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065234 - General - Contract - Miguel Molina and Ana Molina
Date Received: 5/21 /2026 Time Received: 5.00 p.m. Record Number: PN26-00012 City Secretary No.: 65234 PUBLIC PROPERTY EASEMENT ENCROACHMENT LICENSE AGREEMENT TIER I 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 Miguel Molina and Ana Molina, RECITALS WHEREAS, Licensee is the owner of the real property located at 1736 North Sylvania Avenue, Fort Worth, Texas 76111 ("Property"), being more particularly described as, Lot 3R-1, Block 1, Evans, an addition to the City of Fort Worth, Tarrant County, Texas, as recorded in Volume 310, Page 58, Plat Records, Tarrant County, Texas, and by Instrument Number D203162039, Official Public Records, Tarrant County, Texas; and WHEREAS, the City owns a sanitary sewer line (the "Public Property") adjacent to the Property, dedicated by plat, depicted on the final plat of the property (FS-23-296), which plat is recorded in the plat records of Tarrant County as Instrument D224094397; 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 Tier I Easement Encroachment Agreement Revised/Standard OFFICIAL RECORD CITY SECRETARY Page I of I I FT. WORTH, TX on Exhibit "A," but only to the extent shown thereon, for the purpose of constructing, installing, and maintaining a private fence (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." ►01 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. 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. H 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. Tier T Easement Encroachment Agreement Revised/Standard Page 2 of 11 5. Upon termination of this Agreement, Licensee shall, at the option of and at no expense to the City, remove the Encroachment and restore the Public Property to a condition acceptable to the Director of Transportation and Public Works, the Director of the Water Department, the Director of the Development Services Department or their duly authorized representative. Any such removal of the Encroachment shall be in accordance with then -existing City regulations and policies. It is understood and agreed to by Licensee that if this Agreement terminates and Licensee fails to remove the Encroachment and restore the Public Property, Licensee hereby gives City permission to remove the Encroachment and any supporting structures from the Public Property, to restore the Public Property, and to assess a lien on the Property for the costs expended by the City in taking such actions. 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). ill 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 ofTexas 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 Tier I Easement Encroachment Agreement Revised/Standard Page 3ofll contemplated or not, that the parties agree to negotiate in good faith in order to accommodate both the Encroachment and the public purpose. jj 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 $314,000 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 Homeowners liability insurance at all times during the term of this Agreement and until the removal of the Encroachment and Tier I Easement Encroachment Agreement Revised/Standard Page 4 of I restoration of the Public Property. All insurance coverage required herein shall include coverage of all Licensee's contractors and subcontractors. 11. Licensee agrees to deposit with the City when this Agreement is executed a sufficient sum of money to be used to pay necessary fees to record this Agreement in the real property records of the county in which the Encroachment is located. After being recorded, the original shall be returned to the City Secretary of the City of Fort Worth, 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 befbre occupying such property. Tier I Easement Encroachment Agreement Revised/Standard Page 5 of it 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. 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. Tier i Easement Encroachment Agreement Revised/Standard Page 6 of I 1 EXECUTED to be effective on the date signed by the City's Director of Development Services Department City: CITY OF FORT WORTH VaGton fAwl-eU By: Dalton Harrell (May 20, 2026 13:27:51 CDT) D. J. Harrell Director, Development Services Department Date: 05/20/2026 ATTEST: na,� p; FFORT�9pp oa °�0 aQay nEXP`��o4p Jannette Goodall, City Secretary Approved As To Form and Legality Tayler Canton 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. _a� Kandice Merrick Contract Compliance Manager OFFICIAL RECORD CITY SECRETARY Tier I Easement Encroachment FT. WORTH, TX Agreement Revised/Standard Page 7 of 11 Licensee: By: v�A ty Itit o [,;, A - Name: Miguel Molina Date: a �— STATE OF il� COUNTYOF U •� By: CAW Naive: Ana Molina Date: 10/ BEFORE ME, the undersigned authority, a Not Public in and for the State of w �1�� - on this day personally appeared _ , 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 saine for the purposes and consideration therein expressed, and in the capacity therein stated. , V rA GIVEN TINT ER MY HAND AND SEAL OF OFFICE this 0 day of Notary Pub c in and for the State of Tier I Easement Encroacbment Agreement Revised/Standard Madison Goodwin y Oc 4i I Sion f2029Expiras Natery (D135510370 Page 8 of 11 """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 May . 2026. AND SEAL OF OFFICE this 20th day of Notary Public in and for the State of Texas Tier I Easement Encroachment Agreement Revised/Standard �R aL KATNLEEN BRADFORD h Notary Public w STATE OF TEXAS kkVV Notary I.D. 72197197 oc+ My Comm, F y T. Apr. 12, 207J Page 9 of 11 EXHIBIT A Depiction and description of the Encroachment Tier I Easement Encroachment Agreement Revised/Standard Page 10 of 11 rn 3-� 0 3 0 o:_ o cn rn O rn Q 6 9 O CD (D @ Q D s9 N n rn N Z rN Ill rA N Q Q" N. " 3 O a 6 ran 8'-�° rn 3 Z Z 9 to (\ o (D " i (SD O 11 rrn D .� .0 n rz" r rn -0 m o"c, 0,3 „9 ° 3 m N t0 n 0 �I O ra O m O H O o .s p s3 mO 0 O Q o N Z z (Nz O rn rn (A-__-____ OO D N 1 N a D OS ° 9 O W z rn SA fiI I Nip !s �. .,-coc°ofl6� 0" mQ O m r G -C krn § O z 1 p I rni"flz lD O --_ -- €� N 9 O 9 O N �Ntr p rn Q 0° 6 0 W m y rn N °9 zO 3rn3rn �= Ill (A� O rn 1a > E iS N N [D (0 3 Z z 9 O Q O �ti yy sa 59]'O• ��� / 5'WmsLAPS &FFHi� N 9°3551"E 392 d 589°3551"W 25 N69°3551"E 232A0' — — _ _ N89°35'S1'.E 139b9' — — 31' - - s APE �Ers / -- — — — — - r > D Az 59 fll Eg _ u A, iA 177f m 589 '91' W 12 WO' 251 N 89`3551" IQ7.00I-% 5 H9'35'51' 50.00' r--- — — 589°95.'S1" YI 50.00' le'-B�'� as' -lob• aT a• gd_Ij. �� I 81 I Ito rn� un Im 5 m I $I I$ �wQ�D"<"< T 000 _ � Z /fir ZZ 589 3551 W 1100' 0 589°35i1W o S 899551 W. TO00' O 589°35151°H 10 15 npz O � rn. �€ 1 N �A D-0 71 -®_j $F m oA r�fl� ONFn m CL1-d �7p ��O dp _ ' -nD N t�o�O Z N rn Z 3 Z �l s_ /5_zoz5 � ��� �(� BLAKE ARCHITECTS IbMAR/3036 JOB i3]Ib pED qQc 5�^ m 34FEB/�036 IHbEG/3034 '— �NAW]Osb 06MAY@Oss 1202 S. White Chapel Blvd. Suite A " = w/vEc/sons II/Juwsoss 1136 N. �I �/ L ANIA FORT AORTHr TEXAS Southlake,Texas 76092 817-488-9397 19�,Drsll`v sl/OGT/sOsS 02/SEP/sOss Encroachment *See Page 2 of 2 for Exhibit BEING a 60 square foot tract of land, out of Lot 3R-1, Block 1. R.T. Evans Addition, as recorded in D224094397, Plat Records. Tarrant County, Texas: same being a portion of that certain tract conveyed to Molina in D203162039. Real Property Records. Tarrant County. Texas: and being further described by metes and bounds as follows: The following Bearings. Distances, and/or Areas derived from GNSS observations performed by Texas Surveying & Engineering, Inc. and reflect N.A.D. 1983, Texas State Plane Coordinate System. North Central Zone 4202 (Grid - US Survey Feet). BEGINNING at a point. in the north line of said Lot 3R-1. Block 1 of said R.T. Evans Addition, for the northwest and beginning corner of this tract. WHENCE a set 1/2" iron rod with plastic cap stamped "TEXAS SURVEYING INC". at the northwest corner of said Lot 3R-1 bears S 89°35'51" W. 132.00 feet: THENCE N 89°35'51" E, 60.00 feet. with the north line of said Lot 3R-1, to a point, for the northeast corner of this tract. WHENCE a set 1/2" iron rod with plastic cap stamped "TEXAS SURVEYING INC". at the northeast corner of said Lot 3R-1 bears N 89°35'51" E. 60.31 feet: —— — --- Zachariah S ory, Registered Professio and Surveyor No. 5966 Texas rvey' q & Engineering. Inc.. W at rford Branch 104 S Wal t St.. Weatherford, TX 76 weat ordc�txsurveying.com 817 594 0400 AN04999-RlA - March 20, 2026 Texas X SURVEYING & V ENGINEERING WEATHERFORD - MINERAL WELLS - ALEOO SURVEYING FIRM N0. 10100000 • ENGINEERING FIRM N0. F•175116 Encroachment Exhibit Line Bearing Distance Ll N 89°35'51" E 60.00' L2 S 00°24'09" E 1.00' L3 S 89°35'51" W 60.00' L4 N 00°24'09" W 1.00' Lot B-R. Block 1 Goldenrod Addition Vol. 388-48. Pg. 609 Taing Vol. 12924, Pg. 548 Set 1/2" Capped If 132.00' �Sco, 52r 50 �o\.\8cj5,pQ' Lot 3R-1, Block 1 R.T. Evans Addition D224094397 Notes: 1) An easement description accompanies this exhibit. AN04999-RlA - March 20, 2026 2) Bearings, Distances. and/or Areas derived from GNSS observations and reflect N.A.D. 1983. Texas *See Page 1 of 2 for Description State Plane Coordinate System. North Central Zone 9 p 4202 (Grid - US Survey Feet). 3) All corners are points. unless otherwise noted. 60 Sq. Ft. T.E.S.CO. Encroachment Area Vol. 2867, Pg. 431 Ll L3 15' Sanitary Easement (Vol. 4974. Pg. 368) TEXAS URVEYING & ENGINEERING WEATHERFORD - MINERAL WELLS - ALEOO Encroachment *See Page 2 of 2 for Exhibit BEING a 15 square foot tract of land, out of Lot 3R-1. Block 1. R.T. Evans Addition, as recorded in D224094397. Plat Records. Tarrant County, Texas: same being a portion of that certain tract conveyed to Molina in D203162039. Real Property Records. Tarrant County. Texas: and being further described by metes and bounds as follows: The following Bearings. Distances, and/or Areas derived from GNSS observations performed by Texas Surveying & Engineering, Inc. and reflect N.A.D. 1983, Texas State Plane Coordinate System. North Central Zone 4202 (Grid - US Survey Feet). BEGINNING at a point. in the south line of said Lot 3R-1 and in the north line of Lot 4R-1. Block 1 of said R.T. Evans Addition, for the southwest and beginning corner of this tract. WHENCE a set 1/2" iron rod with plastic cap stamped "TEXAS SURVEYING INC at the northwest corner of said Lot 4R-1 bears S 89°35'51" W. 41.35 feet: THENCE S 01°14'45" W. 1.00 feet, to a point, in the common line of said Lots 3R-1 and 4R-1, for the southeast corner of this tract. WHENCE a set 1/2" iron rod with plastic cap stamped "TEXAS SURVEYING INC", at the northeast corner of said Lot 4R-1 bears N 89°35'51" E. 44.64 feet: THENCE S 89°35'51" W. 15.01 feet, with the common line of said Lots 3R-1 and 4R-1. to the POINT OF BEGINNING, and containing 15 square feet, more or less. —� --- ory, Registered Professio and Surveyor No. 5966 iq & Engineering. Inc. - W at rford Branch St. - Weatherford, TX 76 xsurveying.com - 817-594-0400 March 20. 2026 Texas X SURVEYING & V ENGINEERING WEATHERFORD - MINERAL WELLS - ALEOO SURVEYING FIRM N0. 10100000 • ENGINEERING FIRM N0. F•175116 Page 2 of 2 QA Encroachment Exhibit Notes: W 1) An easement description accompanies this exhibit. AN04999-RIB March 20, 2026 2) Bearings, Distances, and/or Areas derived from GNSS observations and reflect N.A.D. 1983, Texas *See Page 1 of 2 for Description State Plane Coordinate System, North Central Zone 9 p 4202 (Grid - US Survey Feet). 3) All corners are points, unless otherwise noted. i I I I I I I I I a Lot 3R-1, Block i R.T. Evans Addition D224094397 I 3 I ion 15 Sq. Ft. Encroachment Area L1 L2 Proposed Fence Set 1/2" 41.35' P.O.B. L4 I L3 44.64' Set 1/2" Capped Capped Iron Rod 0.4' 0.4' I I Iron Rod I I I I J&S Nguyen I I I I I I Lot 4R-1, Block 1 Family Limited I I I R.T. Evans Addition Nguyen Partnership, LTD I I D224094397 Vol. 10234, Pg. 787 D211271332 I I I I I I I I I TEXAS SURVEYING& rT ENGINEERING 111 = O WEATHERFORD - MINERAL WELLS - ALE00 INC SURVEYING FIRM No. 10100000 • ENGINEERING FIRM No. F•17586 AC Bearing Distance t°14'45" E 1.00' 9°35'S1" E 15.01' l°14'45" W 1.00' L4 S 89°35'S1" W. 15.01' 7 O1-1 'ZU^� o a a g g a E g s � 0 o e C/7 io'O 0 H$� /\ it g„ �ss% € � � l'V C y u !A- * o ? 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IMPORTANT NOTICE To obtain information or make a complaint: You may call the Company's toll -free telephone number for information or to make a complaint at: 1-(800) 352-4462 AVISO IMPORTANTE Para obtener information o para someter una queja: Usted puede Ilamar al numero de telefono gratis de la Compania para informacion o para someter una queja al: 1 (800) 352-4462 You may also write to the Company at: Usted tambien puede escribir a la Compania: Chubb Chubb Customer Services Customer Services PO Box 1000 PO Box 1000 Philadelphia, PA 19106-3703 Philadelphia, PA 19106-3703 You may contact the Texas Department of Insurance to Puede communicarse con el Departmento de Seguros de obtain information on companies, coverages, rights or Texas para obtener informacion acerca de companias, complaints at: coberturas, derechos o quejas al: 1-(800) 252 3439 You may write the Texas Department of Insurance P. O. Box 149104 AUSTIN, TX 78714-9104 FAX # (512) 475-1771 Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov 1 (800) 252-3439 Puede escribir al Departamento de Seguros de Texas P.O. Box 149104 AUSTIN, TX 78714-9104 FAX # (512) 475-1771 Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: Should you have a DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una dispute concerning your premium or about a claim you disputa concerniente a su prima o un reclamo, debe should contact your agent or the company first. If the comunicarse con el agente o la compania primero. Si no se dispute is not resolved you may contact the Texas resuelve la disputa puede entonces communicarse con el Department of Insurance. departmento de Seguros en Texas ATTACH THIS NOTICE TO YOUR POLICY: This notice UNA ESTE AVISO A SU POLIZA: Este aviso es solo para is for information only and does not become a part or proposito de informacion y no se convierte en parte o condition of the attached document. condicion del documento adjunto. ALL-4Y30e (07/13) Page 1 of 1 1 Quote Date: General Agent: Address Agent Contact: Producer Code: From Email: 01/07/2026 Policy Number: FSF18894361 001 AMWINS ACCESS INSURANCE SIC Code: 6514 SERVICES LLC 5910 N CENTRAL EXPRESSWAY SUITE 500 DALLAS, TX 75206 Named Insured: Ana Molina and Miguel Molina DBA: Address: 1724 North Sylvania Avenue Fort Worth, TX 76111 Expiring Policy New Number: Thank you for binding the captioned account. Please read this binder carefully, as the limits, coverage, exclusions, and any other terms and conditions may vary from those you requested in your submission and/or from the expiring policy. Terms and conditions that are not specifically mentioned in this binder are not included. The terms and conditions of this binder supersede the submitted insurance specifications and all prior proposals and binders. Actual coverage will be provided by and in accordance with the policy as issued. The insurer is not bound by any statements made in the submission purporting to bind the insurer unless such statement is reflected in the policy or in an agreement signed by someone authorized to bind the insurer. The binder has been constructed in reliance on the data provided in the submission. A material change or misrepresentation of that data voids this binder. Effective Date: 01/07/2026 Expiration Date: 01/07/2027 Company: Westchester Surplus Lines Insurance Company (A.M. Best Rating A++) Coverage: Building and Personal Property Coverage Form Please review the following coverage(s) offered. Coverage's may differ from those on the prior year's policy. Quote is based on the information currently available, and is subject to change upon receipt and review of renewal information. PREMIUM SUMMARY Property Premium $3,241.00 Terrorism $0.00 Total Policy Premium $3,241.00 Any applicable taxes, surcharges or countersignature fees etc. are in addition to the above stated premium. The actual taxes, surcharges or fees, etc. will be those in effect on the date coverage is bound. The insured is responsible for paying these taxes, surcharges or fees in addition to the above stated premium. Please be advised that the General Agent will comply with all state law requirements and is responsible for making State Surplus Filings and remitting the applicable Surplus Lines taxes. BIND CONDITIONS _X_ Retail Agency Commission 12% _X_ Minimum & Deposit _ _ Fully Earned _X_ Minimum Earned _25% COI from all Sub -Contractors or Vendors _X_ Favorable GL & Property Inspection Within 30 _ _ Auditable Annually Days _X_ Signed Application 3 Year Hard Copy Loss Runs _X_ Signed TRIA Form _ _ COI from Tenants PROPERTY 1724 North Sylvania Avenue, Fort Worth, TX 76111 Loc # Bldg # Rate Building Improvements BPP BI Property Equipment Total /Betterments Premium Breakdown Premium 1 1 1.032 1 $314,000 N/A N/A N/A $3,241 $0 $3,241 OTHER PROPERTY COVERAGE TERMS AND CONDITIONS Improvemen Improvemen Business Cause of Building is/Bettermen Contents Loc# Bldg # Coinsurance is/Bettermen Interruption Loss Valuation is Valuation is Valuation Valuation AMMML Coinsurance Special 1 1 Including 80% RC RC 80% RC Theft Theft Water Damage Loc# Bldg # AOP Deductible Wind Deductible Deductible Deductible 1 1 $1,000 $1,000 2%, subject to minimum of $2,500 AOP SIC: 6514 UNDERWRITER COMMENTS FORMS Form Number Edition Title TRIA24a 0820 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Commercial Property Form Number Edition Title ACE0204 (05/10) FUNGUS, WET ROT, DRY ROT AND BACTERIA EXCLUSION ACE0210 (01/08) NUCLEAR, BIOLO (RAL, CHEMICAL, RADIOLO (DIAL EXCLUSION ENDORSEMENT ACE0359 (12/10) EARTHQUAKE SPRINKLER LEAKAGE EXCLUSION ACE0421 (08/09) PRE-EXISTING PROPERTY DAMAGE EXCLUSION ACE0681 (10/11) DEFINITION OF LOSS OCCURRENCE ENDORSEMENT ACE0755 (02/13) CO RCIAL PROPERTY CONDITIONS AWB0213 (10/15) COSMETIC DAMAGE ROOF EXCLUSION CP0140 (07/06) EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA CP0320 (10/92) MULTIPLE DEDUCTIBLE FORM (FIXED DOLLAR DEDUCTIBLES) CP0411 (09/17) PROTECTIVE SAFEGUARDS CP1030 (10/12) CAUSES OF LOSS - SPECIAL FORM CP1056 (06/07) SPRINKLER LEAKAGE EXCLUSION ILP003 (07/05) FLOOD COVERAGE ADVISORY NOTICE TO POLICYHOLDERS FA49317 (06/17) ASBESTOS MATERIAL EXCLUSION ACE0239 (10/19) HURRICANE MINIMUM EARNED PREMIUM ENDORSEMENT ALL39844 (10/16) CHUBB PRIVACY NOTICE CP1075 (12/20) CYBER INCIDENT EXCLUSION FA57843 (03/23) TOTAL OR CONSTRUCTIVE TOTAL LOSS ENDORSEMENT FA58258 (03/24) APPRAISAL LOSS CONDITION AMENDED ALL10750 (01/15) TERRORISM EXCLUSION ENDORSEMENT CP0163 (10/05) TEXAS - MO IFIED LIMITATIONS ON FUNGUS, WET ROT, DRY ROT AND BACTERIA Interline Form Number Edition Title 7 SL17905 (04/09) TEXAS SURPLUS LINES NOTIFICATION CPfs2 (01/11) FORMS SCHEDULE WSG084 (05/11) SURPLUS LINES BROKER NOTICE LD5S231 (10/24) Signatures (Surplus Lines) IL0017 (11/98) COMMON POLICY CONDITIONS ALL20887 (10/06) CHUBB PRODUCER COMPENSATION PRACTICES & POLICIES ALL21101 (11/06) TRADE OR ECONOMIC SANCTIONS ENDORSEMENT AWB0311 (02/16) CLAIMS DIRECTORY AWB0310 (09/15) MINIMUM EARNED PREMIUM ENDORSEMENT SL34255b (04/23) SERVICE OF SUIT ENDORSEMENT ALL38009 (02/13) NOTICE TO POLICYHOLDERS - TEXAS ILP001 (01/04) U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL (OFAC) ADVISORY NOTICE TO POLICYHOLDERS ADDITIONAL FORMS Commercial Property Form Number Edition Title AWB0211 (02/16) W NDSTORM OR HAIL DEDUCTIBLE AWB0215 (10/15) ACV ROOF LIMITATION FORM CP0010 (10/12) BUILDING AND PERSONAL PROPERTY COVERAGE FORM FA53914 (07/20) MAINTENANCE OF HEAT CONDITION Attached please find TR-51520a (08/20) — Policyholder Disclosure Notice of Terrorism Insurance Coverage. This disclosure notice is required by the Federal Terrorism Risk Insurance Act. The specific premium charge for the terrorism coverage is provided on this Disclosure Notice. This terrorism specific premium is included as part of the overall premium stated above for the Company's participation. If the Insured elects to purchase Terrorism Coverage, the policy will include TR-45231 a (08/20) — Policyholder Disclosure Notice of Terrorism Insurance Coverage along with IL 0952 (01-15) — Cap on losses from Certified Acts of Terrorism if Property coverage is purchased and CG 2170 (01/15) — Cap on Losses From Certified Acts of Terrorism if Casualty coverage is purchased. If the Insured elects to reject Terrorism Coverage, the policy will include TRIA24a (08/20) — Policyholder Disclosure Notice of Terrorism Insurance Coverage along with ALL-10750 (01/15) — Terrorism Exclusion if Property coverage is purchased and CG 2173 (01/15) — Exclusion of Certified Acts of Terrorism if Casualty coverage is purchased. I CHUBB Westchester Binding Common Policy Declarations Westchester A Chubb Company Policy Number: FSF18894361 Renewal of: New 001 Company Name: Westchester Surplus Lines Insurance Company (A.M. Best Rating A++) Named Insured & Mailing Ana Molina and Producer's Name & AMWINS ACCESS INSURANCE Address: Miguel Molina Address: SERVICES LLC DBA: 1724 North 5910 N CENTRAL EXPRESSWAY Sylvania Avenue SUITE 500 Fort Worth, TX DALLAS, TX 75206 76111 Producer No.: Z02748 General Policy Form of Business: Individual Business Description: NA Information And When Coverage 01/07/2026 12:01 A.M. Local Time at Named Policy Period Begins: Insured's Address When Coverage 01/07/2027 12:01 A.M. Local Time at Named Ends: Insured's Address In return for the payment of premium, and subject to all the terms and conditions of this policy, we agree to provide the insurance as stated in this policy. The premium for this policy is indicated below next to the applicable Coverage Form(s). Premiums may be subject to adjustment. Coverage Form Property Attached Forms Information Date Issued: Total Policy Term Premium: Total Amount Due See Forms Schedule CPFS2 241.00 $3,241.00 $3,241.00 These Declarations together with the Coverage Declarations, Common Policy Conditions and Coverage Conditions (if applicable), Coverage Form(s) and Forms and Endorsements, if any, issued to form a part thereof, complete the above numbered policy. AWB0102 (02/16) © Chubb. 2016. All rights reserved. Page 9 of 17 Commercial Property Declarations Company: Westchester Surplus Lines Insurance Company (A.M. Best Rating A++) SYM: FS Westchester A Chubb Company Policy ID: FSF18894361 001 Location Loc. Bld. Address No. No. 1 1 1724 North Sylvania Avenue, Fort Worth, TX 76111 Coverages and Limits Provided Insurance at Described Location Applies Only for Coverage for Which a Limit of Insurance is shown Loc. No. Bld. No. Coverage Rate Limit of Insurance$ Premium 1 1 Building 1.032 $314,000 $2,965 Total Advance Premium This Page: $3,241 Total Advance Property Premium : $3,241 Coverage Options Deductible AOP: $1,000 ❑ See Multiple Deductible Theft: $1,000 See Windstorm Or Hail Deductible El Form Form Water Damage: AOP The Replacement Cost and Co-insurance or BI/EE Mo. Limit Of Indemnity options are provided when indicated by an entry below: Covered Causes Replacement Loc. No. Bld. No. Coverage of Loss Form Cost oCo-insurance �o or BI/EE Mo. Limit Of Indemnity 1 1 Building Special Including X 80% Theft See attached Schedule AWB0103s © Chubb. 2016. All rights reserved. AWBO103 (02/16) Includes copyrighted material of Insurance Services Office, Inc with its permission Page 10 of 17 Commercial Property Declarations Westchester A Chubb Company Westchester Surplus Lines Insurance Company Insurance Company Ana Molina and Miguel Molina Policyholder FSF18894361 001 Policy Number AMWINS ACCESS INSURANCE SERVICES LLC Broker/Producer POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE You were notified that under the Terrorism Risk Insurance Act, as amended, you have a right to purchase insurance coverage for losses resulting from acts of terrorism. As defined in Section 102(1) of the Act: The term "act of terrorism" means any act or acts that are certified by the Secretary of the Treasury ---in consultation with the Secretary of Homeland Security, and the Attorney General of the United States ---to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY YOUR POLICY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES 8o% OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PREMIUM THAT WOULD BE CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $ioo BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $ioo BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $ioo BILLION, YOUR COVERAGE MAY BE REDUCED. You elected NOT to purchase terrorism coverage under the Act at the price indicated. ACCORDINGLY, WE WILL NOT PROVIDE THIS COVERAGE AND YOU DO NOT OWE THE ADDITIONAL PREMIUM FOR THAT COVERAGE INDICATED BELOW. © Chubb. 2016. All rights reserved. AWBO103 (02/16) Includes copyrighted material of Insurance Services Office, Inc with its permission Page 11 of 17 CHUBB® Terrorism coverage described by the Act under your policy was made available to you for additional premium in the amount of $292, however you elected to decline such coverage. TRIA24a (08/20) Page 12 of 17 CHUBB° IL P 001 01 04 U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your pol- icy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC. Please read this Notice carefully. The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of "national emergency". OFAC has identified and listed numerous: • Foreign agents; • Front organizations; • Terrorists; • Terrorist organizations; and • Narcotics traffickers; as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's web site — http//www.treas.gov/ofac. In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National and Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply. IL P 001 01 04 © ISO Properties, Inc., 2004 Page 1 of 1 TERRORISM EXCLUSION ENDORSEMENT Named Insured Endorsement Number Ana Molina and Mi uel Molina Policy Symbol Policy Number Policy Period Effective Date of Endorsement FS FSF18894361001 01-07-2026 To 01-07-2027 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BOILER AND MACHINERY COVERAGE PART BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE PART STANDARD PROPERTY POLICY The following exclusion is added to this policy and applies to all coverages, additional coverages, and coverage extensions, notwithstanding any provision to the contrary in this policy or any other endorsement hereto: A. This insurance does not cover loss, damage, injury, expense, cost, or legal obligation directly or indirectly caused by or resulting from any of the following, regardless of any other cause or event, whether or not insured under this policy, contributing concurrently or in any other sequence thereto: 1. "Act of Terrorism"; or 2. Actions taken by or on behalf of any government or any branch or division thereof (including, without limitation, the uniformed armed forces, militia, police, state security, and anti -terrorism agencies) in responding to, preventing, combating, defending or retaliating against any "Act of Terrorism; or 3. dispersal, application, or release of any actual or alleged pathogen, poison, biologic or chemical product, material, waste or substance as a result of an Act of Terrorism, and it reasonably appears that one purpose of the Act of Terrorism was to release such product, material, waste or substance. This exclusion applies whether or not the "Act of Terrorism" was committed in concert with or on behalf of any organization or government. The terms and limitations of this exclusion do not serve to create coverage for any loss which would otherwise be excluded under this Policy, such as, but not limited to, losses excluded by the "Nuclear Exclusion" or the "War Exclusion" or similar provision. B. As used in this endorsement: 1. "Act of Terrorism" means any act against persons, organizations or property of any nature that involves the following or preparation for the following: a. Use or threat of force or violence; or b. Commission or threat of a dangerous act; or ALL-10750 (01/15) © Chubb. 2016. All rights reserved. Page 14 of 17 c. Commission or threat of an act that interferes with or disrupts an electronic, communication, information, or mechanical system; and 2. Appears to be intended, in whole or in part, to: a. Intimidate or coerce a government or the civilian population; or b. Disrupt any segment of a nation's economy; or c. Influence the policy of a government by intimidation or coercion; or d. Affect the conduct of a government by mass destruction, assassination, kidnapping or hostage -taking; or e. Further political, ideological, religious, social or economic objectives or to express (or express opposition to) a philosophy or ideology; or f. Respond to governmental action or policy. "Act of Terrorism" shall also include any incident determined to be such by an official, department or agency that has been specifically authorized by federal statute to make such a determination. C. Exception Covering Certain Fire Losses If an Act of Terrorism results in a fire and the direct physical loss or damage to property insured hereunder located in any State of the United States, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, American Samoa, Guam, each of the United States Virgin Islands and any territory or possession of the United States, that, either pursuant to the Standard Fire Policy or otherwise, prohibits exclusions for acts of terrorism that result in fire, this Company will pay for the loss or damage caused by that fire. Such coverage for fire applies only to direct loss or damage to property insured hereunder and may be limited, in accordance with the Standard Fire Policy, to the lesser of the actual cash value of the property at the time of the loss or the amount which it would cost to repair or replace the property, without allowance for any increased cost of repair or replacement by reason of any ordinance or law, and without any compensation for business interruption, extra expense to continue business activities, or any other coverage for loss or damage other than direct physical loss or damage to the property insured hereunder. All other terms and conditions remain unchanged. ALL-10750 (01/15) © Chubb. 2016. All rights reserved. Page 15 of 17 Westchester Surplus Lines Insurance Company INSURANCE COMPANY 11575 Great Oaks Way Suite 200 Alpharetta, GA 30022 NOTICE POLICY NO: FSF18894361 001 NAME OF INSURED: Ana Molina and Miguel Molina ADDRESS 1724 North Sylvania Avenue Fort Worth, TX 76111 We are pleased to enclose your policy for this account. Please be advised that by binding this risk with the above referenced Surplus Lines Insurance Company, you agree that as the Surplus Lines Broker responsible for the placement of this insurance policy, it is your obligation to comply with all States Surplus Lines Laws including completion of any declarations/affidavits that must be filed as well as payment of any and all Surplus Lines taxes that must be remitted to the State(s). We will look to you for indemnification if controlling Surplus Lines Laws are violated by you as the Surplus Lines broker responsible for the placement. You further confirm that any applicable state requirement concerning a diligent search for coverage by admitted carriers has been fulfilled in accordance with state law. Thank you for this placement and your regulatory compliance. Date: 01-07-2026 WSG-084 (05/11) Page 16 of 17 gym■■■-�-� SIGNATURES Named Insured Ana Molina and Mi el Molina Endorsement Number LD5S2311024 Policy Symbol Policy Number Policy Period Effective Date of Endorsement FS FSFi8894361 oo1 01-07-2026 tO 01-07-2027 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company THE ONLY SIGNATURES APPLICABLE TO THIS POLICY ARE THOSE REPRESENTING THE COMPANY NAMED ON THE FIRST PAGE OF THE DECLARATIONS. By signing and delivering the policy to you, we state that it is a valid contract. ILLINOIS UNION INSURANCE COMPANY (A stock company) 525 W. Monroe Street, Suite 400, Chicago, Illinois 6o661 WESTCHESTER SURPLUS LINES INSURANCE COMPANY (A stock company) Royal Centre Two,11575 Great Oaks Way, Suite Zoo, Alpharetta, GA 30022 &l rl A --- Brandon Peene, Secretary Juan Luis Ortega, President Authorized Representative LD-5S231(10/24) FORT WORTH. City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name: Miguel Molina and Ana Molina Subject of the Agreement: Encroachment needed to build a chain link fence over a City sanitary sewer line 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. Effective Date: Date of Director's signing If different from the approval date. Expiration Date: 30 yrs fr Date of Director's signing If applicable. Is a 1295 Form required? * Yes ❑ No 21 *If so, please ensure it is attached to the approving M&C or attached to the contract. Project Number: If applicable. PN26-00012 *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.