HomeMy WebLinkAboutContract 60688-UDate Received: 1/3/24 Record Number: PN23-00103 -------
Time Received: 3 :oo PM-------City Secretary No.: _G_O_G _aa ___ _
PUBLIC PROPERTY EASEMENT ENCROACHMENT LICENSE AGREEMENT
TIER/I
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 NBT Financial Bank, a(n) Texas
state fmancial institution ("Licensee"), acting by and through its duly authorized
President/CEO.
RECITALS
WHEREAS, Licensee is the owner of the real property located at 2535 Northeast
28th Street, Fort Worth, Texas 76106 ("Property"), being more particular described as,
tract 1 and 2, a portion of the Seburn Gilmore Survey, Abstract No. 590, as recorded in
Deed Records, volume 7671, page 1273, in Tarrant County, Texas, and;
WHEREAS, the City owns a public water and sewer easement (the "Public
Property") adjacent to the Property, recorded in the plat records of Tarrant County as
plat number FS-80-156; 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 water line, irrigation line and a gas line (the
"Encroachment"). Upon completion of the Encroachment, Licensee agrees to be
responsible for maintaining the Encroachment within the Public Property. Licensee shall
Tier II Easement Encroachment Agreement Page 1 of13
Revised 12/2022
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.
�
Upon termination of this Agreement, Licensee shall, at the option of and at no
expense to the City, remove the Encroachment and restore the Public Property to a
condition acceptable to the Director of Transportation and Public Works, the Director of
the Water Department, the Director of the Development Services Department or their
Tier II Easement Encroachment Agreement Page 2 of 13
Revised 12/2022
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.
Tier II Easement Encroachment Agreement Page 3 of 13
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 certifcate 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 13
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.
16.
In any action brought by the City for the enforcement of the obligations of the
Licensee, City shall be entitled to recover interest and reasonable attorneys' fees.
Tier II Easement Encroachment Agreement Page 5 of 13
Revised 12/2022
17.
The parties agree that the duties and obligations contained in Section 5 shall
survive the termination of this Agreement.
18.
Licensee covenants and agrees that it will not assign all or any of its rights,
privileges, or duties under this Agreement without the written approval of the City, and
any attempted assignment without such written approval shall be void. In the event
Licensee conveys the Property, Licensee may assign all of its rights and obligations under
this Agreement to the new owner of the Property, and Licensee shall be deemed released
from its duties and obligations hereunder upon City's approval in writing of such
assignment, which approval shall not be unreasonably conditioned or withheld.
Foreclosure by a secured lender of Licensee or assignment to a secured lender by
Licensee in the event of default or otherwise shall not require City approval provided that
said lender notifies City in writing within sixty (60) days of such foreclosure or
assignment and assumes all of Licensee's rights and obligations hereunder. However, no
change of ownership due to foreclosure or assignment to any secured lender of Licensee
shall be effective as to City unless and until written notice of such foreclosure or
assignment is provided to City.
19.
Any cause of action for breach of this Agreement shall be brought in Tarrant
County, Texas. This Agreement shall be governed by the laws of the State of Texas.
20.
This Agreement shall be binding upon the parties hereto and their successors and
assigns.
21.
This Agreement may be executed in multiple counterparts, each of which shall be
considered an original, but all of which shall constitute one instrument
[SIGNATURES APPEAR ON FOLLOWING PAGE]
Tier II Easement Encroachment Agreement Page 6 of 13
Revised 12/2022
City: Licensee:
CITY OF FORT WORTH NBT Financial Bank
A Texas state financial institute
• 4,.&. I ':>� By: DJ Harrell (Jan 3, 2024 08:32 CST)
c.:;:O By: _______ i ______ _
D.J. Harrell, Director of the
Development Services Department
Name: Wade Donnell
Title: President/CEO
Date: Jan 3, 2024
ATTEST:
Jannette Goodall,
City Secretary
Date: Jan 3, 2024
Tier II Easement Encroachment Agreement
Date: 11-30-23-����--------
Approved As To Form and Legality
Jeremy Anato Mensah
Assistant City Attorney
Date: Dec 13, 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.
Date:
Rebecca Owen
Development Services
Dec 14, 2023 ---------------
Page 7 of 13
Revised 12/2022
***THIS PAGE FOR CITY OF FORT WORTH OFFICE USE ONLY***
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 this3rd day of
Jan uary -----�
Wendy L.
Beardslee
2024 .
