HomeMy WebLinkAboutContract 60434Date Received: 11/08/2023
Time Received: 10:39 a.m.
Permit No.: MAINT23-006
City Secretary No.: 60434
AGREEMENT
FOR MAINTENANCE OF NON-STANDARD
IMPROVEMENTS
THIS AGREEMENT FOR MAINTENANCE OF NON-STANDARD IMPROVEMENTS
("Agreement"), is by and between the City of Fort Worth, a Texas home rule municipal
corporation ("City") and HCA Health Services of Texas, Inc., a Texas corporation
("Developer"). City and Developer are sometimes referred to as a Party or Parties. This
Agreement will be effective as of the Effective Date established herein.
SECTION 1
DESCRIPTION OF PROPERTY
1.01 Developer is the owner of certain property in Fort Worth, Tarrant County, Texas,
located 8500 N Freeway, Tarrant County, and depicted on "Exhibit A ", attached and
incorporated into this Agreement (the "Developer Property").
1.02 The City and Developer hereby agree that Developer will provide, furnish, and
perform the services specified herein on City -owned sidewalks and right-of-ways (the
"Project Site") located adjacent to the Developer Property, as further described in this
Agreement in "Exhibit B", attached and incorporated into this Agreement.
SECTION 2
DUTIES AND RESPONSIBILITIES
2.01 Developer shall commence, carry on, and provide the services contemplated by the
Community Facility Agreement (CFA23-0003), 6/06/23) through which the enhanced
facilities are to be constructed ("Contracts"), in accordance with this Agreement and its
attachments and all applicable laws. In providing such services, Developer shall take such
steps as are appropriate to ensure that the work involved is properly coordinated with any
related work performed by the City or the City's authorized representative.
2.02 Developer represents that it has or will secure, at its own expense, all materials,
supplies, machinery, equipment, tools, superintendence, labor, personnel, insurance, and other
accessories and services necessary to provide maintenance of the following elements
("Improvements"), all of which are to be installed pursuant to and as more particularly
described in the contract for construction services by the Developer.
Maintenance Agreement of Non -Standard Improvements
Revised 2/8/23 BN
Page 1 of 15
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
a. Description of items to be maintained — Non-standard pavers for (3) drive
approaches.
2.03 Developer shall maintain the areas described in Section 2.02 in good working
condition so that the Improvements perform their design function. If pursuant to n o t i c e
from the City, Developer is made aware of any deficiency in the safe and proper functioning
of the Improvements described in Section 2.02 then Developer shall promptly inspect the
Improvements and submit an inspection report to the City. Such i nspection report shall (i)
note any areas described in Section 2.02, or portions thereof, which need maintenance or
replacement to perform their design function and (ii) address the corrective actions to be
taken by Developer in accordance with Section 2.06 of this Agreement.
2.04 The City shall be responsible for maintaining its streets and travel lanes
excluding the special pavement treatments described above in accordance with normal
City policies and procedures. The City shall take such steps as are appropriate to
ensure that the work involved is properly coordinated with any related work performed
by Developer or the Developer's authorized representative.
2.05 In the event that any City -owned property, such as utilities, c u r b s ,
equipment, turf, trees, etc., are damaged or destroyed during maintenance of the
improvements due to negligence or acts of omissions by Developer, Developer shall
be responsible for all repairs or replacements of same.
2.06 In the event Developer, its successor or assigns, fails to maintain the areas
described in Section 2.02 in the manner required by this Agreement, City shall provide
written notice of the non -compliant conditions to Developer, its successor or assigns.
Developer, its successors or assigns, shall make any necessary repairs to comply with
this Agreement within thirty (30) days of receipt of such written notice or, if such
repairs are not reasonably able to be completed within thirty (30) calendar days,
Developer shall have, within that period, begun work on such repairs and shall
diligently pursue them to completion, provided, however, that if the non -compliant
conditions creates a condition which poses an immediate threat to life, health, or
property such repair shall be completed within thirty (30) days of receipt of written
notice. If Developer, its successors or assigns, does not make such repairs as provided
herein, the City may enter upon the Project Site and take whatever steps reasonably
necessary to correct the non -compliant conditions and to charge the costs of such repairs
to Developer, its successors and assigns.
