HomeMy WebLinkAboutContract 60689Date Received: l/3/24 Record Number: PN23-00167 -------
Time Received: 4:lO PM-------City Secretary No.: _6_06_8_9 ___ _
PUBLIC PROPERTY EASEMENT ENCROACHMENT LICENSE AGREEMENT
TIER fl
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 CJ Real Estate II, LLC, a(n) a
Texas limited liability company ("Licensee"), acting by and through its duly authorized
signatory.
RECITALS
WHEREAS, Licensee is the owner of the real property located at 10021
Northwest Highway 287, Fort Worth, Texas 76131 ("Property"), being more particular
described as, Lot 2, Block 31, o Lot 2-6 and 7X, Block 31, Richmond Addition, as
recorded in Deed Records, by Instrument Number D223131787, in Tarrant County,
Texas, and;
WHEREAS, the City owns a water easement (the "Public Property") adjacent to
the Property, in the plat records of Tarrant County as plat number FP-21-007; 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 electric line (the "Encroachment"). Upon completion of the
Encroachment, Licensee agrees to be responsible for maintaining the Encroachment
within the Public Property. Licensee shall not expand or otherwise cause the
Tier II Easement Encroachment Agreement Page I ofl2
Revised 12/2022
Encroachmen� to further infringe u� or on the Public Property beyond what is specificaily
described in Exhibit "A."
2.
All construction, installation, maintenance, and operation of the Encroachment
and tne use or occupancy of the Pubiic Property shaIl comply with and be performed in
strict con�pliance 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 specifiea�ions to the Director of the Development
Services Department or duly authorized representati�e. Licensee shall not commence
cons�ruction or installation of the Encroachment nor make any use of the Public Property
until after the execution ofihis Agreement.
3.
Licensee, at no expense to the City, shall �nake proper provisions far the
relocation and installation of any existing or future utilities affec�ed by such
Encroachrnent and the use and oceupancy of t�e Pub�ic Property, including the securing
the approval and consent of the appropr�ate utility companies and agencies of the State of
Texas and its political subdi�isions. In the event that any installation, reins�allation,
relocation, or repair of any existing or future u#ility or improvemer�ts owned by or
constructed hy ar 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 ta such additionaI
eost as determined by the Director of Trans�ortation and Publie Works, the Director of
the Water Department, t�e Director of the De�elaprnent Services Department, or their
duly authorized representative.
4.
Licensee agrees tha� City may enter and utilize the Public Property at any �ime for
any public purpose, includ�ng installing, repairing, replacing, or maintaining
improvemen�s to i�s public facilities or u�ilities necessary for t�e health, safe#y, and
welfare of the public. The �ity shall have no responsibility or �iability for any darnages
related fo the Encroachment resulting from t�e City's use of the Publie Property;
however, ihe City shall make reasanable efforts to minimize such damage.
5.
Upon termination of this Agree�nent, Licensee shall, at the option of and at na
expense to the City, remove the Encroachment and restore the Pub�ic Property to a
condition acceptable to the Director of Transportation and Pubiic Warks, the Director of
the Water Departmeni, the Director of the Development Services Department or their
Tfer II Easement Ei�croachment Agreement Page 2 af 12
Revised i 212022
duly authorized representative. Any such removal of the Eneroachment shall be in
accordance with then-existir�g Ci�y regulations and polic�es. It is understood and agreed
ta by Licensee that if this Agreement terminates and Licensee fails ta remove the
Encroachment and restore the Public Property, Licensee hereby gives City permission io
re�no�e the Encroachment and any supporting structures from fhe Public Property, to
resiore 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 af Public Property as pro�ided for by this
Agreement, Licensee agrees to pay to City at the time this Agreement is requested an
application iee in the sum ofNine Hundred Dollars ($9UO.OQ).
7.
The te�•m ofthis Agreement shall be for farty (40j years, commencing an the date
this Agreement is executed by City. However, the City may terminaie tl�is Agreement
upon Lieensee's noncompliance wi�h any of the ter�ns of this Agreement. City shall
notify Licensee in wri�ing of any sueh noncompliance and if Lieensee 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, altow the Agreement to temain in
efFect so iong as Licensee has taken reasonable measures to cure the noncompliance or is
cont�nuing to diligently attempt to remedy the noncampliance.