Digitally signed by
Wendy L. Beardslee
Date: 2024.01.03
14:44:53 -06'00'
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
WENDY L BEARDSLEE Notary Public STATE OF TEXAS
Notary I.D. 13323719-3
My Comm. Exp. July 28, 2025
Page 8 of13
Revised 12/2022
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 Wade Donnell, President/CEO (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 NBT Financial Bank, a Texas state finaneial
institute (entity type), and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this 3oth day of
November � 2� 23
RHONDA HERRIAGE
�'� • � • Notary Pubiic, State of Texas
Notary Public in and for the •.,� '`'�� Notary iD si73�t.2
o. My Commission E�. 03-09-2025
State of � Xr�.;�
Tier II Easement Encroachment Agreement Page 9 of 13
Revised 12/2022
EXHIBIT A
Depiction and description of the Encroachment
Tier II Easement Encroachment Agreement Page 10 of 13
Revised 12/2022
D223185307 10/13/2023 12:15 PM Page: 1 of 4 Fee: $31.00 Submitter: Andy Castillo
Electronically Recorded by Tarrant County Clerk in Official Public Records -�,��
MARY LOUISE NICHOLSON
COUNTY CLERK
PARTIAL RELEASE AND ABANDONMENT
OF AN EASEMENT
THE STATE OF TEXAS
KNOWALL BYTHESE PRESENTS
COUNTY OF §
WHEREAS, according to the Official Fublic Records of Tarrant County, Texas, National
Sank of Texas is the real properiy surface owner ("Owner") of all that certam Lot 5, Block 1-R,
United Service Center Addition, an Addition ta the City of Fort Worth, Tarrant County, Texas,
descnbed in Warranty Deedto Owner recorded 'm Volume 7671, Page 1269, of the DeedRecords
of Tat�rant County, Texas; and
WHEREAS, a predecessor in title conveyed to the City of Fort Worth, a Sewer Easement
("Easement"), as evidenced in Instrument No. D181007221 or Volume 388-148, Page 35,
recorded on November 7, 1980, m the Official Public Records of Tarrant County, Texas; and
WHEREAS, the Owner has requested that the City of Fort Worth abandon and release a
portion of said Easement, being more fully descnbed in the attached Exhibits "A" and "B".
NOW, THEREFORE, the City oiFort Worth, in consideration of $10.00 and other good
and valuable consideration, does hereby abandon, release and discharge all of its rights, title, and
interests in, to, and under that Easement, as shown and defined in the attached Exhibits "A" and
ccB»
[SIGNATURES APPEAR ON THE FOLLOWING PAG�]
� J �-
IN WITNESS WHEREOF, this inst�•ument is executed this � � day of
�:�=����-e,�J . Zo �� .
ABANDONMENT/ VACATION OF EASEMENT �ORT VVORTH,=
Rev.20181217
D223185307
THE CITY OF FORT WORTH
By. Uai�Rurqhdnf� ctJ_20231��DT) _
Dana Burghdoff
Assistant CityManager
Appraved as to Form and Legality:
By: ��°t.� � r�l� �-�----�
Name: Thomas Hansen
As sis tant City Attorne y II
CONTRACT COMFLIANCE MANAGER:
By signing, I acknowledge that I am the person responsible for the monitoring and
admi7iist�•ation of this contract, including ensuring all performance and reporting requirements.
By• ReG?tta DlAane Ovren (Cct 6.2023132A C6Ti
RebeccaDiane Owen
Planning Manager
THE STATE OF T�XAS
COUNTY OF TARRANT
ACKNO WLEDGEMENT
�
�
BEFORE ME, the undersigned authority, a Notary Public in and for the State of TEXAS,
on thi� day personally appeared Dana Burghdo� Assistant City Manager of the CITY OF
FORT WORTH, known to me to be the same person whose name is subscrlbed to the foregoing
instrument, and acknowledged to me that the same was the act of the CITY OF FORT WORTH
and that she executed the same for the purposes and consideration therein expressed and, in the
capacity, therein stated.
,..
GIVEN UNDER MY HAND
� �` ��,�� , 20 ��� .
..., �J��
r��_' —
�p0.� pf/B TIFFANY BACON
��,,, Notary ID /t128261860
,� p My Commission Expires
9rfoF.�v.} January 20, 2027
ABANDONMENT! VACATION OF &�SEMENT
Rev.20181217
AND SEAL OF OFFICE this ��L`�� day of
� `: ���
C : ) --�
— — -'��-�- "°� �
Notary Public in and for t� State of TEXAS
�
%RT W�PTH ,
Page 2 of 4
D223185307
EXHIT3IT A
METES AND BdUNDS DESCRII'TTON
3,711 SQUARE TOOT SAMTARY SE'W�R EASEMENT ABANDONMENT
OLiT OF LUT 5, �3LOCK 1-R, UNI'I'Ell SERVICE CENT�R ADDTTION
iN THE S. GILMORE SURVEY, A-590
CITY OF FORT WOR'�H, TAI2RANT COUNTY, TEXAS
AlI that certain 3,711 square feet of land, out of Lot 5, Block 1-R, United Service Center
Addition, recarded in Document Number D181007221 in the Plat Records of Tarrant County,
Texas (P.R.T.C.T.), in the S. Gilmore Survey, A-590, City of Fort Worth, Tarrant County, Texas
and more parkiculazly described by metes and bounds as follows: (All bearings shown hereon are
based on the Texas Coordinate System of 19$3, North Central Zone)
Comrnencing at a 5/8" iron rod with a cap stamped 'BROOKS BAKER" found for the northwest
corner of said Lot 5, Block 1-R, common to the southwest corner of Lot 4R1, Block 1-R, United
Service Center Addition, recorded in Document Number D212125732, P.R.T.C.T., in the east
line of Lot 1R1, Block 1-R, said United Service Center Addition (D212125732), and from which
a found 112" iron rod for tt�e northeast corner of said Lot 5, Block 1-R, common to the southeast
corner of said Lot 4, Block 1-R, bears North 89° 59' 43" �ast — 282.34';1'hen South 00° 24' 44"
West —114.24' along the west line of said Lot 5, Biock i-R, United Service Center Addition to a
to a point in ihe southwest line of the exisring l S' Sanitary Sewer Easement, as shown on the plat
of said United Service Center Addition (D181007221), 'T'hen South 29° 45' 02" East -- 167.1$'
along tt�e southwest line of said 15' Sanitary Sewer Easement to the POINT OF BEGINNING
and the southwest corner of the herein described tract, common to the norkheast corner. of the
Sanitary Sewer Easement, recorded in Document Number D221251303 in the deed Records af
Tarrant County, Texas (D.R.T.C.T.);
THENCE North 00° 24' 44" East - 29.85' to the northwast c�rner the herein described tract, in
the northeast line of said 1 S Sanitary Sewer Basement;
THENCE South 29° 45' 02" East - 252.86' along the northeast line of said 1 S' Sanitary Sewer
Easement, to the southeast corner of the herein described tract, in the north line of said Sanitary
Sewer Easernent (D221251303);
THENGE South 79° 1S' 42" West - 15.87' to the southwest corner of the herein desciibed tract,
in the southwest line of said 1 S' Sanitary Sewer �asement;
'I'fIENCE North 29° 45' 02" West - 231.8$' atong the southwest line of said 15' Sanitary Sewer
Easement, to the POINT OF BEGINNING and containing 3,711 sc�uare feet of land.
THIS NIET�S ANA BOUNDS D1;SCRIPTIDIY IS ISSUED IN CONJUNCTION 'WIT'H
THE SURVEY PREPARED BY SPRY SUR't�EYORS, HEKEBY REFERENCED AS
EXHIBTT B. THIS METES AND BOUNDS DESCRIP'�'ION IS EXIiIBTT A.
SPRY SURVEY(JRS
Issue Date: September 26, 2023 � Certificate Date: January 24, 2020
8241 Mid-Cities Blvd., Suite 102 • North Richland HitIs, T`X 76182
Firm Reg No. 10112000 � Project Numher: 074-038-50
Phone 817-776-4049 • emailsprx{c�sprvsurvevors.com
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' G� 26 Z
David T,ewis� '�
Page 3 of 4
R.P.L.S. NO. 5647
D223185307
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Surveyors, o( ihe same ceriiticptipn date shown hdrean, hereby referenced o. Exhibit A, This
Survay is Ex�ibit 8. ,
gE J. ihis Survay ls IS6upd wlthout the benefit oi o rront iitla report ond Is suDject to raWsion
upon recefpt lhereof. Survayor has dane no odditional reseorch for posslble eosemenis,
� ro�trictions or covenants whicb mvy offect thfe property.
