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HomeMy WebLinkAbout065194 - General - Contract - CoServ Gas, Ltd. dba CoServ Gas4576312.v2 Date Received: Time Received: 5/14/2026 6:54 p.m. Record Number: PN25-00192 City Secretary No.: 65194 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 CoSery Gas, Ltd., d/b/a CoSery Gas, a Texas limited partnership ("Licensee"), acting by and through its duly authorized representative. RECITALS WHEREAS, pursuant to that certain Natural Gas Distribution System Easement and Right -of -Way, dated to be effective as of January 22, 2026, and recorded as Instrument No. 2026-11153 in the Official Records of Denton County, Texas (the "Easement Agreement"), Licensee is the beneficiary of certain easements, rights and privileges with respect to certain property described in the Easement Agreement (the "Easement Property"); and WHEREAS, the City owns water easements (the "Public Property") adjacent to and that cross the Easement Property pursuant to (1) that certain City of Fort Worth Permanent Water Facility Easement, dated July 27, 2017, and recorded as Instrument No. 2018-9514 in the Official Records of Denton County, Texas, and (ii) that certain City of Fort Worth Water Facility Easement, dated December 2, 2021, and recorded as Instrument No. 2021-219339 in the Official Records of Denton County, Texas; 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: OFFICIAL RECORD AGREEMENT CITY SECRETARY 1. FT. WORTH, TX 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 the Tier II Easement Encroachment Agreement Page I of I 1 Revised attached Exhibit "A", which is incorporated herein for all purposes, but only to the extent shown thereon, for the purpose of constructing, installing, and maintaining one (1) or more natural gas distribution pipeline and associated facilities and equipment (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." 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 applicable 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 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 facilities 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, either remove the Encroachment entirely from the Easement Property 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 4576312.v2 Tier H Easement Encroachment Agreement Page 2 of 11 Revised Services Department or their duly authorized representative or abandon the Encroachment in place by filling it with grout which will prevent the Encroachment from any future use. Any such removal of the Encroachment shall be in accordance with then -existing applicable 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, to the extent the Public Property was damaged by Licensee in connection with its removal of the Encroachment, Licensee hereby gives City permission to remove the Encroachment and any supporting structures from the Public Property, to restore the Public Property at Licensee's sole cost and expense. 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 continue for as long as the Encroachment is being utilized by Licensee, commencing on the date this Agreement is fully -executed by the parties. However, the City may terminate this Agreement upon Licensee's noncompliance with any of the terms of this Agreement; provided, 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. 4576312.v2 Tier II Easement Encroachment Agreement Page 3 of 11 Revised 9. 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 RELATED TO THE ENCROACHMENT. 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 Licensee 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. 4576312.v2 Tier H Easement Encroachment Agreement Page 4 of 11 Revised 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 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 third party's 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 4576312.v2 Tier II Easement Encroachment Agreement Page 5 of 11 Revised 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 Easement Property, Licensee may assign all of its rights and obligations under this Agreement to the new owner of the Easement 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 Denton 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] 4576312.v2 Tier II Easement Encroachment Agreement Page 6 of 11 Revised City: CITY OF FORT WORTH By: Dalton Harrell (May 14, 2026 09:53:09 CDT) D. J. Harrell Director, Development Services Department Date: 05/14/2026 nQ QFonr °aa ATTEST: o o 'mom o Approved As To Form and Legality I Jannette Goodall, Assistant City Attorney City Secretary 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. -[a Kandice Merrick Contract Compliance Manager OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX 4576312.v2 Tier II Easement Encroachment Agreement Page 7 of 11 Revised Licensee: COSERV GAS, LTD., d/b/a COSERV GAS, a Texas limited partnership By: CoSery Natural, L.L.C., a Texas limited liability company, its general partner By: ------------------------- Name: Greg W Title: Chief Operating Officer Date: Ng Y [i go24 I STATE OF TEXAS § COUNTY OF DENTON § BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas, on this /IN day of Mdy , 2026, appeared Greg Ward, Chief Operating Officer of CoSery Natural, L.L.C., a Texas limited liability company, the general partner of CoSery Gas, Ltd., d/b/a CoSery Gas, a Texas limited partnership, on behalf of said limited liability company and limited partnership. GIVEN UNDER MY HAND AND SEAL OF OFFICE this It' day of MAY ,2026. LANCE TAHCHAWWI T ai Lt = Notary Public, State of Texas Notary Public in and for the Comm. Ex'ir•sft-o4-2oso �'�%;r°,;, �� Notary ID 13351480-1 State of Mas 4576312.v2 Tier II Easement Encroachment Agreement Page 8 of 11 Revised 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 14th day of May , 2026. K a� Notary Public in and for the State of Texas r¢ a KATHLEM BRADFORD Notary Public * * STATE OF TE5CA5 ���`VV� Notary I.D. M97197 cF My Comm. Ex , Apr.12, 2027 4576312.v2 Tier lI Easement Encroachment Agreement Page 9 of 11 Standard EXHIBIT A Depiction and description of the Encroachment 4576312.v2 Tier II Easement Encroachment Agreement Page 10 of 11 Standard u-> N O N r` 0 z C 0 a v a� 0 U 0 U c d E L U 0 O U C W I O O a) O H z W 2 2 U Q O tY U z W N H W W 2 V) U F- I c / N C a C_ O a t i 0 z I O 0 rn o� LJ /c_ Highway 114 Ciii) RE VICINITY NIAP NTS 11001121111INUM 7 =M�� AutoCAD SHX Text EA10900 -North Point\Plans\Building 1 - TC REV\SHEETS\ENCROACHMENT\10900- Encroachment Cover CoServ.dwg Mon Nov 17 2025 Mon Nov 17 2025 Mon Pike Nov 17 2025 18:15 Middle Schcoi Gene Pike Middle School ���r-'1� LOCATED IN CITY OF FORT WORTH, ORT H, TEXAS PREPARED FOR: ONOrlY]r DEVELOPMENT 12977 N. Outer 40 Road, Suite 203 St. Louis, MO 63141 MAPSCO NO.: 641 T—Z COUNCIL DISTRICT: 7 NOVEM>I]B]ER 2025 1476112y14576312.y2 II�IIII�IIII�IIII� V V U _ O r ���' fec41�'E>;E•nE1rt I r C o m x u (;Iry pc iJRIN�RiM D _ ' ¢c stRRµu9at WA19i � � EAGIMLP SCMENi � �a1B-o511 o.R,DC i,. .POW \ram O) + 0 4 / / _d iA 9."5 rDE61uNT W-W WO#1133124 4' C o S e ry Gas WOO rlwr 156 a Born RULER nx o A - lRIM(MRU ARRNCAIINAN TUf WARP.NUUARfl DMH'K' fIATF: � i01 1 Slemnunfr, u E; ��� t',�rinlh.'I'\ �I;YIO rnroRTwoRTx, nRrzran mvxTVTRRAe � r'!'. 1-800-566-2314 "EXHIBIT A" PROPERTY DESCRIPTION STATE OF TEXAS: COUNTY OF DENTON: BEING a tract of land situated in the A. Robertson Survey, Abstract No. 1553, City of Fort Worth, Denton County, Texas, being a portion of Lot 1, Block 1 of the final plat of Lots 1 & 4, Block 1, Northpoint Alliance Industrial Park, an addition to the City of Fort Worth, Denton County, Texas as recorded in 2022-134, Official Records, Denton County, Texas (ORDCT), being a portion of that tract of land as described in deed to NP-OV Fort Worth Project 7, LLC, recorded in 2025-58295, ORDCT, and being more particularly described as follows: COMMENCING at a bent 5/8" rebar found at the intersection of the northwesterly line of Blue Mound Road - F.M. 156 (variable width R.O.W. per 2007-1 10923, ORDCT) and the southwesterly line of Bold Ruler Road (100' Public Access Easement per 2020-401, ORDCT), being the most southerly corner of Lot 2, Block 1 of the final plat Of Lots 2 & 3, Block 1, Northpoint Alliance Industrial Park, an addition to the City of Fort Worth, Denton County, Texas as recorded in 2021-249, ORDCT and the most easterly corner of said Lot 1, Block 1, from which a 1 /2" rebar capped GMCIVIL set bears North 47 degrees 51 minutes 10 seconds West, 102.37 feet; THENCE Southwesterly, along the northwesterly line of said Blue Mound Road and the easterly line of said Lot 1, Block 1, and a curve to the left, having a radius of 4,683.66 feet, a central angle of 01 degrees 14 minutes 35 seconds, an arc distance of 101.61 feet, and a chord that bears South 40 degrees 04 minutes 12 seconds West, 101.61 feet to the POINT OF BEGINNING of the herein described tract; THENCE Southwesterly, along the northwesterly line of said Blue Mound Road, the easterly line of said Lot 1, Block 1, and a curve to the left, having a radius of 4,683.66 feet, a central angle of 00 degrees 07 minutes 21 seconds, an arc distance of 10.02 feet, and a chord that bears South 39 degrees 23 minutes 14 seconds West, 10.02 feet; THENCE departing the northwesterly line of said Blue Mound Road, across said Lot 1, Block 1, as follows: North 54 degrees 02 minutes 59 seconds West, non -tangent to said curve, a distance of 45.08 feet; Northeasterly, along a non -tangent curve to the right, having a radius of 4,728.66 feet, a central angle of 00 degrees 07 minutes 17 seconds, an arc distance of 10.02 feet, and a chord that bears North 39 degrees 21 minutes 16 seconds East, 10.02 feet; South 54 degrees 02 minutes 59 seconds East, non -tangent to said curve, a distance of 45.08 feet to the POINT OF BEGINNING and containing 451 square feet or 0.010 acre of land. NOTE: Bearings are referenced to Texas State Plane Coordinate System, North Central Zone (4202), North American Datum of 1983 as derived from GPS observation. P. . OF'TF�� civil SSTE cale: NONE Sheet y���G\ RFo Date: 11 / 17/2025 I . JOEL S. BARYON . 0 4914 Q0F 'P Engineering &� Surveying �qN ,ESSIo, o� Job No.: T.r ; F.., .. :a Drafted: ec7-Gz�,.,-�.,ie..� 576312.v2 "EXHIBIT A" CURVE TABLE CURVE # RADIUS ARC LENGTH DELTA ANGLE CHORD BEARING CHORD LENGTH C 1 4683.66' 101.61 ' 10 14'35" S40004' 12"W 101.61 ' C2 4683.66' 10.02' 0007'21" S39023'14"W 10.02' C3 4728.66' 10.02' 0°07'17" N39°21'16"E 10.02' 0 60 SCALE IN FEET LOT2, BLOCK 1 \ OF LOTS 2 & 3, BLOCK 1 00,` NORTHPOINT ALLIANCE ,po "(-C, \ INDUSTRIAL PARK \ —0 -0x�1(+0,� \ 2027-249, O.R.D.C.T. \ O s \ 1 /2"R.C.S. /\ / l�,g AS LOT I, BLOCK 1 \ "GMCIVIL"OF / y PY LOTS 1 & 4, BLOCK 1 / NORTHPOINT ALLIANCE \ / INDUSTRIAL PARK / 2022-134, O.R.D.C.T. CITY OF FORT WORTH 25PERMANENT WATER f .� NP-OV FORT WORTH FACILITY EASEMENT PROJECT7 LLC 2018-9514,O.R.D.C.T. 2025-58295 0.R.D.C.T. S 540 02 59 E 45.08' / Q / /C� p�\ C3 � Q��� �. G i N 54002'59" W / TRACT 1 45.08'� CITY OF FORT WORTH , PERMANENT WATER / FACILITY EASEMENT / 2021-219339, O.R.D.C.T. G V�4 R555 M C116V*1 I Engineering & Surveying 2559 SW Grapevine Pkwy, Grapevine. Texas 76051 817-329-4373 TxEng Firm # F-2944 I TxSury Firm # 10021700 0 0 �r AGREEMENT 451 SQ. F.T Scale: 1" = 60' Sheet Date: 11/17/2025 2 Job No.: 10900 of Drafted: T.J.M. Checked: J.S.B. OF pll,,� .... JOEL S. SARTON 0..�� 4914.,• Op 01A <i4�SURV�� 12/17/2025 117� 1 MI IM I�lului n������■ 111r M; MwIlli " groi n' i"' : u11111111 ■ Iglu M M z� G-) D �1 KKMMorm cn R m n orn m0 m N IT O C) a Vl II < II L II m tN II D II -P�ZIN1 C O D N r m a \ LA O- O 7- TI; rnmTTt �01 • o 07, ZinDDl+1rm=0 A�Oy milVir^ -> rrmz X m��zOOyOCMEx22, v, m AZ iA = �O rOMB AN nmD c'f� {p O + Z Om mX n pDr �jAI rOpagAOmz��f_9moti„j{<DA�rVNOC�'m�A-+1VZ0� �0 CA cf^ nv;-DZAzA mQOyv C,Oc Ll ,Opmmz_Ox mp`J'=T�mzZA N zA 0zDZZ z~mn2 Zi pn; ca R r O A Z iW II � � II III � ' \ II II, II L\•� SESiGN BCALF. �" CoSery Gas WOgHWY r A OftAW,N-fATF, 14 WO# }iWY 66 & RC7LU RULER DR YNfrlyiPR9 tlt:PYlv"P W�C6lC�YWNiRJf[1�FPS C B� TIUIS. Sift9800-56-23116. I'�7FiYll1 fITYORA>PTWpPrP.9PN'mN�tltT^IY'IFJ{ed Ln I.80D•566.2976 4376di-3i0576312 v2 0 \ V \o ip Z./ O K KZ.1 r=Oor CL DO II (ND (D 0)Ln D Z,,DZC m y am D Ln cn N a VI A Ul z m D It �Z(n� QZ Dm a.. t' Cn 'aCD o O0mm OxA�OOfj �Dp mZ ZV1 m(-�dZO r� �nv ;A �OZc��_ iif mm r lA 2 g A;A�����z�oCA �s Z>x yF>� F,c'4 t �e+ IA 00 c�Z In((D'oA D I G Om� NO A 1:2m O� 90 Z r mm� pp=�mZ •Tz G L �Am yOyO Zmt7O 00 n,D �mr� mZD?pZ r){ZD� !r DZ mZ p�Z Ax O� S CoSery Gas 7701 S. Stemmon, Conth,fX 76210�EE P8O(F5W2.414 W � 437631a. 5�6312.v2 AufoCAD SMX Tea, STA. 0+17 INSTALL 4" FLANGE RISER p� EXHIBIT B Certificate of Insurance 4576312.v2 Tier II Easement Encroachment Page 11 of 11 Agreement Revised FORT WORTH. City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name: CoSery Gas, Ltd., d/b/a CoSery Gas Subject of the Agreement: Tier II Easement Encroachment M&C Approved by the Council? * Yes ❑ No M If so, the M&C must be attached to the contract. Is this an Amendment to an Existing contract? Yes ❑ No 0 If so, provide the original contract number and the amendment number. Is the Contract "Permanent"? *Yes ❑ No 0 If unsure, see backpage for permanent contract listing. Is this entire contract Confidential? *Yes ❑ No 0 If only specific information is Confidential, please list what information is Confidential and the page it is located. Certificate of Insurance Effective Date: Date Director signs If different from the approval date. Expiration Date: 30 years from execution If applicable. Is a 1295 Form required? * Yes ❑ No ED *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 0 No ❑ Contracts need to be routed for CSO processing in the followingorder: rder: 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.