S.
It is further understood and agreeci between the parties hereto �hat the Public
Property to be used and encroached upon is held by City as trustee for the public; tha�
City exerc�ses such powers over the Public Property as have beer� delegated to it by the
Constitution c�f the State of Texas or by the Texas Legislature; and that City cannot
cantract away i�s duty and its legislative power to eontrol the Public Property for the use
and beneiit of�the publ�c. 1� is accardingiy agreed that if the governu�g body of City may
at any tune during the term hereof determine in its sale discretion to use or cause ar
permit the Public Property to be used for any other public purpose, including but �ot
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 Encraachment ar�d the public purpose.
Tier II Easement Encroaclunent Agreement Page 3 of 12
Revised 1212022
9.
LICENSEE COVENANTS AND AGREES TO INDEMNiFY, AND DOES
HEREBY iNDEMNIFY, HOLD HARMLESS, AND DEFENll CITY, ITS
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, AND ELECTED OFFICIALS
FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS FOR PROPERTY
DAlVIAGE OR LOSS ANDIOR PERSONAL INJURY, 1NCLUDIN� llEATH, TO
ANY AND ALL PERSONS, OF WHATSOEVER KIND OR CHARACTER,
WFIETHER RCAL OR ASSERTED, ARISING �UT OF OR 1N CONNECTION
WITH, DIRECTLY OR INDIRECTLY, THE CONSTRUCTION,
MAINTENANCE, OCCUPANCY, USE, EXISTENCE, �R LOCATI�N OF THE
ENCROACHMENT AND USES GItANTED HEREUNDER, WHETHER OR NOT
CAUSED, IN WHOLE OR IN PART, BY THE ALLEGED NEGLIGENCE OF
OFFICER�, AGENTS, SERVANT�, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, LICENSE�S, ELECTED OFFICIALS, OR INVITEES OF
THC CITY, AND LICENSEE HEREBY ASSUME5 ALL LIABILITY AND
RESPONSIBILITY FOR SUCH CLAIMS OR SUITS. LICENSEE SHALL
LIKEWISE ASSUME ALL LIABILI'�Y AND RESPONSIBILITY AND SHALL
INDEMNIFY CITY FOR ANY AND ALL INJURY OR DAMAGE TO CITY
PROPERTY ARISING OUT OF OR IN CONNECTION WITH TI�E
ENCROACHMENTS AND ANY AND ALL ACTS OR OMISSIONS OF
LICENSE�, IT� OFFICERS, AGENTS, SERVANTB, 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 sec�red and
paid for a policy of public liability insurance covering all public risks related to the
proposed use and occupancy of �ublic property as located and described in Exhibit "A."
The ainounts of such insurance shall be not less than
��,oao,aoo
with the understanding and agreement by L�censee that such insurance amounts may be
revised upward at City's c�ption and tha� Licensee shall so revise such amounts
immediately foliowing notice io Lieensee of such requirement. Such u�surance policy
shall not be canceled or amended without at least thirty (30) days prior written notiee to
the Building Offic�al of the City. A eopy of sueh Certificate of Insurance is attached as
Exhibi� "B" and incorporated herein for a11 purposes. Licensee agrees, binds, and
obligates itself and �fs successors and assigns tc� maintain and keep in farce such public
liability insurance at all tirnes during the term of this Agreement and until the removal af
the Encraachment and restoration of the Public Property. All u�surance coverage
required herein shall include coverage of all Licensee's contractors and subcontractors.
Tier II Easement Encroachtnent Agreement Page 4 of 12
Revised 12/2022
11.
Licensee agrees io deposit with the City when this Agreement is executed a
sufficient sum of money to be used to pay necessary fees lo record this Agreemen� in the
real property records af ti�e county in which the Encroachment is (ocated. After bein�
recorded, the original shall be returned to the City Secretary of the City o#'Fort Worth.
12.
Licensee agrees to comply fully with all applicable federal, state, and local �aws,
statutes, ordinances, codes, and regulations in connection with the construction,
operation, and maintenance ofthe Encroachment and use of�he Pubiic Property.
13.
Licensee agrees to pay promptly when due all fees, taxes, or rentals provided for
by this Agreement or hy any federal, state, or local statute, law, or regulation.
14.
Licensee covenants and agrees that it shall operate hereunder as an independent
contractor as ta ali rights and priviieges granted hereunder anc� not as an officer, agent,
servant, or employee of City, and Licensee shall have exclusive control of and the
exclusive righ# to control the details of its operations, and all persons performing same,
and shall be solely respc�nsible for the acts and ornissions of its afficers, agents, servants,
employees, contractors, subcantractars, licensees, and invitees. The doctrir�e of
respandeat superior shall not apply as between City and Licensee, its officers, agents,
ser�ants, emp�oyees, 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 per�ni�ting Licensee to construct, maintain, and loeate the Encroachment over or wi�hin
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 canvey any right to use or occupy property in whicl� a
third-party may have an interest. Licensee agrees thaf it will obtain all necessary
permissions before occupying such property.
Tier [ I Easement Encroaclunent Agreement Page 5 of 12
Re�isec� 12I2022
fCt�
In any action brought by the City for the enforcement of the obligations of the
Licensee, City shall be entitled to recover interest and reasonabie attarneys' fees.
17.
The parties agree that �he cEuties and obligations contained in Sec�ion 5 shall
survive tI�e termu�ation ofthis Agreement.
18.
Licensee cavenants and agrees tl�at it vvill not assign all or any af its rights,
privileges, or duties under this Agreerr�ent without the written approvai of the City, and
any attempted assignment without such written approval shali be void. In t�e event
Licensee canveys the Property, Licensee may assign all of iis rights and obtigations under
this Agreement to ihe new owner of the Property, and Licensee shail be deemed released
from its duties and obligations hereunder upan City's approval in writing of such
assignrr�ent, which approval shall nat be unreasanably conditioned or witl�held.
Foreclosure by a secured Iender of Licensee or assignment to a secured lender by
Licensee in the event of default or ott�erwise sha11 not require City approval provided that
said lender notifies City in writing within sixty (60) days af such foreclosure or
assignment and assutnes all af Licensee's rights and obligations hereunder. However, no
change of ownership due to foreclosure or assignment to any secured lender of Licensee
shall be effecti�e as �o City unless and until written notice of such foreclosure or
assignment is provided ta City.
19.
1�ny cause of action for breach af this Agreement shall be brougl�t in Tarrant
County, Texas. This Agreernent shall be governed by the laws of the State of Texas.
20.
This Agreement shall be binding �pon �he parties hereto and their successors and
assigns.
21.
This Agreement may be executed in muitiple counterparts, each of whieh shall be
cansidered an originai, b�it all of which shall cons�itute one instrument
Tier II Ease�nent Encroachment Agreement Page 6 of 12
Revised 12/2022
[SIGNATLTRES APPEAR ON FOLLOWING PAGE]
Tier II Easement Encroachmen# Agreement Page 7 of 3 2
Revised 12/2022
City: Licensee:
CITY OF FORT WORTH CJ Real Estate II, LLC
a Texas limited liability company
·.e' ,,::::.�By: DJ Harrell (Jan 3, 2024 08:36 CST)
D.J. Harrell, Director of the
Development Services Department
Name: MattJamesen
Title: Authorized Signatory
Date: /Z�ZO-Z3 Date: Jan 3, 2024
ATTEST:
Jannette Goodall,
City Secretary
Date: Jan 3, 2024
Tier II Easement Encroachment Agreement
Approved As To Form and Legality
Jeremy Anato Mensah
Assistant City Attorney
Date: Jan 2, 2024
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.
Rebecca. Diane owen (Jan 2, 202416:59 CST)
Date:
Rebecca Owen
Development Services
Jan 2, 2024 --------------
Page 8 of 12 Revised 12/2022
***THIS PAGE FOR CITY OF FORT WORTH OFFICE USE ONLY H *
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 3rd day of
J_a_nu_a_ry___ , 20 li_.
Wendy L.
Beardslee
Digitally signed by Wendy
L. Beardslee
Date: 2024.01.03 15:13:33
-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 9 of 12
Revised 12/2022
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Fublic in and for the State af
, on this day personally appeared Matt Jamesen, Authorized Signatory (Title)
known to me to be the person whose name is subscribed to the foregoing instrument, and
acknowledged ta me that he or she executed the same for the purposes and consideration
therein expressed, as the act and deed of CJ Real Estate II, LLC, a Texas [imiteci
liability company (entity type}, and in the capacity therein stated.
GIVEN UNDER MY IIAND AND SEAL OF OFFICE this �D
2a a3
.. � � � �r� �.
3�iotary Public in and for the
�
State of i e�as
`,SPRv�'�e,; HEATFEER E. MCF.ARLAIN
_ or'' �= Notery Public, State afi Texas
��^;:�••'Q, Comm. Expires 02-16-2026
�./�'of',ti`:
/��1141j� Notary VO t33593379
day of J7ee�elMbQr
Tier II Easement Encroachment Agreement Page 10 of 12
Revised 12/2022
EXHIBIT A
Depic�ion and descrip�ion of the Encroachment
Tier I3 Easement Encroacl�ment Agreement Page ] 1 of 12
Revised 1212022
CJ REAL ESTATE, LLC
3825 CAMP 80W1E BLVD
FORT WORTH, TEXAS 76'I D7
ENlAIL: MJ@HAYDNCUTLER.COM
PREPARED BY:
MJ THOMAS ENG[NEERlNG
4700 BRYANT IRVIN CT, STE: 204
FORT WORTH, TEXAS 7S1 D7
PH:(817}732-9839
FAX: (817)732-9841
REGISTRATION NO. F-9435
CONTACT: MICHAE� THOMAS, P.E.
.—�.� r.•.- '� •'
. •
* � .S * !
,r ; : a
..........e ...............i..i
MICHAEL A, TH�MAS
93640
IONAL Er' ��
1�.������ 11/20/23
Location Map
FOR
STARBUCKS FM 156
AND US HWY 287
(LOT 2, BLOCK 31j
RICHMOND ADDITION
GTY OF F03tT WORTH, TEXAS
N.T.S.
OWNEDIDEVELOPED BY: MAPSCO NO. 20-U
COUNCIL DISTRICT NUMBER: �0
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OWNEDIDEVELOPED BY:
CJ REAL ESTATE, LLC
3825 CAMP BOWIE BLVD
FORT WORTH, TEXRS 76'407
EMAIL: MJ a�HAYDNCUTL�R.COM
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MJ THOMAS ENGINEERING
4700 BRYANT IRV1N CT, STE: 204
FORT WORTH, TEXAS 76107
PH: (817) 732-9839
FAX: (817}732-984�t
REGiSTRATlON NO. F-9435
CONTRCT: MICHAEL THOMAS, P.E.
�
LEGEND
EXISTING WATER LfNE
PROPOSED UN�ERGROUNO
ELECTRlC LINE
PROP05ED ENGROACH�lENT
� �`�� EXHIBIT B -
6 Q'��°�� �� �� � � �..
��,.• � UNDERGROUND ELEC�:fRIC
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,� * ,
; FOR ��
w�iw��eua�ur���raw��s = ��� � ��� .
MICMAEL A, TH❑�1AS � STARBIlCKS FM �.56
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'a,9 ;� 93640 ��Q r SCALE 1" = 20� AN D US H WY 287
�°'��•<ICENSEO..��`�'� F��3 (LOT 2, BLOCK 31)
r�1���,`����� 1/20/2023 as so ,-.. .T
RICHMOND ADDITIO�
CJ REAL ESTATE, LLC
3825 CAMP BOWIE 8{.VD
FORT WORTH, TEXAS 78107
EMAiL: M.]@HAYDNCIfTL�R.COM
PREPARED BY:
MJ THOIVIRS ENGINEERING
47�0 BRYANT tRVEN CT, STE: 2€l4
F�fiT WORTH, TEXRS 76107
RH: (817) 732-9839
FAX: (817)732-9841
REGISTRATION NO. F-9435
CONTACT: MiCHAEL THOMAS, P.E.
� P'��.: :.. j�
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MICHAEL A, TH❑MAS
93640
1/20/2023
PROFILE SCALE
HORiZONTAL SCALE: 1"=�0'
VERTICAL SCALE: 1" =4',
EXHIBIT C2 -
PROFILE
FOR ,
STARBUCKS FM 15fi
AND US HWY 287
�LOT 2, BLOCK 31)
RICHMOND ADDITIOl�
ClTY OF FORT WORTH, TEXAS
o+ oQ o+ 50
OWNED{DEVELOPED BY:
EXHIBIT B
Certificate of Insarance
Tier II Easemeizt Encroachment Ageement Page 12 of 12
Revised 12/2022
�rcoR � CERTIFICATE OF LIAB�LiTY INSURANCE DATE{MMliIDM'YY)
�..,,,� � 2r� Zj�oz3
THIS CERTIFICATE !S iSSUED A5 A MATTER OF fNFORMATI�N ONLY AND CONFERS NO RIGHTS UPON THE CERTEFICATE HOLDER. THIS
CERTIFfCATE DOES NOT QFFIRMATIVELY OR NEGATNELY A�JIEN�, EXTEND OR ALTER THE COVERAGE AFFORDED 8Y iHE POLI�IES
BEL�W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSiITUTE A CONTRACT BETWEEN THE ISSUlNG INSURER(S), AUTH01ttZED
REPRESENiATIVE OR PRODUCER, AND THE CERTtFICATE H�L�ER.
tN�PORTANT: If 4he certificate holder is an AD�ITIONAL INSURED, the policy(ies) must have ADDiTEONAL INSURED pro�isions or be endorsed.
kf SUBROGATION 1S WAlVE�, subject to the terms and candii9ons of the poiicy, ceriatn po[Ecies may require an endorsement. A stateitten4 on
this certificate does not cortfer rights to tt�e certificate holder in lieu of such endorsement(s).
�RoouceR NamE �� Janna Ganzalez, Certificate CSR
Higginbotham insurance Rgency, Inc. P�o►,e �,ax ----
500 W. 13fh Street arc n�_o,Ex��: 877-349-2384 _ ___ [�uc �:
E-MAIL onzalez hi �nbotham.net
FOft WOI�Ii TX %B� OZ ADDRESS: J�__ �_��__ ___ ____ ___ �_______
AFFOROING COVERAGE
FNSURE6 �
Haydn Cutker Company
3825 Camp Bowie
Fort Worth TX 76�l07
Of America
�
' 25674
COVERRGES CERT4F1CA7E NUMBER:174426742 REVfSION NUMBER:
TF€IS IS TO CERTIFY THAT THE POLICiES OF ENSURANGE LISTEp BELOW HAVE SEEfV ISSl1ED TO TFiE INSURED NAMED ABQVE FOR T}1E POLICY !'EFtIOD
INDiCATED. NOTWdTHSTANDING ANY REqUIREMENT, 7ERM OR CONDITION OF ANY CONTRACT OF2 OTHER DOCUMENT WfTH RESPECT TO Wl1ECN 7HiS
CEi2TIFlCATE MAY �3E ISSUED OR AAAY PER7RIN, THE INBUFtANCE AFFOF2DED BY THE POLICIES DESCRIBED FiEREIFV IS SUBJEGT TO RLL THE 'CEF2M5,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIN€ITS SNOWN MAY HAVE BEEN REDUCED 8Y PAID CLA]M5.
INSR TypE OF INSURANCE ADDL SUBR pa��CY NUMBER AAM DDIYYYY AAM! DYlYYYY LIMITS
LTi?
A X COMMERCIALGENERALLIABfLITY fi603C43775A 1'E1112023 41/1/2024 E,qCHOCCURRENCE $4,000�,O�Q
DAMAGE TO RENTE❑
� CLAIMS-MkDE � OCCUR PREMISES Ea occurrence $ 300,000
MED E7(P (Any one person) $ 5,00�
� PERSONAL&A�VINJURY $'i,00(#,000� -
GEN'L AGGREGATE LIM]T APPLIES PER'� GENERAL AGGREGATE $ 2,000,0�0
POLICY ��R� � LQC ' PRO�UCTS - COMPIOP AGG $ 2,000,0�� _
JECT -- - ----
OTHER: �
S AUTOMOBlLE LIABILITY BAOL666491 111�12023 111112024 COMBINE� SlNGLE LINf17 g 1,(f00,00C1
�Es acciden�___
X ANY AUTO BO�ILY INJURY (Per Rerson} $
OWNED SCHEDULE� BO�iLY INJURY [Per accident] $
AUTOS ONLY AUTOS
X iiIRE� NON-OWNED PROPERTYDAMAGE �
AUToS ONLY AVTOS ONLY Per aceident
, $
C X UMBRELLALFAB X ����� CUP�K41834� 1'il'112023 11f112024 Ep,CHOCCURRENCE $15,000,�00
� EACESS llRB CLA3MS-MADE AGGREGATE $ 15,Q00,�00
�ED X RETENTiON 5 S
WORKERSCOMPENSATION P�R OTH- �
AND EMPLOYERS' LIA8ILITY �, r N STATUTE Eft _ _-
ANYPROPR€ETOP2lPARTNERIEXECVTiVE ❑ EL EACH ACCIDENT $ �
OFFICERIMEMBEREXCLIJ�E�? N1A -- -
(Mandatory in NHj E.L. DISEASE - EA EMPLOYEE $
If yes, describe under . . .
DESCRIPTION OF OPERA��IONS hefow E.L. DISEASE - POLICY LIM1T $
6ESCRIPTEON OF OPERATIONS ! LOCA710NS 1 VEHICLES {ACOR6104, Additlona4 Remarks ScFedule, may be aftached if more space is required) ��� �
General Liabiiiiy: Aggregate Per Location can apply subjeci to a cap of $25,0OO,�DO
The General Liabiliky policy incEudes a blanket automatic additional insured endarsement that pro�ides additiona{ insured (Ongoing and Compfated Operations)
status fo the certiiicate holder when required by written contract..
The General Liability policy includes a blanket automatic waiver of subrogation endorsement that provides this feature when required by written coniract:
The Genera[ L"sability and Automobile Liability policy have a blartket Primary & Non Contributary endorsement that affards that coverage to eertifcate hulders
See Attached...
HAYDCUT-92
IN5URER D :
INSi1RER E :
SHOULD APEY OF THE ABOVE DESCRIBED POLICIES BE CANCELtEA �EFORE
THE EXPIRATION DATE FHEREDF, NOTtCE WILL BE DELIVERE� IN
ACCORDANCE WITH THE PULICY PROYISIONS.
Travelers
TE
City of Fort Worfh
200 Texas Sireet
Fort Worth TX 761 O7
PN23-00167
nu�rtoR¢eo
OO 1988-2015 ACORD CORP0�4710N. All r�ghts reserved.
ACORD 25 {2016103) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: HAYDCUT-02
LOC #:
� �
AGENCY
Niggin6otham Insurance Agency, Inc.
POLICY NUSYIBER
CARRIER
NAIC C6DE
EFFEC7IVE DATE:
Page 1 of 1
ADDITIONAL REMARKS
THIS ADD[TIONAL REMARKS FOR�lI IS A SCHE�IlLE TO ACORD FORM,
FORM NfJMBER: 25 �QRM TITLE: �ERTIFICATE OF LIABI�iTY INSURANCE
ln4y where there is a written contract between the f�amed lnsured and the certificate holder thai requires such status.
fhe General Liability and Auromobile LiabiEity policy incfudes an endorsement providing that 30 days notice of cancellation will be #umished ta the certificate
Automobile Liability poiiey includes a bEanket automaiic additionai insured endorsemenl that provides additional insured status to the certificate holder when
ired by written contract.
Automobile Liability palicy includes a bEanket automaiic waiver o# subrogation endorsement that pro�ides this feature when required by written contract.
UmbreAa L'sability is Follow Form underlying the General Liability and Automobile LiabiEity policies.
CJ 5hart�ro McPherson, LLC is insured under fhe captioned policy
Policy contains a Real Estate Developmenf Activifies Exclusinn
Project Name: Starbucks — McPherson
PN23-00167
Certificate holder is insured as noted ahave and complete fo incEude: Cify of Fort Vtlorth
ACOi2D 10V (2008107) 02008 ACORD CORPORATION. All rights ra=served.
The ACORD name and tago are registered marks of ACORD
ADDlTIONAL REMARKS SCHEDULE
NAMEOINSURfD
Haydn Cutler Company
3825 Camp Bawie
Fort Warth 'FX 76107