HomeMy WebLinkAbout065533 - General - Contract - MQ Northside Retail LLCDate Received: 7/16/2026
Time Received: 4: 2 0 p.m.
Record Number: PN26-00056
City Secretary No.: 65533
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 MQ Northside Retail LLC, a(n)
Texas limited liability company ("Licensee"), acting by and through its duly authorized
representative.
RECITALS
WHEREAS, Licensee is the owner of the real property located at 4941
North Tarrant Parkway, Fort Worth, Texas 76244 ("Property"), being more
particularly described as a tract of land situated in the Eli Shiver Survey, Abstract No.
1455, Tarrant County, Texas, and being a portion of a tract of land as described in a deed
to Lazy F, Inc. recorded in Volume 14118, Page 0297 of the Deed Records for
Tarrant County, Texas, as recorded in the Official Public Records, by Instrument
Number D215249920, Tarrant County, Texas; and
WHEREAS, the City owns a water/wastewater easement (the "Public
Property") adjacent to the Property, dedicated by plat, depicted on the final plat of the
property (FP-20-137), which plat is recorded in the plat records of Tarrant County as
Instrument D221224262; and
WHEREAS, the City owns a utility 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 D221224262, depicted on the final plat of the property
(FP-20-137), which plat is recorded in the plat records of Tarrant County as Instrument
Number D221224262;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
CITY SECRETARY
FT. WORTH, TX
Tier II Easement Encroachment Agreement Page 1 of 12
Revised 12/2022
AGREEMENT
1.
The City, in consideration of the payment by Licensee of the fee set out below
and covenants and agreements hereinafter contained to be kept and performed by
Licensee, hereby grants permission to Licensee to encroach in, on, above, or below and
occupy a portion of the City's Public Property as described in and at the location shown
on Exhibit "A," but only to the extent shown thereon, for the purpose of constructing,
installing, and maintaining a rip rap channel, and gas and communication lines (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 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.
U
Licensee, at no expense to the City, shall make proper provisions for the
relocation and installation of any existing or future utilities affected by such
Encroachment and the use and occupancy of the Public Property, including the securing
the approval and consent of the appropriate utility companies and agencies of the State of
Texas and its political subdivisions. In the event that any installation, reinstallation,
relocation, or repair of any existing or future utility or improvements owned by or
constructed by or on behalf of the public or at public expense is made more costly by
virtue of the construction, maintenance, or existence of the Encroachment and use of
Public Property, Licensee shall pay to City an additional amount equal to such additional
cost as determined by the Director of Transportation and Public Works, the Director of
the Water Department, the Director of the Development Services Department, or their
duly authorized representative.
4.
Licensee agrees that City may enter and utilize the Public Property at any time for
any public purpose, including installing, repairing, replacing, or maintaining
improvements to its public facilities or utilities necessary for the health, safety, and
Tier II Easement Encroachment Agreement Page 2 of 12
Revised 12/2022
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
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).
7.
The term of this Agreement shall be for thirty (30) years, commencing on the
date this Agreement is executed by City. However, the City may terminate this
Agreement upon Licensee's noncompliance with any of the terms of this Agreement.
City shall notify Licensee in writing of any such noncompliance and if Licensee does not
cure the noncompliance within thirty (30) days of notice from City, the City may
terminate this Agreement. However, the City may, at its sole option, allow the Agreement
to remain in effect so long as Licensee has taken reasonable measures to cure the
noncompliance or is continuing to diligently attempt to remedy the noncompliance.
8.
It is further understood and agreed between the parties hereto that the Public
Property to be used and encroached upon is held by City as trustee for the public; that
City exercises such powers over the Public Property as have been delegated to it by the
Constitution of the State of Texas or by the Texas Legislature; and that City cannot
contract away its duty and its legislative power to control the Public Property for the use
and benefit of the public. It is accordingly agreed that if the governing body of City may
Tier II Easement Encroachment Agreement Page 3 of 12
Revised 12/2022
at any time during the term hereof determine in its sole discretion to use or cause or
permit the Public Property to be used for any other public purpose, including but not
being limited to underground, surface, or overhead communication, drainage, sanitary
sewerage, transmission of natural gas or electricity, or any other public purpose, whether
presently contemplated or not, that the parties agree to negotiate in good faith in order to
accommodate both the Encroachment and the public purpose.
9.
LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES
HEREBY INDEMNIFY, HOLD HARMLESS, AND DEFEND CITY, ITS
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
Tier II Easement Encroachment Agreement Page 4 of 12
Revised 12/2022
Exhibit "B" and incorporated herein for all purposes. Licensee agrees, binds, and
obligates itself and its successors and assigns to maintain and keep in force such public
liability insurance at all times during the term of this Agreement and until the removal of
the Encroachment and restoration of the Public Property. All insurance coverage
required herein shall include coverage of all Licensee's contractors and subcontractors.
11.
Licensee agrees to deposit with the City when this Agreement is executed a
sufficient sum of money to be used to pay necessary fees to record this Agreement in the
real property records of the county in which the Encroachment is located. After being
recorded, the original shall be returned to the City Secretary of the City of Fort Worth.
12.
Licensee agrees to comply fully with all applicable federal, state, and local laws,
statutes, ordinances, codes, and regulations in connection with the construction,
operation, and maintenance of the Encroachment and use of the Public Property.
13.
Licensee agrees to pay promptly when due all fees, taxes, or rentals provided for
by this Agreement or by any federal, state, or local statute, law, or regulation.
14.
Licensee covenants and agrees that it shall operate hereunder as an independent
contractor as to all rights and privileges granted hereunder and not as an officer, agent,
servant, or employee of City, and Licensee shall have exclusive control of and the
exclusive right to control the details of its operations, and all persons performing same,
and shall be solely responsible for the acts and omissions of its officers, agents, servants,
employees, contractors, subcontractors, licensees, and invitees. The doctrine of
respondeat superior shall not apply as between City and Licensee, its officers, agents,
servants, employees, contractors, and subcontractors, and nothing herein shall be
construed as creating a partnership or joint enterprise between City and Licensee.
15.
Licensee agrees and acknowledges that this Agreement is solely for the purpose
of permitting Licensee to construct, maintain, and locate the Encroachment over or within
the Public Property and is not a conveyance of any right, title, or interest in or to the
Public Property, nor is it meant to convey any right to use or occupy property in which a
third -party may have an interest. Licensee agrees that it will obtain all necessary
permissions before occupying such property.
16.
Tier II Easement Encroachment Agreement Page 5 of 12
Revised 12/2022
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.
22.
Tier II Easement Encroachment Agreement Page 6 of 12
Revised 12/2022
This Agreement may be executed in multiple counterparts, each of which shall be
considered an original, but all of which shall constitute one instrument.
[SIGNATURES APPEAR ON FOLLOWING PAGE]
Tier II Easement Encroachment Agreement Page 7 of 12
Revised 12/2022
EXECUTED to be effective on the date signed by the City's Director of
Development Services Department
City:
CITY OF FORT WORTH
�aGton �fa�YeGG
By: Dalton Harrell (Jul 16, 2026 10:27:02 CDT)
D. J. Harrell
Director, Development Services Department
Date: 07/1 6/2026
00 gnu
ATTEST: �oF Fgnr °
;fie ° �'9$ Approved As To Fonn and Legality
bun o � p
Jannette Goodall, Tayler Canton
City Secretary 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
Contract Compliance Manager
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Tier II Easement Encroachment Agreement Page 8 of 12
Revised 12/2022
Licensee:
MQ Northside Retail LLC
A Texas limited liability company
1
By:
Name: Donald L. Silverman
Title: Manager
Date: I of I, 'zoZ 6
STATE OF
COUNTY OF -D4- ( � &-5� §
BEFORE ME, the undersigned authority, a Notary Public in and for the State of
on this day personally appeared -ponct" L. -S� (V? r Ka ^
Mar�y�d.,�q C r (Title) known tome 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
Cie- L�Jaa -1-L�-r LLC- (entity type), and in the capacity
therein stated.
GIVEN UNDER MY HAND AND SEAL OF OFFICE this S�- day of
2026.
KRISTIN SHILLING HOLMAN
*' It My Notary ID # 132394363
Notary Public in and for the ''.'a 8 „'' Expires March 9, 2028
State of T-L�4a-.
Tier II Easement Encroachment Agreement Page 9 of 12
Revised 12/2022
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.
July
GIVEN UNDER MY HAND AND SEAL OF OFFICE this 16th day of
, 2026.
Notary Public in and for the State of Texas
Tier II Easement Encroachment Agreement
S
KATHLEEK BRA6FORU
Notary Public
STATE OFTEXAS
Notary I.D.12I97197
My Oomm, Ex , Mr. 2027
Page 10 of 12
Revised 12/2022
EXHIBIT A
Depiction and description of the Encroachment
Tier II Easement Encroachment Agreement Page 11 of 12
Revised 12/2022
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PAGE 1 OF 2
ENCROACHMENT #1
Eli Shriver Survey, Abstract No. 1455
City of Fort Worth, Tarrant County, Texas
LEGAL DESCRIPTION
Being a 0.005 acre tract of land out of the Eli Shriver Survey, Abstract Number 1455,
situated in the City of Fort Worth, Tarrant County, Texas, being a portion of Lot 1, Block A
of Northside Addition, a subdivision of record in Document Number D221224262 of the Plat
Records of Tarrant County, Texas, also being a portion of a 20' Utility Easement of record
in Volume 8306, Page 1637 of the Official Public Records of Tarrant County, Texas and
being more particularly described by metes and bounds as follows:
COMMENCING at a mag nail found in the Northwest right-of-way line of North Tarrant
Parkway (200' right-of-way), being the South corner of Lot 2, Block A of said Northside
Addition, also being the East corner of said Lot 1;
THENCE, N43°30'17"W, leaving the Northwest right-of-way line of said North Tarrant
Parkway, over and across said Lot 1, a distance of 244.99 feet to a point in the Southeast
line of said 20' Utility Easement, for the POINT OF BEGINNING;
THENCE, S51 °50'50"W, along the Southeast line of said 20' Utility Easement, a distance of
10.14 feet to a point;
THENCE, N28°29'10"W, over and across said 20' Utility Easement, a distance of 20.22 feet
to a point in the Northwest line of said 20' Utility Easement from which a 1/2 inch iron rod
found bears S71 °36'53"W, a distance of 72.55 feet;
THENCE, N51°48'41"E, along the Northwest line of said 20' Utility Easement, a distance of
10.15 feet to a point;
THENCE, S28°29'10"E, over and across said 20' Utility Easement, a distance of 20.23 feet
to the POINT OF BEGINNING and containing an area of 0.005 acres (202 square feet) of
land, more or less.
Bearings are based on GPS observations utilizing the AIITerra RTK Network, North
American Datum of 1983 (Adjustment Realization 2011).
I hereby certify that this survey, plan or report was prepared by
me or under my direct supervision and that I am a Registered
Professional Land Surveyor under the laws of the State of Texas
Patrick Mallon
R.P.L.S. # 7170
OF
�G\ST ERP
PAT ...........
MALLVON
< 7170 ,••Q�
��� S U R� 04-W-a0a G
„__ Date
ENCROACHMENT #1
Eli Shriver Survey, Abstract No. 1455
City of Fort Worth, Tarrant County, Texas
/ VEY
SHR1vER SUR 455
ELI
ABSTRAG-r NO.
/ LOT 1
BLOCK A
/ NORTHSIDE ADDITION
DOC. NO. D221224262
P.R.T.C.T.
/
20I UTILIr.. rA['rn ArA Ir
/ VOL. 8
/ O.F
ENCROACMENT A
0.005 ACRES (202 SQ.FT
I/G Ir\1
/ 5 �
�P\Odc
O
NOTE: Bearings are based on GPS observations utilizing the AIITerra RTK
Network, North American Datum of 1983 (Adjustment Realization 2011).
PAGE 2OF2
LINE TABLE
LINE
BEARING
DISTANCE
L1
S 51 °50'50" W
10.14'
L2
N 28029' 10" W
20.22'
L3
N 51 °48'41 " E
10.15'
L4
S 28029'10" E
20.23'
LOT 2
BLOCK A
NORTHSIDE ADDITION
DOC. NO. D221224262
P.R.T.C.T.
/
�'17" =4 99 M N F
POC
of
�00 200
N
1"=40'
0 20 40
LEGEND
p
BOUNDARY MONUMENT
IRF
IRON ROD FOUND
MNF
MAG NAIL FOUND
POB
POINT OF BEGINNING
POC
POINT OF COMMENCEMENT
VOL.
VOLUME
PG.
PAGE
DOC. NO.
DOCUMENT NUMBER
P.R.T.C.T.
PLAT RECORDS,
TARRANT COUNTY TEXAS
O.P.R.T.C.T.
OFFICIAL PUBLIC RECORDS,
TARRANT COUNTY, TEXAS
ENCROACHMENT #2
Eli Shriver Survey, Abstract No. 1455
City of Fort Worth, Tarrant County, Texas
LEGAL DESCRIPTION
Being a 0.003 acre tract of land out of the Eli Shriver Survey, Abstract Number 1455,
situated in the City of Fort Worth, Tarrant County, Texas, being a portion of Lot 1, Block A
of Northside Addition, a subdivision of record in Document Number D221224262 of the Plat
Records of Tarrant County, Texas, also being a portion of a 25' Water/Wastewater
Easement of record in Document Number D221224262 of said Plat Records and being
more particularly described by metes and bounds as follows:
COMMENCING at a mag nail found in the Northwest right-of-way line of North Tarrant
Parkway (200' right-of-way), being the South corner of Lot 2, Block A of said Northside
Addition, also being the East corner of said Lot 1;
THENCE, S59°39'22"W, along the Northwest right-of-way line of North Tarrant Parkway,
being the common Southeast line of said Lot 1 and said 25' Water/Wastewater Easement,
a distance of 55.69 feet to the POINT OF BEGINNING;
THENCE, S59°39'22"W, continuing along the Northwest right-of-way line of North Tarrant
Parkway and the common Southeast line of said Lot 1 and said 25' Water/Wastewater
Easement, a distance of 6.00 feet to a point;
THENCE, N30°15'32"W, leaving the Northwest right-of-way line of said North Tarrant
Parkway, over and across said Lot 1 and said 25' Water/Wastewater Easement, a distance
of 25.00 feet to a point in the Northwest line of said 25' Water/Wastewater Easement;
THENCE, N59°39'22"E, along the Northwest line of said 25' Water/Wastewater Easement,
a distance of 6.00 feet to a point;
THENCE, S30°15'32"E, over and across said Lot 1 and said 25' Water/Wastewater
Easement, a distance of 25.00 feet to the POINT OF BEGINNING and containing an area
of 0.003 acres (150 square feet) of land, more or less.
Bearings are based on GPS observations utilizing the AIITerra RTK Network, North
American Datum of 1983 (Adjustment Realization 2011).
PAGE 1 OF 2
EAGLE SURVEYING, LLC
222 S. ELM STREET
SUITE: 200
FAGL L DENTON(940) 222 300901
SURVEYING TX FIRM # 10194177
JOB NUMBER DRAWN BY DATE
2511.008-03 1 PM 1 04-02-2026
I hereby certify that this survey, plan or report was prepared by
me or under my direct supervision and that I am a Registered
Professional Land Surveyor under the laws of the State of Texas
.vt�_�
Patrick Mallon
R.P.L.S. # 7170
�OFTF+�
PATRICK ANTHONY MALLON
4 S Rv �c�0 Data-aoa
ENCROACHMENT #2
Eli Shriver Survey, Abstract No. 1455
City of Fort Worth, Tarrant County, Texas
LINE TABLE
LINE
I BEARING
DISTANCE
L1
S 59039'22" W
6.00'
L2
N 30°15'32" W
25.00'
L3
N 59°39'22" E
6.00'
L4
S 30' 15'32" E
25.00'
RNER SURVEY,
EARS RACT Np. A455
ENCROACMENT #2
0.003 ACRES (150 SQ.FT.)
LOT 1
BLOCK A
NORTHSIDE ADDITION /
DOC. NO. D221224262
P.R.T.C.T. /
/
iffl,
/
/
3AP� '0
25 559 3
1/2" CIRF
-ILLEGIBLE-
NOTE: Bearings are based on GPS observations utilizing the AIITerra RTK
Network, North American Datum of 1983 (Adjustment Realization 2011).
PAGE 2OF2
69
� y5.
559 3922
POB
N
1"=40'
0 20 40
LOT 2
BLOCK A
NORTHSIDE ADDITION
DOC. NO. D221224262
P.R.T.C.T.
/
/
/
/
/
/
/
/
MNF
LEGEND
p
BOUNDARY MONUMENT
IRF
IRON ROD FOUND
MNF
MAG NAIL FOUND
POB
POINT OF BEGINNING
POC
POINT OF COMMENCEMENT
VOL.
VOLUME
PG.
PAGE
DOC. NO.
DOCUMENT NUMBER
P.R.T.C.T.
PLAT RECORDS,
TARRANT COUNTY TEXAS
O.P.R.T.C.T.
OFFICIAL PUBLIC RECORDS,
TARRANT COUNTY, TEXAS
EXHIBIT B
Certificate of Insurance
Tier II Easement Encroachment Agreement Page 12 of 12
Revised 12/2022
FORT WORTH.
City Secretary's Office
Contract Routing & Transmittal Slip
Contractor's Name: MQ Northside Retail LLC
Subject of the Agreement: Easement Encroachment Agreement needed for new construction
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 Directors Signing
If different from the approval date.
Expiration Date: 30 yrs from Directors 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. PN26-00056
*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.