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HomeMy WebLinkAbout065605 - General - Contract - Minor Bradley WallaceDate Received: 8/3/2026 Record Number: PN26-00011 Time Received: 9:37 a.m. City Secretary No.: 65605 PUBLIC PROPERTY RIGHT-OF-WAY ENCROACHMENT LICENSE AGREEMENT TIER 11 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 Minor Bradley Wallace, ("Licensee"). RECITALS WHEREAS, Licensee is the owner of the real property located at 5209 Bryce Avenue, Foil Worth, Texas 76107 ("Property"), being more particularly described as being Lot C, Block 31, Chamberlin Arlington Heights, First Filing, an addition to the City of Fort Worth, Tarrant County, Texas, as recorded in the Official Public Records, by Instrument Number D224230996; and WHEREAS, the City owns a right-of-way (the "Public Property") adjacent to the Property, dedicated by plat, depicted on the final plat of the property, which plat is recorded in the plat records of Tarrant County as Instrument Volume 1271, Page 283; 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 terns and conditions as set forth in this Agreement. NOW, THEREFORE, the City and Licensee agree as follows: AGREEMENT 1. The City, in consideration of the payment by Licensee of the fee set out below and covenants and agreements hereinafter contained to be kept and performed by Licensee, hereby grants permission to Licensee to encroach in, on, above, or below and occupy a portion of the City's Public Property as described in and at the location shown on Exhibit "A," but only to the extent shown thereon, for the purpose of constructing, installing, and maintaining a private driveway (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 Tier 11 ROW Encroachment Agreement Revised OFFICIAL RECORD page 1 of 1 l CITY SECRETARY FT. WORTH, TX 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. 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. 4. Licensee agrees that City may enter and utilize the Public Property at any time for any public purpose, including installing, repairing, replacing, or maintaining improvements to its public facilities or utilities necessary for the health, safety, and welfare of the public. The City shall have no responsibility or liability for any damages related to the Encroachment resulting from the City's use of the Public Property; however, the City shall make reasonable efforts to minimize such damage. 5. Upon termination of this Agreement, Licensee shall, at the option of and at no expense to the City, remove the Encroachment and restore the Public Property to a condition acceptable to the Director of Transportation and Public Works, the Director of 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 Tier 11 ROW Encroachment Agreement Page 2 of 1 I Revised restore the Public Property, and to assess a lien on the Property for the costs expended by the City in taking such actions. G. 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). Additionally, Licensee agrees to pay a fee in the amount of $722.25 ($2.25 per square foot of the encroachment area) upon execution of this Agreement and annually thereafter. 7. The term of this Agreement shall be for thirty (30) years, commencing on the date this Agreement is executed by City. However, the City may terminate this Agreement upon Licensee's noncompliance with any of the terms of this Agreement. City shall notify Licensee in writing of any such noncompliance and if Licensee does not cure the noncompliance within thirty (30) days of notice from City, the City may terminate this Agreement. However, the City may, at its sole option, allow the Agreement to remain in effect so long as Licensee has taken reasonable measures to cure the noncompliance or is continuing to diligently attempt to remedy the noncompliance. 8. It is further understood and agreed between the parties hereto that the Public Property to be used and encroached upon is held by City as trustee for the public; that City exercises such powers over the Public Property as have been delegated to it by the Constitution of the State of Texas or by the Texas Legislature; and that City cannot contract away its duty and its legislative power to control the Public Property for the use and benefit of the public. It is accordingly agreed that if the governing body of City may at any time during the term hereof determine in its sole discretion to use or cause or permit the Public Property to be used for any other public purpose, including but not being limited to underground, surface, or overhead communication, drainage, sanitary sewerage, transmission of natural gas or electricity, or any other public purpose, whether presently contemplated or not, that the parties agree to negotiate in good faith in order to accommodate both the Encroachment and the public purpose. 9. LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY INDEMNIFY, HOLD HARMLESS, AND DEFEND CITY, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, AND ELECTED OFFICIALS FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS FOR PROPERTY Tien I1 ROW Encroachment Agreement Page 3 of 11 Revised 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 homeowner insurance policy for the property as proof that is has secured and paid for a policy of public liability insurance covering all public risks related to the proposed use and occupancy of public property as located and described in Exhibit "A." The amounts of such insurance shall be not less than $300,000.00 with the understanding and agreement by Licensee that such insurance amounts may be revised upward at City's option and that Licensee shall so revise such amounts immediately following notice to Licensee of such requirement. Such insurance policy shall not be canceled or amended without at least thirty (30) days prior written notice to the Building Official of the City. A copy of such Certificate of Insurance is attached as Exhibit iB" 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. Tier IC ROW Encroachment Agreement Page 4 of I I Revised 12. Licensee agrees to comply fully with all applicable federal, state, and local laws, statutes, ordinances, codes, and regulations in connection with the construction, operation, and maintenance of the Encroachment and use of the Public Property. 13. Licensee agrees to pay promptly when due all fees, taxes, or rentals provided for by this Agreement or by any federal, state, or local statute, law, or regulation. 14. Licensee covenants and agrees that it shall operate hereunder as an independent contractor as to all rights and privileges granted hereunder and not as an officer, agent, servant, or employee of City, and Licensee shall have exclusive control of and the exclusive right to control the details of its operations, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers, agents, servants, employees, contractors, subcontractors, licensees, and invitees. The doctrine of respondeat superior shall not apply as between City and Licensee, its officers, agents, servants, employees, contractors, and subcontractors, and nothing herein shall be construed as creating a partnership or joint enterprise between City and Licensee. 15. Licensee agrees and acknowledges that this Agreement is solely for the purpose of permitting Licensee to construct, maintain, and locate the Encroachment over or within the Public Property and is not a conveyance of any right, title, or interest in or to the Public Property, nor is it meant to convey any right to use or occupy property in which a third -party may have an interest. Licensee agrees that it will obtain all necessary permissions before occupying such property. 16. In any action brought by the City for the enforcement of the obligations of the Licensee, City shall be entitled to recover interest and reasonable attorneys' fees. 17. The parties agree that the duties and obligations contained in Section 5 shall survive the termination of this Agreement. 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 Pier 11 ROW Encroachment Agreement Page 5 of I I Revised Licensee conveys the Property, Licensee may assign all of its rights and obligations under this Agreement to the new owner of the Property, and Licensee shall be deemed released from its duties and obligations hereunder upon City's approval in writing of such assignment, which approval shall not be unreasonably conditioned or withheld. Foreclosure by a secured lender of Licensee or assignment to a secured lender by Licensee in the event of default or otherwise shall not require City approval provided that said lender notifies City in writing within sixty (60) days of such foreclosure or assignment and assumes all of Licensee's rights and obligations hereunder. However, no change of ownership due to foreclosure or assignment to any secured lender of Licensee shall be effective as to City unless and until written notice of such foreclosure or assignment is provided to City. 19. Prior to the end of the term of this Agreement, Licensee may submit a new encroachment application to the City. The City will not unreasonably withhold or delay approval of such application provided that the Encroachment follows the then current City codes and compliance. 20. Any cause of action for breach of this Agreement shall be brought in Tarrant County, Texas. This Agreement shall be governed by the laws of the State of Texas. 21. This Agreement shall be binding upon the parties hereto and their successors and assigns. 22. This Agreement may be executed in multiple counterparts, each of which shall be considered an original, but all of which shall constitute one instrument [SIGNATURES APPEAR ON FOLLOWING PAGE] Tier II ROW Encroachment Agreement Page 6 of I I Revised EXECUTED to be effective on the date signed by the City's Director of Development Services Department City: CITY OF FORT WORTH By; Dalton Harrell Jul 31, 2026 12:25:13 CDT) D. J. Harrell Director, Development Services Department 07/31 /2026 Date: �aau poi pORr�IIodp ATTEST: ate° OP * poa oo*� Ka.�Loiurc2 �¢x�ce� dawn nEX o544 Approved As To Form and Legality Jannette Goodall, Tayler Canton City Secretary Assistant City Attorney Contract Compliance Manager: By signing 1 acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. jzu�) Kandice Merrick Contract Compliance Manager OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Tier II ROW Encroachment Agreement Page 7 of I I Revised Licensee: Minor Bradley Wallace By: G✓ Name: P W01L &I.%L&Ir t✓/kLt � Date: 7130%2 (o STATE OF T' X 6 S COUNTY OF rt�-i'Y a"'t r, VIA BEFORE ME, the undersigned authority, a Notary Public in and for the State of 'jcXaS on this day personally appeared MIVIW gy'141e� 1U�IiQCe (Title) known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he or she executed the same for the purposes and consideration therein expressed, as the act and deed of , a IY)6bViAtAa1 (entity type), and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this 90 y , 2026. Notary Public in and for the State of Tt X a S o�.►..�, KARI.EE MOWREY + Notary ID #131125600 My Commission Expires ° May 29, 2029 day of Tier II ROW Encroachment Agreement Page 8 of I I Revised *,-*THIS PAGE FOR CITY OF FORT WORTH OFFICE USE ONLY*-` STATE OF TEXAS § COUNTY OF TARRANT § BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas, on this day personally appeared D.J. Harrell, known to the 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 31 day of July , 2026. w Notary Public in and for the State of Texas Tier II ROW Encroachment Agreement Revised R Au&sy Lea Wellaca Mpg Com�miselon Cxpir-as ` Notary► 6D1150B2586 Page 9 of I I EXHIBIT A Depiction and description of the Encroachment Tier Il ROW Encroachment Agreement Page 10 of I I Reviscd MBL p ESIGN � BUll.p � MAINTAIN o N o z w o IV 0 �I = F ffi NMI qo � MI LLA p�: V� 0 Z z Z X go B a p� 3 LY a 4J p 'unid Gt��S' � j Q ~ Q z3otl F o O a EHpl! Y W ns$.o mo ow !j €t 0 CIE L�O Z O 4M6� N f W xe°ISr` �o w 0SF� ys> o� a05 � 3 0 6 452; dal i .£I'691 M "111.54o44 S I 8 s ----- � ------ J 1i�r11 +'a-erq➢ I 4 S I IIRW MliPi.[¢ I :ems =mc I � � o I II III II 31 aLi I I I I M ':'' ❑ .� cc W N m❑ YO vN � _ N 1 e 44°4f19" W p a 33.74' as� Q k—v oM a V 1 NOTES: 1. THE BEARINGS SHOWN HEREON ARE BASED ON THE PLAT OF CHAMBERLIN ARLINGTON HEIGHTS RECORDED IN COUNTY CLERK'S DOCUMENT NO. D226037338. 2. DISTANCES IN PARENTHESES () ARE PLAT OR DEED CALLS FOR DISTANCE. 30 0 30 7 Scatel V = 30' LOTS 6'RB2-R cv 61?,3A--3R , ISED BLOCK D CHAMBERL IN ARL INGTON HFIGHIS DOC. NO. D215OP5872 O BR3A-3R 5/8' CAPPED - IR. "5587' FND. 1f2. ROCK WALL �No <-'--BEGIN BRYCE' A VENUE q 61' R.O.W. DEDJOATION• N VOL. 1271-PG. 283 REMNOER a Y CUT IN .- CONC. FND. C114RHB HbW ARIIN6TON !If.7GHT5 DOC. NO. D 22orJ3733° 31 C-R OF EVONG CURB 1 2' CAPPED / - '8URNS' FND. CURVE TABLE 1Z?E1111;'ED BLOCK D CHA4f6217RLIN ARLl;VG10M HE%GHl S DOC. NO. D205129704 6R9-R1 V7.1-11AMil A portion of Bryce A ven ue in the City of Fort Worth, Tarrant County, Texas as shown on plot thereof recorded as Volume 1271. Page 283, of the Tarrant County Plot Records. (SEE ACCOMPANYING DESCRIPTION) (55') CHA,{sef AIIN ARIINCTON IICIC 111S FIRST F,'r_J,v0 V01. 1271. RG. 31 LOT B NUMBER DELTA ANGLE ARC CHORD CHORD RADIUS LENGTH DIRECTION LENGTH C1 56'19'12" 55.00 54.06 IS 6148'49" E 51.91 G CURTIS SURVEYORS, LLC T.B.P.E.L.S. Firm No.10194225 P.O. Box 471787 817/334-0381 Fort Worth, Texas 76147-1408 Compiled from records and surveys made on the ground under my supervision. G CURTIS SURVEYORS, LLC .B.P.E.L.S. firm No. 10194225 f-"`A"I RALO A. CURTIS LINE TABL 4f''. F..... NUMBER DIRECTION LI N 00'01'3S' E 24.5 12 IN 89'58'25' W 45.77' Gerald A. urns, RPLS Texas Registration No. 1640 DESCRIPTION OF PORTION OF BRYCE AVENUE for private use. SITUATED in the City of Fort Worth, Tarrant County, Texas, and being a portion of Bryce Avenue, a 61 foot wide public right-of-way dedicated by plat recorded in Volume 1271, Page 283, of the Tarrant County Deed Records, and said portion being more fully described follows: BEGINNING at a '/2" iron rod found in place for the most northerly northeast corner of Lot C-R, Block 31, CHAMBERLIN ARLINGTON HEIGHTS, as shown on plat thereof recorded as County Clerk's File No. D226037338, in the west end of said Bryce Avenue, said point being also the most easterly southeast corner of Revised Lot 6R3A-3R, Block D, Chamberlin Arlington Heights, said point being on a curve whose center bears North 56 degrees, 20 minutes, 47 seconds East, 55.0 feet; THENCE southeasterly with said curve across said Bryce Avenue pavement, through a central (Delta) angle of 56 degrees, 19 minutes, 12 seconds, subtended by chord bearing South 61 degrees, 48 minutes, 49 seconds East, 51.91 feet, a distance of 54.06 to a point at the back of the south curb line along said Bryce Avenue; THENCE North 89 degrees, 58 minutes, 25 seconds West along said south curb, 45.77 feet to a point in said west end of Bryace Avenue and the most northerly east line of said Lot C-R; THENCE North 0 degrees, 01 minutes, 35 seconds East with said west end of Bryce Avenue and most northerly east line of Lot C-R, 24.5 feet to the PLACE OF BEGINNING, and containing 333 square feet. This description prepared to describe the land parcel depicted on the accompanying map. G CURTIS SURVEYORS, LLC TBPELS Firm No. 10194225 Gerald Curtis, RPLS Texas Registration No. 1640 GE -%LD A..CURT19 ........................ ti R 1640 i EXHIBIT B Certificate of Insurance Tier It ROW Encroachment Agreement Page i 1 of I I Revised Ure High Value Homeowners Policy Renemal Declarations Your Agent Higginbotham Insurance Agency, Inc. 500 W 13th Fort Wortli, TX, 76102 (817) 336-2377 61926600 Your Declarations summarizes your coverage NAME & ADDRESS OF INSURED and premium. Please read Brad Wallace your policy, any attached 5213 Bryce Ave forms and endorsements and Fort Wortli, TX' 76107 your Declarations for a hell description of your coverage. Policy Number H0254955301 Policy Period 04/01/2026 To 04/01/2027 at 12:01 AM Standard Time Issuing Company Privilege Underwriters Reciprocal Exchange 800 Corporate Drive, Suite 420 Fort Lauderdale, FL 33334 888-813-7873 LIABILITY COVERAGE Personal Liability Medical Payments to Others COVERAGE LIMIT S500,000 S 10,000 INSURED LOCATION TYPE OF INSURER LOCATION 5213 Bryce Ave Homeowner Fort Worth, TX 76107 COVERAGE Dwelling Other Structures Contents Loss of Use Waiver of All ©ther Peril Deductible Amount ADDITIONAL COVERAGES COVERAGE LIMIT $3,150,000 $315,000 $1,575,000 Reasonable Expenses $100,000 COVERAGE SUBLIMIT I'HVH-DLC-'iX WI (07/2023) Page 1 of 5 High Value Homeowners Policy Page 2 Brad Wallace Policy Number H0254955301 Loss Assessment Loss Assessment Deductible Reimbursement Data Restoration Debris Removal Ensuing Fungi or Bacteria Business Property Landscaping Tree, Shrub or Plant Item Limit Credit Card, EFT Card or Access Device, Forgery, and Counterfeit Money Identity Fraud Expense Loss Mitigation Environmentally Friendly Upgrades Tree Removal Pet Injury Other Additional Coverages Total Location Premium $50,000 $10,000 $5,000 $315,000 $20,000 $10,000 $157,500 $5,000 $10,000 $25,000 $2,500 $50,000 $1,500 $5,000 Refer to Policy $14,475 DEDUCTIBLE Windstorm or Hail Deductible $63,000 (2% of Dwelling Coverage Limit) per covered loss All Other Peril Deductible $25,000 per covered loss In addition to the deductible(s) shown above, the following special deductible(s) may also apply to your policy. Please refer to your High Value Homeowners Policy for more detail regarding these special deductibles. Construction Deductible $157,500 (5% of Dwelling Coverage Limit) per covered loss Vacant House Deductible $157,500 (5% of Dwelling Coverage Limit) per covered loss Fraud and Cyber Defense Coverage Deductible $500 FORMS & ENDORSEMENTS FORM NUMBER EDITION DATE 11HVH-DE(:=11.001 (07/2023) Page 2 of 5 High Value Homeowners Policy Page 3 Brad Wallace Policy Number HO254955301 Declarations Page PIIVH-DEC- 07/01/2023 TX-001 Texas Flood Insurance Disclosure PHVH-DSC- 03/01/2023 Notice TX-043 OFAC Notice PURE-DSC- 11/01/2023 GF_N-001 ADVISORY NOTICE TO PHVH-DSC- 06/01 /2021 POLICYHOLDERS GEN-007 Exclusion for Loss Due to Pollution or PHVH-DSC- 07/01/2023 Contamination TX-002 Texas Period To File A Claim Or Bring PHVH-DSC- 07/01/2023 Legal Action Against Us Notice TX-007 Important Notice PURE-DSC- 06/01/2023 TX-001 High Value Homeowners Policy PHVH-PCF- 10/01/2025 T X-001 Fraud and Cyber Defense Coverage PHVH-END- 07/01/2023 TX-029 Roof Covering Full Reconstfuction Cost PHVH-END- 09/01/2022 Endorsement GEN-030 Home Systems Protection PHVH-END- 04/01/2024 GEN-022 Homeowners Bill of Rights PHVH-BRHO=TX 09/O1/2024 Electrical Arcing Moritoring Service PH\7H-END- 01/01/2024 GEN-071 Privacy Notice PURE-DSC- 02/01/2023 GENT-038 MORTGAGEE INFORMATION BANK OF XMERICA NA BANK OF AMERICA NA PO BOX 961291 Ft Worth, TX 76161 Loan Number 100096749 1111V1i-DEC-TX-001 (07/2023) Page 3 of 5 High Value Homeowners Policy Page 4 Brad Wallace Policy Number H0254955301 The Premium for this Policy reflects the following information that was represented to us. If any of this is inaccurate, please contact your agent or us. Year Built 2015 Year Renovated Beachfront (<500 From Salt Water) No Protection Class 1 Construction Type Frame LEER® Certified Home Credit No Flood Zone PRP - B/C/X Seasonal Surcharge No Rented to Others Surcharge No Vacancy Surcharge No Opening Protection None Size of Home (Heated) 3,973 Central Reporting Burglar Alarm Credit Yes Central Reporting Fire Alarm Credit Yes Guard Gated Community Credit No Residential Sprinkler System Credit No External Perimeter Security Protection Credit No Gas Leak Detector Credit No Lightning Protection System Credit No Full Time Live-in Caretaker Credit No 24 Hour Signal Continuity Protection Credit Yes Sprinkler System with Water Flow Alarm Credit No Permanently Installed Generator Credit No External Perimeter Gate Credit No Low Temperature Monitoring Device Credit No Water Leak Detection System with -Master Shut Off Yes - without alarm Mortgage Free Credit No Auto Companion Credit Yes Excess Companion Credit Yes Jewelry and. Art Companion Credit No PURE Marketing Group Credit N/A Total Premium $14,475 Surplus Contribution $1,448 Texas FAIR Plan Assessment $104 Grand Total $16,027 P11V11-DEC1 '-001 (07/2023) Page 4 of 5 High Value Homeowners Policy Rage S Brad Wallace Policy Number HO254955301 You will be billed separately for any premium due. CEO, PURE Risk -Management, LLC Attorney -in -fact 1'HX7H-UFC= rX-001 (07/2023) Page 5 of 5 FORT WORTH. City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name: Minor Bradley Wallace Subject of the Agreement: Tier II ROW 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.