HomeMy WebLinkAboutContract 28183 (2)A
�
_ � .. � . �,�Y ��������a�
' � ' ' ' � ' Ct7Nif�AC�' �11@ . _, � � �
�(]►l���l�T A.��tE��I�T'T
F�T� .
TElVIF�RA.RX U�E Q�� PU��I� ]P1��PERT�
STATE OF T��.AS
� � ,� ■ � x
�e__ �S__�z� _
� T�IIS AGR.EEMENT is made and exitered into by and �etvcreen
the City of Fort� yflorth, a mun�cipal corporation af Tarrant Coun.ty,
Texas, acting herein by �and �rough its duly authorized Building
Official, herina�er ref�.xed to as th� "Ci..�r"' a� �� �� ��L
. �
acting by and through i�s d.uly authoxize� ��C�'- �� ��
h �
�Ul.t.�_ I�� �. � , herein.af�ter referr+�d to as
f .
4C�"'�W,LLee\i"• - , .
�Ji ,
�i6�Y'I'1�E��ETHo
. 1. . .
For and in consideration of �he payment by Crantee o�the
charges set out below and th� frEze and �aithful per�ormance of the
muival. covenants herein confained, Cifiy hereby granis to Grantee
pernussxan to temporarily encraach upon, uses and occupy parti.ons of
t�ie space under, on andlor above the stree�s, alleys, sidewalks t�r ofi3.ex
public righ�s�af way a��ollows: '
��✓t �,�P�1 ``�{�t3 ���-�-Iv.n ��'--��,�f''
�i�� � ��`�
i +'',��'�i
_�:
The Iocation and description of said encrva.chrnez�t is mare pariicularly
descri�ed in Exhibzt "B" attached hereto, ua.corporated herein and made �
a part hereaf fo� alI purpas�s. , �
� 2.
,All use and occu�ancy ofpublic str�ets,'alleys, s�de�ralks or ather
pu.��ic righ�s-of way und�x ihis agreeameni shall be in sirici compliance
vcritSi �i� Cha�rier, 4rd.inances and Godes of Ci�y and in accoxdance with
the directions of t�e Buz�ding Officia�. and ihe .Diarector af Transporta�.on
and Public W ork� o� Cit�.
3,
Upon expiration of this agreement and the privileges granted
h�reunde�r, there sha�l be �.o en�roachment by C'xrar�tee in, under, on or
aiaove the surface of the public rights�of way involved.
►��
Grantee agrees to pay in advance an encroachment fee for ihe
� temporary privilege of encroachi�ag upan a porti..on of �he public rights�
� of way as described in Exhib�t "B". Said fee is cal.culated in. the m�.nner
and amaunts prescribed by th� Building Code of �h.e Crfiy of Fort Worth
for temporary use or occupancy of publi.c p�operty. The �stimated total
�nounf of said fee �s
� ��aZ3D �` )C .C�1 7�.'� � � 1� � �' c�
_ � j�' �C.o�'�1 � �?�.��
� . _ _ ���� -���
E
�
�
I . I li
,
J�.
0
' Crranfee, at no expen.se to Ci�r, shall make proper pxov�sion fox
�he relvcatian and/or instauation of axiy existing ox future tr�fic coxrtrol �
devices o� othe� impro�vements affected by such encroachm�nt, u�� and
occupancy, in.eluding the s�curin� af approval and conseni from the
appropriate a.gencies of the Sta.te and its pol�tica� subdivis�ons. In �.ie
. • evez�t that any zn�talla�ion, reinst�la.tion, relocation ar repair of any
exi�i�ig ox fixt�e tra�c contro� devic� or impravement owned ox
constructed by or on behalf af �he public vr a.t public expen.se is made . ,
more cvs�ly by virtue of the �xistence of such enc�oachm.ent and use,
C�rra.ntee shall. pay to City an adclitional amount equa.� to such addi.iional �
cast as ctetermin,ed �y .City.
6, � .
The term of ihis agreem.en� shall be for � days, from 1��" ��
to ��'+ �?'�Zprovided, �owever, should the need for the �ncroa�hmen�s
grant�d hereunder at any i�n.e cease, Gra-nte� agxees to i.znmediately
no�ify City of such �condi�ion; ar�d, upon rece�pt of sucl� nQtic� by �he
Sui�ding lJfficza� of f.he �ity of For� Worth, �is agreement �hall
' ferrninate.
,
,;�
. �.
rt is expr�ssly understood and agreed that #his Consent Agreem.ent
is i'or a temporary encroachment in, under, over and upon the public
p�operty as Iqcated and described �n Exh�ibit "S". �'hzs �a�reemenf shall
not be construed as the granting of a pe�manent easemeni, encroachment .
ar license upon Ciiy's pub�ic streets, alleys, sidewalk� or oiher rights�of
way.
:
City, through its duly autha�ized represeniatives, shall have the fu11
and unrestricted right to enter upon a.I1 public rzghts-of way for t�i.e
purPose of ma�kaing insp�ctions to determi.ne coznpliance wi,th �he terms, .
cavenants aazd conclinons hereiri. �n the event �,t any insp�ction shoul.d
reveal a breach of axay t�rnls, cavenants ox conclitions herexn, City �hall
give Gra.n�ee notice of such breach. Shauld such bre�.ch not be �
corrected by �`rxan.tee within tweniy four (24} houxs of recezpt of the
notice, or with�.n such shorter period of tim� as deem�d nec�ssary by the
Building Official for the protectian of public healih or safefy, Gity m�.y
terlrainate and cancel this agreement.
�
Upon expira�ian or temunai�on of this agreement for any reason
whatsoeve�r, Crrantee shall, at no exper�se to City, restore 1he public
rightsnof way and adjacent supporting stxuci�res to a condztion
accepta.b�� ta the Director of Transpartation �and Pub�ie 'Works o� his
_.. ;�
du�y authonzed� representatzve and in accordance wiih then exi.siing Ci�y ,�
specifications, and Grantee shall r�mov� a1i barricades, equ�ipment, ,,,, ;:�, ,� �,, ,
supp�ies, ma.teria.ls or o�her properiy from said Ioca�ion, Grantee furthex
covenants and agr�es ihat for a pe�iod of ane (�) year aft�-r the
termination of ihzs Consent Agreement, Crrantee w�II repair alI condztions
or clamages too the streets and s7dewalks or other right�-of way �hat
have resulted from Grantee's use ar accupancy of iY�.e streets and
sidewa]ks or other rights-of way, as detem�ixied by �ie D�recto� of
Transportation and Pub�ic Works ox his designe�. Gran.tee agrees ia
begin such xepairs wi�un th7riy {30) days of re�eipt of n��ice from the
Direetor of Transparta�ion and Public '�Voxks or his designee. A].1 �
r�paixs shall. be performed in �n e�editious and worl�anl.ike manner
and shall comply with al� appZicab�e laws, cades, ordinances and City
spe�i�tcations.
Tn t�ie e�ent ihat C'rrantee faxls ta comply with the covenan� hezein
contain�d with r�spec� to such removal or restoratian, the City shall have
fi�ie right to remove or dispase vf any barricades, eqlup�ment, supplies,
materi.als or other propexty and repa.ir any conclitions which in the
opnuon of the Ciiy are n�cessa�y �o bring �he public rights�of way io �ie
condi�ion p�eserih�d herein, and City sha�l not be responsib�e fox
fr�spass or any ather damage ar liability in con�.ection wzth su��i remov�
or restoxation. Grantee shall r�imburse City for �ihe cost and expense of
�uc�. r�mo�a� and/ox repa�rs inxmediately fallowing bi�Ii�g for same by
City. . -
Nathing hereir� sha.11 be construed a.s a wazver by City to enfoxce
p.ena� sanctions pxescribed by the Code of the Cify of Fort Worth and
�:.
th.e Iaws of the 5tate of Texas for Grantee's caniinued eneroachm�rit
��� i-..
,. , II �� �
upon the publzc righ.ts�a� way �ollowing tern�ination af this Consent
Agreement.
10.
It is �rth.ez understood and agreed betw�en the paxiies hereto that
City holds th� city streets, alleys, �id�walks and other pub�ic rights-of-
way, inciudin.g fihe portiax� of such street� used and encroached upon as
described he�e�, as trustee �ar th� publie; ihat Gity exercises such
powers over f1a.e streets as have been delegated t� it by the Consiitution
of the Sta.te of Texas or by the Legis�ai�.ue; and �hat City c�not �cantxact
away zts duty and its legislative power io contral the streets far tbe us�
an.d benefit of the public, I# is according�y agxeed �tria.t if the gov�xnin.g
body a� Gity, fio wit, its Ciiy CounciY, should at any t�� during th� texm
hereaf detem�zn� xn its sole discre�.on io use vr cause ar pem�i.t to iae �
used for any public purpose the said �ncroached po�i;ion of the, stre�is,
ihen #,his agreem�nt shall be autozna�ica.�ly cancel�d and ternunated.
1i.
Grantee agrees to comply fully with aII applicable federal, state
and Iocallaws, statutes, ordinance�, codes or reg�.l.a�ions in connec�ion
�vi�h the consiruction, opexaiion and mainienance of said encroachments
and usesa
12. �
. Gran.tee agrees to pay promptly when due a].I fees, ia��es ar rentals .
provi.ded for by this agxeement or by any federa�, sta�e or Iocal. st�t,�.�, -. ...._. _
Iaw or regu�.ation. � ' � �'
13.
,? ;,
, ,..
�� ,
,,����� ��.,� �
��
0
Grantee covenants and agrees that it sha11 e��xcise a11 rights and
privileges granted hereunder as an 7ndependent contractor, and noi as an -
officer, agent, servant o� employee of Ci�; that C�antee shall hav�
�xclusxve control of and the excTusive right to can�ral the details of its
operations and activi�ties an said described public praperty and a�1I
persons p�x�ozmYng same, and shall be so�e�y responsxble for �tie ac�s
and omi�sions of its officers, agen�, servar�is, emp�oyees, cantracfiars,
subconfractors, �icerisees and invitees; ihafi the doctrin.e of �espondea�
superiax sha11 �ot apply as beiween City and Grrantee, its offi.cers, agents, .
servants� emplayees, contractors and subcontractors, and noi�ung herein
� shall be construed as cre�ting a partn�rship 4r,�oint enterpris� between
City and Grante�.
1.4.
Grantee covenan�s and. agxees to�indemnify, and doe� h�reby
ind�r�anifiy, hold har�nless and d��end Ciiy, i�s of�cers, agent�, servanfs
and employees, from and againsi.any and all claims or suits �or property
damage or loss andlo� pexsona�. injurY, including death, to any and all
persoris, of whatsoev� kind ox character, whe�hex real or asserted,
arising out af ox in conneciion with, clix�ctly or indirec�Iy, the
maintenance, occupancy, use, existence or location a� said � ,
encroachment and us�� g�ranted hereunder,.whether or not. cau��d, in
whole ar in part, by all�ged �.egligence of officers, agents, se�ants,
emplvyees, contractors, subcontractors,licensees ar invitees of Ci.ty; ,
and gr�.ntiee hereby assumes a�1 liability a�ae1 respo�sibi��ty of City, its�
�,,,.. �)
;� . ',
.���; �
o£f.cers, ag�nts, servants and employees, for such cZai.ms oz su�tsr �
Gxantee sha�I 1i1��wis� assume a�Z liabilzty and responsibili�y ar�. �hal�
inde�nnify City for any and all injury or da�mage to City property, arising
au� of or in cannection with any and all acts or omissions o�' Crantee, iis
offi�ers, agents, �ervants, emp�oy��s, co�.tractors, subcontractors,
lic�ns�es, in.v�tees or tx�spasssrs.
15.
Grantee agrees to fi�rnash City wit�i a C�rti�xcate of Tnsuranc�, naming
Cit� as cerCificate ho�der, as proof that it has secwred �nd pazd for a policy of
public liabi�ity insuranc�� covering a11 public risks related ta ihe propQsed use
and a�cupancy af public prap�rty as Iocat�d and deseribed in Exhi.l�it "B".
Th� amaunts vf such insurance shall be not less than th� follovving:
Property d�.mage, pe� occurtenc�
Bodi1Y �J�'Y'� Per person
Bod'z�y injury. ar death, p�r occw�rence
� � oa,000
$Z50,000
�soo,oao
�i�h �he undexstanding of and agre�m�ent by t�rantee that such insurance
amoun.ts shal�! be revised upward at City's optivn and that Gran�ee sha11 so
'�evise such amo�nts imna�diately following noti�e to grantiea of sucfi
rec�uirement. Such i.nsuranc� policy sha1�, pxovide thai it cannot be canc�Ied
ax amended wit�.out af l�ast thi�rty (30) days' prior writte�n no�c� to f�ie
Suzlding ��ficial of the City of Fort �JVorth. A copy of such Certzficate nf
Insura�n�e is a�ach�d as Exhi.bit "A,', Grantee agrees to �ubmit a similar
Cex-fi.fi.ca�e of In�urance ax�r.uaXZ� ta City on the anniversary' date of t�.e
execu�ion af this ag`reem�at.
� � , � ��.. M
;i f� , . , ,
� �� ��� .
0
Grantee agxees, binds and. o�I�gates it�elf, its successors and a�szg�a.s,
to maintain and keep in force such public liability insu�ance at all times .
durix�g �he term of th7.s agreem�nnt and unt� the removal of all encroachrnents
and the cleanang and restaraiion �f the ci� streets. All. in�urance coverage
required here�n. shall includ� coverage of a�I a�' Crrantee's con�ractars.
�d. '
Grantee covenan.ts and agrees that �t will na� assi.gn al.I or any vf its
rights, pri�ri�eges or duhes under this �antrac� wit�.out f�a.e priQr written
approval of City, and any atternpt�d ass�gnment witih.out such prior vvritt�n
approval sha11 be vo�d.
�.i.
This agreemen� shall be binding upon the parties hereto, their
su�cessors axld assign.s.
�S. � �
Shou.�d any action, whe�.ier real or asseried, at 1aw or in equity; arise
out of the�terms and condi�ivns of fhis agreer•n.ent or ou� of the use an.d
occupancy of City prap�xty as pern�itted hereu�n.der, venue �or �aid acta.on
sha11 be in Taxrant Count�r, Texas.
� Y9. �
In an.y action br�ugh� by City for the enforcernent of fh.e obliga�ions of
Grante�, City shall be entifiled to recover interest and rea�onable �tiorneys'
fees.
� ,
` . , ' li'� �
, ir
�� �, '
. �C�ED 'I�us ..��'M da, o f �f � .
y _ r���. �,_ , 20�.
G�roR. . �
GRANTEE;
CTTY OF F�RT �rORT
�� ������ �
B:
� B�v G o�zclaz, - -- �. � BY• � ��
ll �
.
APP D { pit� � LE�,AI1ITY: �v f��
' � . __ � - TTT�
-- . y. ., �;.�.� � DATE:
F
, �
� -�! � - - '
Cf'I'i' SECRETAR � . � _ --- `- . "
� + DAT'�:
�, m�-�` ,
� �������t .�utho�i�Stior�
.�.�. �u--�. � . . , - _ `.� . _
� ����
� • , . .� I . ,.:�, I.
I r _ .
�
SZ"ATE OF �`E�AS
CD�I11T�'Y OF 7'�.R�'�'
J
BEFOI�E��E, fl�e rtndersib�red rttrihority; rzNoirrryPrtblic in r�i�d
�F tlte Strt o,�' is, o�z f71is drry personally rrpperrrer7 � �
`� � �: ,: �' ,�j7o}vjr ta �ie ta be flze�ersolt �vhase
rtante is s�ibscpi6ed to the fo1 itig instt'I!l71SIZt� a�td ncktiafvledged to �ne .
tfrnt he/she execrit�d tlte sarrae for . rEr os r u d cotasi erat�oli thereirr
e.rpresserl, as f1:e rret arrd deer! of. _� ,�
r��trl rri tlie cdprreity tli�reiit strrtert.
of �Gl'YE�1' U1hrDE.R lY,f�'HA�1�D A1YD SEAL O.F' OF.�7C�' tJtis `�' � riny'
1 �.fn.c�_.3 , 20 f�. .
�"4� �A
Af�rrnt - .
- � ��°' `� .
'. 1lrotcrry Parblic rsi and for
Tlie State of Texas
�..�......w.w. -- � - �'1. .'.J.�.y
�1,�Y,�� .. f� . C . N�R�Z
Rta4aCy F'usilic
,� .,� � ��'�1�'� {�i� i�X�i�
�� ` ' P� -
'°�� My �it�n'i, ��p� �A/'���
�:�..,
II
�
s��TE oF �x�s
CDUNT'Y OF T"�NT
0
� BEFORE 11TE, the under�igned auihvr
Fo� the State o �J', a 1Vatary Puhlie in and
as, n thi� day persa�ally �cppe��ed '
� A� �� -, � ,,kPaowrt to rrte to be the e�son wh
name is suhscribed to the foregoirag i�st�ur�E�at, a�ad acknowledged td �e
that hels�ae �cQcuted the same fo�° the purpases a�d cansidepaiiar� thered�
eacp�esseal, as the act and deed af
a�d rn the capacity the�ea�s stated � �
p f . G�N UNDER 1y.ly,F�rD � SEAL OF 01�'FICE this �' •= w�' da
` ti - � ao.�., y
_ /�
�.f.�ant -- -
-�fY/I'f'�
Titde -
��'���1 - .
Notary Publ% i� an y�
The State of Texa.s
���Y��...��.��.. � .-��AR�Zy�
Notary �Ilc �
* * S�'AT� (}� TEXAS
�����'�� �ly Corwfi. �xp, 09/9� :�
� .r..u,n.,.,..er�.�.u..r..�.r.�...r�.+�...e..�r �..i. n i . .. .iwy
r.�
� �.��
N�c�, � ��r��
Phone Numbu�: � 1 � .�
Building Peranit Nv� er: `� �"�
purpose for Closure: �,�-� l( Ii :�+�
Begin Date: ���7 r�� End abe• 1( I_.
'I�pe of Tapez acooxding to pos�ed spee3 Iimit:
Tape�rs @ 3U MPH I4ft Offset 30ft +'n� �*+�+
Tapers [a� 35 MPH 1Dft Offsat 35ft minimusn
Tape�s @�#0 MI'H 10ft Offset 4(?ft?n4nim»m
_. ... --�
___ __ _�_,_ �
�
a, „ _ . � _. . �.`., . . _ �,_ _ _ •�
�{
_
.
�
�. . _ - _....
�
iv. �,
� � �
- . (�� , -r. j �
� �/ -_ 1 - � � .
}
�'"', � - — � �, � - o
. �
� '
�
�
. �
�
.
3
� 1��,� .
D 1� L�O r l��r.� S�
� ��.k
�C `�.� , ���s'�
i
_. „ :��y = `.;;�==- -� � �..� . ., � . . _ �� � . .� w �- �- - _- - �
_:... -. � �� . : . .. ,� . �--� - - �
�--_ � - "..'- . .. -- �41 ��,� ,,�� .
• _ � . L��� , - . �
� _ �_ . � . � t `�l�T7�„r�,,.:�..�r, � � � � �, � . � � � — - � ^ ^ _ . �
i .• ~ �� jc�(y� - . .C�r?- � . _� r'� i '-?.,'�'._�— - - •-- ' - � .
, � .. _ _ � _� - ^� - • - ' ^� -���.�.�_-
, -�_�•---- ; . � - _-- 1 _ . . . -
� . Conizactors Name: � _ ���
, � Point of Contact: :�f � �'
� � �
t by: I�DEPENQENT INS�RANCE GROUP 972 231 8291; 10/21l02 5:�9PM;J�g_�989;Page �/1
����„ -- ��R ll������ �� �������.� ��i��l'���� oAt����uoonnr, _ _
_ ��� �� � 1���1/D�
� _ .. ,— . T�,11S C��YEl�ICATE's� I�L��D i� � AAATT���� 11��O�tIVI�oq1�N
I OAILY Afi1� C�N�F.R� NB i�IL3F�� �#�L�Ri •'[�!� ��i�1°I�'I�QT�
��dep��cl�t3� �na�ar�cds ��oup F�OI���R. Ti�IS ��i1�1�14TE ���� Pl�'f Al1��Fd�� Eli`Y�AI� 8�
�fl�.f1 Y,�J ��wra�g ��� .�a0 A��R 7'Fi� �@V�A��r��Fei�q�0 9v Tk� P�61�IE� �6L�l�f.
Aa�.�.as �yb 75�3�-�i00d - -
�i:9n� :�'��d� ��� 62i 7 IF���iti�RS A�F�t��fA��, G�VE1�Gl�
B�SUA�L �'��i11 � �o�16�Z��8eG�oup �nc. ; INSUR€RA: i4����,�ti�� .�e��A2l�s
9�� � �
A�� ear� L� �, �,� � IN511RER B: C1�Y�$E�. a�$eS �'�sg �x�s . Ca .
�� 3.� �T�a����, b� ! �ws��e� c: ��,� �ispub��s �a��san�
5u����99ap�•sa� e� ie��a [��r _.�._.._
AL*8t.3,A '1�]C i�'i�� i IHSLRERD:
� ' I INSURfeR �: ..��
� COV�R19G�s — -
i Y►iE PQLIGES 4F INSUsiANCE uS7ED ��Law ►1aiV� �geNlS3UE� TO Tk� I�rSURfp NAM9D aBOVE �OR qliE POLICY P�RI09 IN�ICATEp. N4'SWITHS�ANOING
rWY AEflUIREi�NT, TERiuI dR CGNDiI 14N OF awY CONTR�GF OR DTF��� �OCtIitiAENT W171i RESP�G7 TO IA'�IIClLTF11s CERTEFfCATE MAY BE �SSU�B Oi�
AWY PER7AIN, 7H& RlSWRANG& A�f4fA�� HY THE POLIOIES DESCAlO@b NERL=IN IS 3U$JECT TO A�.L 7H57�pM9. €%CiUSIONS A1Y0 C4N�{T�ONS �� SUCH
POLIGI6S, �r�-,R�c,�Te �r�cirs snawr � iw�,Y w►v� sSeN seoucea ev ���g a�nlMs. �
,'i7�� it'Pea�ursclF7ana� � POLwwNuiAH�R I oaTE119k�Lrfl�orrnv� r�A1�°Bf�1��om�� Lfldi�s ...`—
CiEHERA6 EA�lTY . ! E1CN OCCIJRRfeNC� I'd �, e o Q Q, aQ �
�l ]S I COA�M�RCWL.GENENN1LtA6i'_YTY (�r��`"ZQ�Q��$ �%�Q��Q'� OiI���O3 � FIR�CAMnGEWnYonofw) I S Ld���Q(i
� CwAfS eaaQE ..,�J OC1UR I I ME4 @XP (My or� person) ' S 10 , 000
� __.._......_.._. ' � P€R60NA! 8 AOV WdURY ; s 1, 4,00� 040
�__I .�....- -- -- I GENERAL AGG�20a1'� a 2, DOa , OQ�
G£N'L AGGREGATE k.INYfr.aPPL]ES 9Eii: I pRpQUCTS • COAIEPI�� ApG S 2, QQ 0,� �(j
-� Po��Y l� �� n :�� _ _ i .