2.07 The City is not obligated to repair the Improvements beyond a level of City's
standard specifications. In the event, however, the City pursuant to this Agreement
performs any work of any nature that is Developer's obligation hereunder and which
Developer has failed to perform, or the City expends any funds in performance of said
Maintenance Agreement of Non -Standard Improvements
Page 2 of 15
Revised 2/8/23 BN
work for labor, use of equipment, supplies, materials, and the like that is Developer's
obligation hereunder and which Developer has failed to perform, Developer, its successors
or assigns, shall reimburse the City, within thirty (30) days of the City making such demand,
for the costs attributable to such work performed by the City including: (i) the cost
difference between the City's standard street specifications and the Improvements installed
by the Developer and (ii) the total cost of any repairs that are outside of the street pavement
area. In the event that Developer or its successors or assigns fails to pay the City for the
costs incurred under this section, the City may take whatever legal steps are necessary to
recover from Developer all reasonable and actual costs incurred by the City for the work
performed.
SECTION 3
TERM OF AGREEMENT
The term of this Agreement shall commence upon the Effective Date and shall continue
until the earlier of (i) Developer's permanent removal of the Improvements from the Project
Site and restoration of the Project Site to the then -existing City standards or (ii) the earlier
termination of this Agreement as provided herein.
SECTION 4
TITLE AND CONSTRUCTION
The Parties acknowledge that the Improvements to be maintained as provided in this
Agreement are the subject of the Contracts and that all necessary reviews, approvals,
consents, inspections and modifications of such Improvements, if any, have been or will be
made pursuant to those Contracts. Subject to the provisions of the Contracts, Developer
shall retain ownership of the landscaping, special sidewalk and pavement pavers, benches,
project signage, special lighting and other Improvements i n s t a l l e d o r located i n the City
right-of-way pursuant to the Contracts.
SECTION 5
RIGHT OF ACCESS
5.01 City through its Manager, Transportation and Public Works Director, police and fire
personnel, and other designated representatives, has the right at any time to enter any
portion of the Project Site (without causing or constituting a termination of the use or an
interference of the use of the Project Site by Developer) for the purpose of inspecting and
maintaining same and taking any and all measures necessary for the proper conduct and
operation of City property; provided this shall not authorize or empower the City to direct
the activities of Developer or assume liability for Developer's activities.
5.02 The City will have the right but not the obligation to make routine inspections of
the Project Site. In the event the City observes non-compliance of an area or a condition
which poses a threat to life, health, or property, the City shall notify Developer in writing i
n accordance with Section 2.06 of this Agreement.
Maintenance Agreement of Non -Standard Improvements
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Revised 2/8/23 BN
SECTION 6
INDEMNIFICATION
6.01 DEVELOPER, ITS SUCCESSORS OR ASSIGNS, AGREES TO DEFEND,
INDEMNIFY AND HOLD THE CITY, ITS OFFICERS, AGENTS AND
EMPLOYEES, HARMLESS AGAINST ANYAND ALL CLAIMS, LAWSUITS,
ACTIONS, COSTS AND EXPENSES OFANY KIND, INCLUDING, BUT NOT
LIMITED TO, THOSE FOR PROPERTY DAMAGE OR LOSS (INCLUDING
ALLEGED DAMAGE OR LOSS TO DEVELOPER'S BUSINESSAND ANY
RESULTING LOST PROFITS) AND/OR PERSONAL INJURY, INCLUDING
DEATH, THAT MAY RELATE TO, ARISE OUT OF OR BE OCCASIONED BY (i)
DEVELOPER'S BREACH OF ANY OF THE TERMS OR PROVISIONS OF THIS
AGREEMENT OR (ii) ANY NEGLIGENT ACT OR OMISSION OR INTENTIONAL
MISCONDUCT OF DEVELOPER, ITS OFFICERS, AGENTS, ASSOCIATES,
EMPLOYEES, CONTRACTORS (OTHER THAN THE CITY) OR
SUBCONTRACTORS, RELATED TO MAINTENANCE OR THE PERFORMANCE
OF DEVELOPER'S OBLIGATIONS UNDER THIS A GREEMENT, EXCEPT THAT
THE INDEMNITY PROVIDED FOR IN THIS PARAGRAPH SHALL NOT APPLY
TO ANY LIABILITY RESULTING FROM THE SOLE NEGLIGENCE OF THE
CITY OR ITS OFFICERS, AGENTS, EMPLOYEES, OR SEPARATE
CONTRACTORS, AND IN THE EVENT OF JOINT AND CONCURRENT
NEGLIGENCE OF BOTH DEVELOPER AND CITY, RESPONSIBILITY, IF ANY,
SHALL BE APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE
LAWS OF THE STATE OF TEXAS. NOTHING HEREIN SHALL BE
CONSTRUED ASA WAIVER OF THE CITY'S GOVERNMENTAL IMMUNITY
AS FURTHER PROVIDED BY THE LA WS OF TEXAS.
6.02 Developer, its successors or assigns, covenants and agrees that City shall in no way
nor under any circumstances be responsible for any property belonging to Developer, its
members, employees, agents, contractors, subcontractors, invitees, licensees, or
trespassers, which may be stolen, destroyed, or in any way damaged, and the Developer
hereby releases the City from any and all such claims. The City does not guarantee police
protection and will not be liable for any loss or damage sustained by Developer, its
members, employees, agents, contractors, subcontractors, invitees, licensees, or trespassers
on the Project Site. It is further agreed that the acceptance of this release shall not
constitute a waiver by the City of Fort Worth of any defense of governmental immunity,
where applicable. or any other defense recognized by the statutes and court decisions of
this State.
Maintenance Agreement of Non -Standard Improvements
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SECTION 7
INSURANCE
Developer shall not commence work under this Agreement until it has obtained a n d
provided documentation thereof for theinsurance required by ExhibitC,
attached hereto and incorporated herein. Developer shall be responsible for delivering to the
City Developer's certificate of insurance for approval. Any contractors performing
maintenance on the Improvements shall a Is o provide to Developer and City documentation
of insurance required by Exhibit C.
SECTION 8
INDEPENDENT CONTRACTOR
Developer shall perform all work and services hereunder as an independent contractor
and not as an officer, agent, servant or employee of the City. Developer shall have
exclusive control of, and the exclusive right to control the details of the work performed
hereunder, and all persons performing same, and shall be solely responsible for the acts
and omissions of its officers, agents, and employees and sub-consultants/subcontractors.
Nothing herein shall be construed as creating a partnership or joint venture between the City
and Developer, its officers, agents, employees and sub consultants/subcontractors, and
doctrine of respondent superior has no application as between the City and Developer.
SECTION 9
LICENSES AND PERMITS
Developer shall comply with all federal, state and local laws, rules and regulations as
well as with all regulations, restrictions and requirements of the police, fire and health
departments now or hereafter in effect which are applicable to its operations. Developer
shall obtain and keep in effect at its own cost and expense all licenses, permits, and taxes
incurred or required in connection with this Agreement and its operations hereunder.
SECTION 10
LIENS
Developer, its successors or assigns, agrees that it shall do no act nor make any contract
that may create or be the foundation for any lien upon or interest in the City's property, and
any such contract or lien attempted to be created shall be void. Should any purported lien
on City property be created or filed, Developer, its successors or assigns, at its sole
expense, shall discharge same within thirty (30) days after notice from City to do so.
Maintenance Agreement of Non -Standard Improvements
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SECTION 11
TERMINATION AND DEFAULT
11.01 Subject to the provisions of Section 11.02 below, in the event Developer fails to
comply with any of the terms and conditions of this Agreement after notice and the
passage of the appropriate cure period provided in this Agreement, City shall have the right,
and without further notice, to declare this Agreement immediately terminated and to enter
into and take full possession of the City's interest in the Project Site, save and except such
personal property and equipment as may be owned by Developer. In the event of such
termination of this Agreement by the City, all rights, duties and privileges of Developer
hereunder shall cease and terminate.
11.02 Developer shall be notified by written correspondence of Developer's failure to comply
with any of the terms and conditions of this Agreement. Developer shall have thirty (30)
calendar days from the date of written correspondence to correct deficiencies or, if such
deficiencies are not reasonably able to be corrected within thirty (30) calendar days,
Developer shall have, within that period, begun work on such corrections and shall diligently
purse them to completion.
11.03 Upon termination, the parties shall be released from all obligations contained in this
Agreement except for any indemnification obligations pursuant to Section 6 of this
Agreement occurring prior to the effective date of such termination.
11.04Termination notice shall be considered rendered three business days after being placed
in the United States Postal Service for delivery to the other party in accordance with Section
13.
SECTION 12
NON-
DISCRIMINATION/DISABILITIES
Developer, in its installation or maintenance of the Improvements, of occupancy or use of
the Project Site, shall not discriminate against any person or persons because of race, age,
gender, religion, color, national origin, sexual orientation, or disability nor will Developer
permit its officers, agents, employees or subcontractors to engage in such discrimination.
Maintenance Agreement of Non -Standard Improvements
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Revised 2/8/23 BN
SECTION 13
NOTICES
Any notice required shall be sufficient if deposited in the U.S. Mail, postage prepaid and
addressed to the other party as follows:
CITY:
City of Fort Worth
Transportation & Public Works Department
Attn: Assistant Director
200 Texas Street
Fort Worth, Texas 76102
With copy to:
City Attorney's Office
200 Texas Street
Fort Worth, Texas 76102
DEVELOPER:
HCA Health Services of Texas, Inc.
One Park Plaza
Nashville, TN 37203
Attn: Ryan McVey
SECTION 14
VENUE AND JURISDICTION
This Agreement shall be governed by the laws of the State of Texas. Venue for any action
brought to interpret or enforce, or arising out of or incident to, the terms of this Agreement
shall be in Tarrant County. Texas or the United States District Court for the Northern District
of Texas, Fort Worth Division.
SECTION 15
ASSIGNMENT
15.01 Developer agrees that it will not assign all or any part of its rights, privileges or
duties hereunder without the prior written consent of the City and any attempted assignment
of same without such prior consent of the City shall be void except that Developer may,
without prior written consent, assign any or all of its rights, privileges or duties hereunder
to an affiliate (defined as an entity under common control with Developer) or to an authorized
Public Improvement District whose boundaries include the Project Site ("Allowed
Assignment") or to the purchaser of the Developer Property as provided in Section 15.03, below.
In the event of an Allowed Assignment, Developer will notify the City within thirty (30)
Maintenance Agreement of Non -Standard Improvements
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Revised 2/8/23 BN
days of such assignment. If notice of an Allowed Assignment is not provided within thirty
(30) days to the City such assignment shall be void. In the event of an assignment permitted
above, Developer shall automatically be released from any further obligation or liability
under this Agreement. Notwithstanding the foregoing, or anything in this Agreement to the
contrary, it is understood and agreed that Developer will contract or subcontract various
parts of its obligations hereunder to others to perform on behalf of Developer, and such
contracting or subcontracting is expressly permitted hereunder.
15.02 Subject to the limitations contained herein, the covenants, conditions and agreements
made and entered into by the parties hereunder are declared to be for the benefit of and
binding on their respective successors, representatives and permitted assigns, if any.
15.03 Notwithstanding anything herein to the contrary, no provision of this Agreement shall
be construed to prohibit or restrict Developer's ability to sell, lease, pledge or otherwise
transfer the Developer Property or any part thereof. Upon any such transfer of the Developer
Property, the benefits and obligations of this Agreement shall run with the Developer
Property, or portion thereof, and bind Developer's successors in interest in proportion to the
interest in the Developer Property so transferred.
SECTION 16
WAIVER, SECTION HEADINGS, AND SEVERABILITY
16.01 In the event any covenant, condition or provision herein contained is held to be invalid
by any court of competent jurisdiction, the invalidity of such covenant, condition or provision
shall in no way affect any other covenant, condition or provision herein contained; provided
however, that the invalidity of any such covenant, condition or provision does not materially
prejudice either Developer or City in connection with the rights and obligations contained
in the valid covenants, conditions or provisions of this Agreement.
16.02. The waiver by the City of any default or breach of a term, covenant or condition of
this Agreement shall not be deemed to be a waiver of any other breach of that term,
covenant or condition or any other term, covenant or condition of this Agreement,
regardless of when the breach occurred.
16.03 The headings in this Agreement are inserted for reference only, and shall not define
or limit the provisions hereof.
Maintenance Agreement of Non -Standard Improvements
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SECTION 17
RECORDATION
This Agreement shall be recorded in the Real Property Records of the applicable county
and shall be a covenant running with the land binding upon all parties having any right,
title or interest in the Developer Property and Project Site, or any part thereof, including
their heirs, successors and assigns, and shall inure to the benefit of the owners of the Developer
Property and Project Site and to the City.
SECTION 18 ENTIRE
UNDERSTANDING
18.01 This written instrument including all Attachments, Schedules, and Exhibits
attached hereto constitutes the entire agreement by the Parties concerning this
Agreement and the obligations of the Parties, and any prior or contemporaneous oral or
written agreement that purports to vary from the terms hereof shall be void. This
Agreement cannot be modified or amended without the written consent of all the Parties.
18.02 Neither this Agreement nor any provision hereof may be modified except by an
instrument in writing, signed by the Parties. This Agreement shall be binding upon and
inure to the benefit of the Parties and their respective successors and assigns.
18.03. This Agreement may be executed in one or more counterparts, each of which shall be
deemed an original, and all of which, taken together, shall be one and the same instrument.
Electronic signatures and facsimile, pdf or other copies of original signatures shall be binding
as originals.
[Signature Pages and Exhibits Follow]
Maintenance Agreement of Non -Standard Improvements
Page 9 of 15
Revised 2/8/23 BN
IN WITNESS WHEREOF, the Parties have each executed this Agreement by each parry's
duly authorized representative. This Agreement shall be effective upon the execution and
date subscribed by the City's designated City Manager ("Effective Date").
CITY OF FORT WORTH
By: JBurh� �cth�
Dana Burch ff (Nov 02318: 3C5T)
Dana Burghdoff
Assistant City Manager
Date: Nov 7, 2023
Approved as to Form and Legality
P t
BY: D_Black (Nov 6, 202317:39 CST)
Douglas Black
Assistant City Attorney
Date: Nov 6, 2023
ATTEST q 1FORr°4
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,d , Li$Sta>Lu °cnn�zosaa
By:
Janette S. Goodall
City Secretary
Date: Nov 8, 2023
DEVELOPER:
HCA Health Services of Texas, Inc.
a Texas corporation
/rJ
By
NA : Nicholas L. Paul
TITLE: Vice President
Date: /0,_� f
M&C:
Contract Compliance Manager
By signing, I acknowledge that I am the person
responsible or the monitoring and administration of
this contract, including ensuring all performance
and reporting requirements.
rl ^
Rebecca Diane Owen (Nov 6, 2023 17:48 CST)
Rebecca D. Owen
Development Manager
Nov 6, 2023
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Maintenance Agreement of Non -Standard Improvements
Page 10 of 15
Revised 2/8/23 BN
lii l Y Llil 4 Dtl1:lU -I I:1 rltl Y 11,1 Dl11110 W&UN
THE STATE OF 'TEXAS
COUNTY OF TARRANT
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
Texas, on this day personally appeared Dana Burghdoff, known to me to be the person
whose name is subscribed to the foregoing instrument, and acknowledged to me that he/she
executed the same for the purposes and consideration therein expressed, as the act and deed
of the City of Fort Worth, and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of
�,0� p`v�a��p, BROOKE BONNELL
3$, �of Notary Public, State of Texas
�; Comm. Expires 10-11-2028
��'"i�,°,;,, ": Notary ID 134008626
N6tary Public in and for the State of Texas
Maintenance Agreement of Non -Standard Improvements
Page II of 15
Revised 2/8/23 BN
THE STATE OF TENNESSEE §
COUNTY OF DAVIDSON §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of Tennessee,
on this day personally appeared Nicholas L. Paul, 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 Vice President of HCA Health
Services of Texas,aTexas corporation, as the act and deed of said corporation.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this 515� day of
October, 2023.
