Time Warner-CS081230ORD CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDD/YYYY)
12/30/2008
PRODUCER
MARSH USA INC.
TWO LOGAN SQUARE
! PHILADELPHIA, PA 19103 -2797
Attn: Comcast.Certs @marsh.com Fax: 212 - 948 -0360
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.
INSURERS AFFORDING COVERAGE
INSURER A: ACE American Insurance Company
NAIC #
22667
L05_1194 - ALL - GAWU -08 -09 COMIC IRVING TX
— -
INSURED
COMCAST CABLE OF INDIANA/MICHIGAN/
TEXAS, INC.
2951 KINWEST PARKWAY
INSURER B: ACE Property And Casualty Ins Cc
20699
INSURER C: Indemnity Ins Co Of North America
43575
IRVING, TX 75063
INSURER D:
INSURER E:
COVERAGES -- --
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS
LTR�
ADD'Li
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM /DDIYY)
POLICY EXPIRATION
DATE (MM /DDIYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GFNERAL LIARILITY
��
I
XSL G2 3749099
12/31/08
12/01/09
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES Ea occurence
4900,000
$ 4,900,00
MED EXP (Any one person)
$ 10,00(
CLAIMS MADE 4:1 OCCUR
PERSONAL & ADV INJURY
$ 4,900,00
X
$100 000 SIR
GENERAL AGGREGATE
$ 25,000,00
GENERAL AGGREGATE LIMIT APPLIES PER
PRODUCTS COMP /OP AG
$ 6,000,00
)( POLICY PRO- LOC
AUTOMOBILE
LIABILITY
A
X
ANY AUTO
ISA H08252361 (AOS)
12/31/08
12/01/09
COMBINED SINGLE LIMIT
(Ea accident)
$ S,000,OO
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY
$
NON -OWNED AUTOS
(Per accident)
—_ —.
PROPERTY DAMAGE
(Per accident)
I$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY:
AGG
$
$
B
EXCESS /UMBRELLA LIABILITY
] OCCUR El CLAIMS MADE
XOO G24873304
12/01/08
12/01/09
EACH OCCURRENCE
$ 5,000,00
AGGREGATE
$ 5 OOO OO
$
DEDUCTIBLE
- --
_
$
RETENTION $
- - --
C
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
WLR C4 4356697 (AOS)
WLR C4 4356776 (CA)
12/31/08
12/31/08
12/01/09
12/01/09
X I WC STATU- OTH-
.L. EACH ACCIDENT
$ 2,000,00
C
A
OFFICER/MEMBER FXCLUDED7
If
SPECIAL PROVISIONS below
WLR C4 4356739 (MN)
SCF C4 435665A (WI)
12/31/08
12/31/08
12/01/09
12/01/09
DISEASE - EA EMPLOYE
$ 2,000'00(0
.L. DISEASE - POLICY LIMIT
$ 2,000,00
OTHER
A
EXCESS AUTO LIABILITY
XSA H08252324
12/31/08
12/01/09
LIMIT $5,000,000
DESCRIPTION OF OPERATIONS /LOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
CITY OF COPPELL IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY POLICY WHERE REQUIRED BY WRITTEN
CONTRACT WITH THE NAMED INSURED. $100,000 PER OCCURENCE SELF INSURED RETENTION APPLIES ONLY TO THE ABOVE GENERAL
LIABILITY POLICY.
CERTIFICATE HOLDER CLE- 001951308 -11
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF COPPELL
P.O. BOX 478
COPPELL, TX 75019
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHOM I�EPRESENTATNE �l „�l� � ✓.. ,� .0 -
U Marsh USA Inc.
Mary Radaszewski
"""' — %`°U I1wol O ACORD CORPORATION 1988
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.
D.-- —f Dom.... 4