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HomeMy WebLinkAbout065662 - General - Contract - Denton County Electric Cooperative, Inc. dba CoServ ElectricC`0 RECT t l l _ 26 ?m2. Date Received: v �a� Record Number: PN26-00112 Time Received: (7 M . City Secretary No.:6WOZr� PUBLIC PROPERTY EASEMENT ENCROACHMENT LICENSE AGREEMENT TIER 11 THIS AGREEMENT is made and entered into by and between THE CITY OF FORT WORTH, a home rile 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 Denton County Electric Cooperative, Inc., d/b/a CoSery Electric, a Texas electric cooperative corporation ("Licensee"), acting by and through its duly authorized representative. RECITALS WHEREAS, pursuant to that certain Electric Line Easement and Right -of -Way, dated to be effective as of June 16, 2026, and recorded as Instrument No. 2026-70171 in the Official Records of Denton County, Texas (the "Easement Agreement"), Licensee is the beneficiary of certain easements, rights and privileges with respect to certain property described in the Easement Agreement (the "Easement Property"); and WHEREAS, the City owns a sanitary sewer easement (the "Public Property") adjacent to the easement property, dedicated to the City in the plat filed in the Denton County Official Records as Instrument Numbers 2020-87 as depicted on the final plat of Greenwood Addition (FP-24-193), which plat is recorded in the plat records of Denton County as Instrument Number 2025-370.;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 shown on the attached Exhibit "A," which is incorporated herein for all purposes, but only to Tier II Easement Encroachment Agreement Page 1 of 11 Revised the extent shown thereon, for the purpose of constructing, installing, and maintaining one or more underground electric distribution line(s) and associated facilities and equipment (the "Encroachment"). Upon completion of the Encroachment, Licensee agrees to be responsible for maintaining the Encroachment within the Public Property. Licensee shall not expand or otherwise cause the Encroachment to further infringe in or on the Public Property beyond what is specifically described in Exhibit "A." 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 applicable charter, ordinances, codes, and policies of the City. Prior to the construction or installation of the Encroachment, Licensee shall submit all plans and specifications to the Director of the Development Services Department or duly authorized representative. Licensee shall not commence construction or installation of the Encroachment nor make any use of the Public Property until after the execution of this Agreement. 3. Licensee, at no expense to the City, shall make proper provisions for the relocation and installation of any existing or future utilities affected by such Encroachment and the use and occupancy of the Public Property, including the securing the approval and consent of the appropriate utility companies and agencies of the State of Texas and its political subdivisions. In the event that any installation, reinstallation, relocation, or repair of any existing or future utility facilities or improvements owned by or constructed by or on behalf of the public or at public expense is made more costly by virtue of the constriction, 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. Tier II Easement Encroachment Agreement Page 2 of I I Revised 5. Upon termination of this Agreement, Licensee shall, at the option of and at no expense to the City, either 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 or abandon the encroachment in place by filling it with grout which will prevent the Encroachment from any future use. Any such removal of the Encroachment shall be in accordance with then -existing applicable City regulations and policies. It is understood and agreed to by Licensee that if this Agreement terminates and Licensee fails to remove the Encroachment and restore the Public Property was damaged by Licensee in connection with its removal of the Encroachment, Licensee hereby gives City permission to remove the Encroachment and any supporting structures from the Public Property, to restore the Public Property at Licensee's sole cost and expense. 6. In order to defray all costs of inspection and supervision which the City has incurred or will incur as a result of the construction, maintenance, inspection or management of the Encroachment and use of Public Property as provided for by this Agreement, Licensee agrees to pay to City at the time this Agreement is requested an application fee in the sum of One Thousand Twelve Dollars and Fifty Cents ($1012.50). 7. The term of this Agreement shall continue for as long as the Encroachment is being utilized by Licensee, commencing on the date this Agreement is fully -executed by the parties. However, the City may terminate this Agreement upon Licensee's noncompliance with any of the terms of this Agreement, provided, City shall notify Licensee in writing of any such noncompliance and if Licensee does not cure the noncompliance within thirty (30) days of notice from City, the City may terminate this Agreement. However, the City may, at its sole option, allow the Agreement to remain in effect so long as Licensee has taken reasonable measures to cure the noncompliance or is continuing to diligently attempt to remedy the noncompliance 8. It is further understood and agreed between the parties hereto that the Public Property to be used and encroached upon is held by City as trustee for the public; that City exercises such powers over the Public Property as have been delegated to it by the Constitution of the State of Texas or by the Texas Legislature; and that City cannot contract away its duty and its legislative power to control the Public Property for the use and benefit of the public. It is accordingly agreed that if the governing body of City may at any time during the term hereof determine in its sole discretion to use or cause or permit the Public Property to be used for any other public purpose, including but not Tier II Easement Encroachment Agreement Page 3 of I I Revised 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. a 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 HIND OR CHARACTER, WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH, DIRECTLY OR INDIRECTLY, THE CONSTRUCTION, MAINTENANCE, OCCUPANCY, USE, EXISTENCE, OR LOCATION OF THE ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY THE ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, ELECTED OFFICIALS, OR INVITEES OF THE CITY; AND LICENSEE HEREBY ASSUMES ALL LIABILITY AND RESPONSIBILITY FOR SUCH CLAIMS OR SUITS. LICENSEE SHALL LIKEWISE ASSUME ALL LIABILITY AND RESPONSIBILITY AND SHALL INDEMNIFY CITY FOR ANY AND ALL INJURY OR DAMAGE TO CITY PROPERTY ARISING OUT OF OR IN CONNECTION WITH THE ENCROACHMENTS AND ANY AND ALL ACTS OR OMISSIONS OF LICENSEE, ITS OFFICERS, .AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, OR INVITEES RELATED TO THE ENCROACHMENT. 10. While this Agreement is in effect, Licensee agrees to furnish City with a Certificate of Insurance naming City as certificate holder as proof that Licensee has secured and paid for a policy of public liability insurance covering all public risks related to the proposed use and occupancy of public property as located and described in Exhibit "A." The amounts of such insurance shall be not less than $1,000,000 with the understanding and agreement by Licensee that such insurance amounts may be revised upward at City's option and that Licensee shall so revise such amounts immediately following notice to Licensee of such requirement. Such insurance policy shall not be canceled or amended without at least thirty (30) days prior written notice to the Building Official of the City. A copy of such Certificate of Insurance is attached as Tier II Easement Encroachment Agreement Page 4 of I I Revised Exhibit "S" 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 constriction, 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. Tier II Easement Encroaclunent Agreement Page 5 of I I Revised 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 Easement Property, Licensee may assign all of its rights and obligations under this Agreement to the new owner of the Easement Property, and Licensee shall be deemed released from its duties and obligations hereunder upon City's approval in writing of such assignment, which approval shall not be unreasonably conditioned or withheld. Foreclosure by a secured lender of Licensee or assignment to a secured lender by Licensee in the event of default or otherwise shall not require City approval provided that said lender notifies City in writing within sixty (60) days of such foreclosure or assignment and assumes all of Licensee's rights and obligations hereunder. However, no change of ownership due to foreclosure or assignment to any secured lender of Licensee shall be effective as to City unless and until written notice of such foreclosure or assignment is provided to City. 19. Any cause of action for breach of this Agreement shall be brought in Denton County, Texas. This Agreement shall be governed by the laws of the State of Texas. 20. This Agreement shall be binding upon the parties hereto and their successors and assigns. 21. This Agreement may be executed in multiple counterparts, each of which shall be considered an original, but all of which shall constitute one instrument. [SIGNATURES APPEAR ON FOLLOWING PAGE] Tier II Easement Encroachment Agreement Page 6 of I I Revised City: CITY OF FORT WORTH D. J. Harrell Director, Development Set -vices Department Date: ATTEST: Approved As To Form and Legality - �4A Tayler &nton 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 report)ng requirements. Kandice Merrick Contract Compliance Manager Tier II Easement Encroachment Agreement Revised Page 7 of I I Licensee: DENTON COUNTY ELECTRIC COOPERATIVE, INC., d/b/a COSERV ELECTRIC, a Texas electric cooperative corporation Y Name: Greg War ls Title: Chief Operating Officer Date: /Juri asr d _ zo 2G STATE OF TEXAS § COUNTY OF DENTON § BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas, on this day personally appeared Greg Ward, Chief Operating Officer 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 Denton County Electric Cooperative, Inc., d/b/a CoSery Electric, a Texas electric cooperative corporation, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this G " clay of llv�vlr )2026. LANCE TAHCHAWWICKAH Notary Public in and for the % n Notary Public, State of Texas `�• �� Comm. Expires01-04-2030 State of •roA Notary ID 13351480-1 Tier II Easement Encroachment Agreement Page 8 of I I Revised STATE OF TEXAS § COUNTY OF TARRANT § BEFORE ME, the undersigned authority, a Notary Public in and for the State of Texas, on this day personally appeared D. J. Harrell, known to ire to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he executed the same for the purposes and consideration therein expressed, as the act and deed of the City of Fort Worth, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE this ��` day of U , 2026. Notary Public in and for the State of Texas /. Audrey Lae Wallace r�yt,� My Commission Explret ��� 9/10/2028 \ice Notary ii)135082588 Tier II Easement Encroachment Agreement Revised Page 9ofII EXHIBIT A Depiction and description of the Encroachment Tier II Easement Encroachment Agreement Page 10 of I I Revised Q W ~' LLJ 7 � Z 3 4 UQ O J � m HWY 114 RD HWY 114 RD y �'D �y 7—ELEVEN O r 0 SITE Cf DHL (I) G7 jKGP LOGISTI OWNED/DEVELOPED BY: CJT REAL ESTATE, LLC 3825 CAMP BOWIE BLVD FORT WORTH, TEXAS 76107 EMAIL: MJ@HAYDNCUTLER.COM PREPARED BY: MJ THOMAS ENGINEERING 4700 BRYANT IRVIN CT, STE: 204 FORT WORTH, TEXAS 76107 PH: (817) 732-9839 FAX: (817)736-0017 REGISTRATION NO. F-9435 CONTACT: MICHAEL THOMAS, P.E. N.T.S. MAPSCO NO. 642N COUNCIL DISTRICT NUMBER: 10 �E•oF..T� Location Map ��.•' *��� FOR * : * �a STARBUCKS WOLF CROSSING ••aaa.......•.w......•ui.•.O MICHAEL A. THOMAS 1348 HWY 114 RD 93640 (LOT 1 BLOCK A) 9 °F •..BENS,.• GREENWAY ADDITION B�aa®���������� 06/17/26 CITY OF FORT WORTH, TEXAS g W w LL � w I� Imo ,Z m �I \% y t PROPERTY LINE 196 2n 696.15' - ---F2 \ ENCROACHMENTAGGREMI E74FR— iANH ,LG FIRE LAN - RSZl '"' F I 8" PVC arsr 6.f % 14 s Pvc I'oaT EXISTING PUBLIC SANITARY —18"FL=110M --- GA GAS S89°49'45 STA. 0+00.001 {- NITARY SEWER EASEMENT _ OWNED/DEVELOPED BY: CJT REAL ESTATE, LLC 3825 CAMP BOWIE BLVD FORT WORTH, TEXAS 76107 EMAIL: MJ@HAYDNCUTLER.COIV PREPARED BY: MJ THOMAS ENGINEERING 4700 BRYANT IRVIN CT, STE.- 204 FORT WORTH, TEXAS 76107 PH: (817) 732-9839 FAX:(817)736-0017 REGISTRATION NO. F-9435 CONTACT: MICHAEL THOMAS, P.E. I r A- lltj3� w 02Z oW au�0 I I I PROPOSED UNDERGROUND ELECTRIC LINE 2-4" PVC STA. 0+07.50 TOP 2-4" 707.74 20' SANIT Y SE EN —�YC ERK. .2025-370 O.P.RD V-T f 20.0' -- - — --- 8" LFFIRE LA ENE 17' PRIVATE DRAINAGE EA MENT I (1 OFF) 25' PRIV �p y IN; E EASEMENT C.P.R.D.C.T. 5 0 PARTIALLY gOyNED BY II I O.P.R.D.C.T. 67 1rygL — y — ` — — — — — — — — 8' PRIVATE RAINAGE 131.86 EASEMEN ABANDONMENT DOC.NO. 26-21859 O.P.R.D. .T. 0 LEGEND PROPOSED UNDERGROUND ELECTRIC LINE 2-4" PVC r , PROPOSED ENCROACHMENT L--J EXHIBIT "A" UNDERGROUND ELECTRIC FOR �•� STARBUCKS WOLF CROSSING "f SCALE 1" = 20' 1348 H WY 114 RD 40 j FEET (LOT 1, BLOCK A) 6/17/2026 25 50 GREENWAY ADDITION CITY OF FORT WORTH, TEXAS BEING a tract of land situated in the C. Tydings Survey, Abstract Number 1276, City of Fort Worth, Denton County, Texas, and being part of Lot 1, Block A of Greenway Addition, an addition to the City of Fort Worth as recorded in Document Number 20250905000529 of the Official Public Records of Denton County, Texas, and being more particularly described by metes and bounds as follows: COMMENCING at a point for the southwest corner of said Lot 1; THENCE North 64 degrees 17 minutes 29 seconds East, over and across said Lot 1, a distance of 85.83 feet to the POINT OF BEGINNING of the herein described tract; THENCE North 00 degrees 10 minutes 15 seconds West, continuing over and across said Lot 1, a distance of 20.00 feet to a point for corner; THENCE South 88 degrees 55 minutes 07 seconds East, continuing over and across said Lot 1, a distance of 15.00 feet to a point for corner; THENCE South 00 degrees 10 minutes 15 seconds East, continuing over and across said Lot 1, a distance of 20.00 feet to a point for corner; THENCE North 88 degrees 55 minutes 07 seconds West, continuing over and across said Lot 1, a distance of 131.86 feet to the POINT OF BEGINNING AND CONTAINING 300 square feet or 0.0069 acres of land, more or less. SHEET 1 OF 2 SURVEY NOTES: 0' 15' 30' 60' 1.The Basis of Bearings is the Texas Coordainte System of 1983, North Central Zone (4202). 2. See Sheet 2 for additional notes and description. ill = 30' N LOT 1, BLOCK A GREENWAY ADDITION I f I J1.02 ACRES 1- o (- zO =w� z o,. 1- :- 1-- DOC. NO. 2025-370 -.� 1 I>1- ~ O.P.R.D.C.T. p U) 0 N 0Q� -U)O0UU Y <0 I JLu I I �<NO L U�NI m>,UrnN w-WQ i) F-zgI �lZ-Q0 0 �tMZ 0 LU>UQU0 ��0 1-W Qp� II 000b Qw ion ry LU I 1 EASEMENT 0 ENCROACHMENT 0.0069 ACRES 20' SANITARY SEWER (300 MO.) EASEMENT I DOC. NO. 2025-370 15' SANITARY SEWER O.P.R.D.C.T. / EASEMENT / DOC. NO. 2020-87 O.P.R.D.C. 88°55107"E �_�1DQ1'1B--- — 5- — — — ------- ------ - - - -- 20.00' in_------- -- �. o• . pF 17' PRIVATE DRAINAGE �� �� S TFR° f �P°• EASEMENT `n 25' PRIVATE DRAINAGE EASEMENT JOEL C. HOWARD - - - - o ••••s v - - - - - - -V- - - r,i COUNTY CLERK NO. 2025470, 2 6 7•••• O.P.R.D.C.T. y Aoc — — — — -� LOI_ �? '!'°• FSS\o PARTIALLY ABANDONED BY '55'01"W BEGINNING O'° •....• v� --- -N8 -DOC. NO. 2026-21859 -, - - - - - - - S U R O.P.R.D.C.T. �3 5.00 ---------t-- N POINT OF LOT 1, BLOCK 1 15' UTILITY EASEMENT DHL ADDITION COMMENCING DOC. NO.2020-87 DOC. NO. 2020-163 O.P.R.D.C.T. 8' PRIVATE O.P.R.D.C.T. DRAINAGE EASEMENT ABANDONMENT DOC. NO. 2026-21859 15' COSERV EASEMENT O.P.R.D.C.T. ENCROACHMENT LEGEND: G E N A V LOT 1, BLOCK A O.P.R.D.C.T. OFFICIAL PUBLIC RECORD OF DENTON COUNTY, TEXAS SURVEYING • MAPPI14G • SCANNING GREENWAY ADDITION FIR(C) FOUND IRON ROD (WITH CAP) SITUATED IN THE SIR SET 112" IRON ROD WI YELLOW CAP STAMPED "GEONAV" 3410M1000URTRD SU1TE110,CARROLLTON,TEXAS 75006 C. TYDINGS SURVEY, DOC. DOCUMENT SCALE 1130' 19f21217-2109 PRQ/ECT NUMJR: 31T6 8P SFIRMNO.10194201 NO. NUMBER ABSTRACT NO. 1276 VOL. VOLUME DATED: JUNE 18, 2026 DRAWN BY:JCH CITY OF FORT WORTH, PG. PAGE SHEET 2 OF 2 DENTON COUNTY, TEXAS 1■■■■U�___._■■■■■■■■■■■■■ 1■■■■AN■■■■■■■■■■■■■■■■■ 1■■■l11o■■■■i■■■■■■■■■■■■ 1■■■■11' '' ''ELECT.IC ' ' ' LINE,'' . ' 1■■■■■■■■■■■ 0 1■■■■■■■■■■■ 1■■■■�u 1■■■Nn______J■■■■■■■■■■■ 1■■■■M■■■■■■■■■■■■■■■■■■ 1■■■r11ININNERIENZ ■■■■■■■■■■■■■■■■■■ SANITARY SEWER EASEMENT MENNEENE 1■■■■U\E■■■■■■■■i■■■■■■■ ,• 1■■■■11■►0r------_■■■■■■■ •• TA. _00.0____■■■■■■■ 1■■■■n■■■a 1■■■■1 m'M! m■■■'■■■■■■■■■■■ 1■■■A ►N" SS FL 7M7■■■■■■■■■■■ 0+00 OWNED/DEVELOPED BY: CJT REAL ESTATE, LLC 3825 CAMP BOWIE BLVD FORT WORTH, TEXAS 76107 EMAIL: MJ@HAYDNCUTLER.COM PREPARED BY: MJ THOMAS ENGINEERING 4700 BRYANT IRVIN CT, STE: 204 FORT WORTH, TEXAS 76107 PH: (817) 732-9839 FAX:(817)732-9841 REGISTRATION NO. F-9435 CONTACT: MICHAEL THOMAS, P.E. r*: :* . . EL.••• MICHAA,THOMAS 93640 : Q NA®7/2 02 6 PROFILE SCALE HORIZONTAL SCALE: 1 "=40' VERTICAL SCALE: 1" =4' EXHIBIT "A" PROFILE FOR STARBUCKS 1348 Highway 114 (LOT 1, BLOCK A) GREENWAY ADDITION CITY OF FORT WORTH, TEXAS EXHIBIT B Certificate of Insurance Tier II Easement Encroachment Agreement Page I I of I I Revised FORTWORTH. City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name: Denton County Electric Cooperative, Inc. Subject of the Agreement: Tier II Easement Encroachment M&C Approved by the Council? * Yes ❑ No If so, the M&C must be attached to the contract. Is this an Amendment to an Existing contract? Yes ❑ No 8 If so, provide the original contract number and the amendment number. Is the Contract "Permanent"? *Yes ❑ No 8 If unsure, see back page for permanent contract listing. C '19 REGA C12"r6F!i 'J1 Is this entire contract Confidential? *Yes ❑ No ® 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 ff applicable. Is a 1295 Form required? * Yes ❑ No N *If so, please ensure it is attached to the approving M&C or attached to the contract. Project Number: If applicable. *Did you include a Text field on the contract to add the City Secretary Contract (CSC) number? Yes ® No ❑ Contracts need to be routed for CSO processing in the followingorder: rder: 1. Katherine Cenicola (Approver) � C-lL up 2. Jannette S. Goodall (Signer) 3. Allison Tidwell (Form Filler) l laCe-- X 5 q 3 7 zy *Indicates the information is required and if the information is not provided, the contract will be returned to the department.