!Nota Public in and for the Stag Tennessee
Commission Expire . a
zj
Maintenance Agreement of Non -Standard Improvements
Page 12 of 15
Revised 2/8/23 BN
EXHIBIT A
PROPERTY DESCRIPTION
Being a tract of land situated in the William McCowen Survey, Abstract Number 999, City of
Fort Worth, Tarrant County, Texas, and being a portion of Tracts 1, 2, and 3 of those tracts of
land conveyed to HCA Health Services of Texas, Inc., by deed recorded in Document Number
D203047768 of Deed Records, Tarrant County, Texas.
Maintenance Agreement of Non -Standard Improvements
Page 13 of 15
Revised 2/8/23 BN
EXHIBIT B
DETAILS OF IMPROVEMENTS
Maintenance Agreement of Non -Standard Improvements
Page 14 of 15
Revised 2/8/23 BN
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GRAPHIC SCALE IN FEET TX REG. SURVEYING FIRM LS-10008001
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FORT WORTH, TX 76109
a Westwood company 1 817.412.7155
DRAWN TE JOB NUMBER
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MAINTENANCE
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
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REFER PEDESTRIAN CROSSWALK DETAIL
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( PROPOSED
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03 BARS ON-1 CLASS A. 3000 S1
18' CENTERS CONCRETE PA ENT AT 28
BOTH WAYS DAYS
Paver
Supplier: Pavestone, Inc.
Contact: Joey Guedea
(817) 442-8070
Thickness: 80mm
Pattern: Cobblestone
Installation: Concrete
pavers sand set
on reinforced concrete
sub -slab
Type: Carriage Stone
Color: Dark Brown
Detectable Warning
Pavers @ ADA Ramps
Supplier: Pavestone, Inc.
Size: 4"x8" Truncated
Domes
Thickness: 60mm/ 2-3/8"
Pattern: Running Bond
Installation: Sand set on
concrete subbase
Color: Charcoal
C-3 Colored Concrete Paving
Supplier: L.M. Scofield Co.
Finish: Medium Sand Blast
Color: #0288 Autumn
Beige
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SCARIFY AND COMPACT SUBGRADE DAYS
/3 REBAR ON SCARIFY AND PACT SUBGRADE
BETWEEN 95X AND 105X MA)L DRY
DENSITY (STD. PROCTOR) AT A
18' CENTERS BETWEEN 95X AND 105X MAIL DRY
BOTH WAYS DENSITY (STD. PROCTOR) AT A
MOISTURE CONTENT BETWEEN -1X AND
MOISTURE CONTENT BETWEEN -1X AND
+3X ABOVE OPTIMUM. LIME STABIUZE
+3X ABOVE OPTIMUM. LIME STABILIZE
(8X HYDRATED LIME DRY UNIT WEIGHT)
(8X HYDRATED LIME DRY UNIT WEIGHT)
CURB & GUTTER
BRICK PAVERS ON
FOR BRICK PAVER CONCRETEPAVEMENT
0
NOT TO SCALE NOT
TO SCALE
TX REG. ENGINEERING FIRM F-469
MAINTENANCE
TX REG. SURVEYING FIRM LS-10008001
Pacheco Koch
4060 BRYANT IRVIN ROAD
AGREEMENT
FORT WORTH, TX 76109
PART OF HCA HEALTH SERVICES OF TEXAS, INC.
a Westwood company
817.412.7155
WILLIAM MCCOWEN SURVEY, ABSTRACT NO. 999,
CITY OF FORT WORTH, TARRANT COUNTY, TEXAS
DRAWN BY
CHECKED BY
SCALE
DATE
JOB NUMBER
PAGE 2 OF 2
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07/27/23
1 5202-21.747
EXHIBIT C
CERTIFICATE OF INSURANCE
Maintenance Agreement of Non -Standard Improvements
Page 15 of 15
Revised 2/8/23 BN
Page 1 of 1
L� B
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@HCAHealthcare.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 $1,000,000 Each and Every Occurrence
• Bodily Injury
• Property Damage $2,000,000 Aggregate
• Products and Completed Operations
• 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
LEAD SHEET
FOR:
WILLIS TOWERS WATSON
SOUTHEAST INC
RUN DATE: 08/17/2023
POLICY NUMBER: ISA H10761426
ID: Z02RIVM1
RUN BY: ACEINAWARIVEO
PAGES OF THIS COPY: 0004
INSURED'S NAME
HCA Healthcare, Inc.
A
CHUBB0
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