360Network-CS040901RIGHT -OF -WAY MAINTENANCE USE FEE
Ordinance No. 2001 -944, Sec. 6 -14 -3.
Registration Form for Service Provider
Registration expires March 1 of every other year after the calendar year in which the first
registration occurs. If registration is not renewed by the expiration date, after written notice
from the City, the facilities of the service provider will be deemed to have been legally abandoned.
Service Provider (include any business name provider operates under or has
operated under for past 5 years) .A_)r, I l & W g- 7" b�'r m 400 rKs
PUC Certificate Number (for certificated telecommunications providers) In Q 9 ' -3
City of Coppell License Ordinance No. / /OO 'n A k f r4� ; S r��e r;-CLACE-
Contact Names/Numbers
Contractor(s) Namev 61 �, r�7n 5frccC. vow
Contact Information
Emergency Contact 6 ti�- C6, 77- 734- 73 G&
Liability Insurance Gamier (-T C��, -tic h Sri
(Sec. 6 -14 -3 (h))
Attach proof of coverage
Plans of Record provided to Engineering Dept. for existing facilities -J--�Y N
For proposed facilities Y N
Forward registration form and fee to Engineering Dept., City of Coppell,
2S5 Parkway Blvd., Coppell TX 75019
For office use only
Registration Fee of $250.00 paid / / Receipt No.
ACORD,. 'CFRT1FICA.' '
PRODUCER
Aon Risk services, Inc. of Colorado
4100 East Mississippi Avenue
Suite1500
Denver CO 80246 USA
FAX
INSURED
360networks Corporation
867 Coal Creek Circle
Suite #160
Louisville CO 80027 USA
L Y 11N S URANCE "" : DATE (MM /DD /YY)—
09/01/04
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
758 -9458
INSURER A
IN B
INSURER C.
INSURER D:
INSURER E:
INSURERS AFFORDING COVERAGE
American Home Assurance Co.
Commerce & industry Ins Co
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE 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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR TYPE OF INSURANCE POLICY NUMBER �12/01/03 ICY EFFECTIVE POLICY EXPIRATION
A DATE(MM\DD\YY) LIMITS
GENERAL LIABILITY RMGLA2507363 _ 1 � /m inn
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
GEN1. AGGREGATE LIMIT APPLIES PER
] POLICY [] ECOT EJ LOC
AUTOMOBH,E LIABILITY
A ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON OWNED AUTOS
GARAGE LIABILITY
I ANY AUTO
EXCESS LIABILITY
] OCCUR ❑ CLAIMS MADE
DEDUCTIBLE
RETENTION
I WORKERS COMPENSATION AND
B
EMPLOYERS' LIABILITY
OTHER
CA3598953
A05 except TX & MA
CAS188713
Texas Auto
All other States Except CA
WC2981720
California WC only
EACH OCCURRENCE
$1,000,000
F one fire)
$ S O, 000
erson)
$10 , 000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG I $1,000,000
®ROPERTYDAMAGE ED SINGLE LIMIT
11/30/03 11/30/04 ent) $5,000,
INJURY
(Per on)
INJURY
ent)
DAMAGE
ent)
AUTO ONLY _ EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY
AGG
EACH Orrr 1R R 9.,.
11/30/03 11/30/04 X WC STATU- OTH_
TORY LIMITS ER
11/30/03 11/30/04 E.L. EACH ACCIDENT $11000,000
E.L. DISEASE - POLICY LIMIT $1,000,0 0
E.L. DISEASE -EA EMPLOYEE $1,000,0 0 ,
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
Cancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of,
and reason for, the cancellation.
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360networks (USA) :nc. 1066 W. Hastings St., #1500 Vancouver BC VIBE 3XI CANADA
Stub 1 of 1
Cnetworks 360networks (USA) Inc.
1066 W. Hastings St., #1500
Vancouver BC V6E 3X1
CANADA
USID TOTAL: 250.00
BANK OF AMERICA NA
901 MAIN STREET
DALLAS TX 75202
USA
PAY »« « TWO HUNDRED FIFTY AND 001100....
250.00
MR,
09/09/04 00013363
USD 250.00
'HE CITY OF COPPELU COPPIELL ISID
I jER STEPHANIE TUMLISON, TAX ASSESSOR
P.O. BOX 9478 PER
COPPELL TX 75019-0000
USA
PER
VOID AFTER 90 DAYS
111000 L3363111 1: L L L0000 L 21: 3 ?5 5 50 38 L ?v
Onetworks
September 13, 2004
Engineering Department
Attn: Rhonda Brothers
255 Parkway Blvd.
Coppell, TX 75019
Dear Ms. Brothers:
Enclosed please find our check for the name change fee for our
telecommunications license from Touch American to 360networks(USA) inc.
Please don't hesitate to call if you have any questions.
Sincerely,
Atw
Mitchell Merryman
303 - 854 -5271