Loading...
HomeMy WebLinkAboutContract 62728Date Received: Record Number: PN24-00182 --------- Time Received: _______ _ . 62728 City Secreta ry No.: _______ _ PUBLIC PROPERTY RIGHT-OF-WAY ENCROACHMENT LICENSE AGREEMENT TIER II 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 Fort Worth Independent School District, a political subdivision of the state of Texas and a legally constituted independent public school district located in Tarrant County, Texas public school district located in Tarrant County, Texas, ("Licensee"), acting by and through its duly authorized representative. RECITALS WHEREAS, Licensee is the owner of the real property located at 5816 Rickenbacker Place, Fort Worth, Texas 76112 ("Property"), being more particularly described as, Block Al, Carver Heights, an addition to the City of Fort Worth, Tarrant County, Texas, in the Record of Deeds, Volume 2357 on page 284; and WHEREAS, the City owns a right of way (the "Public Property") adjacent to the Property, dedicated by plat, which plat is recorded in the plat records of Tarrant County in Volume 388-Z on page 121; 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; and NOW, THEREFORE, the City and Licensee agree as follows: Tier II ROW Encroachment Agreement Page 1 of 12 Updated 2024 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 storm drainage pipe connecting to the public drop inlet within the City's drainage easement (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 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 ar 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, to the extent allowed by law, 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. �. Licensee agrees that City may enter and utilize the Public Property at any time for any public purpose, including installing, repairing, replacing, or maintaining Tier II ROW Encroachment Agreement Page 2 of 12 Updated 2024 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. 5. 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 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). Additionally, Licensee agrees to pay a fee in the amount of $2.00 per square/linear foot of the encroachment area upon execution of this Agreement and annually thereafter. City shall annually invoice License said fee in the amount of $13.40 which Licensee will pay in accordance with the Texas Prompt Payment Law. 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 Tier II ROW Encroachment Agreement Page 3 of 12 Updated 2024 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. TO THE EXTENT ALLOWED BY TEXAS LAW AND WITHOUT WAIVING ITS GOVERNMENTAL IMMUNITY, LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY IlVDEMNIFY, HOLD HARMI.ESS, 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. TO THE EXTENT ALLOWED BY TEXAS LAW AND WITHOUT WAIVING ITS GOVERNMENTAL IMMUNITY, 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. Tier II ROW Encroachment Agreement Page 4 of 12 Updated 2024 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 $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. 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. f f►� 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. fK� Licensee agrees to pay promptly when due all applicable 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, Tier fI ROW Encroachment Agreement Page 5 of 12 Updated 2024 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. To the extent allowed by Texas law, 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. 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. 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. Tier II ROW Encroachment Agreement Page 6 of 12 Updated 2024 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 ROW Encroachment Agreement Page 7 of 12 Updated 2024 EXECUTED to be effective on the date signed by the City's Director of Development Services Department City: CITY OF FORT WORTH By: Dalton HarrelHfeb 4, 202511:38 CST) D.J. Harrell Director, Development Services Department Date: ___ F_e_b_4_, 2_0_2_s ____ _ ATTEST: Jannette Goodall, City Secretary Approved As To Form and Legality Hye Won Kim Assistant City Attorney 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. Rebec;c;a Diane Owen Rebecca Diane Owen (Jan 30, 202516:10 CST) Rebecca Owen Development Services Manager Tier II ROW Encroachment Agreement Page 8 of 12 Updated 2024 Licensee: Fort Worth Independent School District a political subdivision of the state of Texas and a legally constituted independent public-school district By: � Name: Kellie Spencer Title: Deputy Superintendent Date: 1 /21 /25 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 Ke11ie Spencer , Deputy Superintendent (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 Fort Worth Independent School District, an i�ir�er��ndznt s�hool district (entity type), and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this 21st day of January , 2025 . W � ��iiiriir ' � . .,.��nY;���, LETICIA LAING ARRIAGA : F i��-'G� � MY COMMISSION EXPIRES � ;�; �ji�; t � OCTOBER 20, 2027 Tvotary Public in and for the '-';eo5�±' NOTARY ID:124718386 State of Texas Tier [I ROW Encroachment Agreement Page 9 of 12 Updated 2024 ***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 this�day of February 2025 -----� Notary Public in and for the State of Texas Tier II ROW Encroachment Agreement WENDY L BEARDSLEENotary Public ST ATE OF TEXAS Notary I .D. 13323719-3 My Comm. Exp. July 28, 2025 Page 10 of 12 Updated 2024 EXHIBIT A Depiction and description of the Encroachment Tier II ROW Encroachment Agreement Page 11 of 12 Updated 2024 EXH(BIT "A" LEGAL DESCRIPTION ENCROACHMENT EASEMENT BEING 0.001 acre of land located in the CHARLES PHIPPS SURVEY, Abstract No. 1224, City of Fort Worth, Tarrant County, Texas, and being a portion of Ramey Avenue (a 60 foot wide public right-of-way). Said 0.001 acre of land being more particularly described by metes and bounds as follows: BEGINNING at a point lying N 89° 35' 19" E 13.28 feet, from an "X" cut in concrete found at the Southwest corner of Block A1, CARVER HEIGHTS, an addition to the City of Fort Worth, Tarrant County, Texas, according to the plat recorded in Volume 388-Z, Page 121, of the Plat Records of Tarrant County, Texas, and said paint also lying in the North right-of-way line of aforesaid Ramey Avenue; THENCE N 89° 35' 19" E 6.00 feet, along the South boundary line of said Block A1, Carver Heights and the North right-af-way line of Ramey Avenue, to a point; THENCE severing said Ramey Avenue, as follows: 1. SOUTH 6.66 feet, to a point; 2. WEST 6.00 feet, to a point; 3. NORTH 6.62 feet, to the POINT OF BEGINNING containing 0.001 acre (40 square feet) of land. � �F . . G ST• r. �' � �+ iJ+ .. .. .. . .. ...... . .. . .. . . t.. CHRIS L BLEVINS r..... ....,d.. �.q 5792 � r P �: 9�'� �suR�E��� 09/25/2024 G:�2024\EASEMENTS\Carver Heights, Blk A1 - Maudrie Walton Elementary Schoo] - Encroachment - 0 001 Ac doc E�HIBIT "A" � �'— � W 3 �I � � � O � � � 2 � � � � Q O V POINT OF BEGINNING "X"IN CONC. Course Bearing Distance L1 N 89°35'19" E 13.28' L2 N 89°35'19" E 6.00' L3 SOUTH 6.66' L4 NlEST 6 . 00' L5 NORTH 6.62' BLOCK A1 CARVER HEIGHTS VOL. 388-Z, PG. 121 P.R.T.C.T. ENCROACHMENT EASEMENT 6EARING BASE: 0.001 ACRE THE BEARINGS SHOWN HEREON ARE TEXAS STATE (40 SQ. FT.) PLANE GRID BEARINGS (NAD83 NORTH CENTRAL ZONE 4202) ESTABLISHED USING THE GLOBAL POSITIONING SYSTEM SATELLITES, AND LOCAL CONTINUOUSLY L2 OPERATING REFERENCE STATIONS. — — R.O. W. — � Ln ch J J L4 L1 tZAM EY AVE. _ 60' RIGHT-OF-WAY �RITTAIN & CRAWFORD LAND SURVEYING & TOPOGRAPHIC MAPPING TEL (B17) 926-0211 FAX (B17) 926-9347 P.O. BOX 11374 � 3908 SOUTH FREEWAY FORT WORTH, TEXAS 76110 EMAIL: admin�brittain—crowford.com W`e85fTE- .wr6neee�n-.crowf4d.com FIRM CERTIFICATIONj) 1019000 —R.O. W. ENCR�ACHMENT EASEII�EI�T LOCATED IN BLOCK A1, CARt►ER HEIGHTS AN AQDITION TO THE CITY QF FORT 1�IORTH NT COUNTY TEXAS �� o� . Ps' � � , T � E. :�+ .............oe...oa..oa.. ..CHRIS L. BLEVINS ..4 �..5792 � �: �•.����F 5 5!Q��p� 9�� S U R`� 4"{ PREPaRE�: 5EP7E�15ER 25. _2024 z 0 s TARRA • SCALE 1"=20' (K.G.) ...PROJECTS\CARUER HEIGHTS BLOCK A1 LOT At\CARVER HEIGHTS-ENCROACHMENT EASEMENT.dwg I I i � I I � � � i � m � � � I I � �S o3% � ! � I �� � �Fz� _ � " � -i"• y�j--IGO.W.__�'__""ed�_�—"__ '��__— L --- �Q_�...� `� — � �� -__.:;S��J � kI- —�� � -- .I'���� �� �AS�STF2EET.� ��„ �rw , = u '' ,� �I �A I �L _ o D ; I� � �. �� ;�-,. =m � � o'� ;� �. � � D � : .f � < �� � >m � � � �l � �� �' 1 �� , �1 � , �, ,,, , pQ���_��.�'� � � �. ' rtf mc� �;�� � � �oo r ry z tn r*� D o� O � p o o a � �J � � � � o o � e � a � z _ < 9� ��a� 4g 2�a�€ o ��^. '�`� 4� 96�pi m � �9F� b mgg$� �m g��� � §€��� 4$ ���g 2 ��_€ � 4nim F ���� � `�g� ` g-> g �R� 9 �m�� S a�$ � ��oi o � b � e o _ e �r� B`� �V o at m� a��' MAUDRIE M. WALTON ELEMENTARY I �Sti I x m i. SCHOOL RENOVATION �� R �w' �jjo En eerin I.LC 2 � � 581fiRICKENBACKERPL, 5�g��°����gL � � g' � FORTWORTH.TX7fi112 eA'4��� i�' W � '��� J01 Cummcrtc SYrcl, Sic 1410 � Fort Wo�,Tcvs J61CS � STORMDRAINEXHIBITPIAN �°���`•f '�� _,_, -+ �'hovcBl]69]1996�Fi�mli�gitvLnoNF15l9] EXHIBIT B Certificate of Insurance Tier II ROW Encroachment Agreement Page 12 of 12 Updated 2024 �� � DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE ,oizzizoza THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANlD 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 CONSTfTUTE 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 CONTRCT NpM�: Caraiyn Howard Higginbotham Insurance Agency, Inc. PHOHE �Ax 500 W. 13th Street rnr�.Ho�Ex«: 8�7-347-7090 I cnrc,r,ol; 8t7-3a7-s981 F-MAIL Fort Worth TX 76102 _woa�ss: choward a�hiqqinbainam.net __ Texas Political Subdivisions INSURED Fort wortn is� Attn: Risk Management Dept 7060 Camp Bowie Blvd Fort Worth TX 76116 INSURER C : INSURER D : NAIC # 99999 INSURER F : i COVERAGES CERTIFICATE NUMBER: 1414558465 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 COND�TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUftANCE 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 7ypE OF INSURANCE AODL=SIFBR� POLICY NUMBER I MMlDDY/YYVY MM DDyIYYYYI I LIMITS � LTR . A X COMMERCIALGENERALLIABILITY F0632 7H12�24 7H(2025 EqCHOCCURRENCE $3,000,000 — ��'�— � DAMA�E�t N'iEb _I CLAIMS-MADE C OCCUR I PREA4ISES Ea orcurrence I S 100,000 _ �� MED EXP (An one person) $ 0 PERSONAL & ADV INJURY $ 3.000.000 GEI1VL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 I� PQLIGY I_.' JECT � LOC � PRODUCTS -COMPIOP AGG $ 3,000,000 I OTHER: � $ AUTOMOBILE LIABILITY � j��7�BINEO SihiGLE LIMIT $ ANY AUTO � I BODILY INJURY (Per person) $ � � OWNED � SCHEDULED � BODILY INJURY (Per accident) $ AUTOS ONLY � _„ AUTOS HIRED " NON-0WNED PFtaPERTY�AMAGE $ ,. AUTOS ONLY i ; AUTOS ONLY I Per acclden[ I$ _ I UMBRELLA LIAB ;� pCCUR I ' EACH OCCURRENCE II$ 1 EXCESS LIAB I_ CLAIMS-MADE I AGGREGATE 1$ DED � � RETENTION S � $ � WORKERS COMPENSATION - I FR I F'tlt � U I FI- AND EMPLOYERS' LIABILITY , I, STATUTE, , ANYPROPRIETORIPARTNER/EXECUTIVE Y� N E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? � N�A ' (Mandatory in NH) � i � E.L. DISEASE-EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS 6elow E L DISEASE - POLICY LIMIT S I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may 6e attached if more space is required) CERTIFICATE city of Fort wortr, CFA Office PN24-00182 100 Fort Worth Trail Fort Worth TX 76102 ACORD 25 (2016/03) ELLA' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Al1THaRIIEi]R PRE5EHTRTlVE I O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD