HomeMy WebLinkAboutContract 45468-CA1 (2)1 uy4 1 V1 L.V
Electronically Recorded
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ntarractRETARte
4/23/201m No,
frow, PGS 23 $104.00
ASSIGNMENT O aVER,961TVIENT AGREEMENTANDIDONSENT BY THE CITY
OF FORT WORTH
City Secretary Contract No. 45468
THIS ASSIGNMENT OF ENCROACHMENT AGREEMENT AND CONSENT BY
THE CITY OF FORT WORTH ("Assignment") is made and entered into as of this j 0 day of
204, by and between the CITY OF FORT WORTH, a Texas home -rule
municipal corporation ("City"), Pantos Properties, LLC., a Texas limited liability company
Assignor"), and America CAN!, a Texas non-profit corporation (` Assignee"). (Sometimes
City, Assignor and Assignee are referred to individually as a "Party" and collectively as the
Parties").
WITNESSETH:
WHEREAS, the City entered into a Right of Way Encroachment Agreement, City
Secretary Contract No. 45468 (the "Encroachment Agreement"), with Assignor, the owner of
certain real property more particularly described in the attached Legal Description (the
Property") located adjacent to or near the City's right-of-way on which the encroachments are
located. The encroachments are more particularly described in the Encroachment Agreement
and are sometimes called therein and herein the "Improvements";
WHEREAS, the Encroachment Agreement, filed on April 4, 2014 and recorded as
Instrument No. D214066923 in the Real Property Records of Tarrant County, Texas, is attached
hereto as Exhibit "A" and incorporated herein by reference as if set forth in full;
WHEREAS, Assignor has sold the Property to Assignee on April 16, 2014 as evidenced
by a deed recorded as Instrument No. D214077058 in the Real Property Records of Tarrant
County, Texas; and
WHEREAS, Assignor desires to assign the Encroachment Agreement to Assignee and
obtain the City's consent to the Assignment as required in the Encroachment Agreement.
AGREEMENT:
NOW, THEREFORE, for and in consideration of the above and foregoing premises and
the mutual covenants, t erms and conditions herein contained , and other good and valuable
consideration, the receipt and sufficiency of which is hereby acknowledged, the Parties hereby
agree as follows:
1. Assignor hereby assigns, transfers and conveys all rights and interests and
delegates it duties and obligations under the Encroachment Agreement to Assignee.
2. Assignee hereby accepts the Assignment granted herein, and assumes all of
Assignor's rights, duties and obligations wising under the Encroachment Agreement.
QC $7o8I
CSC No, 45468 Consent to Assignment Page 1 of 6
Right of Way Encroachment Agreement Rev 4/2014
Paulos Properties, LLC
RECEIVED APR 2 9 2014 RECEIVED APR 21 204
3. Assignor has full right, power and authority to enter into this Assignment, to
make the representations set forth herein, and to carry out Assignor's obligations hereunder.
Assignee has the full right, power and authority to enter into this Assignment, to make the
representations set forth herein, and to carry out Assignee s obligations hereunder.
4. The effective date of this Assignment shall be the date of its execution by the City
the "Effective Date"). All rights , duties and obligations under the Encroachment Agreement
arising, accruing or relating to the period before the Effective Date are allocated to Assignor and
all rights, duties and obligations arising, accruing or relating to the period thereafter shall be
allocated to Assignee.
5. Except as otherwise expressly set forth in this Assignment, Assignor will be
discharged from any and all further obligations under the Encroachment Agreement as of the
Effective Date.
6. Assignor represents warrants and covenants with City and Assignee that as of the
Effective Date, Assignor is not in default of any of its obligations contained in the Encroachment
Agreement.
7. City hereby consents to this Assignment upon the terms and conditions set forth
herein. This Assignment is not effective until City has executed it. The consent granted herein
should not be construed as consent to any further assignment The failure or delay of City in
seeking to enforce any provision of the Encroachment Agreement or this Assignment shall not be
deemed a waiver of rights or remedies that City may have or a waiver of any subsequent breach
of the terms and provisions therein or herein contained.
8. Any notice given by any Party to another Party must be in writing and shall be
effective upon receipt when (i) sent by U.S. mail with proper postage, certified mail return
receipt requested, or by a nationally recognized overnight delivery service, and (ii) addressed to
the other Party at the address set out below or at such other address as the receiving Par5ty
designates by propel notice to the sending Party.
City
Planning and Development Department
1000 Throckmorton Street
Fort Worth TX 76102
Attention: Director
Assignor
Paulos Properties, LLC
6708 Ashbrook Drive
Fort Worth TX 76132
Attention: President
CSC No. 45468 Consent to Assignment
Right of Way Encroachment Agieement
Paulos Properties, LLC
Page 2 of 6
Rev 4/2014
Assignee
America CAN!
325 W. 12th Street, Suite 250
Dallas TX 75208
Attention* President
9. Except as herein otherwise provided, this Assignment will be binding upon and
inure to the benefit of the Parties and their respective successors and assigns.
10. Assignee shall cause this Assignment to be filed of record at Assignee's expense
in the Real Property Records for Tarrant County, Texas.
11. The Certificate of Insurance for the Assignor attached as Exhibit "B" to the
Encroachment Agreement is hereby deleted and replaced with the attached Certificate of
Insurance from the Assignee as Exhibit `B" Revised 4/2014.
12. All terms and conditions of the Encroachment Agreement not amended herein
remain unaffected and in full force and effect are binding on the Parties and are hereby ratified
by the Parties. Capitalized terms not defined herein shall have meanings assigned to them in the
Encroachment Agreement.
13. This Assignment may be executed in multiple counterparts, each of which shall
be deemed an original, and all of which, when taken together, shall constitute one and the same
document which may be evidenced by one counterpart.
SIGNATURES APPEAR ON FOLLOWING PAGES]
CSC No. 45468 Consent to Assignment
Right of Way Encroachment Agreement
Paulos Properties,'LLC
Page 3 of 6
Rev 4/2014
ASSIGNOR:
PAULOS PROPERTIES, LLC
a Texas limited liability company
By:
Name: Flora Brewer
Title: President
STATE OF TEXAS
COUNTY OF TARRANT
ASSIGNEE:
AMERICA CAN ! ,
a Texas non-profit corporation
By:
Name: Richard Marquez
Title: President
This instrument was acknowledged before me on
as the President of Paulos Properties, LLC, a Texas limited
liability company.
NOTARIAL SEAL]
STATE OF TEXAS
COUNTY OF TARRANT
STEFANIE HAVES
Notary Pubtk
State of TexasComm. Expires 07/20/2016
20 by Flora Brewer,
lability company, on behalf of said limited
a
Notary Public, State of Axas
This instrument was acknowledged before me on 20 by Richard Marquez,
as the President of America Can!, a Texas non-profit corporation, on behalf of said corporation.
Notary Public, State of Texas
NOTARIAL SEAL]
CSC No. 45468 Consent to Assignment
Right of Way Encroachment Agreement
Paulos Properties, LLC
Page 4 of 6
Rev 4/2014
ASSIGNOR:
PAULOS PROPERTIES, LLC
a Texas limited liability company
By:
Name: Flora Brewer
Title: President
STATE OF TEXAS
COUNTY OF TARRANT
ASSIGNEE:
AMERICA CAN',
a Texas non-profit corporatio
By:
Nar . Richard arqu
Title: President
This instrument was acknowledged before me on , 20 by Flora Brewer
as the President of Paulos Properties, LLC, a Texas limited liability company, on behalf of said limited
liability company.
NOTARIAL SEAL]
STATE OF TEXAS
COUNTY OF TARRANT
Notary Public, State of Texas
This instrument was acknowledged before me on Ab; 1 j , 20 jgby Richard Marquez,
as the President of America Can!, a Texas non-profit corporation, on behalf of said corporation
c:mot
Notary Public, State of Texas
Linda Hodge
My Commission Expires
08/13/2016
CSC No. 45468 Consent to Assignment
Right of Way Encroachment Agreement
Paulos Properties, LLC
Page 4of6
Rev 4/2014
APPROVED AS TO FORM AND
LEGALITY:
iLitLy a -code
Assistant City Attorney
ST:
pity Secretary
No M&C Required]
STATE OF TEXAS
COUNTY OF TARRANT
CITY 0 FOR WORTH
Randle : rwo f drect Planning
and Development Department ea\
124. { Date: This
instrument was acknowledged before me on Harwood,
as the Director of the Planning and Developmen Texas
municipal corporation, on behalf of the City of Fort OW
I Wilt 06,10( :II£
la_
grNOTARI
CASSANDRA
F. FOREMAN Notary
Public, State of Texas My
Commission Expires April
26, 2017 CSC
No. 45468 Consent to Assignment Right
of Way Encroachment Agreement Paulos
Properties, LLC epartinent
of the Ci h.
otary
Public, State of Texas y
Randle of
Fort Worth, a Page
5 of 6 Rev
4/2014
LEGAL DESCRIPTION OF THE PROPERTY
Lots 1 through 3 and part of Lot 4, Block 89, of THE TEXAS PACIFIC AND RAILWAY CO.
ADDITION, an Addition to the City of Fort Worth, Tarrant County, Texas, according to the Plat
thereof recorded in Volume 63, Page 107, Plat Records of Tarrant County, Texas
CSC No. 45468 Consent to Assignment
Right of Way Encroachment Agreement
Paulos Properties, LLC
Page 6 of 6
Rev 4/2014
E.,aU " A"
crry SECRETARY
coMencr NO.Lel
RIGHT OF WAY
ENCROACHMENT AGREEMENT
COMMERCIAL)
MIS AGREEMENT is made and entered into by and between the City of Fort
Worth, a municipal corporation of Tarrant County, Texas, acting herein by and through
its duly authorized City Manager or its duly authorized Assistant City Manager or
Planning and Development Department Director, hereinafter referred to as the "City", and
Paulos Properties, LLC, acting herein by and through its duly authorized President
hereinafter referred to as "Licensee", Owner of the property located at 1316 East
Lancaster Avenue, Fort Worth, Texas 76102 ("Property").
AGREEMENT
1.
For and in consideration of the payment by Licensee of the fee set out below and
the true and faithful performance of the mutual covenants herein contained, City hereby
grants to Licensee permission to construct/ install and/or allow to remain,
Improvement(s) ("improvement") that encroaches upon, uses and/or occupies portions of
the space under, on and/or above the streets, alleys, sidewalks and other public rights -of -
way, such Improvement(s) are described as follows:
Tilt -wall ;nasonry building extends 2'8" into the easement on the west at Poplar Street
for 52' adjacent to sidewalk.
The location and descnption of said Improvement and the encroachment is more
particularly described in Exhibit "A", attached hereto, incorporated herein and made a
part hereof for all purposes.
2.
All construction, maintenance and operation in connection with such
Improvement, use and occupancy shall be performed in strict compliance. with this
Agreement and the Charter, Ordinances and Codes of the City and in accordance with the
L!! v r ft) claqt
2012 ROW Encroachment Agreement -Commercial Page 1 of 10
directions of the Director of Transportation and Public Works of City, or his duly
authorized representative. Alt plans and specifications thereof shall be subject to the
prior written approval of the Director of Transportation and Public Works, or his duly
authorized representative, but such approval shall not relieve Licensee of responsibility
and liability for concept, design and computation in preparation of such plans and
specifications.
3.
Upon completion of construction and installation of said Improvement and
thereafter there shall be no encroachments in, under, on or above the surface area of the
streets, alleys, sidewalks and other public rights -of -way involved, except as described
herein and shown on the hereinabove referred to Exhibit "A".
4.
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 use and occupancy, including the securing of approval and consent from
the utility companies and the appropriate agencies of the State and its political
subdivisions. In the event that any installation, reinstallation, relocation or repair of any
existing or future utility or improvements owned by 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 such encroachment and use, Licensee shall pay to City an
additional amount equal to such additional cost as determined by the Director of
Transportation and Public Works of the City, or his duly authorized representative.
5.
City may enter and utilize the referenced areas at any time for the purpose of
installing or maintaining improvements necessary for the health, safety and welfare of the
public or for any other public purpose. In this regard, Licensee understands and agrees
that City shall bear no responsibility or liability for damage or disruption of
2012 ROW Encroachment Agreement -Commercial Page 2 of 10
improvements installed by Licensee or its successors, but City will make reasonable
efforts to minimize such damage.
6.
In order to defray all costs of inspection and supervision which City has incurred
or will incur as a result of the construction, maintenance, inspection or management of
the encroachments and uses 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 Two
Hundred and Seventy Five Dollars ($275.00). Upon execution of this Agreement and
annually thereafter, Licensee agrees to pay a fee in the amount of $.56 per square/linear
foot of the encroachment area
7.
