HomeMy WebLinkAbout064447 - General - Contract - The Destiny Center Corporation. 12/11/2025 Date Received: --------
Time Received: ll:59 p.m.
Record Number: PN24-00176
City Secre tary No.: _6_4_4 _47 ___ _
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 The Destiny Center, Inc, a Texas
non-profit corporation ("Licensee"), acting by and through its duly authorized
representative.
RECITALS
WHEREAS, Licensee is the owner of the real property located at 10200 Blue
Mound Road, Fort Worth, Texas 76131 ("Property"), being more particularly described
as, Lot lR, Block 1, The Destiny Center Addition, an Addition to the City of Fort Worth,
Tarrant County, Texas, by deed recorded in Tarrant County Deed Records, as Instrument
Number D210008247; and
WHEREAS, the City owns a sewer easement (the "Public Property") adjacent
to the property, dedicated to the City in an easement filed in the Tarrant County Deed
Records as Instrument Number D22517 4217, as depicted on the final plat of the property
( FP-25-011), which plat is recorded in the plat records of Tarrant County as Instrument
Number D225178983; 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 tenns 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 perfonned 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,
Tier II Easement Encroachment Agreement
Revised
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 1 of 11
installing, and maintaining a water and fire water line (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 perfonned in
strict compliance with this Agreement and with the charter, ordinances, codes, and
policies of the City. Prior to the construction or installation of the Encroachment,
Licensee shall submit all plans and specifications to the Director of the Development
Services Department or duly authorized representative. Licensee shall not commence
construction or installation of the Encroachment nor make any use of the Public Property
until after the execution of this Agreement.
3.
Licensee, at no expense to the City, shall make proper prov1s10ns 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 detennined 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 acceptable to the Director of Transportation and Public Works, the Director of
Tier II Easement Encroachment Agreement
Revised
Page 2 of 11
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.
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 Nine Hundred Dollars ($900.00).
7.
The term of this Agreement shall be for forty (40) 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 ninety (90) days of notice from City, the City may tenninate 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.
Tier II Easement Encroachment Agreement
Revised
9.
Page 3 ofl 1
LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES
HEREBY INDEMNIFY, HOLD HARMLESS, 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. 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
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.
Tier II Easement Encroachment Agreement
Revised
11.
Page 4 of 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.
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 perfonning 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.
Tier II Easement Encroachment Agreement
Revised
17.
Page 5 of 11
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, which
approval shall not be delayed or withheld, and any attempted assignment without such
written approval shall be void. In the event Licensee conveys the Property, Licensee may
assign all of its rights and obligations under this Agreement to the new owner of the
Property, and Licensee shall be deemed released from its duties and obligations
hereunder upon City's approval in writing of such assignment, which approval shall not
be unreasonably conditioned or withheld. Foreclosure by a secured lender of Licensee or
assignment to a secured lender by Licensee in the event of default or otherwise shall not
require City approval provided that said lender notifies City in writing within sixty (60)
days of such foreclosure or assignment and assumes all of Licensee's rights and
obligations hereunder. However, no change of ownership due to foreclosure or
assignment to any secured lender of Licensee shall be effective as to City unless and until
written notice of such foreclosure or assignment is provided to City.
19.
Any cause of action for breach of this Agreement shall be brought in Tarrant
County, Texas. This Agreement shall be governed by the laws of the State of Texas.
20.
This Agreement shall be binding upon the parties hereto and their successors and
assigns.
21.
This Agreement may be executed in multiple counterparts, each of which shall be
considered an original, but all of which shall constitute one instrument
[SIGNATURES APPEAR ON FOLLOWING PAGE]
Tier II Easement Encroachment Agreement
Revised
Page 6 of 11
EXECUTED to be effective on the date signed by the City's Director of
Development Services Department
City:
CITY OF FORT WORTH
h u
By: mm. x.mr gvu,eu,u�
D. J. Harrell
Director, Development Services Department
Date: 12/09/2025
ATTEST:
,¢` Row`T°hpyoa
u �se
Jannette Goodall,
City Secretary nna
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.
Kandice Merrick
Development Services Manager
OFFICIAL RECORD
CITY SECRETARY
Tier Tl Easement Encroachment Agreement FT. WORTH, TX page? of 11
Revised
Licensee:
The Destiny Center, Inc.
a Texas non-p t co ratio
By:
�Name:S Russell
Title: Pre iden
Dater 2�LS
STATE OF \'l.hQ1S §
COUNTY OF �(��r'AVY1' §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of 4F9_, on this day personally appeared Scott B Russell, President 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 The Destiny Center, Inc.. a Texas non-profit
corporation, and in the capacity therein stated.
GIVEN CINDER MY HAND AND SEAL OF OFFICE this A-- day of
m et , ztt—TO-.
� I r
Notary Public in and for the
State of QiL.
EMY E5 RAUES
aryID 1UtEN
MY eOMMI&SIon Expires
octener s, zaza
Tier II Easement Encroachment Agreement Page R of I I
Revised
Tier II Easement Encroachment Agreement Page 9 of 11
Revised
***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
_____________, 202 .
__________________________________
Notary Public in and for the State of Texas
EXHIBIT A
Depiction and description of the Encroachment
Tier II Easement Encroachment Agreement
Revised
Page 10 of 11
PROJECT
v
TARRANT COUNTY
v MAPSCO F20-U
VICINITY MAP
(NOT TO SCALE)
DEVELOPED
COUNCIL DISTRICT N0.4 HIMF BONDS LAND DFW002 LTC,
TIM HAU Y, PRESIDENT
3700 NORTH CAPITAL
OF TEXAS HIGHWAY,
STE 420, AUSTIN, TEXAS 76746
TX REG. ENGINEERING FIRM F-11756 BONDS RANCH
TX REG. SURVEYING FIRM LS-10074301 VACINITY MAP
LOCATED IN THE CITY OF FORT WORTH
Westwood FOR MYANTWORTH ITX NROAD AND BEING OUTOF THE
FORT V/ORTH, TX T41o9 W LL S ACTREDFIELD
NO. SURVEY,
81T.4u.T155 ABSTRACT NO. 1348,
CDS I ---- I N.T.S 1 09/12/2024 1 5106-21.534 TARRANT COUNTY, TEXAS
0 100 zoo
I
aoo soo
T
1�L
GRAPHIC
SCALE
IN FEET
I 1
. - HPIMF BONDS LAND
DFW002 LLC
(INST. N0. D22211I30548)
LOT 1, BLOCK 1,
SIKH ADDITION
(INST. NO. D216050152)
I PROPOSED ULT—,�J( ENCROACHMENT 1,
100-YR FLOODPLAIN I
LOT 1R, BLOCK 1, _
THE DESTINY
CENTER ADDITION
(INST. NO. D216172487)
I— E G E IV
PRIVATE WATER (DOM./FIRE) - - - - PUBLIC WATER
PRIVATE SEWER - PUBLIC SEWER
PRIVATE STORM - - - - PUBLIC STORM
PRIVATE IRRIGATION - - - - ENCROACHMENT AREA
TX REG. ENGINEERING FIRM F-11756 OVERALL
TX REG. SURVEYING FIRM LS-10074307 ENCROACHMENT
Westwood FOR MRTHRYANT ITX 7610 AO
FORT WORTH, TX N ROAD
91T.412.7155
CDs I ---- 1 1"=2009 1 09/13/2024I 5106-21.534
EXHIBIT "A"
EASEMENT ENCROACHMENT AGREEMENT
Part of Lot 1R, Block 1
The Destiny Center Addition
William Redfield Survey, Abstract No. 1348
City of Fort Worth, Tarrant County, Texas
DESCRIPTION, of a 225 square foot (0 005 acre) tmct of land situated in the William Redfield Survey, Abstract No 1348,
City of Fort Worth, Tarrant County, Texas; said tract being part of Lot 1R, Block 1, The Destiny Center Add Rio n, an addition
to the City of Fort Worth according to the plat recorded in Instrument No D216172487 of the Official Public Records of
Tarrant County, Texas; said 225 squarefoot(0.005 acre) tract being mom particularly described as follows (bearing System
for this survey is based on the Texas Coordinate System of 1983 (2011 adjustment), North Central Zone 4202, based on
observations made on May 1, 2024);
COMMENCING, at a 5/8-inch iron rod with yellow cap marked "PELOTON" found for the most northerly northeast corner of
Block 6, Hawthorne Meadows, an addition In the City of Fort Worth according to the plat recorded n Instrument No.
D218039058 of the Official Public Records of Tarrant County, Texas; said pointbeing in the south line of thattract of land
described in a plat to Lot 1, Block 1, Bonds Ranch Residwtial Neighborhood Addition recorded in Instrument No.
D225178983 of said Official Public Records;
THENCE, South 89 degrees, 33 minutes, 24 seconds West, along the north line of said Block 6 and said south line
of Lot 1, at a distance of 115 00 feet passing the northwest corner of said Block 6 and the northeast comer of said
Lot 1R, continuing in all a total distance of 132 50 feet, to a point from said point a 1/2-inch iron rotl with a green
cap found in the east right-of-way line of Blue Mound Road (also known as State Highway 156), and being the
southwest comer of said Lot 1 beam South 89 degrees 33 minutes 24 seconds West, a distance of 978.07 feet,
THENCE, South 00 degrees, 17 minutes, 44 seconds East, departing said south line of Lot 1, and the north line of
said Lot 1R and along the east line of a 15-foot sanitary sewer facility easement recorded in Instrument No.
D225174206 of said Official Public Records, a distance of 368.88 feet to the POINT OF BEGINNING;
THENCE, South 00 degrees, 17 minutes, 44 seconds East, continuing along said east line of a 15-footsanitary sewerfacilily
easement a distance of 15.00 feet to a point for comer,
THENCE, South 89 degrees, 42 minutes, 16 seconds West, departing said east line of a 15-foot sanitary sewer facility
easement, a distance of 15 00 feet to a point for comer,
THENCE, North 00 degrees, 17 minutes, 44 seconds West, along the wrest line ore 15-footsandary sewer facility easement,
a distance of 15 00 feet to a point for comer;
THENCE, North 89 degrees, 42 minutes, 16 seconds East, departing said wrest line of a 15-foot sanitary sewer facility
easement of a distance of 15.00 feet in the POINT OF BEGINNING;
CONTAINING 225 square feet or 0 005 acres of land, mom or less
(A survey ptat of even survey date herewith accompanies this description.)
The and mgned, Registered Professional Land Surveyor, hereby certifies that the foregoing description accurately sets
out the metes and bounds of the msement encroachment tract described.
�i.�.�i.r r. � - +'/ 9ngs-1A-15
ustin C Puste/ovs y Da a
Registered Professional Land Surveyor No. 6690
Westwood Professional Services, Inc
9800 Hillwood Pkwy, STE 250, Fort Worth, TX 78759
(817) 562-3350
TX Reg, Surveying Firm LS-10074301
PAGE 1 of 2
C
EXHIBIT "Brr
1"=30'
LOT
1, BLOCK 1
BONDS
RANCH RESIDENTIAL
NEIGHBORHOOD
ADDITION
(INST.
NO. D225178983)
0' 30' 60'
90,
15' SANITARY SEWER EASEMENT
1/24NCN IRON ROD POUND
MST. NO D225174206J P
C
O 3
TH
WIGREEN CAP (GM)
1
5/84NCN IRON ROD FOUND WITH
p1 O
589033'24•W
GREEN CAP"PELOTON"(CM)
� oc
97d07 \
589.3324•W 13250
1
C)r
f
IIS00
3
LOT 30X
rcl
w
g (aLOT
1,
q
f'
W
L" a
BLOCK 1
m >
IKH ADDITION
w
2 b!!
(INST. NO.
$
3 �f
D216050152)
LOT 30
$
BLOCK 6 x
HAWTHORNE MEADOWS
I
(INST. NO. D218039058)
I
I I
I I
LOT 29
15'SANITARY506ER E45EMENT
(IN5T NO D225174217)
L4 � P.aa
Line Table
15' EASEMENT
wi
't Line# Length Direction
ENCROACHMENT
—
AGREEMENT n
L1 15.0 5O 17 4•E
225 SF (0.005 ACRE)
Lz uon 50.42•16w
L3 1500 N00.1T44•W
REDIREL.D SUR;'� ;
-LA
I Ls lson Na9•az•16•E
AHS; RAC; " . 1348
LOT 1 R, BLOCK 1
THE DESTINY CENTER ADDITION I
LEGEND
(INST. NO. D216172487)
FOR POINTOFBEGINNING
POC POINT OF COMMENCING
(C M) CONTROLLING MONUMENT
• POW FOR CORNER
The undersigned, Registered Professional Land Surveyor,
EASEMENT UNE
hereby certifies that this plat of survey accurately sets out OF
PROPERTY UNE
the metes and bou rids of the easement tract described. pixie"
— — — PROPOSED EASEMENT UNE
tiQ'eE M
0; N
GENERAL NOTES
RTIN C P JST " W
DUSTIN C. PUSTEJOVSKYpf
1. A metes and bounds description o even survey dare
Y
herewith accompanies this plat ofsuney.
�l 2�2cJ-1 D-1 cJ (�'tpF� O.,
2 Bea' stem r this survey is Lased a bean
t^9 system for n9
9 es51 O
ti08URN�
Y' on
Dustin C. Date
of 1983 (2011 4ushri North Cenral Zone
Professional
Registered PmfessiarW l
4202, based on observations made on May 01, 2024
I.nH c,i mnvn. min 669n
•
15' EASEMENT
SHEET NUMBER
ENCROACHMENT
AGREEMENT
Aim, m+naeasasa a wvoaarxwr.. aTaaao
Out OF 2 OF 2
rar ®
LOT 1R . BLOCK 1 DIMTNY
arum oo
ClM ADDITION
WILKUL RErFIELD SURVEY,
AB5IN0hCT NO. late,
CRY OF FORT WORTH, DATE. 09/11/2024
TP MT COUNTY, TDAS
VTErn* Ioo-m
M 2'WAM
YAN4
725
ze
gyp'
iPE 1NE Nsn�
—l4
4— • _
woo a4�mox® uu
Im-m ELdIC —
un New
" m as wr
. wv oamwosE
ExTa1)
d�
0 20 40 80
HORIZONTAL SCALE: 1*=40'
0 4 8
VERTICAL SCALE 1I=e
I i i i
LIMIT OF
ENCROACHMENT
I
725
720 I I I I I I I I 'ol I I 1 1 720
PROPOSED
E CONCRET1 _
— CONCRE
ENCASEM--NT 1
LOWER EXISTING
8" FIRE LINE &
- � 2" DOMESTIC
TI 9.W8ATER 715
3+00 4+00
1 E GE- 1V
® ENCROACHMENT AREA
TX RED. ENGINEERING FIRM F-11756 EASEMENT
TX RED. SURVEYING FIRM LS-10074301 ENCROACHMENT
Q60 BRVANT IRVIN ROAD N OA
West wood FORT WORTH, TX ifi109
`rYv FORT ORT
COS I ---- I7'=40' V:11-4'I 10/03/2025 1 5106-21.534
EXHIBIT B
Certificate of Insurance
Tier II Easement Encroachment Agreement
Revised
Page 11 of 11
FORT WORTH.
City Secretary's Office
Contract Routing & Transmittal Slip
Contractor's Name: The Destiny Center Corporation
Subject of the Agreement: Tier II Easement Encroachment
PN24-00177
M&C Approved by the Council? * Yes ❑ No
If so, the M&C must be attached to the contract.
Is this an Amendment to an Existing contract? Yes ❑ No
If so, provide the original contract number and the amendment number.
Is the Contract "Permanent"? *Yes ❑ No
If unsure, see backpage for permanent contract listing.
Is this entire contract Confidential? *Yes ❑ No ® Ifonlyspeck information is
Confidential, please list what information is Confidential and the page it is located.
Certificate of Insurance
Effective Date: Date Director signs Expiration Date: 30 years from execution
If differentfrom the approval date. If applicable.
Is a 1295 Form required? * Yes ❑ No
*If so, please ensure it is attached to the approving M&C or attached to the contract.
Project Number: If applicable.
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes ® No ❑
Contracts need to be routed for CSO Drocessing in the following order:
1. Katherine Cenicola (Approver)
2. Jannette S. Goodall (Signer)
3. Allison Tidwell (Form Filler)
*Indicates the information is required and if the information is not provided, the contract will be
returned to the department.