land
Surveyor, hereby certifies that this plat of survey
accurately sets out the metes and bounds of
the easement encroachment tract described.
Dustin C. Pustejovsky
N Registered Professional
N Land Surveyor No. 6690
o
2023-09-19
Date
DUS1W .,PUSTEJOVSKY
.......................
� ..P� :.
4t 6690
9 �FfSS%�� J(SUR
F- N
0 W
N
Q�
��o z
J ~
Q Cn
Z
EASEMENT
O.B. ENCROACHMENT NO. 4
150 SF
(0.003 ACRES)
I
DUE SOUTH
10.00'
I
NOTES:
TX REG. ENGINEERING FIRM F-469
TX REG. SURVEYING FIRM LS-10008001
Pacheco Koch 1 4060 BRYANT IRVIN ROAD
Y FORT WORTH, TX 76109
o IN a Westwood company 817.412.7155
DRAWN BY CHECKED BY SCALE DATE JOB NUMBER
D
o GAL DCP 1"=20' FEB. 2023 5202-21.747
1. A metes and bounds description of even
survey date herewith accompanies this plat of
survey.
2. Bearing system for this survey is based on a
bearing of 1983 (2011 adjustment), North
Central Zone 4202, based on observations
made on December 12, 2021 with a combined
scale factor of 1.00012.
EASEMENT
ENCROACHMENT
NO. 4
PART OF LOT 4, HCA HEALTH SERVICES ADDITION
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
PAGE 2 OF 2
EXHIBIT "A"
EASEMENT ENCROACHMENT NO. 5
Part of Lot 4, HCA Health Services Addition
William McCowen Survey, Abstract No. 999
City of Fort Worth, Tarrant County, Texas
DESCRIPTION, of a 150 square foot (0.003 acre) tract of land situated in the William McCowen Survey,
Abstract No. 999, City of Fort Worth, Tarrant County, Texas; said tract being part of Lot 4, HCA Health
Services Addition, an addition to the City of Fort Worth according to the plat recorded in D223168009 of
the Official Public Records of Tarrant County, Texas; said tract also being part of that tract of land described
in Special Warranty Deed to HCA Health Services of Texas, Inc. recorded in Volume 16373, Page 418 in
the Deed records of Tarrant County, Texas; said 150 square foot (0.003 acre) tract being more particularly
described as follows (bearing System for this survey is based on the Texas Coordinate System of 1983
(2011 adjustment), North Central Zone 4202, based on observations made on December 12, 2021 with a
combined scale factor of 1.0012);
COMMENCING, at a 5/8-inch iron rod found for an inner ell corner of Lot 1 OR, HCA Health Service Addition,
an addition to the City of Fort Worth according to the plat recorded in Instrument No. D219046637 of the
Official Public Records of Tarrant County, Texas;
THENCE, Due West, along the west line of said Lot 1 OR, at a distance of 40.06 feet passing a 5/8-
inch iron rod with "KHA" cap found for the most westerly northwest corner of said Lot 1 OR, and the
northeast corner of Lot 1 R-1 R, HCA Health Services Addition, an addition to the City of Fort Worth
according to the plat recorded in Instrument No. D214123625 of said Official Public Records,
continuing in all a total distance of 54.06 feet to a point for the southeast corner of a future 15-foot
wide water easement; from said point a 1/2-inch iron rod with "PACHECO KOCH" cap found for
the northwest corner of said Lot 1 R-1 R bears Due West, a distance of 1,415.33 feet;
THENCE, Due North, departing the north line of said Lot 1 R-1 R and along the east line of said
future 15-foot wide water easement, a distance of 9.41 feet to the POINT OF BEGINNING;
THENCE, Due West, departing said east line of the future 15-foot wide water easement, a distance of 15.00
feet to a point for corner in the west line of said future 15-foot wide water easement;
THENCE, Due North, along said west line of the future 15-foot wide water easement, a distance of 10.00
feet to a point for corner;
THENCE, Due East, departing said west line of the future 15-foot wide water easement, a distance of 15.00
feet to a point for corner in said east line of the future 15-foot wide water easement;
THENCE, Due South, along the east line of said future 15-foot wide water easement a distance of 10.00
feet to the POINT OF BEGINNING;
CONTAINING: 150 square feet or 0.003 acres of land, more or less.
(A survey plat of even survey date herewith accompanies this description.)
The undersigned, Registered Professional Land Surveyor, hereby certifies that the foregoing description
accurately sets out the metes and bounds of the easement encroachment tract described.
AF +q'P
5 �G,
Dom- C 2023-09-19
W
..:...... .....::.,
Dustin C. Pustejovsky Date
DUSTIN C. PUSTEJOVSKY
��6690 ��
Registered Professional Land Surveyor No. 6690
;A ,:�
Westwood Professional Services, Inc.
9tip'�fss�o?moo
4060 Bryant Irvin Road, Fort Worth, TX 76109
SUii��
(817) 412-7155
TX Reg. Surveying Firm LS-10008001
5202-21.747EX 10_Legal.doc
5202-21.747EX10.dwg MMJ
PAGE 1 OF 2
LEGEND
- - - PROPERTY LINE
EASEMENT LINE
O POINT FOR CORNER
(UNLESS OTHERWISE NOTED)
(C.M.) - CONTROLLING MONUMENT
IRF - 1/2-INCH IRON ROD WITH
"PACHECO KOCH" CAP FOUND
P.0.5: POINT OF BEGINNING
P. 0. CO- POINT OF COMMENCING
LEWU UO B 07 W
0 10 20 40
GRAPHIC SCALE IN FEET
v
26' PUBLIC ACCESS EASMENT
I
/
(INST. NO. D219038787)
/
LOT 4
J� I
HCA HEALTH SERVICES
ADDITION
I (INST. NO. D223168009) / �o�o�� 0P1
I HCA HEALTH SERVICES
OF TEXAS, INC. /
L
P� �� /
(VOL. 16373, PG. 418)
DUE EAST
/
EASEMENT
1
��o
ENCROACHMENT
15.00
NO. 5
DUE NORTH
150 SF
I 10.00'
DUE OUTH
(0.003 ACRES)
I
10.00
DUE WES
P. 01B.
P. 0. C.
IRF DUE WEST 1,415.33' 15•00
54.06'
— 4L
_ _
40.06'
5/8—INCH IRON
I
ROD FOUND
LOT 1 R-1 R
5/8—INCH
IRON ROD
HCA HEALTH SERVICES ADDITION
W/
"KHA" CAP FOUND (C.M.)
(INST. NO. D214123625) I
I
LOT 1OR
HCA HEALTH
SERVICES ADDITION
(INST.
NO. D219046637)
The undersigned, Registered Professional Land
~
Surveyor, hereby certifies that this plat of survey
,OF, TF
accurately sets out the metes and bounds of
�Q:•'G%STEq'•:fy
`?�
the easement encroachment tract described.
e� 0%(P
�PUSTEJOVSKY
DUSTIN� C.
•
9 yo 6690o�P o
;�,S Z 2023-09-19
Dustin C. Pustejovsky Date
SUR`I
N Registered Professional
N Land Surveyor No. 6690 TX REG. ENGINEERING
FIRM F-469
TX REG. SURVEYING FIRM LS-10008001
Pacheco Koch 4060 BRYANT IRVIN ROAD
Y FORT WORTH, TX 76109
o a W istwlood company 817.412.7155
N DRAWN BY CHECKED BY SCALE DATE JOB NUMBER
MMJ I DCP I 1"=20' JUNE 2023 5202-21.747
0
NOTES:
1. A metes and bounds description of even
survey date herewith accompanies this plat of
survey.
2. Bearing system for this survey is based on a
bearing of 1983 (2011 adjustment), North
Central Zone 4202, based on observations
made on December 12, 2021 with a combined
scale factor of 1.00012.
EASEMENT
ENCROACHMENT
NO. 5
PART OF LOT 4, HCA HEALTH SERVICES ADDITION
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
PAGE 2 OF 2
EMC ROQC HMEa4 HDA o PLAM AMD PG OFULE
0 20 40 80 120
GRAPHIC SCALE IN FEET
715
710
705
0 4 8 12
VERTICAL SCALE IN FEET
PROP. PRIVATE
8" SANITARY
SEWER LINE
Q PROP. PUBLIC
�— 12" WATER LINE
/ - 15' WATER FACILITY EASEMENT
(INST NO. D223144484)
- 26' PUBLIC ACCESS EASEMENT
(INST NO. D219038787)
LIMIT OF
ENCROACHMENT
EXISTIN 3 GRADE
FINISHEI) GRADE
PROP. PUBLIC
12" WAI R LINE
DROP. PRIVATE
ti SAVIIAKY
700 SEWED LINE
0+ 40
1 +00
TX REG. ENGINEERING FIRM F-11756
TX REG. SURVEYING FIRM LS-10074301
Westwood4060 FORT
W055H IRXI 6R0 AD
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DRAWN BY CHECKED BY SCALE DATE JOB NUMBER
a OA I MGZ I1"=40' V:1"=4'I 09/19/2023 I 5202-21.747
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710
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700
EASEMENT
ENCROACHMENT
NOA
PART OF HCA HEALTH SERVICES OF TEXAS, INC.
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
PAGE 2 OF 2
J
0 20 40 80 120
GRAPHIC SCALE IN FEET
PROP. PUBLIC
12" WATER LINE
15' WATER FACILITY EASEMENT —
(INST NO. D223144484)
LIMIT OF
720 ENCROACHMENT
0 4 8 12
VERTICAL SCALE IN FEET
PROP. PRIVATE
8" SANITARY
SEWER LINE
— 26' PUBLIC ACCESS EASEMENT
(INST NO. D219038787)
720
715 FINISHED GRADE � I I ---\ 715
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DRAWN BY CHECKED BY SCALE DATE JOB NUMBER
o OA I MGZ I1"=40' V:1"=4'I 09/19/2023 I 5202-21.747
EASEMENT
ENCROACHMENT
NO.2
PART OF HCA HEALTH SERVICES OF TEXAS, INC.
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
PAGE 2 OF 2
0 20 40 80 120
GRAPHIC SCALE IN FEET
PROP. PUBLIC _
12" WATER LINE
0 4 8 12
VERTICAL SCALE IN FEET
PROP. PRIVATE
8" SANITARY
SEWER LINE
IT __
15' WATER FACILITY EASEMENT - - 26' PUBLIC ACCESS EASEMENT
(INST NO D223144484) (INST NO. D219038787)
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EASEMENT
ENCROACHMENT
NO.3
PART OF HCA HEALTH SERVICES OF TEXAS, INC.
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
PAGE 2 OF 2
0 20 40 80 120 0 4 8 12
GRAPHIC SCALE IN FEET VERTICAL SCALE IN FEET
- 15' WATER FACILITY EASEMENT
(INST NO. D223144484)
PROP. PUBLIC
12" WATER LINE — — — -
PROP PRIVATE
8" SANITARY LIMIT OF — 26' PUBLIC ACCESS EASEMENT
SEWER LINE ENCROACHMENT (INST NO. D219038787)
4�
715 EXISTIN�fADE — 715
--7T
FINISHED 1ADE—\,".
710 710
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705 i 705
700 700
PROP. PRIVATE _
8" SANITARY
SEWER-1 INIF 697 T 697
7+50 8+00 8+50
TX REG. ENGINEERING FIRM F-11756
TX REG. SURVEYING FIRM LS-10074301
Westwood 4060 FORT
DR 1WORTH,
D 55H IRXI 6R ROAD
w
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DRAWN BY CHECKED BY SCALE DATE JOB NUMBER
o OA I MGZ I1"=40' V:1"=4'I 09/19/2023 I 5202-21.747
EASEMENT
ENCROACHMENT
NO.4
PART OF HCA HEALTH SERVICES OF TEXAS, INC.
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
PAGE 2 OF 2
W
a
0
0 20 40 80 120
GRAPHIC SCALE IN FEET
PROP. PUBLIC
12" WATER LINE
PROP. PRIVATE
8" SANITARY
SEWER LINE
715
710
705
0 4 8 12
VERTICAL SCALE IN FEET
- 15' WATER FACILITY EASEMENT
(INST NO. D223144484)
1,nx
- 26' PUBLIC ACCESS EASEMENT
I (INST NO. D219038787)
LIMIT OF '
ENCROACHMENT
EXISTING
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'
12" WATER
FINE
700
N
DROP. PRIVATE
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695
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9+50 10+00
TX REG. ENGINEERING FIRM F-11756
TX REG. SURVEYING FIRM LS-10074301
Westwood 80R1W0 55H,ITX1 6R OAD
DRAWN BY CHECKED BY SCALE DATE JOB NUMBER
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i[6MY%
715
710
705
700
695
694
EASEMENT
ENCROACHMENT
NO.5
PART OF HCA HEALTH SERVICES OF TEXAS, INC.
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
PAGE 2OF2
EXHIBIT B
Certificate of Insurance
Tier II Easement Encroachment Agreement Page 12 of 12
Revised 12/2022
Page 1 of 1
IRCI 13
Health Care
Indemnity, Inc.
This is to certify to:
(Name of Certificate Holder)
Health Care Indemnity, Inc.
2515 Park Plaza, Builiding 2-3E
Nashville, TN 37203
Phone: 615-344-5193
Fax: 855-775-0393
Email:Corp.Insurance@HCAHeaIthcare.com
The City of Fort Worth
200 Texas Street
Fort Worth, TX 76102
Certificate of Insurance
Date: 08/15/2023
COW: 116149-2023
that the described insurance coverages as provided by the indicated policy has been issued to:
Named Insured: HCA Healthcare, Inc. AND SUBSIDIARY ORGANIZATIONS
Address: EXISTING NOW OR HEREAFTER CREATED OR ACQUIRED
ONE PARK PLAZA
NASHVILLE, TN 37202-0550
The Policy identified below by a policy number is in force on the date of Certificate issuance. Insurance is afforded only with respect to those coverages for which
a specific limit of liability has been entered and is subject to all the terms of the Policy having reference thereto. This Certificate of Insurance neither affirmatively
nor negatively amends, extends or alters the coverage afforded under any policy identified herein. Coverage is excess of self-insurance. Such self-insurance is
adequately funded as verified by a Fellow of the American Society of Casualty Actuaries.
POLICY NO. I POLICY PERIOD
Effective: 1 /1 /2023
HCI-EX-10123-01 Expiration: 1 /1 /2024
TYPE OF INSURANCE I LIMITS OF LIABILITY
Comprehensive General Liability
• Occurrence Form
• Bodily Injury $1,000,000 Each and Every Occurrence
• Property Damage
• Products and Completed Operations $2,000,000 Aggregate
• Personal and Advertising Injury
Health Care Professional Liability $1,000,000 Each and Every Occurrence
Occurrence Form $2,000,000 Aggregate
SPECIAL CONDITIONS/OTHER COVERAGES:
The Named Insured Includes: HCA Health Services of Texas COID: 34372
Reference AGREEMENT FOR MAINTENANCE OF NON-STANDARD IMPROVEMENTS — MAINT23-006
Comprehensive General Liability coverage includes the City of Fort Worth, its employees, officers, officials, and agents as
Additional Insureds.
This insurance is primary with respect to Additional Insureds own insurance.
Named Insured waives it right of subrogation against the Additional Insured as required by Agreement MAINT23-006.
Named Insured will provide Certificate Holder with a minimum 30 day notice of cancellation/ 10 days in the event of
nonpayment of premium.
Cancellation: Should any of the above described policies be canceled before the expiration date thereof, the issuing company will endeavor to mail ninety days written
notice to the above named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company.
Authorized Signature
^
C H U B E3
LEAD SHEET
FOR:
WILLIS TOWERS WATSON
SOUTHEAST INC
RUN DATE: 08/17/2023
POLICY NUMBER: ISA H10761426
ID: Z02RIVM1
RUN BY: ACEINA\MARIVEO
PAGES OF THIS COPY: 0004
INSURED'S NAME
HCA Healthcare, Inc.
0
CHUBB
GENERAL PURPOSE ENDORSEMENT POLICY NUMBER: ISA H10761426
PRODUCER NUMBER: Z08448
ITEM ONE- POLICY INFORMATION
Named Insured: HCA Healthcare, Inc.
Address: One Park Plaza
Nashville TN 372036527
Policy Period: 01/01/2023 to 01/01/2024
This Endorsement Effective: 08/16/2023 12:01 a.m. standard time at the named insured's address stated above.
In -Term Policy Change Number: 107
ENDORSEMENT SUMMARY:
It is agreed effective 08/16/2023, the following endorsement is added to the policy:
Endorsement #108 ALL-32688 (01/11) Notice To Others Endorsement - Specific Parties
AUTHORIZED REPRESENTATIVE
DA-31<66 (08/11) Page 1 of 1
NOTICE TO OTHERS ENDORSEMENT - SPECIFIC PARTIES
Named Insured HCA Healthcare, Inc. Endorsement Number
108
Policy Symbol Policy Number Policy Period Effective Date of Endorsement
I SA H 10761426 01 /01 /2023 To 01 /01 /2024 08/16/2023
Issued By (Name of Insurance Company)
ACE American Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
A. If we cancel the Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than
nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic
or other form of notification as we determine, to the persons or organizations listed in the schedule set out below (the
"Schedule"). You or your representative must provide us with both the physical and e-mail address of such persons or
organizations, and we will utilize such e-mail address or physical address that you or your representative provided to
us on such Schedule.
B. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each
person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the
Policy.
C. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or
organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal
obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of
cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any
kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any
cancellation of the Policy.
D. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any
incorrect information that you or your representative provide to us. If you or your representative does not provide us
with the information necessary to complete the Schedule, we have no responsibility for taking any action under this
endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address
information with respect to a particular person or organization, then we shall have no responsibility for taking action
with regard to such person or entity under this endorsement.
E. We may arrange with your representative to send such notice in the event of any such cancellation.
F. You will cooperate with us in providing, or in causing your representative to provide, the e-mail address and physical
address of the persons or organizations listed in the Schedule.
G. This endorsement does not apply in the event that you cancel the Policy.
Name of Certificate Holder
City of Forth Worth
SCHEDULE
E-Mail Address
Physical Address
200 Texas Street
Fort Worth, TX 76102
ALL-32688 (01/11) Page 1 of 2
Name of Certificate Holder E-Mail Address Physical Address
All other terms and conditions of this Policy remain unchanged.
Authorized Representative
ALL-32688 (01/11) Page 2 of 2