The term of this Agreement shall be for thirty (30) years, commencing on the date
this Agreement is executed by the City of Fort Worth. Provided however, this Agreement
shall terminate upon the non-compliance of any of the terms of this Agreement by the
Licensee. City shall notify Licensee of the non-compliance and if not cured within thirty
days this Agreement shall be deemed terminated.
8.
Upon termination of this Agreement, Licensee shall, at the option of' City and at
no expense to City, restore the public right-of-way and remove the Improvement
encroaching into the public right-of-way, to a condition acceptable to the Director of
Transportation and Public Works, or his duly authorized representative, and in
accordance with then existing City specifications. it is understood and agreed to by
Licensee that if this Agreement terminates and Licensee fails to remove the
Improvement, Owner hereby gives City permission to remove the Improvement and any
supporting structures and assess a lien on the Property for the costs expended by the City
to remove such Improvement.
9.
2012 ROW Encroachment Agreement -Commercial Page 3 of 10
It is further understood and agreed upon between the parties hereto that the public
rights -of -way alleys, sidewalks ("public right-of-way") to be used and encroached upon
as described herein are held by City as trustee for the public; that City exercises such
powers over the public nght-of way as have been delegated to it by the Constitution of
the State of Texas or by the Legislature; and that City cannot contract away its duty and
its legislative power to control the public right-of-way 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 right of way
to be used for any other public purpose, including but not being limited to underground,
surface of overhead communication, drainage, sanitary sewerage, transmission of natural
or electricity, or any other public purpose whether presently contemplated or not, that
this Agreement shall automatically terminate.
10.
Licensee agrees and acknowledges that this Agreement is solely for the purpose
of permitting Licensee to construct, maintain and locate the Improvements over or within
the described public right of way and is not a conveyance of any right; title or interest in
or to the public right of way 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 permission before occupying such property.
11.
Licensee agrees to comply fully with all applicable federal, state and local laws,
statutes, ordinances, codes or regulations in connection with the construction, operation
and maintenance of said Improvement, encroachment and uses.
12.
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.
13.
2012 ROW Encroachment Agreement -Commercial Page 4 of 10
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.
14.
LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES
HEREBY INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS
OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, 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, WHETAFR REAL OR
ASSERTED, ARISING OUT OF OR IN CONNECTION WITH, DIRECTLY OR
INDIRECTLY, THE CONSTRUCTION, MAINTENANCE, OCCUPANCY, USE,
EXISTENCE OR LOCATION OF SAID IMPROVEMENT AND
ENCROACHMENT AND USES GRANTED AF,REUNDER, WHETHER OR NOT
CAUSED, IN WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF
OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS,
SUBCONTRACTORS, LICENSEES 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 ANY AND ALL ACTS OR OMISSIONS OF
LICENSEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES,
2012 ROW Encroachment Agreement -Commercial Page 5 of 10
CONTRACTORS, SUBCONTRACTORS, LICENSEES, INVITEES, OR
TRESPASSERS.
15.
While this Agreement is in effect, Licensee agrees to furnish City with a
Certificate of Insurance, naming City as certificate holder, as proof that it 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 the following:
1,000,000 Commercial General Liability
with the understanding of and agreement by Licensee that such insurance amounts shall
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 provide that it cannot be canceled or amended without at least ten (10) days prior
written notice to the Building Official of the City of Fort Worth. A copy of such
Certificate of Insurance is attached as attached as Exhibit `B' . Licensee agrees to submit
a similar Certificate of Insurance annually to City on the anniversary date of the
execution of this Agreement.
Licensee agrees, binds and obligates itself, 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 all encroachments and the cleaning and restoration of
the city streets. All insurance coverage required herein shall include coverage of all
Licensees contractors.
16.
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 Consent
Agreement in its entirety in the deed records of Tarrant County, Texas. After being
2012 ROW Encroachment Agreement -Commercial Page 6 of 10
recorded, the original shall be returned to the City Secretary of the City of Fort Worth,
Texas.
17.
In any action brought by the City for the enforcement of the obligations of
Licensee, City shall be entitled to recover interest and reasonable attorney's fees.
18.
Licensee covenants and agrees that it will not assign all or any of' its rights,
privileges or duties under this contract without the prior written approval of the City
Manager or designee. Any attempted assignment without prior written approval will be
void.
19.
THE PAR RI S AGREE THAT THE DUTIES AND OBLIGATION
CONTAINED IN PARAGRAPH 8 SHALL SURVIVE THE TERMINATION OF
THIS AGREEMENT.
20.
This Agreement shall be binding upon the parties hereto, their successors and
assigns.
EXECUTED this day of Mot r (,l„ , 20 /4.
2012 ROW Encroachment Agreement -Commercial Page 7 of 10
City
City of Fort Worth
By
Randle Harwsod
Director
Planning and Development
ATTEST:
rye!„( at-1'
55-16- City Secretary
2012 ROW Encroachment Agreement -Commercial
Licensee
Poulos Properties, LLC
By: 2:1-1SEH
Name Flora A. Brewer
Title President
Approved As To Form and Legality
Assistant City Attorney
Page 8 of 10
STA I 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 Randle Harwood, known to me to be the person whose
name is subscribed to the foregoing instrument, and acknowledged to me that he/she
executed the same for the purposes and consideration therein expressed, as the act and
deed of the City of Fort Worth, and in the capacity therein stated.
GI UNDER ND AND SEAL OF OFFICE thisC day of
20 .
r
LASS PNbIA FStars R0*Elexos t4ntoiY
n(
1curnfl jh05 Apt1126, 201 Notary
Public in and for the State
of Texas 2012
ROW Encroachment Agreement -Commercial Page 9 of 10
STATE OF I'EXAS
COUNTY OF TARRANT §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
Texas, on this day personally appeared Flora A. Brewer, Fres dent, known to me to be
the person whose name is subscribed to the foregoing instrument, and acknowledged to
me that he/she executed the same for the purposes and consideration therein expressed, as
the act and deed of Paulos Properties, LLC, and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this 45 (f
day of
nArciel ,20H1.
Ito
0111111/1/2,
l\••• ,
e'
er
6iP ' .
0:'
RE .C 6•/
05/20,``.` i` 2012
ROW Encroachment Agreement -Commercial ALL -
IL 74K J2fi Notary
Public in and for the' State
of Texas Page
10 of 10
GARRY W. CRUST
eldwaommemomt
IUD M. M0RR11
DON W. NICKLT
Co RICHARD DAVIS, Jilts
e.
ESTABLISHED 1980
BROOKES BAKER SURVEYORS
A ROf1SSlONAL CORPORATION
LAND BOUNDARY AND TOPOGRAPHIC SURVEYING
SROONIS SAKSR BUILDING • S11 1. SLUff tTRf1T
S17.335.7151
METRO 420.0111
FONT WORTH. TUAS 76102
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MAXIM (1S01I.1S,SD1 JOHN
P. SAKSR. CONSULTANT J.
1AK[R. CONSULTANT, W
so• ,
t, ti;
Sketch
showing exhibit for Encroachment Agreement `f.hr:::pr:oposed buildinngg , adjacent ,
to Lot 1 in Block 89 of Texas & Pacific Railway Company's Addi•ion ' in
the City of Fort Worth in Tarrant County, Texas.-as.-.said".Iibt appears. tporf+_., the
map recorded in volume 33, page 141 of the Tarraht..County Deed Records.:: Prepared
January 10, 1986. BROOKES
BAKER SURVEYORS EXHIBIT
A r.
OARILY W. OILLtY
FPtD M. MONAIt
DON W. MICIISY
G MICNAAD DANIS. a
k
ESTABLISHED inc
BROOKES BAKER SURVEYORS.
A MIO/ESOIONAL CORPOtATION
LAND BOUNDARY AND TOPOGRAPHIC SURVWNO
STRNA W OOIDI SUILDINO . Sit S. SLUT tTIIttt 17.335.
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1-1119 - i.}. FORT WORTH,
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CONSULTANT U1LD l N
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SO
2a Fig• A//
ey It Sketch showing exhibit
for Encroachment Agreement for proposed building, adjacent to Lot
1 in Block 89 of Texas & Pacific Railway Company's Addition in the City
of Fort Worth in Tarrant County, Texas as said Lot appears upon the map recorded
in volume 33, page 141 of the Tarrant.County Deed Records.;,; Prepared January 10,
1986. ' BROOKES BAKER SURVEYORS,._
ACOR® CERTIFICATE OF LIABILITY INSURANCE
PAUPR-2 OP ID: CU
DATE (MUDO/YYYY)
03/07/2014
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: N the certificate holder Is an ADDITIONAL INSURED, the poiicy(les) must be endorsed. It 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
Kilpatrick Insurance
Agency, Inc.
2410 Montgomery Street
Ft. Worth, TX 76107
Kim Terrell
INSURED Paulos Properties LIc
6708 Ashbrook Dr.
Fort Worth, TX 76132
COVERAGES
CN ea"t` Kim Terrell
817-7314771 I (a, No): 817-7314520PHONE
ADORI:SS:
INSURERS) AFFORDING COVERAGE
INSURER A : Union Standard Mumma* Go.
INSURER B :
INSURER C •
INSURER D :
INSURER E :
INSURER F
CERTIFICATE NUMBER: REVISION NUMBER: 1
NAIC
A+
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
LIR TYPE OF INSURANCE 1 ° POLICY NUMBER IMAMPOLICY DAM/DDPainIEXPLIMITS GENERAL
LIABILITY A
X COMMERCIAL GENERAL uABIuTY 1
CLAIMS -MADE X OCCUR GEN'
L AGGREGATE LIMIT APPUES PER: POLICY
1 I JET I I LOC AUTOMOBILE
LIABIUTY ANY
AUTO ALL
OWNED AUTOS
HIRED
AUTOS SCHEDULED
AUTOS
NON -OWNED AUTOS
UMBRELLA
LLAB EXCESS
LIAR DED
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COMPENSATION AND
EMPLOYERS' LIABILITY Y I N ANY
PROPRIETOR/PARTNER/EXECUTIVE 7 OFFICER/MEMBER EXCLUDED? Mandatory
In NH) If
yes, describe under DESCRIPTION
OF OPERATIONS below OCCUR
CLAIMS -
MADE NIA
CPA118842636
01/01/2014 01/01/2015 DESCRIPTION
OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ti more apace is required) 1316
E a..ancester Ave.; Ft. Worth, TX CERTIFICATE
HOLDER City
of Fort Worth David
Schroeder 1000
Throckmorton Fort
Worth, TX 76104 ACORD
26 (2010/06) CITFT-
1 CANCELLATION
EACH
OCCURRENCE 1 $ DAMAGE
TO RENTED PREMISES (
Ea occurrerae) $ MED
EXP (Any one parson) $ PERSONAL &
ADV INJURY $ GENERAL
AGGREGATE $ PRODUCTS •
CCMP/OP AGO $ COMBINED
SINGLE LIMIT Ea
accident S BODILY
INJURY (Per person) $ BODILY
INJURY (Per accident) $ PROPERTY
DAMAGE PER
ACCIDENT) EACH
OCCURRENCE AGGREGATE
I
WC STATU- I TORY
LIMITS S
S
E.
L. EACH ACCIDENT j
i
E.
L. DISEASE - EA EMPLOYEd $ E.
L. DISEASE - POUCY LIMIT I $ 1,
000,0001 100,
0001 5
1,
000,0 2,
000,0 2,
000 SHOULD
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
WITH THE POLICY PROVISIONS. AVTHORRED
REPRESENTATIVE flAsteNtakaf
1988-
2010 ACORD CORPORATION. All rights reserved. The
ACORD name and logo are registered marks of ACORD
MARY LOUISE GARCIA
COUNTY CLERK
11111111
CITY OF FORT WORTH
1000 THROCKMORTON ST
FT WORTH, TX 76102
Submitter: CITY OF FORT
WORTH/DEVELOPMENT &
PLANNING
II I
100 West Weatherford Fort Worth, TX 76196 0401
PHONE (817) 884-1195
DO NOT DESTROY
WARNING - THIS IS PART OF THE OFFICIAL RECORD.
Filed For Registration: 4/4/2014 10:45 AM
instrument #: D214066923
E 14 PGS $64.00
9zyuat cLc uw
D214066923
ANY PROVISION WHICH RESTRICTS THE SALE RENTAL OR USE OF THE DESCRIBED REAL PROPERTY
BECAUSE OF COLOR OR RACE IS INVALID AND UNENFORCEABLE UNDER FEDERAL LAW.
AC'OORDATE (MM/DD/YYYY)
04/15/2014
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 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 1-713-623-2330
Arthur J. Gallagher Risk Management Services, Inc.
CERTIFICATE OF LIABILITY INSURANCE
1900 Weat Loop South
Suite 1600
Houston, TX 77027
Norman Henley
INSURED
Texans Can! America Can! dba Dallas Can! Academy,
Ft.Worth Can!
325 Weat 12th Ste Ste 250
Dallas, TX 75208-6502
CONTACT Gloria BroumandNAME:
PHONE 713-358-5206INC, No, Extl:
E-MAILADDRESS: Gloria Broumand@ajg.com
INSURER(S) AFFORDING COVERAGE
INSURERA: ARCH INS CO
INSURER B:
INSURER C:
INSURER D :
INSURER E :
FAX(A713-358-5207 NAIC #
11150
INSURER
F : COVERAGES
CERTIFICATE NUMBER* 39257949 REVISION NUMBER: THIS
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE
MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR
TYPE
OF INSURANCE ADDL
SUERW' POLICY
EFF
POLICY EXP LIMITS LTR
INSRVDPOLICYNUMBER (M/Y M/DDYYY) (MM/DO/YYYY) A GENERAL
LIABILITY NCPKG0250101 12/15/1_ 12/15/14 A A
X
COMMERCIAL
GENERAL LIABILITY CLAIMS -MADE
X OCCUR GEN'L
AGGREGATE LIMIT APPLIES PER: I POLICY
I I JP ERGOT - AUTOMOBILEECT
AUTOMOBILE
LIABILITY
X X
ANY
AUTO
ALL OWNED
AUTOS HIRED
AUTOS
UMBRELLA LIAB
EXCESS LIAB
X LOC
SCHEDULED AUTOS
NON -
OWNEDAUTOSOCCUR
CLAIMS -
MADE
DED X
I RETENT ON $ 10, 000 WORKERS COMPENSATION
AND EMPLOYERS'
LIABILITY ANY PROPRIETOR/
PARTNER/EXECUTIVE OFFICER/MEMBER
EXCLUDED? Mandatory in
NH) If yes,
describe under DESCRIPTION OF
OPERATIONS below Y/N
N/A
NCAUT0250101 12/
15/1? 12/15/14 NCFXS0250101 12/
15/1: 12/15/14 EACH OCCURRENCE
DAMAGE TO
RENTED PREMISES (Ea
occurrence) MED EXP (
Any one person) PERSONAL & ADV
INJURY GENERAL AGGREGATE
PRODUCTS - COMP/
OP AGG COMBINED SINGLE
LIMIT Ea accident)
BODILY INJURY (
Per person) BODILY INJURY (
Per accident) PROPERTY DAMAGE
Per accident)
1,000,
000 100,000
g 5,
000 1,000,
000 3,000,
000 3,000,
000 s 1,
000,000 EACH OCCURRENCE $
2,000,000 AGGREGATE $ 2,
000,000 I TORY
LIMITS I I OER E.L.
EACH ACCIDENT E.L.
DISEASE - EA EMPLOYEE E.L.
DISEASE - POLICY LIMIT I $ DESCRIPTION OF
OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: 1316
E. Lancaster Ave., Fort Worth, TX 76102 City of
Fort Worth is an Additional Insured as respects to the General Liability and Auto Liability policies, pursuant to
and subject to the policy's terms, definitions, conditions and exclusions. CERTIFICATE HOLDER
City of
Fort Worth City Hall,
Lower Level 1000 Throckmorton
St. Fort Worth,
TX 76102 ACORD 25 (
2010/05) j salias
39257949 USA
CANCELLATION
SHOULD
ANY
OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE
1988-2010
ACORD CORPORATION. All rights reserved. The ACORD
name and logo are registered marks of ACORD
SUPPLEMENT TO CERTIFICATE OF INSURANCE
NAME OFINSU RED: Texans Can! America Can! dba Dallas Can! Academy,
Ft.Worth Can!
Additional Description of Operations/Remarks from Pape 1:
Additional Information:
Endorsement Forms if Applicable:
General Liability:
Additional Insured- Managers, Landlords, or Lessors of Premises -
Additional Insured- Lessor of Leased Equipment -(When required er lease agrmt)
Additional Insured- Grantor of permits -
Transfer of Rights of Recovery Against Others To us- (As per written contract)
Additional Insured -Designated Person or Organization -
Additional Insured- Lessors of Leased Equipment -
Automobile :
Lessor- Additoinal Insured and Loss Payee-
SUPP (05/04)
DATE
04/15/2014