AUT�IAQ�l�E IJA8ILSTY . - — —
A i� aNYACFTd { O��SIM�QQ$INGLE L1Mff s 1 � ODO � OOO
��3�a��� o��0�/02 0�/0�/0� crJd >
eLL oV1fN�D A[Jl'QS 80ofLY lf�LluRY .`uy w.-.' +• ,--
� SCNflDULEOAUTpS ' S
�`2 � �i3� C+�I�-1E1�k:Fd�N3=� {Par�aaraanj
IC HIReoAUTDS �I,eOO C07aIe���A�1 �..�.R
[ eoo�r �nuv�Y f �
X NON-OWNE� AUTQS f tPer acusler�tj �
----.._ ,...---.. PRGP�R7YOMMG� ��
I IPer ar�fdent}
G1�pAG� 6iA9�l.ITV � i ^ ^ ^ /WTO ONLY • EA ACCIQEN� $
�i �►NY AUTp ' EA RCC g
� 6iHEl� Ti�AN
; _ • i AUTO ONLYI AGG $ .��~• •
� �XEXGF.SS W1gfLITY � FACH OGCUfIR�NCE b�� Q O� DO
oecuta � ct1uM5�laD� I,saee3n7os i 35R3315�3 07%01./02 Oi/A�/03 I Ac3�R���6Te _ I M1 5, OdQ,@�0
p�aucna�e
3C RE7ENTlQN � Q
WOliiibl�8 COk38F�SA7ION At�w
� Eikl�LOYSRB'LW91�ffY I
�
OT1�Eii �
�xc��e s
s�/IKe��r . s�0,D00,00Q�
-- I_ ��$��e : s 2Q,eoa,�ao
X� T�sYTLIM175 � PR I »
�O%Q1��� I £.L EAC}IACGIGIENT I � � . O�O , OOO ~
b9/A1/Q9 I E.L, �ISEAS�•EAF.�k1PLQY�� S�. � i)O� rQO�
_I E.L, 8�8�3E-➢OLICYLIMIT � S ��`OOO. QQO
a a���/��,�-Ai�, ��� �����o�o��� � a°r/aa/�2 � 07/o�./a3 �����c��� S9,4a�,o��
����a��u�g�n� i=ra�s�o�3� � o�io��oa a��aa.ir�� I ��s�a�� sa�a.oao
a�scwrr�ora o� oP��u�foWe�oca�u �t�snr�rnC�.Esrr�%c�us�oi� aooeo er c-�ooRSEb� rrsPec�w� ��avis��s . _ - •— _ . _ . .
�aa�eer �].�ctsi�caar� - Laa�rt Janes I�i�s� a�� J907
k"ax: ��,7��7� ��944 / ��7-���-Oi26 /21,4-35'7�5794
CERT1�#CAY� HOL,D�R ��: p6p�T�ofifleL INSifREsDi IHSiJR�it L�TfER:
� T C 7�7°Y
City A� �ort.�i �Ta��ch
���a��aa1� ei ��av�l�e�wrst
� L���c��c���l 9���s�ao�
�a�0 i�flgOd�Sfi+07:I:�f1
�'�.. eQorth �Y 7�ig�
AGO�tI �SS {�197j ' �.
WC�4f7705 07/Ab/@2
wca��v639o302 1a/o�/D�
CANCEl�iION ' ' � P —
� sa�u6o Arrr a� �pe eauv� nesc�r��o Poi.��s �� carice��Eo seFaa� r� exPiaanen�
p�srE Trie�eoF, niE �SUIN� iNsi�R6R wu.�. ENa��oq Yo r�ai6 � Q— A4Y8 VYRCfTEN
kOTICE 70 7k� CERIiFICA?g qp�.pEfa N,a��D YO TR� I.EF�', �UT Fbll,�p� TO DA SO SHA66
lR4P06� t10 �Hl�pYqM CR LWfMLITY OP eNv WMi1 GPOx TY1p urBuqFA. 4YB Ap6µ7'9 Wt,
RLFREBENTbTNES.
AUTMGl�Ep REPR@SSNTAiIVg � .
.r..�et6� M�sl�a}aj► � _ _ --
�AC�RD COR�O �N 19�8