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HomeMy WebLinkAboutContract 63330Date Received: 5/29/2025 Time Received: 10 : 30 a.m. Record Number: PN25-00073 City Secretary No.: 63330 PUBLIC PROPERTY EASEMENT 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 QT South, LLC, a Texas limited liability company ("Licensee"), acting by and through its duly authorized manager. RECITALS WHEREAS, Licensee is the owner of the real property located at 2529 Meacham Boulevard, Fort Worth, Texas 76106 ("Property"), being more particularly described as, Lot 1, Block 1, of J. Bruner Subdivision, an addition to the City of Fort Worth, Tarrant County, Texas, as recorded in Deed Records, by Instrument Number D223206530; and WHEREAS, the City owns a sanitary sewer easement and a utility easement (the "Public Property") adjacent to the Property, dedicated by plat, depicted on the final plat of the property, which plat is recorded in the plat records of Tarrant County as Instrument D221195018; 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, operating, and maintaining a private storm pipe and electrical conduit (the "Encroachments"). Upon completion of the Encroachment, Licensee agrees to be responsible for maintaining the Encroachment within the Public Property. Licensee shall OFFICIAL RECORD Tier II Easement Encroachment Agreement CITY SECRETARY Page 1 of 11 Revised 12/2022 FT. WORTH, TX not expand or otherwise cause the Encroachment to further infringe in or on the Public Property beyond what is specifically described in Exhibit "A" without written consent in the form of an encroachment agreement amendment. 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 for review and approval. 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. 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 equal to or better than existed prior to the commencement of construction of the Encroachment. 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 Tier II Easement Encroachment Agreement Page 2 of 11 Revised 12/2022 this Agreement terminates and Licensee fails to remove the Encroachment and restore the Public Property as provided herein, 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. Prior to assessing a lien on the Property, City shall give Licensee thirty (30) days to cure. 6. In order to defray all costs of inspection and supervision which the City has incurred or will incur as a result of the construction, maintenance, inspection or management of the Encroachment and use of Public Property as provided for by this Agreement, Licensee agrees to pay to City at the time this Agreement is requested an application fee in the sum of One Thousand Twelve Dollars and Fifty Cents ($1012.50). 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 Tier II Easement Encroachment Agreement Page 3 of I I Revised 12/2022 OFFICERS, AGENTS, SERVANTS, EMPLOYEES, AND ELECTED OFFICIALS (COLLWCTIVELY THE "INDEMNIFIED PARTIES") 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, EXCEPT FOR CLAIMS CAUSED BY THE GROSS NEGLIGENCE OR INTENTIONAL MISCONDUCT OF THE INDEMNIFIED PARTIES; 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 $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 promptly 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. Tier II Easement Encroachment Agreement Page 4 of 11 Revised 12/2022 Licensee agrees to deposit with the City when this Agreement is executed a sufficient sum of money to be used to pay necessary fees to record this Agreement in the real property records of the county in which the Encroachment is located. After being recorded, the original shall be returned to the City Secretary of the City of Fort Worth. 12. Licensee agrees to comply fully with all applicable federal, state, and local laws, statutes, ordinances, codes, and regulations in connection with the construction, operation, and maintenance of the Encroachment and use of the Public Property. 13. Licensee agrees to pay promptly when due all fees, taxes, or rentals provided for by this Agreement or by any federal, state, or local statute, law, or regulation. 14. Licensee covenants and agrees that it shall operate hereunder as an independent contractor as to all rights and privileges granted hereunder and not as an officer, agent, servant, or employee of City, and Licensee shall have exclusive control of and the exclusive right to control the details of its operations, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers, agents, servants, employees, contractors, subcontractors, licensees, and invitees. The doctrine of respondeat superior shall not apply as between City and Licensee, its officers, agents, servants, employees, contractors, and subcontractors, and nothing herein shall be construed as creating a partnership or joint enterprise between City and Licensee. 15. Licensee agrees and acknowledges that this Agreement is solely for the purpose of permitting Licensee to construct, maintain, and locate the Encroachment over or within the Public Property and is not a conveyance of any right, title, or interest in or to the Public Property, nor is it meant to convey any right to use or occupy property in which a third -party may have an interest. Licensee agrees that it will obtain all necessary permissions before occupying such property. 16. In any action brought by the City for the enforcement of the obligations of the Licensee, City shall be entitled to recover interest and reasonable attorneys' fees. 17. Tier II Easement Encroachment Agreement Page 5 of I I Revised 12/2022 The parties agree that the duties and obligations contained in Section 5 shall survive the termination of this Agreement. 18. Licensee covenants and agrees that it will not assign all or any of its rights, privileges, or duties under this Agreement without the written approval of the City, and any attempted assignment without such written approval shall be void. In the event Licensee conveys the Property, Licensee may assign all of its rights and obligations under this Agreement to the new owner of the Property, and Licensee shall be deemed released from its duties and obligations hereunder upon City's approval in writing of such assignment, which approval shall not be unreasonably conditioned or withheld. Foreclosure by a secured lender of Licensee or assignment to a secured lender by Licensee in the event of default or otherwise shall not require City approval provided that said lender notifies City in writing within sixty (60) days of such foreclosure or assignment and assumes all of Licensee's rights and obligations hereunder. However, no change of ownership due to foreclosure or assignment to any secured lender of Licensee shall be effective as to City unless and until written notice of such foreclosure or assignment is provided to City. 19. Prior to the end of the term of this Agreement, Licensee may submit a new encroachment application to the City. The City will not unreasonably withhold or delay approval of such application provided that the Encroachment follows the then current City codes and compliance. 20. 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. 21. This Agreement shall be binding upon the parties hereto and their successors and assigns. 22. 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 11 Revised 12/2022 EXECUTED to be effective on the date signed by the City's Director of Development Services Department City: CITY OF FORT WORTH By: Dalton Harrell Wav 28, 202511:41 CDT) D. J. Harrell Director, Development Services Department Date: ATTEST: Jannette Goodall, City Secretary gA44�.�RTn�a a � F0000000oo�o9do Pvo o=d dQ nC nBX4?o°a 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. ka� Kandice Merrick Development Services Manager OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Tier II Easement Encroachment Agreement Page 7 of I I Revised 12/2022 Licensee: QT South, LLC a Texas limited liability company By: w)` 1P____ Name: Matthew Miller Title: President Date: .S/ZO / 6zr-- STATE OF —T[ }CAS § COUNTY OF '�,5 KPH) § BEFORE ME, the undersigned authority, a Notary Public in and for the State of 15Xr4S , on this day personally appeared Matthew Miller, President (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 QT South, LLC, a Texas limited liability company (entity type), and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this Zo`�" day of 2025. J Paul T Gorman MY Commission E xpires e Notary 10134914164 ublic in and for the a Stoa�teof �� )CAS Tier II Easement Encroachment Agreement Page 8 of 11 Revised 12/2022 �""THIS PAGE FUR U1TY OF FUKT WURTH UFFIUE USE UNLY" r 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 28 day of May , 2025. !Z� G*yO�PFtY P(%1�1','i Notary Public in and for the State of Texas 2 N to .r .� of 9 .O 03-2ra-'! Tier II Easement Encroachment Agreement Page 9 of 11 Revised 12/2022 EXHIBIT A Depiction and description of the Encroachment Tier II Easement Encroachment Agreement Page 10 of I 1 Revised 12/2022 Lu n Q_' J Q fl >C- W Q SW P <WY w }GREAT Y z O UJ > O j m QDORUMDR Y FRANKLIN DR Q POLARIS ')R MEACHAM BLVD MEACHAM BLVD LS1TE < ` o a z Lui W M 0 DOWNING DR Vicinity Map Not to Scale EXHIBIT A - VICINITY MAP .............................................................................. OWNER/DEVELOPER: [a] QUIKTRIP No. 1877 QUIKTRIP CORP. �{irkman ® 4705 SOUTH 129THEASTAVENUE DATE: A April P TULSA, OK 74134-7008 ENGINEERING PHONE: (918) 515-7685 21 6200 STATE HIGHWAY COLLEYVILLE, TX 76034 Phone: 817-488-4960 J ............................................................................... CB = N30'08'3b L SITE LEGEND / � SS -429.90' BOUNDARY UNE -( �1S�W{+ CONCRETE CURB AND GUf1ER o —N M a O O ENCROACHMENT #1 PROP. 12" STORM I �° • S70R PIPE (RCP) II ecac 28.84' S89°51'53"E SO°57'54"E J 89°5153"W 5_00 _� 20_00' 00, 689°51'53"W \ TFIR I TRACT 1�1 vTvIII LOT 1, BBLOCK 1 L J. BRUNER SUBDIVISION VOLUME 388-46, PG 247 S89°51'53"E D.R.T.C.T. 5.00'J III Cl ENCROACHMENT #2 TRACT 2 PROP. CONDUIT FOR UNDERGROUND LOT 2, BLOCK 1 ROY ORR LIMITED PARTNERSHIP NO°57'54"W J I I I ELECTRICAL�TELEPHONE SERVICE LINE MERCANTILE CENTER INSTRUMENT N0. D2132642074 20.00' I ( 1 WEST ADDITION O.P.R.T.C.T. I I' ^t : CABINET A, SLIDE 1752 I I � P.R.T.C.T. O �J I O a I o I I I , MERCANTILE PARTNERS VOLUME 11752. PG 190 10' UA-4 EASEMENT VOLUME — O.P.R.T.C.T. 388-48, PC 247 D.R.T.C.T. U A a EX. 15' SANITARY O O O O O SEWER EASEMENT �p F-K. mao.. o- a. Ugfo ugfo SNs fi;, Rp ss SS ss 0 SS EXHIBIT C - ENCROACHMENT AGREEMENT .............................................................................. OWNER/DEVELOPER: [a] 0 ® 60 QUIKTRIP No. 1877 QUIKTRIP CORP. 4705 SOUTH 129THEASTAVENUE �{irkman I I DATE:A April 2025 ENGINEERING I p TULSA, OK 74134-loos 6200 STATE HIGHWAY 121 PHONE: (918) 615-7685 COLLEYVILLE, TX 76034 GRAPHIC SCALE Phone:817-488-4960 LEGAL DESCRIPTION BEING a 5 foot wide utility easement encroachment area located in the City of Fort Worth, Tarrant County, Texas, being upon, over, across, and through a portion of Lot 1, Block 1 of J. Bruner Subdivision to the City of Fort Work, Tarrant County, Texas, as shown on the plat recorded Volume 388-46, Page 247 of the Deed Records of Tarrant County, Texas, same being described in a deed to QT SOUTH, LLC as recorded in document D223206530 of the Official Public Records of Tarrant, County, Texas, and said easement being further described as follows: Beginning at a calculated point in the north line of said Lot 1 and the south line of Lot 2, Block 1 of Mercantile Center West Addition to the City of Fort Worth, Tarrant County, Texas, as shown on the plat recorded in Cabinet A, Slide 1752 of the Plat Records of Tarrant County, Texas, from which a 1 inch pipe found for the northwest corner of said Lot 1 bears North 89 degrees 51 minutes 53 seconds West, 8.14 feet; THENCE South 89 degrees 51 minutes 53 seconds East, 5.00 feet with the common line of said Lots 1 and 2 to a calculated point for corner, from which a 1/2 inch steel rod capped "1519 SURVEYING' set for the common east corner of said Lot 1 and 2 bears South 89 degrees 51 minutes 53 seconds East, 5.00 feet; THENCE the following bearings and distances upon, over, across and through said Lot 1: South 00 degrees 57 minutes 54 seconds East, 5.00 feet to a calculated point for corner; North 89 degrees 51 minutes 53 seconds West, 5.00 feet to a calculated point for corner, from which a 1/2 inch steel rod capped "JPH LAND SURVEYING' found for the southwest corner of said Lot 1 bears South 00 degrees 53 minutes 44 seconds West, 247.53 feet; North 00 degrees 57 minutes 54 seconds West, 5.00 feet to the POINT OF BEGINNING and containing 0.001 acre (25.0 square feet) of land. I, the undersigned, do hereby certify that the plat as shown hereon was prepared from an on -the -ground survey performed by me or under my supervision and completed on September 9, 2023; No warranty is made or intended for the location of any or all easements that may exist within the bounds of this survey. iathan Edward Coops/% P.L.S.5369 /a0 Date: April 2, 2025 ...................... ONATHAN E. COOPER :4 5369 - . QL a 5 FOOT WIDE UTILITY EASEMENT ENCROACHMENT AREA 0.001 ACRES OUT OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION BEING UPON, OVER, ACROSS, AND THROUGH A PORTION OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION TO THE CITY OF FORT WORK, TARRANT COUNTY, TEXAS, AS SHOWN ON THE PLAT RECORDED VOLUME 388-46, PAGE 247 OF THE DEED RECORDS OF TARRANT COUNTY, TEXAS, SAME BEING DESCRIBED IN A DEED TO QT SOUTH, LLC AS RECORDED IN DOCUMENT D223206530 OF THE OFFICIAL PUBLIC RECORDS OF TARRANT, COUNTY, TEXAS. Bowman Job No.: 210852 Drawn By: HMH Sheet 1 of 2 Reviewed By: JEC Property Address: Prepared For: 2529 Meacham Blvd., QuikTrip South LLC Fort Worth, Texas Bowman 2805 Dallas Parkway, Ste. 310, Plano, TX 75093 972.497.29901 TBPELS# 10120600 0' 10, 20' 2021 GEMINI, LLC INSTRUMENT NO. D221369746 ---------------------- O.P.R.T.C.T I LOT 2, BLOCK 1 I MERCANTILE CENTER WEST ADDITION CABINET A, SLIDE 1752 P.R.T.C.T. EXHIBIT "D" L0 UTILITY EASEMENT I ' POINT 01C VOLUME 11364, PAGE 2077 D.R.T.C.T. ' r B E G I N N I N G 15' SANITARY SEWER EASEMENT I CABINET A, SLIDE 1752 P.R.T.C.T. L5 LI „ I I � 0.001 S 89'51'53" E 161.81' I I I Acre � N Ir-- — — — I I L3 — — — — — — — — — — — — — — — — — — — — — — I LOT 1, BLOCK 1 J. BRUNER SUBDIVISION I i VOLUME 388-46, PAGE 247 10UTILITY M D.R.T.C.T. E I_ 10' I t Lo VOLUMMENT 388-46, 247 I QT SOUTH, LLC PAGE i o N INSTRUMENT NO. N D223206530 LOT 1, BLOCK 1 I i O.P.R.T.C.T. MERCANTILE CENTER WEST ADDITION I CABINET A, SLIDE 1524 I I P.R.T.C.T. I 1/2 Inch Steel Rod Capped I I "JPH LAND SURVEYING"Found I I I ' I I I I (SCALE: 1" = 10') N I B I S LEGEND 112 Inch Steel Rod Capped "1519 SURVEYING" Set 1 Inch Pipe Found (unless noted otherwise) Calculated Point D.R.T.C.T. Deed Records of Tarrant County, Texas O.P.R.T.C.T. - Official Public Records of Tarrant County, Texas P.R.T.C.T. - Plat Records of Tarrant County, Texas NOTES: 1. Bearings, distances, and acreage are grid, NAD83 State Plane I LINE BEARING DISTANCE I Coordinate System, Texas North Central Zone 4202. I Ll S 89051'53" E 5.00' I I L2 S 00°57'S4" E 5.00' I 2. This survey was prepared without the benefit of a current title 1 L3 N 89°51'53" W 5.00' I report/commitment. There may be easements, restrictions, and/or 1 L4 N 00057'54" W 5.00' I covenants affecting this property, not shown hereon. 1 L5 N 89051'53" W 8.14' I 3. No flood zone determination was made as part of this survey. Bowman Job No.: 210852 Drawn By: HMH 5 FOOT WIDE UTILITY EASEMENT I Sheet 2 of 2 Reviewed By: JEC ENCROACHMENT AREA Property Address: Prepared For: 2529 Meacham Blvd., QuikTrip South LLC 0.001 ACRES OUT OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION Fort Worth, Texas BEING UPON, OVER, ACROSS, AND THROUGH A PORTION OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION TO THE CITY OF FORT WORK, TARRANT COUNTY, TEXAS, AS SHOWN ON THE PLAT RECORDED VOLUME 388-46, PAGE 247 OF THE DEED RECORDS OF TARRANT COUNTY, TEXAS, SAME BEING DESCRIBED IN A DEED TO QT SOUTH, LLC AS RECORDED IN DOCUMENT Bowman D223206530 OF THE OFFICIAL PUBLIC RECORDS OF TARRANT, COUNTY, TEXAS. 2805 Dallas Parkway, Ste. 310, Plano, TX 75093 972.497.29901 TBPELS# 10120600 LEGAL DESCRIPTION BEING a 5 foot wide utility easement encroachment area located in the City of Fort Worth, Tarrant County, Texas, being upon, over, across, and through a portion of Lot 2, Block 1 of Mercantile Center West Addition to the City of Fort Work, Tarrant County, Texas, as shown on the plat recorded in Cabinet A, Slide 1752 of the Plat Records of Tarrant County, Texas, same being described in a deed to 2021 Gemini, LLC as recorded in document D221369746 of the Official Public Records of Tarrant, County, Texas, and said easement being further described as follows: Beginning at a calculated point in the south line of said Lot 2 and the north line of Lot 1, Block 1 of J. Bruner Subdivision to the City of Fort Worth, Tarrant County, Texas, as shown on the plat recorded in Volume 388-46, Page 247 of the Deed Records of Tarrant County, Texas, from which a 1 inch pipe found for the northwest corner of said Lot 1 bears North 89 degrees 51 minutes 53 seconds West, 8.14 feet; THENCE the following bearings and distances upon, over, across, and through said Lot 2: North 00 degrees 57 minutes 54 seconds West, 15.00 feet to a calculated point for corner, from which a 5/8 inch steel rod found bears North 71 degrees 43 minutes 11 seconds West, 255.83 feet for reference; South 89 degrees 51 minutes 53 seconds East, 5.00 feet to a calculated point for corner; South 00 degrees 57 minutes 54 seconds East, 15.00 feet to a calculated point for corner in the common line of said Lots 2 and 1, from which a 1/2 inch steel rod capped "1519 SURVEYING' set for the east common corner of said Lots 2 and 1 bears South 89 degrees 51 minutes 53 seconds East, 161.18 feet; THENCE North 89 degrees 51 minutes 53 seconds West, 5.00 feet with the common line of said Lots 2 and 1 to the POINT OF BEGINNING and containing 0.002 acres (75.0 square feet) of land. I, the undersigned, do hereby certify that the plat as shown hereon was prepared from an on -the -ground survey performed by me or under my supervision and completed on September 9, 2023; No warranty is made or intended for the location of any or all easements that may exist within the bounds of this survey. Al •COOPER JONATHAN E. Jo than Edward Cooper L.S.5369 y .5369 p k S U R� ate: April 10, 2025 5 FOOT WIDE UTILITY EASEMENT ENCROACHMENT AREA 0.002 ACRES OUT OF LOT 2, BLOCK 1 OF MERCANTILE CENTER WEST ADDITION BEING UPON, OVER, ACROSS, AND THROUGH A PORTION OF LOT 2, BLOCK 1 OF MERCANTILE CENTER WEST ADDITION TO THE CITY OF FORT WORK, TARRANT COUNTY, TEXAS, AS SHOWN ON THE PLAT RECORDED IN CABINET A, SLIDE 1752 OF THE PLAT RECORDS OF TARRANT COUNTY, TEXAS, SAME BEING DESCRIBED IN A DEED TO 2021 GEMINI, LLC AS RECORDED IN DOCUMENT D221369746 OF THE OFFICIAL PUBLIC RECORDS OF TARRANT, COUNTY, TEXAS. Bowman Job No.: 210852 Drawn By: HMH Sheet 1 of 2 Reviewed By: JEC Property Address: Prepared For: 2529 Meacham Blvd., QuikTrip South LLC Fort Worth, Texas Bowman 2805 Dallas Parkway, Ste. 310, Plano, TX 75093 972.497.2990 1 TBPELS# 10120600 0' 10, 20' 5/8 Inch Steel Rod Found N 2SS L2 ------------------------- 2021 GEMINI, LLC -------------------------- INSTRUMENT NO. D221369746 O.P.R.T.C.'r 5' LOT 2, BLOCK 1 E _ MERCANTILE CENTER WEST ADDITION CABINET A, SLIDE 1752 0.002 P.R.T.C.T. r Acre r EXHIBIT UTILITY EASEMENT i F-i POINT 0 IC W VOLUME 11364, PAGE 2077 C.T. ' r BEGINNING 15' SANITARY SEWER EASEMENT I CABINET A, SLIDE 1752 P.R.T.C.T. I ; L5 L4 --I —I— -- ■k I � I I „ -- -- -- S 89"51'53" E 161.81' I I Ir---------------------------------- LOT 1, BLOCKI1 LOT 1, BLOCK 1 MERCANTILE CENTER I I J. BRUNER SUBDIVISION WEST ADDITION I VOLUME 388-46, PAGE 247 CABINET A, SLIDE 1524 I D.R.T.C.T. P.R.T.C.T. I 10. UTILITY I I I VOLUME 10, 388-46, PAGE 247 I I D.R.T.C.T. I I I I I ILINE BEARING I L1 N 0005754" W I L2 S 89051'53" E I L3 S 00057'54" E I L4 N 89051'53" W I L5 N 89051'53" W QT SOUTH, LLC INSTRUMENT NO. D223206530 O.P.R.T.C.T. DISTANCE 15.00' 5.00' 15.00' 5.00' 8.14' 5 FOOT WIDE UTILITY EASEMENT ENCROACHMENT AREA 0.001 ACRES OUT OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION BEING UPON, OVER, ACROSS, AND THROUGH A PORTION OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION TO THE CITY OF FORT WORK, TARRANT COUNTY, TEXAS, AS SHOWN ON THE PLAT RECORDED VOLUME 388-46, PAGE 247 OF THE DEED RECORDS OF TARRANT COUNTY, TEXAS, SAME BEING DESCRIBED IN A DEED TO QT SOUTH, LLC AS RECORDED IN DOCUMENT D223206530 OF THE OFFICIAL PUBLIC RECORDS OF TARRANT, COUNTY, TEXAS. (SCALE: 1" = 10') N "I. I / -g- I S LEGEND 112 Inch Steel Rod Capped "1519 SURVEYING" Set 1 Inch Pipe Found (unless noted otherwise) AL Calculated Point D.R.T.C.T. Deed Records of Tarrant County, Texas O.P.R.T.C.T. Official Public Records of Tarrant County, Texas P.R.T.C.T. - Plat Records of Tarrant County, Texas NOTES: 1. Bearings, distances, and acreage are grid, NAD83 State Plane Coordinate System, Texas North Central Zone 4202. 2. This survey was prepared without the benefit of a current title report/commitment. There may be easements, restrictions, and/or covenants affecting this property, not shown hereon. 3. No flood zone determination was made as part of this survey. Bowman Job No.: 210852 Drawn By: HMH Sheet 2 of 2 Reviewed By: JEC Property Address: Prepared For: 2529 Meacham Blvd., QuikTrip South LLC Fort Worth, Texas Bowman 2805 Dallas Parkway, Ste. 310, Plano, TX 75093 972.497.29901 TBPELS# 10120600 LEGAL DESCRIPTION BEING a 3.47 foot wide storm sewer easement located in the City of Fort Worth, Tarrant County, Texas, being upon, over, across, and through a portion of Lot 2, Block 1 of Mercantile Center West Addition to the City of Fort Work, Tarrant County, Texas, as shown on the plat recorded in Cabinet A, Slide 1752 of the Plat Records of Tarrant County, Texas, same being described in a deed to 2021 Gemini, LLC as recorded in document D221369746 of the Official Public Records of Tarrant, County, Texas, and said easement being further described as follows: Beginning at a calculated point in the south line of said Lot 2 and the north line of Lot 1, Block 1 of J. Bruner Subdivision to the City of Fort Worth, Tarrant County, Texas, as shown on the plat recorded in Volume 388-46, Page 247 of the Deed Records of Tarrant County, Texas, from which a 1 inch pipe found for the northwest corner of said Lot 1 bears North 89 degrees 51 minutes 53 seconds West, 6.11 feet; THENCE the following bearings and distances upon, over, across, and through said Lot 2: North 45 degrees 57 minutes 53 seconds West, 21.63 feet to a calculated point for corner, from which a 5/8 inch steel rod found bears North 70 degrees 25 minutes 41 seconds West, 239.42 feet for reference; South 89 degrees 51 minutes 53 seconds East, 5.00 feet to a calculated point for corner; South 45 degrees 57 minutes 53 seconds East, 21.63 feet to a calculated point for corner in the common line of said Lots 2 and 1, from which a 1/2 inch steel rod capped "1519 SURVEYING' set for the common east corner of said Lots 2 and 1 bears South 89 degrees 51 minutes 53 seconds East, 163.84 feet; THENCE North 89 degrees 51 minutes 53 seconds West, 5.00 feet with the common line of said Lots 2 and 1 to the POINT OF BEGINNING and containing 0.002 acre (75.0 square feet) of land. I, the undersigned, do hereby certify that the plat as shown hereon was prepared from an on -the -ground survey performed by me or under my supervision and completed on September 9, 2023; No warranty is made or intended for the location of any or all easements that may exist within the bounds of this survey. NATHAN E, COOPER ..................... rte than Edward Cooper//L.S.5369(/: April 10, 2025 3.47 FOOT WIDE SANITARY SEWER EASEMENT ENCROACHMENT AREA 0.002 ACRES OUT OF LOT 2, BLOCK 1 OF MERCANTILE CENTER WEST ADDITION BEING UPON, OVER, ACROSS, AND THROUGH A PORTION OF LOT 2, BLOCK 1 OF MERCANTILE CENTER WEST ADDITION TO THE CITY OF FORT WORK, TARRANT COUNTY, TEXAS, AS SHOWN ON THE PLAT RECORDED IN CABINET A, SLIDE 1752 OF THE PLAT RECORDS OF TARRANT COUNTY, TEXAS, SAME BEING DESCRIBED IN A DEED TO 2021 GEMINI, LLC AS RECORDED IN DOCUMENT D221369746 OF THE OFFICIAL PUBLIC RECORDS OF TARRANT, COUNTY, TEXAS. Bowman Job No.: 210852 Drawn By: HMH Sheet 1 of 2 Reviewed By: JEC Property Address: Prepared For: 2529 Meacham Blvd., QuikTrip South LLC Fort Worth, Texas Bowman 2805 Dallas Parkway, Ste. 310, Plano, TX 75093 972.497.2990 1 TBPELS# 10120600 0' 10, 20' 5/8 Inch Steel Rod Found L2 2021 GEMINI, LLC INSTRUMENT NO D221369746 0-P.R.T.C.T LOT 2, BLOCK 1 MERCANTILE CENTER WEST ADDITION CABINET A, SLIDE 1752 y� P.R.T.C.T. EXHIBIT •D• rn r UTILITY EMENT `C VOLUME 11364, PAGE 2077 r--------- I ----------- D.R.T.C.T. ---------- I I 15' SANITARY SEWER EASEMENT I CABINET A, SLIDE 1752 I L4 P.R.T.C.T. ---I --I �LS -- S 89°51'53" E 163.84' I I I I I I LOT 1, BLOCKI1 I MERCANTILE CENTER WEST ADDITION CABINET A, SLIDE 1524 I P.R.T.C.T. 10. UTILITY EASEMENT 10' VOLUME 388-46, PAGE 247 I— D.R.T.C.T. I I POINT OF BEGINNING ---------------------------------- LOT 1, BLOCK 1 J. BRUNER SUBDIVISION I VOLUME 388-46, PAGE 247 D.R.T.C.T. I j QT SOUTH, LLC I INSTRUMENT NO. D223206530 _I O.P.R.T.C.T. I I I (SCALE: 1" = 10') LEGEND 112 Inch Steel Rod Capped "1519 SURVEYING" Set 1 Inch Pipe Found (unless noted otherwise) Calculated Point D.R.T.C.T. Deed Records of Tarrant County, Texas O.P.R.T.C.T. - Official Public Records of Tarrant County, Texas P.R.T.C.T. - Plat Records of Tarrant County, Texas I LINE BEARING DISTANCE I I LI N 45057'53" W 21.63' I NOTES: L2 S 89051'53" E 5.00' I distances, and acreage are rid, NAD83 State Plane 1. Bearings, r L3 S 45°57'53" E 21.63' I Coordinate System, Texas North Central Zone 4202. I L4 N 89051'53" W 5.00' I L5 N 89051'53" W 6.11' I 2. This survey was prepared without the benefit of a current title I L6 N 70025'41" W 239.42' I report/commitment. There may be easements, restrictions, and/or covenants affecting this property, not shown hereon. 3. No flood zone determination was made as part of this survey. 3.47 FOOT WIDE SANITARY SEWER EASEMENT ENCROACHMENT AREA 0.002 ACRES OUT OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION BEING UPON, OVER, ACROSS, AND THROUGH A PORTION OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION TO THE CITY OF FORT WORK, TARRANT COUNTY, TEXAS, AS SHOWN ON THE PLAT RECORDED VOLUME 388-46, PAGE 247 OF THE DEED RECORDS OF TARRANT COUNTY, TEXAS, SAME BEING DESCRIBED IN A DEED TO QT SOUTH, LLC AS RECORDED IN DOCUMENT D223206530 OF THE OFFICIAL PUBLIC RECORDS OF TARRANT, COUNTY, TEXAS. Bowman Job No.: 210852 Drawn By: HMH Sheet 2 of 2 Reviewed By: JEC Property Address: Prepared For: 2529 Meacham Blvd., QuikTrip South LLC Fort Worth, Texas Bowman 2805 Dallas Parkway, Ste. 310, Plano, TX 75093 972.497.29901 TBPELS# 10120600 LEGAL DESCRIPTION BEING a 3.47 foot wide storm sewer easement located in the City of Fort Worth, Tarrant County, Texas, being upon, over, across, and through a portion of Lot 1, Block 1 of J. Bruner Subdivision to the City of Fort Work, Tarrant County, Texas, as shown on the plat recorded Volume 388-46, Page 247 of the Deed Records of Tarrant County, Texas, same being described in a deed to QT SOUTH, LLC as recorded in document D223206530 of the Official Public Records of Tarrant, County, Texas, and said easement being further described as follows: Beginning at a calculated point in the north line of said Lot 1 and the south line of Lot 2, Block 1 of Mercantile Center West Addition to the City of Fort Worth, Tarrant County, Texas, as shown on the plat recorded in Cabinet A, Slide 1752 of the Plat Records of Tarrant County, Texas, from which a 1 inch pipe found for the northwest corner of said Lot 1 bears North 89 degrees 51 minutes 53 seconds West, 6.11 feet; THENCE South 89 degrees 51 minutes 53 seconds East, 5.00 feet with the common line of said Lots 1 and 2 to a calculated point for corner, from which a 1/2 inch steel rod capped "1519 SURVEYING' set for the common east corner of said Lot 1 and 2 bears South 89 degrees 51 minutes 53 seconds East, 5.00 feet; THENCE the following bearings and distances upon, over, across said through said Lot 1: South 45 degrees 57 minutes 53 seconds East, 7.21 feet to a calculated point for corner; North 89 degrees 51 minutes 53 seconds West, 5.00 feet to a calculated point for corner, from which a 1/2 inch steel rod capped "]PH LAND SURVEYING' found for the southwest corner of said Lot 1 bears South 01 degrees 36 minutes 21 seconds Wes,t 247.59 feet; North 45 degrees 57 minutes 53 seconds West, 7.21 feet to the POINT OF BEGINNING and containing 0.001 acre (25.0 square feet) of land. I, the undersigned, do hereby certify that the plat as shown hereon was prepared from an on -the -ground survey performed by me or under my supervision and completed on September 9, 2023; No warranty is made or intended for the location of any or all easements that may exist within the bounds of this survey. OFF TF ?ate:April JONATHAN E. COOPER rd Coope 90 5369 . p '� . S U ii� 2025 Bowman Job No.: 210852 Drawn By: HMH 3.47 FOOT WIDE STORM SEWER EASEMENT I Sheet 1 of 2 Reviewed By: JEC ENCROACHMENT AREA Property Address: Prepared For: 2529 Meacham Blvd., QuikTrips 0.001 ACRES OUT OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION Fort Worth, Texas BEING UPON, OVER, ACROSS, AND THROUGH A PORTION OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION TO THE CITY OF FORT WORK, TARRANT COUNTY, TEXAS, AS SHOWN ON THE PLAT RECORDED VOLUME 388-46, PAGE 247 OF THE DEED RECORDS OF TARRANT COUNTY, TEXAS, SAME BEING DESCRIBED IN A DEED TO QT SOUTH, LLC AS RECORDED IN DOCUMENT Bowman D223206530 OF THE OFFICIAL PUBLIC RECORDS OF TARRANT, COUNTY, TEXAS. 2805 Dallas Parkway, Ste. 310, Plano, TX 75093 972.497.2990 1 TBPELS# 10120600 0' 10, 20' 2021 GEMINI, LLC INSTRUMENT NO. D221369746 ---------------------- O.P.R.T.C.T I LOT 2, BLOCK 1 I MERCANTILE CENTER WEST ADDITION CABINET A, SLIDE 1752 P.R.T.C.T. EXHIBIT "D" L0 UTILITY EASEMENT ' POINT 01C VOLUME 11364, PAGE 2077 D.R.T.C.T. ' BEGINNING 15' SANITARY SEWER EASEMENT I CABINET A, SLIDE 1752 P.R.T.C.T. L1 I LS 0.001 I �� S 89"51'53" E 163.84' Acre Ir----- o� L3 ---------------------- I I u� LOT 1, BLOCK 1 N I J. BRUNER SUBDIVISION I i 31 VOLUME 388-46, PAGE 247 10UTILITY I '- I D.R.T.C.T. EASEMENT I 10' I N VOL46 PAGE 247 I I ° QT SOUTH, LLC D.R.T.C.T. I o l INSTRUMENT NO. En l D223206530 LOT 1, BLOCK 1 I i �J O.P.R.T.C.T. MERCANTILE CENTER WEST ADDITION I CABINET A, SLIDE 1524 I I P.R.T.C.T. I 1/2 Inch Steel Rod Capped I I I "JPH I I I � I I I I � I I I LAND SURVEYING" Found ILINE BEARING DISTANCE 1 L1 S 89051'53" E 5.00' 1 L2 S 45057'53" E 7.21' 1 L3 N 89051'53" W 5.00' 1 L4 N 45057'53" W 7.21' 1 L5 N 89051'53" W 6.11' 3.47 FOOT WIDE STORM SEWER EASEMENT ENCROACHMENT AREA 0.001 ACRES OUT OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION BEING UPON, OVER, ACROSS, AND THROUGH A PORTION OF LOT 1, BLOCK 1 OF J. BRUNER SUBDIVISION TO THE CITY OF FORT WORK, TARRANT COUNTY, TEXAS, AS SHOWN ON THE PLAT RECORDED VOLUME 388-46, PAGE 247 OF THE DEED RECORDS OF TARRANT COUNTY, TEXAS, SAME BEING DESCRIBED IN A DEED TO QT SOUTH, LLC AS RECORDED IN DOCUMENT D223206530 OF THE OFFICIAL PUBLIC RECORDS OF TARRANT, COUNTY, TEXAS. (SCALE: 1" = 10') N I B I S LEGEND 112 Inch Steel Rod Capped "1519 SURVEYING" Set 1 Inch Pipe Found (unless noted otherwise) AL Calculated Point D.R.T.C.T. Deed Records of Tarrant County, Texas O.P.R.T.C.T. Official Public Records of Tarrant County, Texas P.R.T.C.T. Plat Records of Tarrant County, Texas NOTES: 1. Bearings, distances, and acreage are grid, NAD83 State Plane Coordinate System, Texas North Central Zone 4202. 2. This survey was prepared without the benefit of a current title report/commitment. There may be easements, restrictions, and/or covenants affecting this property, not shown hereon. 3. No flood zone determination was made as part of this survey. Bowman Job No.: 210852 Drawn By: HMH Sheet 2 of 2 Reviewed By: JEC Property Address: Prepared For: 2529 Meacham Blvd., QuikTrips Fort Worth, Texas Bowman 2805 Dallas Parkway, Ste. 310, Plano, TX 75093 972.497.29901 TBPELS# 10120600 i (nN8 51'53"W p ® 5.00' 620 (ENCROACHMENT W1 s45°57'R�E I PROP. 12" STORM (RCP) -ASF1v1E�TE(()T F�OK W�RTF VOL 11339, pc 5,66; D ? T ('T ) \_N45°5r53"W 11 / 28.84' 61 f ) �/ UGET UGE SS S8151'53'E 10' UTILITY 5.00' EASEMENT VOLUME 388-46, PG 247 D.R.T.C.T. 61 -DR0 D. -�AI)t 605 15' SANITARY i SEWER EASEMENT CABINET A, SLIDE 1752 P.R.T.C.T ' 1PRGPOSED 18" STORNI (R--P) (F-RMfTE) 60 EX. 8" SEWER LINL (F�JBLIC) 1 59 EXISTINS GR )UI4) PRWOS=D 12" SlORA, (R,;P) ( r..\0 TG) \ I 1 10" CLEARAJCE TO 6" ]EWt R IINF (PJBLI.,) PRCP. (1SN ENCASEMEN- ARCIINE EX 8" SSVC L NE 15' SANITARY SEWER EASENENI CAB NET A, SLIC 1 >b2 P.R T.C.t 1 Gr UTILIT' E?5EM -NT VOLUME 388-46, PG 247 D.R.T.(.T. EXHIBIT C - ENCROACHMENT #1 .............................................................................. OWNER/DEVELOPER: [a] QUIKTRIP No. 1877 QUIKTRIP CORP. �{irkman 4705 SOUTH 129THEASTAVENUE ENGINEERING DATE: A April P TULSA, OK 74134-7008 5200 STATE HIGHWAY 121 PHONE: (918) 615-7685 COLLEYVILLE, TX 76034 Phone: 817-488-4960 - - ENCROACHMENT #2 PROP. 2"CONDUIT FOR UNDERGROUND ELECTRICAL/TELEPHONE SERVICE LINE 620 SO'57'54"E 20 00' N89°51'53"W UGO. 5.00' UGE SS I I NO'57'54"W r � 20.00' 10' UTILITY EASEMENT VOLUME 388-46, PG 247 D.R.T.C.T. L i 15' SANITARY SEWER EASEMENT CABINET A, SLIDE 1752 P.R.T.C.T 61 61 60 kOPOSEM 1 &" STORM ;RCP) (PR VATF) 60 EX. 8"SEWED _INE (PUBLIC) 59 #2 PLRMI,NE�T $ANIT,�RY SEVIOER EASE:ME� T CITY OF FORT �KORTH V,i ' 1 R--) PG E 66 D.R.-.C.1.) EXI�TINC GRCUNC PF OP. . GF'ADE PROPUSEE 4" HCF cnwf i lff (FRIVFTE) 1.E' CI.EAR4NC TO 4" UGET CONDU T PREP. CLS vA FN,�ASEMENT AR )UN) EX. 8" ii'W9 JNG 15' SANITARY SI-WEP EASEMENT GABIIJET A, � L& 1-Z2 P.R.'r.C.1 1 J' LTILI-N CrEHEN1 VOk-UW 388-46, PC 247 D.R.T.C.T. EXHIBIT C - ENCROACHMENT #2 .............................................................................. OWNER/DEVELOPER: [a] QUIKTRIP No. 1877 QUIKTRIP CORP. �{irkman 4705 SOUTH 129THEASTAVENUE ENGINEERING DATE: A April P TULSA, OK 74134-7008 5200 STATE HIGHWAY 121 PHONE: (918) 615-7685 COLLEYVILLE, TX 76034 Phone: 817-488-4960 i EXHIBIT B Certificate of Insurance Tier II Easement Encroachment Agreement Page 11 of 11 Revised 12/2022 QUIKCOR-02 RBLEVINS1 ,4coR0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/14/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 100101891 CONTACT Ramona Blevins NAME: Hub International Mid -America PHONE , Ext): (918 359-6104 FAX 6100 S. Yale Avenue ) (A/C, No): Suite 1900 ADDARIESS! ramona.blevins@hubinternational.com Tulsa, OK 74136 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Old Republic Insurance COmDanv 24147 INSURED INSURER B : QuikTrip Corporation/QT South LLC INSURER C : P.O. Box 3475 INSURER D : Tulsa, OK 74101-3475 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH DOLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY RAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS J_TR INSD WVD (MM/DDIYYYY) (MM/DDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,0001 CLAIMS -MADE OCCUR MWZY318915 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO ❑ LOC JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EXCESS LAB HCLAIMS-MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DAMAGE TO RENTED 5,000,0001 3/1/2025 3/1/2026 PREMISES Ea occurrence) $ 01 MED EXP (Anv one person) $ 5,000,0001 PERSONAL & ADV INJURY $ 10,000,0001 GENERAL AGGREGATE $ 10,000,0001 PRODUCTS - COMP/OP AGG $ SELF INSURED RE 1,000,0001 $ COMBINED SINGLE LIMIT IEa nnnidenfl $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ 1 EACH OCCURRENCE ( AGGREGATE $ $ 1 SER OTH- TATUTE FIR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Location: QuikTrip #1877, 2529 Meacham Blvd., Fort Worth, TX 76106 CERTIFICATE HOLDER City of Fort Worth CFA Office PN25-00073 100 Fort Worth Trail Fort Worth, TX 76102 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 SREPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD