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HomeMy WebLinkAboutTUP23-001514 This is an arial view of our property, Cross Creek at Grapevine Ranch. In the direct center with a dark blue circle around it is our leasing office. We will have some of the animal rescues inside there. The dark blue lines indicate where we’ll be placing food trucks as well as animal rescues and shelters that have a dog transport truck that the dogs will stay on. In light green, marked with an arrow and P1, P2 and P3 indicate open parking lots available for attendees. We also have a large parking garage onsite that is available for use. We will have someone directing arriving attendees to the parking areas available for them to park at. Below is an ariel view of the parking available onsite, to the right of our property. All the open spaces that are uncovered are available for attendees. Below is an ariel view of the parking available onsite, to the left of our property. All the open spaces that are uncovered are available for attendees. Below is an ariel view of our pool area, which is where we will have a DJ (with only 2 speakers) playing. Our event will last for a total of 5 hours, with attendees coming at various times during the event. We will have staff directing arriving attendees to the parking areas the entire event and do not anticipate there to any traffic issues on the main road. 09/15/16 Tarrant County Public Health Department Environmental Health Promotion 1101 S. Main Street, Room 2300 Fort Worth, Texas 76104 Phone: (817) 321-4960 Fax: (817) 321-4961 Temporary Food Establishment Permit Application PLEASE COMPLETE & RETURN THIS FORM WITH FEE FOR EACH STAND AT LEAST 10 DAYS BEFORE THE START OF THE EVENT. Fee Information: (submit one of the following) 1) $35.00 for each stand or unit. We are unable to accept credit/debit cards by phone or online. 2) IRS 501 (c) (3) official recognition documentation for tax exempt charitable organizations. General Event Information: 3) Name of Event: ___________________________________________________________ 4) Date(s) of Event: __________________________________________________________ 5) Hours of Operation: ________________________________________________________ 6) Location of Event: _________________________________________________________ 7) Event Coordinator: Name: ___________________________________________ Phone: ________________ Address: ________________________________________________________________ Applicant Information: 8) Your Organization/Business Name: ___________________________________________ 9) Applicant’s Name: _________________________________________________________ Address: ________________________________________________________________ City: ____________________________ State: _________________ Zip: ____________ Business Phone: _______________________ Home Phone: _______________________ Mobile Phone: _________________________ Fax: ______________________________ Email: __________________________________________________________________ 10) Does this business have a current mobile food unit or pushcart permit from the Tarrant County Health Department? [ ] Yes [ ] No If yes, what is the permit type and site number? __________________________________ Note: Vendors with these types of health permits are not required to pay the permit fee for a temporary food service establishment. 11) List full menu to be served at the event: ________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 09/15/16 Temporary Food Establishment Permit Application Page 2 Tarrant County Public Health Department 12) Where will the food be purchased/obtained from: ________________________________ _______________________________________________________________________ 13) Will any foods be prepared prior to the start of the event? [ ] Yes [ ] No If yes, where will the food be prepared? _______________________________________ _______________________________________________________________________ If answering yes to question 11, all foods prepared prior to the event are required to be made in an approved and permitted facility. A copy of the Food Establishment Permit and signed Commissary Agreement (attached) are required for approval of this application. Applications submitted without this information will be returned. Has a copy of the Food Establishment Permit and signed Commissary Agreement been included with this application? [ ] Yes [ ] No [ ] N/A 14) Will frozen foods be thawed at the event? [ ] Yes [ ] No If yes, describe process/method to be used: ____________________________________ 15) How will any leftovers of cooked food be handled at the end of the day? _______________________________________________________________________ 16) How will food temperatures be checked during the event? __________________________ 17) Describe equipment used at the event for: a) Cold holding: _________________________________________________________ b) Hot holding: _________________________________________________________ c) Cooking/Reheating: ___________________________________________________ 18) Describe hand washing facilities inside your temporary food establishment: [ ] Plumbed Sink [ ] Gravity Flow Set-up 19) Describe utensil washing facilities inside your temporary food establishment: [ ] 3 Compartment Sink [ ] 3 Basin Set-up 20) How will hot water be made available for the hand wash and utensil washing stations? _______________________________________________________________________ 21) What type of sanitizer will be used at the event? _________________________________ 22) How will potable water be obtained during the event? _____________________________ 23) How will waste water from hand & utensil washing be disposed? ____________________ _______________________________________________________________________ Form completed by: ___________________________________________________________ Name/Title Date FO O D H A N D L E R S : Av o i d f o o d h a n d l i n g w h e n y o u h a v e t h e f o l l o w i n g sy m p t o m s .  Di a r r h e a .  Vo m i t i n g .  So r e t h r o a t w i t h f e v e r .  Pe r s i s t e n t c o u g h i n g , s n e e z i n g o r n a s a l d i s c h a r g e .  Wo u n d c o n t a i n i n g p u s u p o n y o u r f i n g e r s , h a n d s , wr i s t s .  Ye l l o w i s h e y e s o r s k i n w i t h d a r k c o l o r e d u r i n e . Re p o r t a n y o f t h e s e s y m p t o m s t o y o u r m a n a g e r i m m e - di a t e l y . Pe r s o n n e l t h a t h a n d l e f o o d m u s t w a s h t h e i r ha n d s a s f r e q u e n t l y a s n e c e s s a r y . D i s p o s a - bl e g l o v e s m a y b e u s e d b u t t h e i r u s e d o e s no t s u b s t i t u t e f o r h a n d w a s h i n g . Th e u s e o f t o b a c c o i n a l l f o r m s i s p r o h i b i t e d i n t h e f o o d pr e p a r a t i o n o r s e r v i c e a r e a s . Pe r s o n n e l s h a l l n o t e a t o r d r i n k i n t h e f o o d p r e p a r a t i o n or s e r v i c e a r e a s . Ha i r r e s t r a i n t s a n d c l e a n c l o t h i n g a r e r e q u i r e d o f p e r - so n n e l d o i n g f o o d p r e p a r a t i o n . F o o d h a n d l e r s a r e n o t pe r m i t t e d t o w e a r o r n a t e h a n d j e w e l r y . Un a u t h o r i z e d p e r s o n n e l s u c h a s s m a l l c h i l d r e n a r e n o t pe r m i t t e d i n b o o t h s . BA R E H A N D C O N T A C T : Ba r e h a n d c o n t a c t o f r e a d y t o e a t f o o d b y w o r k e r s i s no t a l l o w e d . Re a d y -to -ea t f o o d i n c l u d e s a n y f o o d , f r u i t o r v e g e t a b l e pr o d u c t t h a t i s e d i b l e w i t h o u t w a s h i n g , c o o k i n g , o r a d - di t i o n a l p r e p a r a t i o n b y w o r k e r s , a n d i s r e a s o n a b l y e x - pe c t e d t o b e c o n s u m e d i n t h a t f o r m . Av o i d t o u c h i n g f o o d w i t h b a r e h a n d s b y u s i n g u t e n s i l s , di s p o s a b l e g l o v e s , d e l i t i s s u e o r o t h e r s u i t a b l e m e t h o d s . Te m p o r a r y F o o d Es t a b l i s h m e n t Re q u i r e m e n t s Ta r r a n t C o u n t y P u b l i c H e a l t h D e p a r t m e n t 11 0 1 S . M a i n S t . , R o o m 2 3 0 0 Fo r t W o r t h , T e x a s 7 6 1 0 4 81 7 -32 1 -49 6 0 CH E C K L I S T :  Va l i d t e m p o r a r y o r m o b i l e f o o d u n i t p e r m i t i s s u e d by T a r r a n t C o u n t y P u b l i c H e a l t h D e p a r t m e n t .  Fo o d f r o m a n a p p r o v e d s o u r c e . N o f o o d p r e p a r e d in a p r i v a t e h o m e . Fo o d i n v o i c e s / r e c e i p t s m u s t b e av a i l a b l e a t b o o t h f o r i n s p e c t o r ’ s a u d i t .  Ad e q u a t e s u p p l y o f p o t a b l e w a t e r a t b o o t h .  Wa s t e w a t e r c o n t a i n e r s a n d p r o p e r d i s p o s a l s i t e .  Bo o t h s w i t h c l e a n a b l e f l o o r (g r a s s a n d d i r t c o v e r e d wi t h a p p r o v e d m a t e r i a l ) a n d o v e r h e a d p r o t e c t i o n .  BB Q a n d d e e p -fr y i n g c o o k i n g a r e a s f e n c e d o f f fr o m p u b l i c a c c e s s .  Ad e q u a t e c o n t a i n e r s , c o v e r s , w r a p p i n g s o r o t h e r me a n s t o e f f e c t i v e l y p r o t e c t f o o d f r o m i n s e c t s a n d ot h e r e n v i r o n m e n t a l c o n t a m i n a t i o n .  Ha n d w a s h s t a t i o n s e t u p a n d r e a d y f o r u s e .  5 g a l . c o n t a i n e r w i t h n o n -se l f -cl o s i n g s p i g o t .  Li q u i d s o a p i n p u m p d i s p e n s e r .  Pa p e r t o w e l s .  Wa s t e w a t e r c a t c h b u c k e t .  Ut e n s i l c l e a n i n g s t a t i o n s e t u p a n d r e a d y f o r u s e .  3 c o n t a i n e r s (s i z e d t o i m m e r s e a l l i t e m s )  So a p y w a t e r i n 1 st co n t a i n e r .  Cl e a n r i n s e w a t e r i n 2 nd co n t a i n e r .  Sa n i t i z i n g s o l u t i o n i n 3 rd co n t a i n e r .  Sa n i t i z e r c o n c e n t r a t e (b l e a c h ) an d t e s t s t r i p s .  En o u g h e q u i p m e n t p r o v i d e d t o h o l d A L L :  Co l d f o o d s a t 4 1 ° F o r b e l o w .  Ho t f o o d s a t 1 3 5 ° F o r a b o v e .  Pr o b e -ty p e , m e t a l s t e m f o o d t h e r m o m e t e r w i t h pr o p e r r a n g e (0 ° F t o 2 2 0 ° F ) .  Ut e n s i l s a n d d i s p o s a b l e g l o v e s p r o v i d e d t o m i n i - mi z e h a n d c o n t a c t w i t h f o o d .  Wo r k e r s a r e w e a r i n g c l e a n c l o t h i n g a n d h a i r i s ef f e c t i v e l y r e s t r a i n e d .  Wo r k e r s h a v e n o o p e n s o r e s a n d a r e f r e e o f i l l n e s s sy m p t o m s l i s t e d i n b r o c h u r e .  Wo r k e r s k e e p h a n d s c l e a n a n d w a s h h a n d s f r e - qu e n t l y .  No b a r e h a n d c o n t a c t w i t h r e a d y t o e a t f o o d .  Co n d i m e n t s p r o v i d e d i n s i n g l e -se r v i c e , p u m p -ty p e or s q u e e z e c o n t a i n e r s .  Sn e e z e g u a r d s a n d b a r r i e r s t o p r o t e c t e x p o s e d f o o d an d f o o d w o r k s u r f a c e s f r o m c u s t o m e r s . TE M P O R A R Y F O O D E S T A B L I S H M E N T : Th e t e r m t e m p o r a r y f o o d e s t a b l i s h m e n t a p p l i e s t o a n es t a b l i s h m e n t t h a t o p e r a t e s a t a f i x e d l o c a t i o n f o r a p e r i - od o f t i m e o f n o t m o r e t h a n 1 4 c o n s e c u t i v e d a y s i n c o n - ju n c t i o n w i t h a s i n g l e e v e n t o r c e l e b r a t i o n . PE R M I T R E Q U I R E D : Pe r s o n s v e n d i n g o r o f f e r i n g s a m p l e s o f f o o d o r b e v e r a g e pr o d u c t s m u s t s e c u r e a v a l i d T a r r a n t C o u n t y H e a l t h D e - pa r t m e n t p e r m i t p r i o r t o o p e r a t i o n . P e r m i t s i s s u e d b y ot h e r h e a l t h a u t h o r i t i e s a r e n o t a c c e p t a b l e . Ve n d o r s h a n d l i n g o n l y c o m m e r c i a l p r e - p a c k a g e d , s h e l f - st a b l e , n o n -po t e n t i a l l y h a z a r d o u s f o o d s d o n o t n e e d a pe r m i t . CO N S T R U C T I O N O F S T A N D : Al l s t a n d s m u s t h a v e a s u i t a b l e t i g h t - fi t t i n g , w a t e r r e p e l l e n t r o o f o r c e i l i n g t o p r o v i d e f o r o v e r - he a d p r o t e c t i o n o f f o o d p r e p a r a t i o n , c o o k i n g a n d s e r v i n g ar e a s . Al l s t a n d s m u s t h a v e a p p r o v e d f l o o r i n g , w h i c h i n c l u d e s co n c r e t e , a s p h a l t o r t i g h t -fi t t i n g p l y w o o d o r o t h e r s i m i l a r ap p r o v e d m a t e r i a l . If f u l l w a l l s a n d s c r e e n i n g a r e p r o v i d e d , o t h e r s u i t a b l e me t h o d s o f p r o t e c t i n g f o o d f r o m c o n t a m i n a t i o n , s u c h a s co n t a i n e r s , c o v e r s o r w r a p p i n g s m u s t b e u s e d . Ad e q u a t e c o v e r e d r e c e p t a c l e s f o r d i s p o s a l o f s o l i d w a s t e mu s t b e p r o v i d e d . Ad e q u a t e t o i l e t f a c i l i t i e s m u s t b e a c c e s s i b l e f o r w o r k e r s . WA T E R S U P P L Y & W A S T E W A T E R D I S P O S A L : Po t a b l e w a t e r m u s t b e f r o m a n a p p r o v e d s o u r c e a n d k e p t on -si t e i n s u f f i c i e n t q u a n t i t i e s f o r e a c h d a y ’ s u s e . Al l w a s t e w a t e r g e n e r a t e d f r o m t h e t e m p o r a r y f o o d e s - ta b l i s h m e n t ( f r o m b e v e r a g e d i s p e n s e r s , s i n k s , s t e a m t a - bl e s , i c e m e l t , e t c . ) m u s t b e d i s p o s e d o f i n t o t h e s a n i t a r y se w e r s y s t e m o r a p p r o v e d s e p t i c s y s t e m . UT E N S I L W A S H I N G : Th o s e s t a n d s t h a t d o n o t h a v e 3 -co m p a r t m e n t s i n k s w i t h ho t a n d c o l d r u n n i n g w a t e r m u s t p r o v i d e t h e f o l l o w i n g : Th r e e ( 3 ) s t u r d y p l a s t i c o r s t a i n l e s s s t e e l b u c k e t s o r tu b s o f a d e q u a t e s i z e t o b e u s e d f o r u t e n s i l c l e a n i n g an d s a n i t i z i n g . On e b u c k e t o r t u b s h a l l b e u s e d t o w a s h ( s o a p y w a - te r ) ; On e b u c k e t o r t u b s h a l l b e u s e d t o r i n s e ( c l e a n , c l e a r wa t e r ) ; On e b u c k e t o r t u b s h a l l b e u s e d t o s a n i t i z e ( l i q u i d ch l o r i n e b l e a c h / w a t e r s o l u t i o n w i t h 2 t e a s p o o n s o f bl e a c h p e r g a l l o n w a t e r ) . U s e c h l o r i n e t e s t s t r i p t o ve r i f y p r o p e r s t r e n g t h o f 5 0 t o 1 0 0 p p m . HA N D W A S H I N G : So a p , p a p e r t o w e l s a n d a c o n t a i n e r ( 5 g a l l o n m i n i m u m ) wi t h a s p i g o t t h a t r e m a i n s o p e n t o w a s h b o t h h a n d s s h a l l be p r o v i d e d f o r h a n d w a s h i n g . Co n t a i n e r s w i t h s e l f -cl o s i n g s p o u t s a r e n o t a c c e p t a b l e . In a d d i t i o n , a b u c k e t t o c a t c h w a s t e w a t e r s h a l l b e p r o - vi d e d . FO O D P R E P A R A T I O N : Al l f o o d s m u s t b e f r o m a n a p p r o v e d s o u r c e a n d / o r l i - ce n s e d f a c i l i t y o r p r e p a r e d i n t h e t e m p o r a r y b o o t h . An a p p r o v e d s o u r c e i s a n e s t a b l i s h m e n t th a t i s u n d e r i n s p e c t i o n a n d / o r l i c e n s e d b y a h e a l t h a u t h o r i t y . NO fo o d s p r e p a r e d i n a p r i v a t e h o m e m a y be s o l d o r s e r v e d t o t h e p u b l i c . On l y s i n g l e -se r v i c e , d i s p o s a b l e i t e m s a r e t o b e p r o v i d e d fo r c u s t o m e r u s e . Al l f o o d s , f o o d c o n t a i n e r s , u t e n s i l s , n a p k i n s , b e v e r a g e cu p s , s t r a w s a n d o t h e r s i n g l e s e r v i c e i t e m s m u s t b e s t o r e d at l e a s t s i x i n c h e s a b o v e t h e f l o o r a n d p r o t e c t e d f r o m sp l a s h , d u s t , i n s e c t s , w e a t h e r o r o t h e r c o n t a m i n a t i o n . Al l p o t e n t i a l l y h a z a r d o u s f o o d p r o d u c t s m u s t b e st o r e d a t 4 1 ° F o r l o w e r o r a t 1 3 5 ° F o r a b o v e . A me t a l s t e m p r o d u c t t h e r m o m e t e r ( 0 ° F t o 2 2 0 ° F ) mu s t b e a v a i l a b l e a t t h e s t a n d s t h a t s e l l p o t e n t i a l l y ha z a r d o u s f o o d s . Se l f -se r v i c e o f i c e b y p a t r o n s i s n o t p e r m i t t e d . I c e s c o o p s mu s t b e u s e d b y w o r k e r s t o d i s p e n s e i c e . I c e f o r h u m a n co n s u m p t i o n m u s t b e s t o r e d s e p a r a t e l y f r o m i c e u s e d t o ch i l l o t h e r f o o d s o r b e v e r a g e s . Fo o d s a n d b e v e r a g e s c h i l l e d i n i c e m u s t n o t b e s u b - me r g e d i n w a t e r . T h e i c e s t o r a g e u n i t m u s t h a v e o p e n dr a i n s a n d c o v e r s . S t y r o f o a m i c e c h e s t s a r e n o t a c c e p t a - bl e f o r t h e s t o r a g e o f i c e o r o t h e r f o o d s p r o d u c t s . Al l c o n d i m e n t s , i n c l u d i n g o n i o n s , r e l i s h , c a t s u p , m u s t a r d , ma y o n n a i s e , e t c . , a v a i l a b l e f o r c u s t o m e r s e l f -se r v i c e m u s t be a v a i l a b l e i n s i n g l e s e l f -se r v i c e p a c k e t s o r p r o p e r l y di s p e n s e d f r o m s a n i t a r y d i s p e n s e r s . Cu s t o m e r s e l f -se r v i c e o f o p e n c o n d i m e n t s f r o m c o n t a i n - er s , e v e n i f p r o v i d e d w i t h l i d s , i s n o t a l l o w e d . So a p SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY C 1,000,000 01/01/2024 GGR30000169302 X HOU-004006909-01 1,000,000 03/01/2024 10,000,000 WCRS1088K0 (WI) X X 11551 10,000,000 See Attached0308-8595 of Marsh USA LLC Attn: Greystar@marsh.com N X EBL: $1M/$1M 01/01/2023 Allied World Assurance Company 1 01/01/2024 03/01/2023 Products Completed 03/01/2024 greystar@marsh.com GAR30030141600 Excess Liability A 4,000,000 2,000,000 10,000,000 X 20699 Endurance Assurance Corporation 1,000,000 X D 04/24/2023 See Attached 03/01/2023 90,000,000 The City of Grapevine is included as Additional Insured where required by written contract. X 01/01/2023 Grapevine, TX 76051 City of Grapevine Various - See Acord 101 E 03/01/2022 X B ACE Property & Casualty Insurance Company CN102368349-FullE-GAWUX-23-24 Excess - $90M Xs $10M Excluded 01/01/2024 1,000,000 G72508877 003 Environmental X A 2,000,000 11126 500,000 1,000,000 03/01/2024 WCDS1086I0 99 HIGH STREET MARSH USA, LLC. X BOSTON, MA 02110 600 E. Las Colinas Blvd. Suite 2100 Greystar Real Estate Partners, LLC Irving, TX 75039 X See Attached Acord 101 01/01/2023 200 S. Main Street 03/01/2023 A Victoria Williams 03/01/2024 19489 Sompo America Insurance Company ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: � $15,000,000 Excess $40,000,000 - XL Insurance America, Inc. - US00066704LI23A A+ XV� ACE Property & Casualty Insurance Company A++ XV� $15,000,000 Excess $55,000,000 - Ohio Casualty Insurance Company - ECO(24)58399876 A XV� AM Best ratings as of 2/27/2023: � $25,000,000 Excess $25,000,000 - ACE Property and Casualty Insurance Company - XEU G72508877 003 - A+ XV � Allied World Assurance (US) Inc - Policy No. 0308-8595 A XV� $3,000,000 - Policy Aggregate� $10,000,000 p/o $30,000,000 Excess $70,000,000 - National Casualty Company - ECO2300108 A+XV� 2 Marsh, Inc. makes no representations or warranties, expressed or implied, concerning the financial condition or solvency of any insurers or reinsurers. A.M. Best’s Ratings are under continuous review and subject 2 $15,000,000 Excess $10,000,000 - Fireman's Fund Insurance Company - USL005025232 A+ XV� � Dallas Terrorism is included � � Excess Liability Schedule:� � Automobile Liability and Workers Compensation coverage is for first named insured.� �� General Liability and Umbrella Deductible $0� Self-Insured Retention $500K� Certificate of Liability Insurance � CN102368349 to change and/or affirmation. For the latest Best’s Ratings and Best’s Company Reports (which include Best’s Ratings), visit the A.M. Best website at www.ambest.com. Refer to the Guide to Best’s Ratings for � � � Sompo American Insurance Company A+ XV� � � � explanation of use and charges. Best’s Ratings reproduced herein appear under license from A.M. Best and do not constitute, either expressly or impliedly, an endorsement by Marsh. A.M. Best is not responsible $150,000 Deductible - Each Incident� $3,000,000 - Each Incident� $15,000,000 p/o $30,000,000 Excess $70,000,000 - Aspen Specialty Insurance Company - Non-Admitted - CX00FRN23 A XV� � MARSH USA, LLC.� for transcription errors made in presenting Best’s Ratings. Best’s Ratings are proprietary and may not be reproduced or distributed without the express written permission of A.M. Best Company. 600 E. Las Colinas Blvd. Suite 2100� Greystar Real Estate Partners, LLC� Irving, TX 75039 $5,000,000 p/o $30,000,000 Excess $70,000,000 - Navigators Insurance Company - NY23MXE831781IV A+ XV� � Enviromental Site Liability� $150,000 Deductible - Will Apply For All Claims Arising From Mold, Asbestos & Lead� 25 $15,000,000 Excess $25,000,000 - Ascot Insurance Company - Non-Admitted - EXNA2210000208-02 A XIV