4. The Surveyw has not physically locoted any underqrountl uti�iUes and/or Improvements which
g may be �ocoted under or near the subjsct property. �
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Graphic Scale in Feet
0 60' 12Q'
SCALE 1"=60'
A B B R� U T A T I O N S
D.R.T.C.T. PUBUC RECORDS OF TARRANT COUNTY; IEXAS
P.R.7.C..T. PUBLIC RECORDS OF TARRANT CdUNTY, TEXAS
VOI. VOLUME
PG. PACE
DOC, NO. DOCUMEN7 NUMDER
P,O.C. POINT Ot' COMMENGNG
P.O.B. POINT OF BECINNiNG
C.M. CONTR0111NG A70NUMENT
IRF IRON R00 FWNU
R.O.H, RIGHT—OF—WAY
EXNIBIT 8-3,711 SQUARE FOOT
SANITARY SEWER EASEMENT ABANDONEMENT
OUT OF LOT 5, BLOCK 1--R, UNITED SERVICE CENTcR ADDITION
IN TNE S GI! MORE SURVEY, A-590
CIN OP FORT SYORTN, TARRANT COUNTY, 7EXA5
ISSUE DATE: 9/26/2b23 5GAIP 1'=60' PRDJECT NO.; 074-038-50
SPRY(� SURVEYORS
8241 Mid—Cities Olvd., Suite 102 � Norih Richland Hilis, iX 76182
PH:817.776.4049 • spryg,prysurveyors.com � www.sprysurveyors.com
Flrm Rey. No. 101120Dp
Page 4 of 4
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THE NATIONAL BANK OF TEXAS
NEW RETAIL BANK
2535 NE 28TH STREET
FORT WORTH, TEXAS 76106
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EXHIBIT B
Certificate of Insurance
Tier II Easement Encroachment Agreement Page 13 of 13
Revised 12/2022
DATE (MM/DD/YYYY)
A�� �� CERTIFICATE OF LIABILITY INSURANCE
11 /09/2023
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT Latresa Powell
NAME:
Bankers InsO�ance Ogenc❑ AIC No ext :�OOC318-�1 CQ Faic No :�12033�0972
203 West 10th Street E"M'v� latresa@bia.ins7�ance
enno�cc•
INSURER(S) AFFORDING COVERAGE NAIC #
CCstin TX 78701 iNsuRERA: Travelers GroCC 2567❑
INSURED INSURER B :
NBT Financial Bank
5550 N Riverside Dr.
INSURER D :
INSURER E :
Fort Worth TX 76137
COVERAGES CERTIFICATE NUMBER: �L1���yu�y� REVISION NUMBER:
THIS IS TO CERTIFD THOTTHE POLICIES OF INSORONCE LISTED BELOW HWE BEEN ISSDED TO THE INSORED NOMED OBOVE FOR THE POLICD PERIOD
INDIC�TED. NOTWITHSTONDING ON� RED DIREMENT�fERM OR CONDITION OF OND CONTROCT OR OTHER DOCOMENT WITH RESPECT TO WHICH THIS
CERTIFICOTE M00 BE ISSDED OR M�0 PERTDIN�THE INSORONCE �FFORDED BD THE POLICIES DESCRIBED HEREIN IS SOB�CT TO OLL THE TERMS❑
EXCLOSIONS OND CONDITIONS OF SOCH POLICIES. LIMITS SHOWN M H VE BEEN REDOCED B� PDID CLDIMS.
INSR TYPE OF INSURANCE POLICY EFF POLICY EXP
LTR IN D WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EDCH OCCORRENCE ❑ ��OOLOOO
CLoIMS-MODE � OCC R PREMISES �a ooc� ence❑ ❑ 1 LOOOL000
MED EXP �n0one Cerson❑ ❑ 100000
� 660uL23�209 05/11/2023 05/11/202� pERSONOL00DVWQR❑ ❑ 11900�000
GENm OGGREG�TE LIMIT OPPLIES PER❑ GENEROL OGGREG�iE ❑ 2LOOOL000
POLIC❑ ��� � LOC PRODCCTS- COMP/OP CGG ❑ 2LOOOL000
OTHER❑ Eu IJO�e BeneitS ❑ 11900�000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ 1 LOOOLO00
�a accident❑
X❑NO DOTO BODILD INmRO �er CersonC ❑
� OWNED SCHEDCLED BLJ9M671120 05/11/2023 05/11/202� BODILDINmRO�eraccident❑ ❑
❑OTOS ONL- ❑OTOS
HIRED NON-OWNED PROPERTD DOMOGE �
❑OTOS ONLD ❑OTOS ONLO �er accident�
�ninsu-ed uotorist ❑ 11900�000
UMBRELLA LIAB vV"""'�"" ""'y��" "J'• 10[ID00�00
OCC7R EDCH OCCORRENCE ❑
J EXCESSLIAB CLDIMS-MCDE CUPSN$32��LJ 05/11/2023 05/��/202J ❑GGREGCTE ❑ ��������
DED X RETENTION ❑ � O[DOO �
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY ST�TCTE ER
Y I N � Lm�OLm�O
❑NO PROPRIETOR/PORTNER/EXECOTIVE E.L. EOCH oCCIDENT ❑
� OFFICER/MEMBEREXCLODED❑ � NIA LBLL232L$6 05/11/2023 05/11/202�
(Mandatory in NH) E.L. DISECSE- ED EMPLODEE ❑ ������0
lo�sctlescribe rnder 1 LOOOL000
DESCRIPTION OF OPER�iIONS below E.L. DISECSE - POLICD LIMIT ❑
DESCRIPiION OF OPERATIONS / LOCAiIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached if more space is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Cituo�Fort Worth Planning u Develouuent CFu OuiCe PN23-00103 ACCORDANCE WITH THE POLICY PROVISIONS.
200 Texas Street
AUTHORIZED REPRESENTATIVE
Fort Worth TX 76102 ���,� �Qu,,���_
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD