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HomeMy WebLinkAboutContract 45643 RIGHT OF WAY CONTRACT ENCROACHMENT AGREEMENT (COMMERCIAL) THIS AGREEMENT is made and entered into by and between the City of Fort Worth, a home rule municipal corporation of Tarrant County, Texas, acting herein by and through its duly authorized City Manager or its duly authorized Assistant City Manager or Planning and Development Department Director, hereinafter referred to as the "City", _ and CVS Inc., a Rhode Island corporation, acting herein by and through its duly authorized I .�:��%� "°kC:r' ►eremafter referred to as "Licensee", the owner ("Owner") of the property located at 8601 and 8777 Boat Club Road, Fort Worth, Texas 76179 ("Property"). AGREEMENT 1. For and in consideration of the payment by Licensee of the fee set out below and the true and faithful performance of the mutual covenants herein contained, City hereby grants to Licensee permission to construct/install and/or allow to remain, certain improvements (whether one or more, the "Improvements") that encroach upon, use and/or occupy portions of the space under, on and/or above the streets, alleys, sidewalks and other public rights-of-way (collectively, the "public right-of-way"), such Improvements being described as follows: Paved parking area and drive aisle The location and description of the Improvements and the encroachment is more particularly described or depicted in Exhibit "A", attached hereto, incorporated herein and made a part hereof for all purposes. OFFICIAL RECORD 2014 ROW Encroachment Agreement-Commercial 1 CVS Pharmacy, Inc.—8601 and 8777 Boat Club Road rev.03/2014 RECEIVED MAY 3 0-2014 2. All construction, maintenance and operation in connection with such Improvements, use and occupancy shall be performed in strict compliance with this Agreement and the City's Charter, Ordinances and Codes and in accordance with the directions of the City's Director of Transportation and Public Works, or his or her duly authorized representative. All plans and specifications for the Improvements shall be subject to the prior written approval of the Director of Transportation and Public Works, or his or her duly authorized representative, but such approval shall not relieve Licensee of responsibility and liability for concept, design and computation in preparation of such plans and specifications. 3. Upon completion of construction and installation of the Improvements and thereafter, there shall be no encroachments in, under, on or above the surface area of the streets, alleys, sidewalks and other public rights-of-way, except as described herein and depicted on Exhibit "A". 4. 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, use and occupancy, including the securing of approval and consent from any affected utility companies and the appropriate 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, 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 such encroachment and use, Licensee shall pay to City an additional amount equal to such additional cost as determined in the reasonable discretion of the Director of Transportation and Public Works, or his or her duly authorized representative. 2014 ROW Encroachment Agreement-Commercial Page 2 of 14 CVS Pharmacy,Inc.—8601 and 8777 Boat Club Road rev.03/2014 5. Upon prior written notice to Licensee, except in the case of an emergency, City may enter and utilize the referenced areas at any time for the purpose of installing or maintaining improvements necessary for the health, safety and welfare of the public or for any other public purpose. In this regard, Licensee understands and agrees that City shall bear no responsibility or liability for damage or disruption of the Improvements, but City shall make reasonable efforts to minimize such damage. 6. In order to defray all costs of inspection and supervision which City has incurred or will incur as a result of the construction, maintenance, inspection or management of the encroachments and uses provided for by this Agreement, Licensee agrees to pay to City an application fee of $275.00 at the time this Agreement is requested. Upon execution of this Agreement and annually thereafter, Licensee agrees to pay a fee in the amount of$.56 per square/linear foot of the encroachment area. 7. The term of this Agreement shall be for 30 years commencing on the date this Agreement is executed by City. Provided however, this Agreement shall terminate upon Licensee's non-compliance with any of the terms of this Agreement. City shall notify Licensee of the non-compliance in writing, and if Licensee has not cured within 30 days of such notice, this Agreement shall be deemed terminated unless such non-compliance is not susceptible to cure within 30 days, in which case this Agreement shall be deemed terminated in the event that Licensee fails to commence and take such steps as are necessary to remedy the non-compliance within 30 days after written notice specifying the same, or having so commenced, thereafter fails to proceed diligently and with continuity to remedy same.. S. Upon termination of this Agreement, Licensee shall, at no expense to City, remove the Improvements encroaching into the public right-of-way, and restore the 2014 ROW Encroachment Agreement-Commercial Page 3 of 14 CVS Pharmacy,Inc.—8601 and 8777 Boat Club Road rev. 03/2014 public right-of-way to a condition acceptable to the Director of Transportation and Public Works, or his or her duly authorized representative, in accordance with then-existing City specifications. It is understood and agreed by Licensee that if this Agreement terminates and Licensee fails to remove the Improvements and restore the public right-of-way, Owner hereby gives City permission to remove the Improvements along with any supporting structures, restore the public right-of-way and assess a lien on the Property for the costs expended by the City in taking such actions. 9. It is further understood and agreed upon between the parties hereto that the public right-of-way to be used and encroached upon as described herein, is held by City as trustee for the public; that City exercises such powers over the public right-of way 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 right-of-way for the use and benefit of the public. It is accordingly agreed that if City's governing body at any time during the term hereof determines in its sole discretion to use or cause or permit the public right-of-way to be used for any other public purpose, including, but not 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 this Agreement shall terminate upon 60 days' written notice to Licensee. In the event this Agreement is terminated under this Section 9, Licensee shall perform the obligations regarding removing the Improvements and restoring the public right-of-way described in Section 8. 10. Licensee agrees and acknowledges that this Agreement is solely for the purpose of permitting Licensee to construct, maintain and locate the Improvements over or within the described public right-of-way and is not a conveyance of any right, title or interest in or to the public right-of-way nor is it meant to convey any right to use or occupy any property in which a third party may have an interest. Licensee agrees that it will obtain all necessary permissions before occupying such property. 2014 ROW Encroachment Agreement-Commercial Page 4 of 14 CVS Pharmacy, Inc.—8601 and 8777 Boat Club Road rev.03/2014 11. Licensee agrees to comply fully with all applicable federal, state and local laws, statutes, ordinances, codes or regulations in connection with the construction, operation and maintenance of the Improvements, encroachment and uses. 12. 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. 13. 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. 14. LICENSEE COVENANTS AND AGREES TO INDEMNIFY, AND DOES HEREBY INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, 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 IMPROVEMENTS AND 2014 ROW Encroachment Agreement-Commercial Page 5 of 14 CVS Pharmacy, Inc. —8601 and 8777 Boat Club Road rev.03/2014 ENCROACHMENT AND USES GRANTED HEREUNDER, WHETHER OR NOT CAUSED, IN WHOLE OR IN PART, BY ALLEGED NEGLIGENCE OF OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES 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 ANY AND ALL ACTS OR OMISSIONS OF LICENSEE, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, LICENSEES, INVITEES, OR TRESPASSERS. 15. While this Agreement is in effect, Licensee agrees to furnish City with a Certificate of Insurance naming City as certificate holder, as proof that it 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 described or depicted in Exhibit "A". The amounts of such insurance shall be not less than the following: $1,000,000 Commercial General Liability 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 promptly following notice to Licensee of such requirement. Licensee agrees that it shall not cancel or amend such insurance policy without at least 30 days prior written notice to the Building Official of the City of Fort Worth. A copy of such Certificate of Insurance is attached as attached as Exhibit "B" and incorporated herein for all purposes. Licensee agrees to submit a similar Certificate of Insurance annually to City on the anniversary date of the execution of this Agreement. Licensee agrees, binds and obligates itself, its successors and assigns, to maintain and keep in force such public liability insurance at all times during the term of this 2014 ROW Encroachment Agreement-Commercial Page 6 of 14 CVS Pharmacy,Inc.—8601 and 8777 Boat Club Road rev.0312014 Agreement and until the removal of all encroachments and the cleaning and restoration of the public right-of-way. All insurance coverage required herein shall include coverage of all Licensees' contractors and subcontractors. 16. 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 its entirety in the Real Property Records of Tarrant County, Texas. After being recorded, the original shall be returned to the City Secretary of the City of Fort Worth. 17. City shall be entitled to recover interest and reasonable attorney's fees in any action brought by the City for the enforcement of Licensee's obligations. 18. Licensee covenants and agrees that it will not assign all or any of its rights, privileges or duties under this Agreement without the prior written approval of the City Manager or his or her designee. Any attempted assignment without prior written approval shall be void. In the event Licensee conveys the Property, Licensee may assign in writing 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 shall not require City approval provided that said lender notifies City in writing within 60 days of such foreclosure or assignment in event of default and assumes all of Licensees' 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. 2014 ROW Encroachment Agreement-Commercial Page 7 of 14 CVS Pharmacy, Inc.—8601 and 8777 Boat Club Road rev. 03/2014 19. THE PARTIES AGREE THAT THE DUTIES AND OBLIGATIONS CONTAINED IN PARAGRAPH 8 SHALL SURVIVE THE TERMINATION OF THIS AGREEMENT. 20. This Agreement shall be binding upon the parties hereto, their successors and assigns. [SIGNATURES APPEAR ON FOLLOWING PAGE] 2014 ROW Encroachment Agreement-Commercial Page 8 of 14 CVS Pharmacy, Inc.—8601 and 8777 Boat Club Road rev.03/2014 THIS AGREEMENT may be executed in multiple counterparts, each of which shall be considered an original, but all of which shall constitute one instrument. CITY: LICENSEE: City of Fort Worth, CVS Pharmacy, Inc., aTexas municipal cor oration a Rhode Island corporation By: By: ............ -ReedtdH larwood, hector Name: Toni A. MOM Assistant Secr6f6iv- anning and Development Department Title: CVS Legal Approval: Dustin Stevens, I-Iolland & Kitight LLP APPROVED AS TO FORMA LEGALITY L .14_e�,4 t�-—" "A—. Jj— .................... Assistant City Attorney ATTEST: ,3 T "00fJ10000 TTF 0 7 0 Ci y Se r t 0, y % C VH a. EO C ]!-Fs TJ I R iwwwwnmii RECORD C, RETARY No TX 2014 ROW Encroachment Agreement-Commercial Page 9 of 14 CVS Pharmacy,Inc. - 8601 and 8777 Boat Club Road rev, 03/2014 STATE OF TEXAS COUNTY OF TAItRANT This instrument was acknowledged before me on _ 201_ by Randall Harwood, Director of the Planning Develop t Department `th City of Fort Worth, on behalf the City of Fort Worth, ®ar p SA R RE ublic State of Texas a My comNS6 Apill 26, tot"t' After Recording Return to: Cassandra Foreman Planning and Development Department 1000 Throckmorton Street Fort Worth Tag 76102 2014 ROW Encroachment Agreement-Commercial Page 10 of 14 C;VS Pharmacy,Inc.. 8601 and 8777 Boat Club Road rev.03(2014 STATE OF RHODE ISLAND § X COUNTY OF BEFORE ME, the undersigned authority, a Notary Public in and for the State of Rh d- IS] d, on this day personally appeared ­'L22,kz 4111 , 2' 7Ao1r`4�/k_, ode known to me to be is (title the person whose nai subscribed to the foregoing instrument, and acknowledged to me that he/she executed the same for the purposes and consideration therein expressed, as the act and deed of CVS Pharmacy, Inc., a Rhode Island corporation, and in the capacity therein stated, GIVEN-UNDER My HAND AND SEAL OF OFFICE this day of ........... Notary Public in and for tt#1 State ol"Rhode Island Susan Dupre Notary Public State of Rhode Island My Commission Expires 06102/2o1 5 2014 ROW Encroachment Agreement-Commercial Page I I of 14 CVS Pharmacy,Inc.--8601 and 8777 Boat Club Road rev.0362014 .......... ........ .............. ................................................................... .......................... ..................................... J ocy- :e�, fl p ............... A:,.48*5758" R--: 30.50' 4`5 L=,26.07 Ct 56502 47 Q. 04-11 93 25.28' PRA 1,151 E L91 A=90100'00" 42.58' 11, 1 R=1.50' C) A- Is L=2.36 Cb=S44*31945"w EXISTIN� C=2.1,�' RAILRO D NOO*28'15"W 28.47' EXIS77N STONE "POINT F .......... WALL O G ...... SB % .......... `CROSSWAL� NOO28'15'w /G ....» ....... LIGHT moil 589*31"45" /CV GL W 15.34' I C7 58931'45'°W r ASPHALT 2.73' PAVEMENT 500'28'15"E WICONCRETE CURB & GUTTER LAKE COUNTRY DRIVE 16.50' ISN LP N CVS PARKING ENCROACHMENT AREA 0.015 C. (649 S,F) LAKE COUN7RY EST HOA ENCROACHMENT AREA Ol 10* 20 CITY SECRETARY CONTRACT N 4i 5m sods 11-av a INWinkelmann & Associates, Inc. CONSULTING CIVIL ENGINEERS ■ SURVEYORS 47"'q HILLCRESP PLAZA DRNE,SUITE 325 (972)490®7080 CALLAS,TEVAS 75231 (972)490-7099 rAx T_V r Ag(_Rqfstodw Na 89 1-66-00 copyRayr 020N14, mv,o—,&A.B .lvtes, Me. PARKING ENCROACHMENT EXHIBIT Scme, �NCTJ�D Cum,ac, 04-11-2014 CVS BOAT CLUB ADDITION roiecRe! No�7 09�1090&��ZRDA!2 ADJACENT TO GAUNTT PROPERTY R . 708 ................................................................ ............ LEM S— A�NEUNDS PARKING ENCROCHMENT BEGIN A P 77ON OF THE RIGHT—OF—WAY FOR LAKE COUNTRY DRIVE AS SHOWN ON THE FINAL PLAT OF THE LOT 1, BLOCK 1, I.D./. ADDITION PER PLAT RECORDED IN VOLUME 388-122 PAGE 8J DEED RECORDS OF TARRANT COUNTY, TEXAS (DRTCT), AND BEING A40RE PARTICULARLY DESCRIBED AS FOLLOWS. BEGINNING AT A POINT ON AN INTERIOR EAST LINE OF LOT 1, BLOCK 1 OF SAID LD.L ADDITION, SAID POINT BEING NORTH 00 DEG 28 A41N 15 SEC WEST A DISTANCE OF 10.03 FT FROM THE A40ST SOUT14ERLY SOUTHEAST CORNER OF SAID ADDITION, THENCE NORTH 00 DEG 28 A41N 15 SEC WEST, ALONG SAID EAST LINE, FORA DISTANCE OF 28.47 FT TO A POINT FOR CORNER, THENCE NORTH 89 DEG Jl MIN 15 SEC EAST, FOR A DISTANCE OF 42.58 FT TO A POINT FOR CORNER AND FOR THE BEGINNING OF A CIRCULAR CURVE TO THE RIGHT, THENCE WITH SAID CIRCULAR CURVE TO THE RIGHT WITH AN CENTRAL ANGLE OF 48 DEG 57 MIN 58 SEC, A RADIUS OF 30.50 FT, AND A CHORD WHICH BEARS SOUTH 65 DEG 02 MIN 47 SEC WEST, 25.28 FT FOR AN ARC LENGTH OF 26.07 FT TO A POINT OF TANGENCY FOR CORNER, THENCE SOUTH 89 DEG Jl MIN 45 SEC WEST, FOR A DISTANCE OF 2.73 FT TO A POINT FOR CORNER AND FOR THE BEGINNING OF A CIRCULAR CURVE TO THE LEFT, THENCE WITH SAID CIRCULAR CURVE TO THE LEFT WITH AN CENTRAL ANGLE OF 90 DEG 00 MIN 00 SEC, A RADIUS OF 1.50 FT, AND A CHORD WHICH BEARS SOUTH 44 DEG Jl MIN 45 SEC WEST, 2.12 FT, FOR AN ARC LENGTH OF 2.36 FT TO A POINT OF TANGENCY FOR CORNER, THENCE SOUTH 00 DEG 28 MIN 15 SEC EAST, FOR A DISTANCE OF 16.50 FT TO A POINT FOR CORNER, THENCE SOUTH 89 DEG Jl MIN 45 SEC WEST, FOR A DISTANCE OF 15034 FT TO THE POINT OF BEGINNING AND CONTAINING 0.015 ACRES, OR 649 SO. FT OF LAND, A40RE OR LESS. `� Winkelmann & Associates, Inc. CONSULTING CIVIL ENGINEERS ■ SURVEYORS 6750 HLLCIEST PLAZA DRIVE,SUITE 325 ('ll)490-7090 DALLAS,TOM 752M 072)490-7029 FAX r..a E 00—Rep—ti—Af.. 89 lar" -00 MPYR10ir 0 2014, ft,Wm &As.—W&A M. PARKING ENCROACHMENT EXHIBIT 5r-lrja� :NA bu(le :04-11-2014 CVS BOAT CLUB ADDITION wq, Rl :70908—GROA1119 L Projov No. : 7090a ADJACENT TO GAUNTT PROPERTY EXHIBIT°B" Certificate of Insurance 2014 ROW Encroachment Agreement-Commercial Page 14 of 14 CVS Pharmacy, Inc.—8601 and 8777 Boat Club Road rev.03/2014 A 05/21/2014 CERTIFICATE OF LIABILITY INSURANCE °ATE`2014 , "' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC, NAME PHONE ............................._ FAX .�._ ...------------ 99 HIGH STREET (AA Nq EXt1 ._._ LAIC ko1—_� BOSTON,MA 02110 ADDRIESS:.......................................................: AIIIt':CV'SCaremark C'erlRegclesl rnarsh I Fax:212-949-5336 -— .......- -.....---------- ...... ------ ................._.. ............... INSURERS)„AFFORDING COVERAGE ---.--_..--.--_q. .--- NAIC# S02406-GL•GL-14-15 INSURER A:New Harnpshlre Ins Cornpany 23641 -— ....... _ _.......— ..—........... .- INSURED INSURER B: CVS CAREMARK CORPORATION AND ITS ..... --- .............. _ ..... .­ . SUBSIDIARIES AND AFFILIATES INSURER C: __— ..... ----- _--------— ONE CVS DRIVE — WOONSOCKE T,RI 02695 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER. NYC-006666533-03 REVISION NUMBER:4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN Y HAVE BEEN REDUCED BY PAID CLAIMS. ISR ------- - AtbDL OR POLICY EFF POLICY EXP — LTR TYPE OF INSURANCE INSR n POLICY NUMBER --,--(MMIDDIYYYYI IMMIDDIYYYYI LIMITS A GENERAL LIABILITY GL 6619521 01101/2014 01/01/2015 EACH OCCURRENCE $ 4,500,000 X PREMISES rb RE I 1000 000 COMMERCIAL GENERAL LIABILITY PREMISES-LEa occunag9 — ....] CLAIMS-MADE I...- .... OCCUR MED EXP(Any.-one person) $ ...— _ X SIR: $500,000 PERSONAL&ADV INJURY $ 4,500,000 . __.... -....�.. ........�. ...., - ........_....—..._._�—_......_....._....._ .. X LIQUOR LIABILITY INCLUDED GENERAL AGGREGATE $ 26,000,000 _ ,._, m .,......._. ............. _ ........._......- ._...... ._..... _...... GEN'L-AGGREGATELIMITAPPLIESPER: PRODUCTS-COMPlOPAGG $ INCLUDED _ _. —... ........_ ...... �......... X POLICY PRO- LOG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _..._.. ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED —.—.---.....:....._._._.—....—_.,,... __...._...._..—_..--- ........_..... A.U'J.OS _ AUTOS BODILY INJURY(Per accid t) $ ....—_. NON-OWNED PFZ®PEFdTY DAMAGE $ HIREDAJTOS -... AUTOS (Per.accdpnt� $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S ............... ......... ............— .....-d....._. .-.,. ........ --_. �:EO XCESS LIAO CLAIMS-MADE AGGREGATE $ RETENTION$ $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LIABILITY YIN —.-IQEY...LIM.1� ..........EF3_ _... ..._.� ._..._..._. ANY PROPRIETORIPARTNERIEXECUTIVE '” .E:L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? F1'd N 7 A . ......_ _................._.__........................_......._......... .........................................._........_ (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ If yos,dasoriba under -_.— ___. ....__�.. .........................................__—.. -_........ DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,W more apace Is required) RE:#1D489-FT WORTH(BOAT CLUB);AS I'T PERTAINS'T'O'THE PROPOSED USE AND OCCUPANCY OF PUBLIC PROPERTY AS LOCATED AND DESCRIBED IN EXHIBIT A OF AN EASEMENT ENCROACHMENT LICENSE AGREEMENT BETWEEN THE CITY OF FOR'Y'WORTH AND CVS PHARMACY„INC.REGARDING THE REAL PROPERTY LOCATED AT 6601 AND 6777 BOAT CLUB ROAD, FORT WORTH,'TX'76179 CERTIFICATE HOLDER CANCELLATION CITY OF FORT WORTH,A HOME RULE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MUNICIPAL CORPORATION OF TARRANT COUNTY„TEXAS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1000 THROCKMORTON STREET ACCORDANCE WITH THE POLICY PROVISIONS. FORT.WORTH,'TX 76102 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Yevgeniya Muyarnina ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 5024 06 "- .... ........ L 0 C -a Os t On" .......... . Is .. . ................ CC)R AEP ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA,INC CVS CAREMARK CORPORATION AND ITS SOBSIDIARIES AND AFFILIATES POLICY NUMBER ONE CVS DRIVE WOONSOCKET:,RI 02895 .......... CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ---L5— FORM TITLE: Certificate of UaNity Insurance .................... .............. COMMON POLICY CONDITIONS A.Cancellation Z We[Carflerl may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a.10 days before the effective date of cancellation If we cancel for non payment of premium 1)General Liability Additional Insured-Where Required Under Contract or Agreement language per endorsement 61712(12106): SECTION It-WHO IS AN INSURED,is amended to include as an additional insured: Any person or organization to whom you become obligated to include as an additional insured under this policy,as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy,but only wfth respect to liability arising out of your opeurtions or premises owned by or rented to you. However,the insurance provided will not exceed the lesser of: The coverage and/or limits of this policy,or The coverage and/or limb required by said contract or agreement. 2)General Liability Earlier Notice of Cancellation Provided By Us language per endorsement GO 02 2410 93: Number of Days'Notice 90 For any stalviorgy,permitted reason other than nonpayment of premium,the number of days required for notice of cancellation,as provided in paragraph 2.of either the CANCELLATION Common Policy Condition or as amended by an applicable state cancellation endorsement,is increased to the number of days shown in the Schedule above. 3)General Liability Advance of Cancellation to Entities Other The Named Insured Limited to E-Mail Notification per Charts Manuscript endorsement: In the event that the Insurer cancels this polo for any reason other than non payment of premium,and 1. The cancellation eff ective date is pflortD this polo's expiration date; Z The First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is cancelled(hereinafter,the"certificate Holders)');and has provided to the insurer,eMier directly or through Its broker of record,the email address of the contact at such entity, and the Insurer received this information after the First Named Insured received notice of cancellation of this policy and prior to this policy's cancellation effective date,via an electronic spreadsheet that is acceplatrie to the insurer, the Insurer will provide advice of cancellation(the'Advknj via e-mail to such Certificate Holders. Prod of the Insurer emailing the Advice,using the information provided under this policy by the First Named Insured,will serve asp f that the Insurer has fully satisfied Its obligations under this endorsement. This endorsement does not affecL in any way,coverage provided under this poky or the cancellation of this policy or the eff ective date thereof,nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: I.First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2.Insurer means the insurance company shown in the header on the Declarations Page of ft policy. All other terms,conditions and exclusions shall remain the same. ACORD 101 (2008101) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD