HomeMy WebLinkAboutContract 26061 0 pp (q3 qoo of
CITY SECRETgRY
CONTRACT NO. ®�I
CONSENT AGREEMENT
FOR
TEMPORARY USE OF PUBLIC PROPERTY
STATE OF TEXAS
COUNTY OF TARRANT
THIS AGREEMENT is made and entered into by and between
the City of Fort Worth, a municipal corporation of Tarrant County,
Texas, acting herein by and through its duly authorized Building
Official, herinafter referred to as the "City"' and
R.J. Miller and Associates Inc.
acting by and through its duly authorizer) President, RJ Miller
hereinafter referred to as
"Grantee".
WITNESSETH:
1.
For and in consideration of the payment by Grantee of the
charges set out below and the true and faithful performance of the
mutual covenants herein contained, City hereby grants to Grantee
permission to temporarily encroach upon, uses and occupy portions of
the space under, on and/or above the streets, alleys, sidewalks or other
public rights-of-way as follows:
Sidewalk at southwest corner of 1000 Block Houston Street i
Sidewalk at southwest corner of 200 Block West 9th Avenue
OKK JAL ERWOQD
4TV $EC; 1�MQy-
P.. �f'}r!i�CRI H.M..
The location and description of said encroachment is more particularly
described in Exhibit `B" attached hereto, incorporated herein and made
a part hereof for all purposes.
2.
All use and occupancy of public streets, alleys, sidewalks or other
public rights-of-way under this agreement shall be in strict compliance
with the Charter, Ordinances and Codes of City and in accordance with
the directions of the Building Official and the Director of Transportation
and Public Works of City.
3.
Upon expiration of this agreement and the privileges granted
hereunder, there shall be no encroachment by Grantee in, under, on or
above the surface of the public rights-of-way involved.
4.
Grantee agrees to pay in advance an encroachment fee for the
temporary privilege of encroaching upon a portion of the public rights-
of-way as described in Exhibit `B". Said fee is calculated in the manner
and amounts prescribed by the Building Code of the City of Fort Worth
for temporary use or occupancy of public property. The estimated total
amount of said fee is
no fee Tornado Storm Damage F;t�'Oy
D l yg� x
-70 =7 33Cc. �'° 5 (eye K �alY
2
5.
Grantee, at no expense to City, shall make proper provision for
the relocation and/or installation of any existing or future traffic control
devices or other improvements affected by such encroachment, use and
occupancy, including the securing of approval and consent from the
appropriate agencies of the State and its political subdivisions. In the
event that any installation, reinstallation, relocation or repair of any
existing or future traffic control device or improvement owned or
constructed by or on behalf of the public or at public expense is made
more costly by virtue of the existence of such encroachment and use,
Grantee shall pay to City an additional amount equal to such additional
cost as determined by City.
6.
The term of this agreement shall be for 70 days, from 07-11-00
to 09'W oo provided, however, should the need for the encroachments
granted hereunder at any time cease, Grantee agrees to immediately
notify City of such condition; and, upon receipt of such notice by the
Building Official of the City of Fort North, this agreement shall
terminate.
OFROA GEfav")D
MV IM P, IN
7.
It is expressly understood and agreed that this Consent Agreement
is for a temporary encroachment in, under, over and upon the public
property as located and described in Exhibit `B". This agreement shall
not be construed as the granting of a permanent easement, encroachment
or license upon City's public streets, alleys, sidewalks or other rights-of-
way.
8.
City, through its duly authorized representatives, shall have the full
and unrestricted right to enter upon all public rights-of-way for the
purpose of making inspections to determine compliance with the terms,
covenants and conditions herein. In the event that any inspection should
reveal a breach of any terms, covenants or conditions herein, City shall
give Grantee notice of such breach. Should such breach not be
corrected by Grantee within twenty-four (24) hours of receipt of the
notice, or within such shorter period of time as deemed necessary by the
Building Official for the protection of public health or safety, City may
terminate and cancel this agreement.
9.
Upon expiration or termination of this agreement for any reason
whatsoever, Grantee shall, at no expense to City, restore the public . _
fi-,ICIAI EEC
rights-of-way and adjacent supporting structures to a condition
r r
acceptable to the Director of Transportation and Public Works or his, r7l,
duly authorized representative and in accordance with then existing City
specifications, and Grantee shall remove all barricades, equipment,
covenants and agrees that for a period of one (1) year after the
termination of this Consent Agreement, Grantee will repair all conditions
or damages too the streets and sidewalks or other rights-of-way that
have resulted from Grantee's use or occupancy of the streets and
sidewalks or other rights-of-way, as determined by the Director of
Transportation and Public Works or his designee. Grantee agrees to
begin such repairs within thirty (30) days of receipt of notice from the
Director of Transportation and Public Works or his designee. All
repairs shall be performed in an expeditious and workmanlike manner
and shall comply with all applicable laws, codes, ordinances and City
specifications.
In the event that Grantee fails to comply with the covenants herein
contained with respect to such removal or restoration, the City shall have
the right to remove or dispose of any barricades, equipment, supplies,
materials or other property and repair any conditions which in the
opinion of the City are necessary to bring the public rights-of-way to the
condition prescribed herein, and City shall not be responsible for
trespass or any other damage or liability in connection with such removal
or restoration. Grantee shall reimburse City for the cost and expense of
such removal and/or repairs immediately following billing for same by
City.
Nothing herein shall be construed as a waiver by City to eafefe
penal sanctions prescribed by the C ort Worth and
,��sr��� ��� ' !GCollb
the laws of the State of Texas for Grantees� i�, d ncroachment
upon the public rights-of-way following termination of this Consent
Agreement.
10.
It is further understood and agreed between the parties hereto that
City holds the city streets, alleys, sidewalks and other public rights-of-
way, including the portions of such streets used and encroached upon as
described herein, as trustee for the public; that City exercises such
powers over the streets as have been delegated to it by the Constitution
of the State of Texas or by the Legislature; and that City cannot contract
away its duty and its legislative power to control the streets for the use
and benefit of the public. It is accordingly agreed that if the governing
body of City, to wit, its City Council, should at any time during the term
hereof determine in its sole discretion to use or cause or permit to be
used for any public purpose the said encroached portion of the streets,
then this agreement shall be automatically canceled and terminated.
ll.
Grantee 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 said encroachments
and uses.
12.
Grantee 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. , � ;1�PC ECOG�D
i`cv %W.RRM Ri�M
13.
Grantee covenants and agrees that it shall exercise all rights and
privileges granted hereunder as an independent contractor, and not as an
officer, agent, servant or employee of City; that Grantee shall have
exclusive control of and the exclusive right to control the details of its
operations and activities on said described public property 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; that the doctrine of respondeat
superior shall not apply as between City and Grantee, its officers, agents,
servants, employees, contractors and subcontractors, and nothing herein
shall be construed as creating a partnership or joint enterprise between
City and Grantee.
14.
Grantee 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
maintenance, occupancy, use, existence or location of said
encroachment and uses granted hereunder, whether or not caused, in
whole or in part, by alleged negligence of officers, agents, servants, �, 4���t
7
employees, contractors, subcontractors, licensees or invitees of City;
and grantee hereby assumes all liability and responsibility of City, its
officers, agents, servants and employees, for such claims or suits.
Grantee 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 Grantee, its
officers, agents, servants, employees, contractors, subcontractors,
licensees, invitees or trespassers.
15.
Grantee 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 located and described in Exhibit "B".
The amounts of such insurance shall be not less than the following:
Property damage, per occurrence $1002000
Bodily injury, per person $2501000
Bodily injury or death, per occurrence $500,000
With the understanding of and agreement by Grantee that such insurance
amounts shall be revised upward at City's option and that Grantee shall so
revise such amounts immediately following notice to grantee of such
requirement. Such insurance policy shall provide that it cannot be canceled
or amended without at least thirty (30) days' prior written notice to the
Building Official of the City of Fort Worth. A copy of such Certific to of ' iKOPW
r ,Tui
Insurance is attached as Exhibit "A". Grantee agrees to submit a similar
s
Certificate of Insurance annually to City on the anniversary date of the
execution of this agreement.
Grantee 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 agreement and until the removal of all encroachments
and the cleaning and restoration of the city streets. All insurance coverage
required herein shall include coverage of all of Grantee's contractors.
16.
Grantee covenants and agrees that it will not assign all or any of its
rights, privileges or duties under this contract without the prior written
approval of City, and any attempted assignment without such prior written
approval shall be void.
17.
This agreement shall be binding upon the parties hereto, their
successors and assigns.
18.
Should any action, whether real or asserted, at law or in equity, arise
out of the terms and conditions of this agreement or out of the use and
occupancy of City property as permitted hereunder, venue for said action
shall be in Tarrant County, Texas.
19.
In any action brought by City for the enforcement of the obligations of
Grantee, City shall be entitled to recover interest and reasonable attorneys'
fees. '9 C�&L Ell,E(GUv�D
COY
R �' C'� o �� 0 9
EXECUTED This day of July , 2000.
GRANTOR: GRANTEE:
R.J.Miller and Associates, Inc.
CITY OF FORT WORTH RJ Miller, President
BY: AL BY:
BUI OFFICI
APPROVED TO F RM AND LEGALITY: President
TITLE
CIT TTORNEY DATE:
CITY SECRETAR DATE: ,-/-
Na mec 2&QU.r260
contract Authorization
Date
''i FC SAL P,EC0DD
C-� U '(-E PISWnEl)
STATE OF TEXAS
COUNTY OF TARRANT
BEFOREME, the undersigned authority, a Notary Public in and
Fo lte State f Te s jop this day personally appeared
►' L- "a��, ,known to me to be the person whose
name is subscribed to the foregoing instrument, and acknowledged to rite
that he/she executed the same for the uc erposes and ttst atior therein
expressed, as the act and deed of �� � ,
and in the capacity therein stated.
r ;� rr1�rDER :fY11A11D A1VD SEAL OF OFFICE this _ day
Of }
Affrattt
oti�aY' s, BRENDA J. NUNN
2 ° NOTARY PUBLIC
y STATE OF TEXAS
My Commission Expires 7-10-2001
otary Public h and or
The State of Te-r
11
0CAI
G°?ERA �
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
M 1 L.E&E ,known to me to be the person whose
name is subscribed to the foregoing instrument, and acknowledged to me
that he/she executed the same for the p�fpo�ses and consideration therein
expressed, as the act and deed of f '�.1) l2/ L.L ES 01C
and in the capacity therein stated.
VE UNDER MY HAND AND SEAL OF OFFICE this day
of 20-0-a.
Affia
l
Title'
Notary Public in and for
The State of Texas
�;;ac�nooc�cp000000a�00000000n�ooc�
CYNTHIA AN TURNER 8
; Notary Public,state of Texas 8
...../,:'My commission Exp.0613-2002
'3 g
12 Irl "{i`• °�` �`'' Cr--Or1C'
ok\L J: `u�_D
??�1 trr'��'r
L
07-10-2000 01:39PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 972-484-0159 T-466 P.001/001 F-315
Pa Olds Heavq oulq Post Bridges stem New&
g contractors with pedestrian overhead protection Canopq Frames
• Meets OSHA and local • The Heavy Duty 300 lbs. Canopy Frames can provide
codes for pedestrian per sq. ft. system (1,456 economical pedestrian pro-
protection. kgs per sq. meter] allows for tection on secondary
• Plain design can aes- use of erected scaffolding streets. Used in-conjunction
thetically blend with any or material storage on with Patent's Heavy Duty
jobsite. top. Post Bridge, a complete
• The standard design •16 ft. (4.9m) high drive- pedestrian canopy can be
provides 8 ft. wide (2.4m) thru bays available. provided. Canopy Frames
walkway. Other widths can • Fast and efficient erection (Part #03S) are 7'6' (2.3m)
be accommodated. and dismantling. high by 6' (1.8m) wide. They
provide 7' (2.1m] of unob-
• Standard 150 lbs. per sq. • Electrical lighting, plywood structed headroom for
ft. capacity 1732 kgs per sq. parapets and-siding can pedestrian traffic. (See back
mecerl. be added to enhance aes- page for illustration.)
thetics and eet safety _
W t'�o•t•"de re ent Typical Installation
KERw lett past Scafthfiiee can easily he of the Sidewalk Canopy
ml
Bridge Sheik erected atop canopies built
Caam�". Froin the B-h.-pride pest Frames provides a struc-
Iriroes. ♦ Lure with a load rating of
150 Ib/sq. ft. (732 kg/s o
using single bracing and
1
frame spacing up to 10'
(3.0m) on center. A load
funu,l _ - rating of 300 Ib/sq. ft.
(1965 kg/sq. m) can be
achieved with double brac-
ing, steel 1-beams as head-
ers, and frame spacing of
6' main) on center. Nuts on
the adjustable legs (02J)
can be used instead of the
normal handles to maximize
lift !q 114 clearance.
1VlU@�Y��1C'��
Igo VU`.7L:'UVUI YLiUia
07-10-2000 12:48PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 9T2-484-0159 T-461 P.001/001 F-306
Heavy Duty Post
8ri6'
. .
Canopy
7"6'
i
Sidewc&Canopy Fame
Heot 7'6' (229 m).,56 ibs. (2.54 kg).
.0.Ja7�yj .
Heavy Duty Sidewalk Bridge
7'(2.3 m),
8'(2.44 m),
10'(3.05 mJ
I
Brace
71123 m), 8'(2.44 m), 10'(3.05 m)
Horizontal Brace
S-SaH7; 13.4 lbs. (6.08 V
S8 } : 15.3 lbs. (6.94 k4 S-MrW; 18.9 lbs.(8.57 k6
�A3 H1Q:19.11 lbs. (a 66 V SZ3D$: 20.3 lbs. (9.22 kd
��:2P.6 Ibs.(10.7 kg)
8'12.44 m) 16' (4.88 m)
Post Post
6:$1: 79 lbs. _S-0; U2 lbs.
(35.81 (64.4 Wj
Clump
a$4:2.2 lbs. (1.0 w
ji-
W� o 'f��C �p TEE ji
O7-10-2000 02:03PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 972-484-0159 T-469 P.002/006 F-320
4Tx 9 ` aA A I
!i6 D (WELDe.0 /V PL ACS:) I
go
Z•.:�
39
ION
a 2Eo a
/5 Jf-ORol
� .
i
' .51,OE WA L X CAAIG Y PRAA4C
. .
• owls; l2.87-37 NtVI...�. � tsvlsa� oq+•
• ARAWNI ,Oro. 1• I 20�.'sd .�Q >s-
" Al�P'VDe �• 7.
SCALCI
• THE PATENT SCAFFOLDING Cd.. INC' :)S ' •
ty
07-10-2000 02:03PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 972-464-0159 T-469 P.003/006 F-320
MUETIN PSS-50
Maw
SIDEWALK CANOPIIES
d
Erected
roue aver®
Sectional
PATEW
0
07-10-1000 02:03PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 972-484-0159 T-469 P.004/006 F-320
Wieffide Frame
r ' Assures Strong,
0 Easyp4oxwEirect
Sidewalk Canopy
NEW Sidewalk Canopy 117-ames (Part #08) for use with
I' "Trouble Saver" Sectional Scaffolding,are 716" high by 6'
tt wide.They provide T of wiabstructed headroom for pedes-
trian traffic during overhead construction work,repairs or
t _ washing down. Canopies erected with these frames make a
neat installation which de Qnitely marks the contractor as
progressive.
Strong yet lightweieht, !%eae frames can be erected to
carry loads up to 300 lbte, per square foot. Standard
r' "Trouble Saver"braces,eacteneina legs and base plates are
used in the erection. For use on narsow sidewalks, Mo.
can also furnish a Tb"high by b'-wlde frame(Part X039).
REMODELING and eller0ttone on building In Wichita, Kanass, re• _
qulred the use of new 810awalk Canopy frames.Atop the canopy
was erected a"Trouble Bavar"Sectional Scaffold.
TYPICAL Installation of thews new Sidewalk Canopy framse to
provide a structure with a loved rating of 9000aq,it Nae that,to
achieve this rattnp, double bracing and 8"or T steel 1-beams as
headers, aro required. If no cad Is to be applied to the Canopy,
single bracing and frame spacing up in 10' may be used. Nuts
on the adjustable legs (02J), turned by a comaetfonal spanner
wrench, can be used InstaAii of the handles normally found on
029 extension Inge,
77
U tIF" p��j'V111
G ^n,1� •�S'i511 11
07-10-2000 02:03PM FROM-PATENT CONSTRUCTION SYSTEMS DALLAS 972-484-0159 T-460 P.005/006 F-320
9
SIDEWALK CANOPY FRAME Is B`wide and Te'high, providing 7` TYPICAL of the clean. neat Inatglllaelorts poastWe with "Tm WO
of headroom for pedestrians. saver" Canopy frames Is this ltuNlletlop In Schenectady, N.Y.
Adluntablo togs components for siops'of sidewalk.
I,
I I
I �
5
SGAFFOLDINQ can eaelly bpi eractod atop Canopies bull trom NEW YORKs4y6crapar conlractorvalso find those frames make
these now W.-widu frames.Consult Your nearest Patent Scaffolding an Ideal Sidewalk Canopy. On this installation, part of sidewalk
Co. office for load factors beaed on various Jolet spacing and ,Otey was walled off. 'Tubetox" Scaffolding provides handrail.
�l�b' K'r fid c'1`(
07-10-2000 02:04PM FROM-PATENT CONSTRUCTION SYSTEMS
DALLAS 972-464-0159 T-469 P.006/006 F-320
a
TWO FRAMs:-WIDE Sidewalk Canopies,such an thilt installation In Datralt, are sametime& required In special circumstances. In this aline, also, a eoaftold was readily
erected atop the canopy,for comlae removal operations.
J
i � it �r ).�. .. .•. ,.
it �• • -�W .,:4��`-i•' , .. ,.;.
PITTSBURGH'S famous Gateway center STEEL I-t3EaM In U-head atop frame leg provides rigid support for 2'planking which
protects pedestrians by means of this formed the ;roteouve covering over sidewalk an Inetal stlona In Detroit. Canopy was
email Canopy aracte4 with "Trouble acclaimed ty contractor,hotel owners and City Officials,
Saver"6'-wfds framee.caulking work was
being performed overhead.
SALES . . RENYAI:S
60CUTW OFFICE
OW BfaME PLATA.FORT LEE,N.J. USA 07024 ��� «»—•
TELEPHONE.,201-4014F700 • TWX 710 901 95119 ■tpI OLDINa OCL Y
be"6A 91m9,MA Ci9MNMs1,am fly MvrM FL -&164Clq.Of MMV1 1'111011 1116 441 an Room.G Thwe,FL
191.093.1011 617-M-M 21f-771.3396 813-W-1233 816.421-3190 41+M-9121 215-743-611'0 41642~ Y17•Q1aN1
awe CUr,lu 'Cs19or.Wy 1110111111 IN Nift trsith,Thi las AIp ft,CA Men loam.U nos"All on im,III 761166 ITC
111111111114464W 601'-2*111 19 214.367.0961 917+991!-9619 213-776-20% 59*733-2611 40-21MOI 1667��2 91tt•591,1d11
I9lsle111K W Cbwbu,IIC 111pow.e0 NOK CT WOOL TN tmwwk Nu ItlNiow$L PA $No&t!�
3r1-121VIII 104.319.1771 303.177.1901 203 623.1291 001.368-299 201.1"12 414.22W,17 6&707.01
kwi as Ix China.IL 011111n6.IE PrAft,TX M14m1 FL tNW Yule.tilt Pmud,ell R lwdL N
4MA31-M 912.877.2626 919-931.90D0 719.344.1712 905-734.0565 212.761.2100 503.263.3115 s14�1.7080
1 10Wssaft4wimm Cc 'M•B c renin"W Sup*Co. 46PNO Go. �.■.�..__-_--
MI CAUM CMW M FWW WAMM6M W L16• t011eMM�O3•4MN= MOMIM K 514-V+W9 T1 71410*71MM =M4&V3-9331
W N9=AtMW 9 FA1UiTA001&x a C& ■EI=Citi W41EW
IM 9111016tiAnAt WUMWAVK EslWwo"",Maim o15:,'i broia kWW T111N rd Lit SYrYr.lrl.WEr49RWW2198 9 W 0M R£rAq 81 � �•u�1�I
3►WrMMrCMlpi11Y. iM/NQ�CB17i•..Jfi�JflrZTArlI 3011071L19F13�5109}I,�Illll•Ipt7�1�11rIIJ ^•!�C7.1(�,?�/r•
MAN WA M AossrW Wily.A0 PN MM arA 19AprWM WIrY be WI W WMuad W We only*lot WMmANd br tri or fo amemu mpolans.cWdn 41 WWI="ad am M AN JA 491q �
IoW 119 PMiAWWW UA IA IN 1111010111119 mq M 01490 WO MW40 win CwI mtity WO seN pra%M.SPIC040"W POW"Wo sgipmm W M11Nh-n WfF Raw to MAP Visas 411WW.,i
Client : 30146 RJMIL
A.�O1r?L�. CERTIFICATE OF LIABILITY INSURANCE 03/(13/00
PR,DDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
HIGGINBOTHAM & ASSOC. , INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. 0. BOX 908 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Fort Worth, TX 76101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
817 336-2377 INSURERS AFFORDING COVERAGE
INSURED INSURERA:General Accident Ins Co ofAmeric
R.J. Miller & Associates, Inc. dba INSURER B:Camden Fire Insurance Assoc .
3624 W. Vickery Blvd. INSURER C:Potomac Insurance Co of Illinois
Fort Worth, TX 76107
INSURER O:
INSURER E:
OVERAGES
THE POLICES 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAUS.
NSRTYPE OF INSURANCE POLICY NUMBER POUCY EFFECATE TIVE POLICY EXPIRATIONOMITS
A GENERALUABILITY CPP121342700 07/22/99 07/22/00 EACH OCCURRENCE $1, 000 , 000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) 32 0 O 0 0 0
CLAIMS MAD X OCCUR MED EXP(Any one person) $10, 000
PERSONAL&ADV INJURY $1, 000 , 000
GENERAL AGGREGATE s2 , 000 , 000
GENLAGGREGATE LIMIT APPLIES PER: PROD UCTS-COMP/OP AGG s2, 000, 000
POLICY PRO-JECT LOC
B AUTOMOBILE LIABILITY BA028883400 07/22/99 07/22/00 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1, 000, 000
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per penon)
X HIRED AUTOS
BODILY INJURY $
X NON-OWNED AUTOS (Peraccident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANYAUTO OTHER THAN EAACC $
1 AUTO ONLY: AGG $
C E=ESSUASILm CIM015348100 07/22/99 07/22/00 EACH OCCURRENCE 34 000000
X OCCUR ❑CLAIMS MADE AGGREGATE S4 0 00, 000
S
DEDUCTIBLE $
Ex'
RETENTION $10000 ! $
B WORKERSCOMPENSATIONAND WC035048500 07/22/99 07/22/00 WCSTATjT 0TH
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500, 000
17EXHIBIT E.L.DISEASE-EAEMPLOYE $5 0 O 0 0 0
E.L.DISEASE-POLICY LIMI S5 0 O 0 0 0
OTHER
DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES/E=LUSIONSADDED BY CIALPRCVISIONS
The City of Fort Worth is named as Additional Insured as respects General
Liability & Automobile Liability. A Waiver of Subrogation is issued in
favor of the City of Fort Worth as respects General Liability, Automobile
Liability and Workers' Compensation policies.
CERTIFICATE HOLDER ADDITIONALINSURE INsuRERLETI-EI} CANCELLATION
SHOULD ANY OFTHE ABOVE DESCF013E D POLICES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Worth DATETHEREOF,THEISSUING INSURER WILL ENDEAVORTOMAIL3..0._DAYSWRITTEN
Transportation and Public Works NOTICETOM-ECUTTI ICATEHOLDERNA1rEDTOTHEtffT.BUTFAIUJRETOOOSOSHALL
1000 Throckmorton St . IMPOSE NO OBLIGATION ORLJABILITYOFANY KIND tnpf I , OR
Fort Worth, TX 76102 REPRESENTATIVES �t � �" I(;u�1J!Li
AUTHORIZED RESENT CNN WN6UWs1!
ACORD 25-S(7/97)1 of 2 #S40921/M33510 SHA 'TIOI 1 11988
f
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
Ric '1 VICORD
ACORD25-S(7/97)2 of 2 #S40921/M33510
B � d JC
ra V ' J I
1181HX3014.
14, c • Q43
M
o-�
w r n is a
Q Lu n 0
c
noCO
Qo O o 41
n� a I 4 6�
Z U X X y
S► Z G� U
Lu
t V V
Z05 N h
_
S
C 0 \tQ
� �l�{� -S S'Lyr7 n' CffYn
C
FF
S
� M , � • . . Oq�Q�G
is � I lea