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HomeMy WebLinkAboutContract 63948Date Received: 9/15/2025 Record Number: PN25-00093 Time Received: 1:43 p.m. City Secretary No.: 63948 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 Richard Marek and Charity Marek, ("Licensee"), acting by and through its duly authorized property owners. RECITALS WHEREAS, Licensee is the owner of the real property located at 7720 Quail Ridge Street, Fort Worth, Texas 76179 ("Property"), being more particularly described as, Lot 19, Block 10, of Lake Country Estates, an addition to the City of Fort Worth, Tarrant County, Texas, as recorded in Deed Records, by Instrument Number D214266200; and WHEREAS, the City owns a sewer easement (the "Public Property") adjacent to the Property, dedicated by plat, depicted on the final plat of the property (SF-71-18), which plat is recorded in the plat records of Tarrant County in Volume 388-67, Page 5-6; and WHEREAS, Licensee desires to construct, place, and maintain certain improvements which will encroach in, on, above, or below the Public Property; and WHEREAS, to accommodate the needs of the Licensee, the City will allow the encroachment under the terms and conditions as set forth in this Agreement. NOW, THEREFORE, the City and Licensee agree as follows: AGREEMENT 1. The City, in consideration of the payment by Licensee of the fee set out below and covenants and agreements hereinafter contained to be kept and performed by Licensee, hereby grants permission to Licensee to encroach in, on, above, or below and occupy a portion of the City's Public Property as described in and at the location shown on Exhibit "A," but only to the extent shown thereon, for the purpose of constructing, installing, and maintaining a retaining wall (the "Encroachment"). Upon completion of the Encroachment, Licensee agrees to be responsible for maintaining the Encroachment Tier H Easement Encroachment Agreement OFFICIAL RECORD Page 1 of 13 CITY SECRETARY Revised 12/2022 FT. WORTH, TX within the Public Property. Licensee shall not expand or otherwise cause the Encroachment to further infringe in or on the Public Property beyond what is specifically described in Exhibit "A." 2. All construction, installation, maintenance, and operation of the Encroachment and the use or occupancy of the Public Property shall comply with and be performed in strict compliance with this Agreement and with the charter, ordinances, codes, and policies of the City. Prior to the construction or installation of the Encroachment, Licensee shall submit all plans and specifications to the Director of the Development Services Department or duly authorized representative. Licensee shall not commence construction or installation of the Encroachment nor make any use of the Public Property until after the execution of this Agreement. 0 Licensee, at no expense to the City, shall make proper provisions for the relocation and installation of any existing or future utilities affected by such Encroachment and the use and occupancy of the Public Property, including the securing the approval and consent of the appropriate utility companies and agencies of the State of Texas and its political subdivisions. In the event that any installation, reinstallation, relocation, or repair of any existing or future utility or improvements owned by or constructed by or on behalf of the public or at public expense is made more costly by virtue of the construction, maintenance, or existence of the Encroachment and use of Public Property, Licensee shall pay to City an additional amount equal to such additional cost as determined by the Director of Transportation and Public Works, the Director of the Water Department, the Director of the Development Services Department, or their duly authorized representative. 4. Licensee agrees that City may enter and utilize the Public Property at any time for any public purpose, including installing, repairing, replacing, or maintaining improvements to its public facilities or utilities necessary for the health, safety, and welfare of the public. The City shall have no responsibility or liability for any damages related to the Encroachment resulting from the City's use of the Public Property; however, the City shall make reasonable efforts to minimize such damage. Upon termination of this Agreement, Licensee shall, at the option of and at no expense to the City, remove the Encroachment and restore the Public Property to a condition acceptable to the Director of Transportation and Public Works, the Director of the Water Department, the Director of the Development Services Department or their duly authorized representative. Any such removal of the Encroachment shall be in Tier H Easement Encroachment Agreement Page 2 of 13 Revised 12/2022 accordance with then -existing City regulations and policies. It is understood and agreed to by Licensee that if this Agreement terminates and Licensee fails to remove the Encroachment and restore the Public Property, Licensee hereby gives City permission to remove the Encroachment and any supporting structures from the Public Property, to restore the Public Property, and to assess a lien on the Property for the costs expended by the City in taking such actions. 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 13 Revised 12/2022 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. 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 OIL 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 homeowner insurance policy for the property as proof that is has secured and paid for a policy of public liability insurance covering all public risks related to the proposed use and occupancy of public property as located and described in Exhibit "A." The amounts of such insurance shall be not less than $300,000.00 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 Tier H Easement Encroachment Agreement Page 4 of 13 Revised 12/2022 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. The parties agree that the duties and obligations contained in Section 5 shall survive the termination of this Agreement. Tier II Easement Encroachment Agreement Page 5 of 13 Revised 12/2022 18. Licensee covenants and agrees that it will not assign all or any of its rights, privileges, or duties under this Agreement without the written approval of the City, and any attempted assignment without such written approval shall be void. In the event Licensee conveys the Property, Licensee may assign all of its rights and obligations under this Agreement to the new owner of the Property, and Licensee shall be deemed released from its duties and obligations hereunder upon City's approval in writing of such assignment, which approval shall not be unreasonably conditioned or withheld. Foreclosure by a secured lender of Licensee or assignment to a secured lender by Licensee in the event of default or otherwise shall not require City approval provided that said lender notifies City in writing within sixty (60) days of such foreclosure or assignment and assumes all of Licensee's rights and obligations hereunder. However, no change of ownership due to foreclosure or assignment to any secured lender of Licensee shall be effective as to City unless and until written notice of such foreclosure or assignment is provided to City. 19. 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 H Easement Encroachment Agreement Page 6 of 13 Revised 12/2022 Licensee: Property Owner �i Name. Richard Marek Title: Property Owner Date: a P-1 - STATE OF %� § COUNTY OF ��,�'� § BEFORE ME, the undersigned authority, a Notary Public �in and for the State of ,�WJIS on this day personally appeared �Gxhla� k- 0 (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 �� ► �' ��.� y� ), and in the capacity t therein state . GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of 202 b, Notary Public in and kLt State of Tier II Easement Encroachment Agreement gpRY Pug TIFFANY BACON _ r° Notary ID #128261860 My Commission Expires 9 of January 20, 2027 Page 8 of 13 Revised 12/2022 Licensee: Property Owner By: Name: Charity arek Title: Prop ( Property Owner Date: 0<;o 1 , 1. I 1� STATE OF / § COUNTY OF ll� 411,41� � § 1*0 BEFORE ME, the undersigned authority, a Notary Public in and for the State of �LhAAS , on this day personally appeared 1 �� O.LuS2 W (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 p�ZA - ----- (entity type), and in the capacity therein \\ stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this ;—! '—day of 20257 J th0.Y PUS TIFFANY BACON r° Notary ID #128261860 My Commission Expires January 20, 2027 Notary Public�anor the Stateof Tier II Easement Encroachment Agreement Page 9 of 13 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 Dattoil tfavl-eu By: Da[ton Ha rreII(Sep 15,202510:03:50CDT) D. J. Harrell Director, Development Services Department Date: 09/15/2025 cngn ATTEST: p01a o° so -d oa° �+o9i Jannette Goodall, City Secretary Approved As To Form and Legality Jackson Skinner 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. jz�� Kandice Merrick Development Services Manager OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Tier II Easement Encroachment Agreement Page 7 of 13 Revised 12/2022 III Y:1 i.Y Wl!! If IIU:i�I Y YI''l11 Yt O111:�1 Y\�i�111:�1 Y.11111 Il l�l D111.`l DtIJ►1 r1`��I 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 15tf day of September 202 25. Irt���f��a�ee Notary Public in and for the State of Texas Wendy Beardslee My Commission Expires TI281202/2029 Notary ID133237193 Tier II Easement Encroachment Agreement Page 11 of 13 Revised 12/2022 EXHIBIT A Depiction and description of the Encroachment Tier II Easement Encroachment Agreement Page 12 of 13 Revised 12/2022 1 \ LOT 17 I LOT 16 SET 1 I�- PK na N 64° 18' 30" E 61.10' 01 AB' ©112; 112.IRGff X R13FOPMER IRF BEARS CABLE (r) _ 5 UTILITY j r P aPE : EASEMENT o.' S73'40' W 0.8' �D.s+ % iU1LDIL40 LIKE ._ i' I 5' OUTBUILDING LINE ( -- AO.IACENi•� BRICK STOUEO&FPAM/Ef 1 j� ' \1" { � 1 I a?� J LOT 18 f LOT 19, BLOCK 10 - IIO,. s LAKE COUNTRY ESTATES �° I .8 21.3• - co I O I o 125' C6 a Q 722p �R'A 4,C, Y QUgq m i Y Nw �A, � ~• Mq ST ., 3, ¢ LOT 20 Ja\ h 5 RF = a N �..15 BUILDING UNF I - I Z 80,00, /"E4Na] 14, I iQ N,IR3SE — LEGE —N--M—ND: cPE FENCE ASPHALT=® HAINLINK FENCE - - FENCE CONCPETE-O _CUGHTMON w000 FENCE GP.El —Y—L�VINYLFENCE TILE-� —E—ELECTRIC UNE V1000.0 GM=GAS METED EM. ELECTRIC METED BRICK-EM IPONPIPE flODSET WRH'PREMIEW CAP STONE=,r- NOTES: BEARINGS ARE BASED ON THE RECORDED PLAT. IRF.IRON ROD FOUND ON CONTPOLUNG MONUMENT(wOOD) RAILROAD TIE-® BUILDING LINES AND EASEMENTS ARE BASED ON THE RECORDED PLAT UNLESS OTHERWISE NOTED. LEGALDESCRIPTION: BEING LOT 19. BLOCK 10, OF LAKE COUNTRY ESTATES, AN ADDITION TO THE CITY OF FORT WORTH, TARRANT COUNTY, TEXAS, ACCORDING TOTHE MAP THEREOF RECORDED IN VOLUME 38M7, PAGE 5, OF THE MAP RECORDS OF TARRANT COUNTY, TEXAS. SURVEYOR'S CERTIFICATION: THIS IS TO DECLARE THAT ON THIS DATE A SURVEY WAS MADE ON THE GROUND, UNDER MY SUPERVISION AND REFLECTS A TRUE AND CORRECT REPRESENTATION OFTHE DIMENSIONS AND CALLS OF PROPERTY LINES, LOCATION AND TYPE OF IMPROVEMENTS. THIS SURVEY IS NOTTO BE USED FOR CONSTRUCTION PURPOSES AND WAS PREPARED WITHOUT THE BENEFITOF ATITLE COMMITMENT PROVIDED BY A TITLE COMPANY. THERE MAYBE EASEMENTS AND OTHER MATTERS OF RECORD AFFECTING THE PROPERTY SHOWN HEREON THAT ONLY A PROPER TITLE SEARCH WOULD REVEAL. USE OF THIS SURVEY FOR ANY OTHER PURPOSE BY ANY OTHER PARTIES SHALL BEAT THERE OWN RISK AND THE UNDERSIGNED IS NOT RESPONSIBLE FOR ANY LOSS RESULTING THEREFROM. THIS SURVEY IS SUBJECTTO ANY AND ALL COVENANTS AND RESTRICTIONS PERTAINING TOTHE RECORDED PLAT REFERENCED HEREON. DATE: 09/13/18 JOBNO.: 18-0T26 7720 QUAIL RIDGE STREET, FORT WORTH, TX 76179 FIELD: 09112n5 LOT 19, BLOCK 10, LAKE COUNTRY ESTATES -- • S T T4, ....................... DAVID APPLE 4p, •5932••• P' �EAs 1s OQ- �/'''� O .S••RN� f/ B ITPte onel Bm9e7w 5700 W. ES. Plano Parkway Suite 1200 Plano, Texas 75093 'm 972-612-3601 (0)I8S5 892-0469 IT) Sun.r.1111.1 nl. _ _ DATE ACCEPTED BY: CM 0' 10, 20' 40' 1 ". ,, SCALE: 1 "= 20' I TECH AVRAG I FIELD MJ FLOOD INFORMATION: THE SUBJECT PROPERTY DOES NOT APPEAR TO LIE WITHIN THE LIMITS OF A IODYEAR FLOOD HAZARD ZONE ACCORDING TO THE MAP PUBLISHED BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY. AND HAS A ZONE'%' RATING AS SHOWN BY MAP NO. 4B439OW40 K, DATED SEPTEMBER 25, 2009. 6TB0 W. Pb". P.H Y SUite 1200 P60n. Tens 7509A OK¢9]Lb12-3601 RFax:855.89N.. Finn egutratien NP. 10146200 BEDROCK FOUNDATION REPAIRS LLC ( —10832) Engincedag Division 1018 Fletcher, Dallas, Texas 75223 (972) 261-4711 (800) 880-1811 fax www.bedrockfoundation.com email: office(a-)bedrockfoundation.com General Structural Design 7720 Quail Ridge St. Fort North, Texas 76179 May 21, 2025 Client: Darren Elmore Extreme Construction (817)966-6799 extremelandscapeconstruction(a�hotmaiLco J. S. Barton, P. E. (214) 824-1211 t `` 4 Bedrock Foundation Repair, LLC (972) 26114711 Re: 7720 Quail Ridge St. — Fort Worth, Texas It is proposed to construct a retaining wall to replace existing retaining wall on the subject property in the approximate location shown. The retaining wall will be constructed of stone and a high strength mortar (type "S"). The new wall will be in the same location, length and height as the existing walls. A fence will be constructed on the wall. The footing should be 8" thick and the width will be variable as a function of the height. Use 2 #3 horizontal rebar in the footing as shown. The wall should be flush with the front and rear of the footing. The face of the wall should have a 12:2 slope. The top of the wall should be 12" wide. Concrete should be a minimum of 5 sacks per cubic yard mix, 3000 psi @ 28 days and reinforcing steel 60 ksi. Construct a drain pocket on the rear near the bottom of the wall as shown. The drain pocket should be approximately 12" in diameter at each weep hole. The drain pocket should be filled with a uniform sized rock wrapped with filter fabric. Use 2" weep holes extending through the wall at maximum 10' centers. The 2021 IRC was referenced for this design. l�S\ti 4Nkti`` May 21.?02w -2- Bedrock Foundation Repair, LLC (972) 261-4711 Re: 7720 Quail Ridge St. — Fort Worth, Texas Q�e4e - vu' '14' p P-? k p t f may 21, 20m; 0.7 SUDLITY EASEMENT - -Aid, 1 . , WlrweEARs N ?7 37 Y�- -3 - Bedrock Foundation Repair, L,L,C (972) 261-4711 Re: 7720 Quail Ridge St. — Fort Worth, 'Texas 'soil Gracie —loll —I-12"—I 12:2Slope Wall Height Footing Width 1 {;{ 11 Stone Wall 2' 1611 31 11 � �1 2Q�1 ,� Weep Hole O / C) Drain —oto11 - __ Pocket a Footing y � 221, 01(? 20 Re�iar IStone Retaining wall I Scale in Indies -4- Bedrock Foundation Repair, ££C ( 7 )26S37fi Re: 7720 Quail Ridge St — tort Worth, Texas Fie Post x .sae 1alS7ex eoneW6y j S � �F «eP T)-T ic 6 S ectic n #w 21,m0-15 -5- Bedrock Foundation Repair, LLC (972) 261-471I Re: 7720 Quail Ridge St. — Fort Worth, Texas AGREEMENTS: Opinions expressed in this report are based on sound engineering judgment and evaluation regarding past performance of the property inspected on the day of this inspection. The report also gives engineering advice with regard to the best and most economical method to stabilize and maintain the property. This advice assumes normally expected subsurface conditions and conventional construction methods. No warranty is expressed or implied as to the performance of this retaining wall. Bedrock Foundation Repair, LLC report does not warrant or predict the future performance of the structure. The information provided in this report is intended for the private use of our client. If you have any questions or comments regarding this report or if we can be of further assistance, please call. J. S. Barton, P. E. F ♦ ..��� r s`�iryV `.. � 1r May 21,2025 M EXHIBIT B Certificate of Insurance Tier H Easement Encroachment Agreement Page 13 of 13 Revised 12/2022 � d i USA' General Indemnity Company 9800 Fredericksburg Road San 4ntonlo. TX 78288 I HOMEOWNERS -1 101V INI NCE %_10 0 � 1V1I33 3 0..E RICHARD ALLEU MAREK AND CHARITY J MAREK 7720 QUAIL RIDGE ST FORT WORT i { TX 76179 Existing USAA Homeowners Insurance Poflcv Surmmnavy ekua st 14, 202 i We'ip'8t{yking W oy vije tVe fo!!fi1ffi1_n—, ,�wmma'y:of the US'AA hoq-e4:)' /TIZ'rS' ticw': Effective Date of Policy: December 07, 202412,01 a.m. standardtime Policy Ex-piratir5n -fate: Dec € rnt-jE?( (17, 2025 i2:£11 a.mt. s€,andarcl tCrYt€° Policy Location: 7720 QUAIL RIDGE ST, FORT WORTH, TX 76179 iic'y Nurrrlbe€ GIL G-D91 29 93A Named Insured: RICHARD ALLEN MAREK AND CHARIT`( J MAREK Descrtalors of coves (s) Dwelling coverages $15291000 Home Protector: Included PP�ersoFF��nal liability: $500,000 Deductible(s) Ali', ot"her w ilu. 0.0 S 3.g ':-?us h=;'. � d�rlo!; f4sP. cony. Revised Annual PrP.m!Urn, $3.394.72 :p'C'i ^ i_'Pn nA kill kl A e6ty7 evi i..n c irQaiSc. r--r-t_�S F _'RG;J e.+riiiii, G'v.e�. ITS SUCCESSORS AND/OR ASSIGNS PO BOX 100515 FLORE-NCE, SC 29502-O515 Load Number: 0487114837 Your I"I's UIC4 Protector coverage, if inc.ludJer , provides you an atd`tiona-! }.'r_.s n_ r}7 dwellino coverage- Policy terms, conddiilens and exclusions apply. Zi {�+YIL L7 iS F }tR J-UOL=i