HomeMy WebLinkAboutContract 61635Date Received: July 3, 2024
Time Received: lQ:QQ a.m.
Record Number: PN24-00060
City Secretary No.: 61635
PUBLIC PROPERTY EASEMENT ENCROACHMENT LICENSE AGREEMENT
TIERII
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 Miguel Molina and Ana Molina,
a(n) property owners ("Licensee"), acting by and through its duly authorized home
owners.
RECITALS
WHEREAS, Licensee is the owner of the real property located at 2611 Daisy
Lane, Fort Worth, Texas 76111 ("Property"), being more particularly described as,
being the East 101 feet of the West 241 feet of Lot 4, Block 1, R. T. Evans Addition, to
the City of Fort Worth, Tarrant County, Texas, as recorded in Deed Records, by
Instrument Number D217192186, in Tarrant County, Texas, and;
WHEREAS, the City owns a sewer easement (the "Public Property") adjacent
to the Property, recorded in the deed records of Tarrant County as plat number FS-23-
296; 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 stoop, and stairs (the "Encroachment"). Upon completion
of the Encroachment, Licensee agrees to be responsible for maintaining the
Tier II Easement Encroachment Agreement Page 1 of12
Revised 12/2022
Encroachment within the Public Property. Licensee shall not expand or otherwise cause
the Encroachment to further infringe in or on the Public Property beyond what is
specifically described in Exhibit "A."
2.
All construction, installation, maintenance, and operation of the Encroachment
and the use or occupancy of the Public Property shall comply with and be performed in
strict compliance with this Agreement and with the charter, ordinances, codes, and
policies of the City. Prior to the construction or installation of the Encroachment,
Licensee shall submit all plans and specifications to the Director of the Development
Services Department or duly authorized representative. Licensee shall not commence
construction or installation of the Encroachment nor make any use of the Public Property
until after the execution of this Agreement.
3.
Licensee, at no expense to the City, shall make proper provisions for the
relocation and installation of any existing or future utilities affected by such
Encroachment and the use and occupancy of the Public Property, including the securing
the approval and consent of the appropriate utility companies and agencies of the State of
Texas and its political subdivisions. In the event that any installation, reinstallation,
relocation, or repair of any existing or future utility or improvements owned by or
constructed by or on behalf of the public or at public expense is made more costly by
virtue of the construction, maintenance, or existence of the Encroachment and use of
Public Property, Licensee shall pay to City an additional amount equal to such additional
cost as determined by the Director of Transportation and Public Works, the Director of
the Water Department, the Director of the Development Services Department, or their
duly authorized representative.
4.
Licensee agrees that City may enter and utilize the Public Property at any time for
any public purpose, including installing, repairing, replacing, or maintaining
improvements to its public facilities or utilities necessary for the health, safety, and
welfare of the public. The City shall have no responsibility or liability for any damages
related to the Encroachment resulting from the City's use of the Public Property;
however, the City shall make reasonable efforts to minimize such damage.
�
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
duly authorized representative. Any such removal of the Encroachment shall be in
Tier II Easement Encroachment Agreement Page 2 of 12
Revised 12/2022
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.
�
In order to defray all costs of inspection and supervision which the City has
incurred or will incur as a result of the construction, maintenance, inspection or
management of the Encroachment and use of Public Property as provided for by this
Agreement, Licensee agrees to pay to City at the time this Agreement is requested an
application fee in the sum of Nine Hundred Dollars ($900.00).
7.
The term of this Agreement shall be for thirty (30) years, commencing on the
date this Agreement is executed by City. However, the City may terminate this
Agreement upon Licensee's noncompliance with any of the terms of this Agreement.
City shall notify Licensee in writing of any such noncompliance and if Licensee does not
cure the noncompliance within thirty (30) days of notice from City, the City may
terminate this Agreement. However, the City may, at its sole option, allow the Agreement
to remain in effect so long as Licensee has taken reasonable measures to cure the
noncompliance or is continuing to diligently attempt to remedy the noncompliance.
8.
It is further understood and agreed between the parties hereto that the Public
Property to be used and encroached upon is held by City as trustee for the public; that
City exercises such powers over the Public Property as have been delegated to it by the
Constitution of the State of Texas or by the Texas Legislature; and that City cannot
contract away its duty and its legislative power to control the Public Property for the use
and benefit of the public. It is accordingly agreed that if the governing body of City may
at any time during the term hereof determine in its sole discretion to use or cause or
permit the Public Property to be used for any other public purpose, including but not
being limited to underground, surface, or overhead communication, drainage, sanitary
sewerage, transmission of natural gas or electricity, or any other public purpose, whether
presently contemplated or not, that the parties agree to negotiate in good faith in order to
accommodate both the Encroachment and the public purpose.
9.
LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES
HEREBY INDEMNIFY, HOLD HARMLESS, AND DEFEND CITY, ITS
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, AND ELECTED OFFICIALS
Tier II Easement Encroachment Agreement Page 3 of 12
Revised 12/2022
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 HIND OR CHARACTER,
WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION
WITH, DIRECTLY OR INDIRECTLY, THE CONSTRUCTION,
MAINTENANCE, OCCUPANCY, USE, EXISTENCE, OR LOCATION OF THE
ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT
CAUSED, IN WHOLE OR IN PART, BY THE ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, LICENSEES, ELECTED OFFICIALS, OR INVITEES OF
THE CITY; AND LICENSEE HEREBY ASSUMES ALL LIABILITY AND
RESPONSIBILITY FOR SUCH CLAIMS OR SUITS. LICENSEE SHALL
LIKEWISE ASSUME ALL LIABILITY AND RESPONSIBILITY AND SHALL
INDEMNIFY CITY FOR ANY AND ALL INJURY OR DAMAGE TO CITY
PROPERTY ARISING OUT OF OR IN CONNECTION WITH THE
ENCROACHMENTS AND ANY AND ALL ACTS OR OMISSIONS OF
LICENSEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS, SUBCONTRACTORS, LICENSEES, OR INVITEES.
10.
While this Agreement is in effect, Licensee agrees to furnish City with a
Certificate of Insurance naming City as certificate holder as proof that is has secured and
paid for a policy of public liability insurance covering all public risks related to the
proposed use and occupancy of public property as located and described in Exhibit "A."
The amounts of such insurance shall be not less than
$300,000
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.
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.
Tier II Easement Encroachment Agreement Page 4 of 12
Revised 12/2022
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.
17.
The parties agree that the duties and obligations contained in Section 5 shall
survive the termination of this Agreement.
Tier II Easement Encroachment Agreement Page 5 of 12
Revised 12/2022
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 12
Revised 12/2022
City:Licensee:
CITY OF FORT WORTH Property Owners
D.J. Harrell, Director of the
Development Services Department
Date: Jul 2, 2024
By: V"'-r + V {,, ) t,vt • I,•.,_ ,._
Name: Miguel Molina
Title: Property Owner
Date: le· � '1 • 'd-Y
ATTEST:
Jannette Goodall,
City Secretary
Date: Jul 3, 2024
Tier II Easement Encroachment Agreement
By: � n{pJfu �
Name: Ana Molina
Title: Property Owner
Approved As To Form and Legality
Jeremy Anato Mensah
Assistant City Attorney
Date: Jul 1, 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.
ecc� Owen (Jul 11 202415:25 CDT)
Date: Jul 1, 2024
Rebecca Owen
Development Services
Page 7 of 12
Revised 12/2022
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
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 LTNDER MY HAND AND SEAL OF OFFICE this 2nd day of
J u ly , 2024.
��
Brooke Bonnell Uul2, 202413:57 CDTI
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
Q�PRY P(�e`/ BR�OKE �ONIVEI�L
2 � Notary Public
* � * STATE OF TEXAS
`��,��o��� Notary I.D. 134a09525
My Comrr�. Exp. Oct. 11, 2026
Tier II Easement Encroachment Agreement
Page 8 of 12
Revised 12/2022
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
,�yllJ�S , on this day personally appeared Miguel Molina, Property Owner (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, and in the capacity therein stated.
GIVEN UNDER MI' HAND AND SEAL OF OFFICE this o��day of cil�.r-=
2024.
' ��,�! �,�J� �y�'�`- �
���"yp�/i� TERESA MCGEE
:_`.���'��`�s Notary Public, State of Texas
Notary Public in and for the ;N,,;�:�; Comm. Expires 06-16-2027
State of `"rJt�CC.I S �'n,°,i��t� Notary ID 132132208
Tier II Easement Encroachment Agreement Page 9 of 12
Revised 12/2022
STATE OF TEXAS §
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
Tt�ras , on this day personally appeared Ana Molina, Property Owner (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, and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this �y� day of J��
,
2024.
c
'���Jl�.%� `�Y�l'-
Notary Public in and for the
State of ��O�S
,�`'�aYP'''� TERESA MCGEE
� <P.... Vg �i
; r°,�' �_ Notary Public, State of Texas
: �9 �+P; Comm. Expires 08-16-2027
�'�n°i,���`� Notary ID 132132208
Tier II Easement Encroachment Agreement
Page 10 of 12
Revised 12/2022
EXHIBIT A
Depiction and description of the Encroachment
Tier II Easement Encroachment Agreement Page 11 of 12
Revised 12/2022
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Lots 3R-1, 3R•2
and 4R-1, Block 1
R.T. Evans Addition
an atltlition to the City of Fort Worth,
Tarrant County. Texas
Being e I.]50 acre hact oi IanE calleJ to be portions of Lots ]
anJ 0. Blo�k I. P T. Evans AEEitlon. az �xorEeE in Valume ]I0.
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Surveyor's Notes:
$UfveVor: I) All cwners are points, unless otherwise nated.
Zachariah R. Savory, RPLS 5966 Vicinity Map (not to scale) 2) Exhibits illustratinq detail anA leqal tlesaiption accanpany ihis vicinity
208 S. Front St sketch (see Pa[Je 2 and Page 3.lespe[tlVel�).
� Aledo, TX 76008 3) This encroachment exhibit is to acrompany the replat pracessea unaer [ity
-=d�,�j� r� aledoC�txsurveyinq.com wa�a�ya aoaa of Fort Worth Case No. FS-23296.
��\ �i Owner. TEXAS
Miquel & Ana Molina ,- GO1Oe�SITEAVen -
1724 N. Sylvania Ave m n S U R V E Y I N G
Fort Worth, TX 76111 0�sv�a"e , oe��y�e�e �
3 Q
�0 60 120 180 _�, INC.
.�A�a�- i"`9°'° i""'"` A�EDO BRANCH • 817•441•5263
J FIRM N0.10194122 - ALE00@TXSURVEYING.COM C
Detail - Encroachments on 15' Sanitary Sewer Easement Paqe 2 of 3
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S 89°35'51" W 4135;
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0.033 Acres
(1,441 Square Feet)
Encroachment Area
(see Paqe I for vicinity and
Paqe 3 for leqal description)
Buildinq
P.58) C.I.R.S.
P. 58)
0.8'��:<,'�'.��� �:� �� .,..:�Portion of steel fence�within...'..`.:�. �'�'•�-� `'�I I
Portion of f.` .:. . � �
° 1S Sanitar Sewer Easement . � o
frame residence I�'•, �� ".. �'� � (fence is 70' tall with seven :� ��`� I�
within 15' SanitarV I, .::' : �, '' �.�.'� �:� �
Sewer Easement � �., , 3" steel fence posts set in :
(concrete foundation � � ' " �� �� • ` concrete. with estimated 3
is •1.0' above qrade) � ��"�'� ���' �'-*' �N��; depth of 2.5' [30 inches]) ,n
J.J� �.-. .�..:-� .�.. _. �
� Sanitary Sewer I
I Manhole I
�
� �
� �� � 44.64'
�
Portion of frame buildinq
within lY Sanitary
Sewer Easement
(concrete foundation is
�0.0' at qrade) 11.1'
- ',�. _
. : . � � � .. �'..
��,"
One-story
Frame Residence with
Concrete Foundation
2611 Daisy Lane
�Sa Portion of concrete
O°Z0.� �gb driveway within
�2�� 15' Sanitary
Sewer Easement
u.es. 39.29'
� �!T1T�T
� o
� �. Approx. location of�':/ o
I�_`�,z., :__ "��sewerlinerunninqi� o
to residence � o
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L3 ::..:: . '-;.' : : � � .: :� 46.70' �,.R.S.
�' . .;. ?, � �: � 5' R.o.W. Dedi<ation�
� . ��., `: . 0.012 Acres (505 Sq. Ft.) o
S 89°35'51" 1N 101,00'.:'.:'''...1 �=ozza___� �
� �:�..
set maq Sanitary Sewer Manhole �„ .,. �' _� �� rd. i/z"
Nail �� � � � � : �,I Iron Rod
�..��..�:.'..��;�..:: "..'<.: '':.;�� \
Daisy tan'e... .:_; ...,, :. .:, .,_
Asphalt - Called "Paul St" & 30' R.o.W. (Vol. 310, Pg. 58)
Encroachment Trad Calls
LINE BEARING DISTANCE
L1 N 89°35'S1" E 15.01'
L2 S 01°14'45" W 96.04'
1 I' —� 0' L3 S 89°35'S1" W 15.OT
L4 N 01°14'45" E 96.04'
Surveyor's Notes:
$U�veyor: 1) All corners are points, unless otherwise noted.
Zachariah R. Savory, RPLS 5966 2) Exhibits illustratinq vicinity sketch and leqal description accompany this
208 S. Front St detail (see Paqe 1 and Paqe 3, respectively).
Aledo, TX 76008 3) This encroachment exhibit is to accompany the replat processed under City
of Fort Worth Case No. FS•23•296.
aledoc�txsurveyinq.com
Owner:
Miquel & Ana Molina
1724 N. Sylvania Ave
Fort Worth, TX 761fl
• • �� .•
� � � �
TEXAS
SURVEYING
INC.
A�EDO BRANCH - 817-441-5263 /
FIRM N0. 10194122 • ALEDO@TXSURVEYING.COM `
Descriation - Encroachments on 15' Sanitary Sewer Easement Paqe 3 of 3
BEING a 1,441 square foot (0.033 acre) tract of land, out of Lot 4R-1, Block 1, R.T. Evans Addition, as recorded in
Clerk's File No. D224______, Plat Records, Tarrant County, Texas; same beinq a portion of that certain called
0.24 acre Molina tract, as recorded in D217192186, Real Property Records, Tarrant County, Texas; and beinq
further described by metes and bounds as follows:
The followinq Bearinqs, Distances, and/or Areas derived from GNSS observations performed by Texas
Surveyinq, Inc. and reflect N.A.D. 1983, Texas State Plane Coordinate System, North Central Zone 4202 (Grid -
US Survey Feet):
BEGINNING at a point in the north line of said Lot 4R-1, Block 1, for the northwest and beqinninq corner of this
tract. Whence a set 1/2° capped iron rod at the northwest corner of said Molina tract, same beinq the northeast
corner of that certain J&S Nquyen Family tract recorded in Clerk's File No. D2fl271332, R.P.R.P.C.T., and beinq
the northwest corner of said Lot 4R-1, Block 1 bears S 89°35'51" W 124.06 feet.
THENCE N 89°35'51" E 15.01 feet, alonq the north line of said Lot 4R-1, Block 1, to a point, for the northeast corner
of this tract.
THENCE S 01°14'45" W 96.04 feet, over and across said Molina tract and said Lot 4R-1, Block 1 to a point in the
north line of Daisy Lane (a paved surface), same beinq the south line of said Lot 4R-1, Block 1, for the southeast
corner of this tract.
THENCE S 89°35'51" W 15.01 feet, alonq the common line of said Daisy Lane and said Lot 4R-1, Block 1 to a point,
for the southwest corner of this tract.
THENCE N 01°14'45" E 96.04 feet, over and across said Molina tract and said Lot 4R-1. Block 1, to the POINT OF
BEGINNING, and containinq 1,441 square feet (0.033 acres), more or less.
Description Certified Correct:
Preliminary; this document shall not be recorded for any purpose and
shall not be used or viewed or relied upon as a final survey document.
-------------------------------------------
Zachariah R. Savory, Reqistered Professional Land Surveyor No. 5966
Texas Surveyinq, Inc. - Aledo Branch
P.O. Box 651 - 208 S. Front Street, Aledo, TX 76008
aledoc�txsurveyinq.com • 817•441•5263
Project ID: AN04999-E
Field Date: November 10, 2023
Preparation Date: April 23, 2024
SurveVor's Notes:
1) No abstract of title or title commitment was provided to this surveyor.
Record research performed by this surveyor was made only for the purpose of
determininq the boundary of this property and of the adjoining parcels. Record
documents other than those shown on this survey may ezist and enwmber
this property.
2) Bearinqs, Distances, and/or Areas derived from GN55 observations and
reflect N.A.D. 1983, Texas State Plane Coordinate System. North Centrel Zone
4202 (Grid - US Survey Feet).
3) Underqround utilities were not located durinq this survey. Call 811 and/or
Utility Providers before excavation or construction. No permanent buildinqs or
structures shall be constructed over any existing or platted water, sanitary
sewer, qas, electric. cable or other utility easement of any type.
4) Before construction please consult all applicable governinq entities
reqardinq rules & regulations, that may affed wnstruction on this property.
(i.e. architectural control committee, municipal departments. home owners
assoc., etc.). No permanent buildinqs or structures shall be wnstructed over
any existinq or platted water. sanitary sewer, qas. electric, cable or other
utility easement of any type.
5) All corners are points, unless otherwise noted.
6) Exhibits illustratinq vicinity sketch and detail acwmpany this legal
description (see Paqe 1 and Paqe 2, respectively).
7) This encroachment exhibit is to accompany the replat processed under City
of Fort Worth Case No. FS•23•296.
TEXAS
SURVEYING
INC.
ALEDO BRANCH • 817•441•5263
FIRM N0. 10194122 • ALEUO@TXSURVEYING.COM C
EXHIBIT B
Certificate of Insurance
Tier II Easement Encroachment Agreement Page 12 of 12
Revised 12/2022
State Farm Lloyds
Applicant Name: MOLINA, ANA
Binder Effective Date: 04-30-2024
TX Rental Dwelling
Application / Binder-Receipt 93-KB-L463-9
NEW BUSINESS
APPLICANT: MOLINA, ANA CO-APPLICANT: MOLINA, MIGUEL A SR
MAILING ADDRESS: 2621 DAISY LN PROPERTY LOCATION: 2611 DAISY LN
FT WORTH, TX 76111-2720 FORT WORTH, TX 76111-2720
BILLING:
Put application on SFPP: No
Renewal Bills to: Named Insured
COVERAGES / PREMIUM SECTION:
Type: RENTAL DWELLING
Policy Coverage
Dwelling (Coverage A)
Dwelling Extra Replacement Cost
Dwelling Extension
Personal Property (Coverage B)
Business Liability (Coverage L) each
occurrence
Business Liability (Coverage L) annual
aggregate
Premises Medical Payments (Coverage M)
each person
Loss of Rents (Actual Loss Sustained)
Accepted Options
Discounts / Charges
Utility rating plan
Policy deductible
Total Premium:
Amount Paid:
Credit Amount:
Balance Due:
$1, 320.00
$1, 320.00
$0.00
Policy Deductible:
Limit Premium
185, 000 1, 395.00
Excluded
18, 500
9, 250
300,000
600,000
3,000 2.00
70.00
(147.00)
Endorsement Bills to: Named Insured
2% 3,700
Endorsements
Declined Options / Endorsements
Building Ordinance or Law
Building Ordinance or Law
Building Ordinance or Law
Loss Assessment
Modified Loss Settlement
Replacement Cost on Contents - Opt
RC
Stored Personal Property
Windstorm or Hail Exclusion
Agreement Endorsement
Rate IV: 84.5%
Limit Premium
10%
25%
50%
UNDERWRITING:
Has applicant had any losses, insured or not, in the past 3 years: No
Has any insurer or agency canceled or refused to issue or renew similar insurance to the named applicant or any household member within the past 3
years: No
Is there any damage to the dwelling that has not been repaired: No
Are there any conditions with respect to the property to be insured that create an increased risk of hazard: No
Has that condition ever been the subject of a prior loss or claim:
Has the applicant been convicted of arson, fraud, or other insurance related offenses: No
APPLICANT(S) ACKNOWLEDGEMENT:
By submission of this application, you agree that: (1) You have read this application, (2) your statements on this application are correct, (3) the coverages,
including options and endorsements, and the amounts of coverage on this application are those chosen by you, and (4) the premium charged must
comply with State Farm's rules and rates and may be revised.
EB 2612 TX.3 Rev. 01-2019 Page 1 of 2
State Farm Lloyds
TX
Rental Dwelling
Application / Binder-Receipt
Applicant Name: MOLINA, ANA
Binder Effective Date: 04-30-2024
93-KB-L463-9
BINDER:
State Farm will provide coverage to the applicant and his or her legal representative on the property described for up to thirty (30) days from the Effective
Date, subject to all terms and conditions of the policy and endorsements for which application has been made. If no Effective Date is indicated, this Binder
does not provide any coverage. This Binder will be void when the declarations page is issued on the policy for which application has been made or when
coverage under this Binder is canceled in accordance with policy provisions.
The premium due State Farm for the coverage provided by this Binder will be the full annual premium for the policy for which application has been made, and
will be pro-rated for the length of time coverage is provided under this Binder.
AGENT INFORMATION:
App date and time: 04-30-2024, 02:32 PM
Agent: Veronica Mendoza
Location Address: 1717 N Beach St
Fort Worth, TX 76111-6619
Agent / AFO Code: 7939 / 08FA36
IMPORTANT NOTICES
Agent Phone: (817)222-9300
REGARDING CONSUMER REPORTS...
Consumer reports may be ordered in conjunction with this application. These reports provide information that assists with determining your eligibility for
insurance.
REGARDING YOUR RENTAL DWELLING COVERAGE AMOUNT....
It is up to you to choose the coverages and limits that meet your needs. We recommend that you purchase a coverage limit at least equal to the estimated
replacement cost of your rental dwelling. Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your
agent can provide an Xactware estimate using information you provide about your rental dwelling. We can accept the type of estimate you choose as long
as it provides a reasonable level of detail about your rental dwelling.
State FarmO does not guarantee that any estimate will be the actual future cost to rebuild your rental dwelling. Higher limits are available at higher
premiums. Lower limits are also available, as long as the amount of coverage meets our underwriting requirements.
We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your rental dwelling.
INFLATION COVERAGE NOTICE -TEXAS...
Your policy will automatically increase its protection limits at each renewal. The percentage of increase will be at the same rate as the increase in the
Inflation Coverage Index. The limits of liability will not be reduced unless you specifically request a reduction. If during the term of this policy the building
or business personal property limit is changed at your request, the effective date of this Inflation Coverage provision is changed to coincide with the
effective date of such coverage.
EB 2612 TX.3 Rev. 01-2019 Page 2 of 2