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Spectrum-CS210917T H E C 1 T Y. 0 F COPPELL 4 =: 'a rr PUBLIC RIGHTS-OF-WAY MANAGEMENT ORDINANCE REGISTRATION FORM Submit completed form to the Engineering Dept:, Town Center,265 Parkway Blvd., Coppell, TX, 75019 This registration. forma is req rsired.by Sec. 6-14-3 of the City of Coppell Code.of Mynicipal Ordinances. It is to he renewed every other year by March]. Th is. document does not take the place of obtaining a. Right -Of - Way Use Ferniit prior to perfornung any work in the public right-of-way. L Date of Submittal: 9 1 10 1 21 Z. Name and Address of Service Provider (Include all naines.used within the last 5 years): Spectrum .3. 4. Charter Communications 1565 Chenault St. Dallas, TX 75228 Is. Provider certified by the Texas Public Utility Commission? ( ) NO ()o YES if'YES, Certificate. Number SICFA NO, 94448 Does Provider have a Valid License or Franchise .Agreement with the City of Coppell?. 00 NO (} YES if ` i'ES, Ordinance Numbex Date Approved 5. Provide Two Business Contacts (One must be within the Dallas/Fort Worth area): Clem Maddox (primary contact) Name Dir, Government Affairs Title 754 Canyon Dr. #540 Coppell,. TX 75419 Addr•esti 469-464-4845 7elrlilrufrrr email: clem.maddox@charter.com Crystal Hampton Narrre Sr. Admin Asst rifle 750 Canyon Dr. #500 Coppell, TX 75.019 Address 9.72-630-5116 7'elephcare email: crystal.hampton@cha.rter.com 6. Provide Two Emergency Contacts (Moist be available ATALL TIMES): ROC Naive Emergency Notifications.Confidential Title 754 Canyon Or. #544 Coppell, TX Address 972-914-9471 Telephone (No Charge to -the City) Name Titre Address Telephone (No Charge to the GO J 7. Have the narnes, addresses, and contact information for all known contractors or subcontractors that will be working in the public right-of-way .on behalf of the Provider been furnished to the City? 0() YES ( ) NO if'NQ,..Reason: 8.. Has. proof of insurance meeting the. requirements of Sec.. 6-14-3. BA(h) of the Public Rights -Of - Way Management Ordinance been furnished to the City (the City must be named as an additional insured on the policy by using endorsement CG 20 26 or broader)? (x) YES (} NO if NO, Reason - Chrystal Hampton 911.4121 Signa4ure of Applicant Printed Name Date FOR CITY USE ONLY (REGISTRATION ACCEPTED Comments: ( )REGISTRATION DENIED Signature of City Representative Printed Nance Date Provider shall indeinnify acid forever hold.harviless against the City of Coppell each an&evezy claire, demand, or clause of action that ma}r be tuade or conte against it by reason wf or if any way arisiiig out of the closure; blocklrza, excavating, cutting, tunneling, or other work by the provider under permit fi-onz the City, if such permit iS granted. Charter C0MMUNICATI0NS 09/10/2021 Re: Right of Way Authorized Contractors Gordon Harp Area Vice Pres dent North Texas Fie d ❑ps The contractors listed below are authorized to request Right of Way permits for and work within the Texas on behalf of Spectrum unless otherwise communicated in writing. Sincere] Gordon Harp AVP, Field Operations STC Chris Pederson biachris@stcutilit .com 214-295-5422 Terrell, TX 75160 18535 FM 1488 Suite 230 Superior Telecom Mark Peebles m.peeblesesuperiortelecom.us 346-775-0292 Magnolia, TX 77354 6205 Chapel HIII Blvd 4600 BrldgepointCommunications Inc Steve Holt steveholt@bticom.net 972-670-2050 Plano, TX 75093 Gardner Telecom 555 S Town East Blvd (Soon to be Primoris) Casey Vaughn - Casey@gardner100.com 469-853-3882 Mesquite,TX 75149 _ 2612 Quail Hollow 0r JACO Rick Jaskula rick jasku a@iacoutillty.com 214-298-75D2 — Sechse TX 75048 — PO Box 8967 Tex Comm Steve Robinson s.robinson@texGomm.net 817-822.2836 Spring, TX 77387 _ . 2045 W Union Ave Bldg E TCS Communications Inc Mike McFadden mike.mcfadden@tcscomm.com 3.03-210-4710 Englewood, CO 80110 P0Box 1185 Northeast Services Chester Hess_ ch_et.nes457@yahoo.com 817.688-1918 Kennedal�TX 76060 _ 1321 Valwood Pkwy 440 ASH Communications Keith Bracken k.bracken@ashcomllc.com 810-459-7911 Carrollton, TX 75006 PO Box 47086 Archey Way Communications Victor Navarro nav_arrovictor67@vahoo.com 214-325-6822 Kansas City, MQ 64188 1585 Jameson Rd Kinetic Danny Kern danny@kinetic-en8.co„m 214-695-6680 Van Alstyne, TX 75495 1710 Firman Dr Ste 2011 Wilkins - Faye Wilkins fa a(Pwilkins.com 972-479-1090 Richardson, TX 75081 390 E Devon Ave Ste 202 Sunrise Jeremy Albrecht ialbrec_ht@sunrisetelecom.blz 608-279-9401 Roselle, IL 60172 801 Hammond 5t. Ste 350 Glass and Wire (GW) josh Stewart istewart@unitekgs.com 214-548-3697 Coppell, TX 75019 _ 3550 S Bryant Blvd Housley Communications Inc. Ken Wilson kwilsgn he-inc com 972-977-0161 San Angelo, TX 76903 2001 Limbus Ave Noble Resources Corporation Dave Austin noblel@tampabay.rr.com 512-394-2770 Sarasota FL 34243 5935 Agua Fria St New Mexico Boring Inc. Ben Mossa bmossala nnmborin .com 575-541-3221_ — Santa Fe NM 87507 7526 Alameda Ave Quality Splicers V I ctor Arme nd a riz qualitvvicrene@gmaii.com 915-772-1188 EI Paso, TX 79915 *Prepared by Crystal Hampton, Sr. Admin Assistant, 972-630-5116 750 Canyorr surt? soci Coppol. i x 7501", 1 ;5:2) 485-62M 9ordor.ItF,ip6:c:harter-r.Uri� AC�RO°� CERTIFICATE OF LIABILITY INSURANCE AAFI» ii41MIDDlYYYY) PAT5( MIDD CERTIFICATE MAY BE ISSUED OR -MAY PERTAIN, THE IMSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,. 71 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 poilcy(ies] must have ADDITIONAL INSURED provisions or pe endorsed. If SUBROGATION IS WAIVED, subject to the `tert and conditions of the policy, certain. policies may require an endorsement. A statement on this certificate doesnot. confer rights to the certificate holder in. lieu of such endorsement(s). PRODUCER CONTACT Marsh USP, I NAME_NC. PHONE. .------------_.._-.. _ . ] d.t M.a l�ket street'. Suite 1 i 0 {]Exp_�_�._........___._.__---------� I St. Louis, MO 63161 E-MAIL ADDRESS- INSURER 5 AFFDRDINGCOVERAGE. NAICJI. COMPANY A: Nat tonal. ilnian F-.ra ins Oo PiLis6urgh PA 11944:5 INSURED COMPANY B; commerce and Yndi)stry Tnsurance. COmPariy ..1...M..,_.,__,.._,...�— C.hartar Coramunzca.taons, Itis; 61941C}. COMPANY C:_'•AEc xanpxt & .0 Es ill Irisu=ince Com an ��.�i.�g -- Y Y P. Y A00 Atlantic .Street PRE=MISES Ea occurrence Stamford, CT 0.690.1 [:OPPANr D: Yew t[ imr shire'In',urai CQPsP71NY. E; Al0 .Tr sui:.ancr Company COVERAGES CERTIFICATE NUMBER: 3i26en REVISION mllmrwrt- TNS 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 OFi CQNDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR -MAY PERTAIN, THE IMSURANCE 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. fh15R �_..........._...._— ___.....___.._......__._....—_ .A—DLSt1BR ".„'.__.......____----.�„�_..._..........f._.P�LICYEFF POLICYE,YP _...._......._....._.._. �..__-_.._......_..._ LTR' . TYPE OF INSURANCIE POLICY NUMBER 144MIDDIY.YYY MMIDDIYYYY LIMITS' S X I COMMERCIALGENERAL LIABILITY f X i.. r GL 3.6299QG 1117021 1/1/2072 EACH: OCCURRENCE DA�utICG`E7 RENTED g S1•QOti;000 CLAIMS-MADE OCCUR L � I * .0110" -"Ga� E PRE=MISES Ea occurrence $ EHPLAn one person] 5 _PE _RSONALB ADV INJURY_ $i_ 01000 GENTAGGREGAP _ATELIMITPLIES.PEii: GENERALAGGREGATE .�$ �.53,.pitFl,POP._ H._. PaLICY ] Loc _ .. ;iiia . 0 00 LP .._.. JECT L_ JECT I,,.._...., PRODUCTS COMNOP AGG .. _ j $ -- Y �.._...u.w..,_. OTHER: i � A A l AUTOMOBILE LIAOILIT Y I C4 ?92.1838 lAL;.A'1., 1/1/2071 i/I/2022 COMBINED.SINGLELIMIT s�Ea .$ 5t,pu0.,i)Op A X ANY.AUTO I CA, CO,.C'%,1 C, I"L, Gl1: fi7; , TD, IL,.7:N,. KS, KY,I.A, Mz., h1:I, KN .•.111:102,1 : 1112021 I111�UZ:? I I1120i7 —�—.._._�_.w...,_....._..---- BODILY INJURY (Per parson) .$ _ _ OWNED SCHEDULED. AUTOS ONLY g. AUTOS , M0; MT..NC, NEE' NII, N.r„ 1V, NY, OSi []H, i A, SC;. 1N; TX. VT, WA, Wi, NV --- """'-"'"'...'"-""'."'" ..E g BODILY INJURY(Per:accident) -- $ -- — „„ ____,_W -..----� HIRED NON -OWNED € AU70S.ONLY _....__E A1iTOSONLY t4.YJ i i ._.-----_---__.._ . I PRdPERTY DAMAGE fPer------- _.-----.-----.-----..__...._.-_ t C7+ 19?.2839 [P4A1 CA. -1921846 (VA) 3 U C X I UMBRELLALIAS X I _ _ OCCUR 62811.96.16 11f)6 I 112az . 111.raaza EACH OCCURRENCE $10, 0a $ EXCESS LIA6 CLAIMS MADE: i w._.... ---i ET0.T3[i0'Tf?i„ AGGREGA7E.Y. _ . ..._._.. $ DED RETENTION $ WORKERS COMPENSATION ; See secobd page inr. 1!117427 117.12022 X. PER. 0TH, AND EMPLOYERS' LIABILITY YlN € Spi:Ci i r. put icy 111/2.021. 1/1/7022 --..__ _S7ATLFTI= _ ANYPROPFIIETORIPARTNERIEXEGUTiVE y OFFICERIMEMBEREXCLUDEDp N.1A l information,. 1/1/2021 1/1/2022 E1, EACH ACCIDENT -----`"-'"-•.'" '"""" 1$ $`�• 004, UI]U I (Mandatary in NH) 1Il/.2{121 11117.022 E:L�DESEASE; EA EMPLOYEE S5, 000., D0G $ Il.yes descn6e under I DESdHJPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S5 CCU 040 $ A €Excess I l WC 011 ($5K Retention) I III xwC 9595556 {0111 F I 11:/2021. 111/2022 Empldyers Liability $5,D#0.1fl U DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEmcLES IACORD IOI, AddEFional Remarks Sch@dule; maybe attached It more space Is required] Please see page 2 far addition -al insureds and any additional :Language.. City of. Cnppel-3. 265.Parpway %1vd CQppe-U, 'FX '15019 S,MN SHOULD ANY ORTHE ABOVE DESCRIBED] POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE IDELIVERED IN ACCORDANCE WITH THE POLICY PROVI5i0Ns. AUTHORIZED REPRESENTATIVE Joseph H. Lea ©1988-2015 ACORD CORPORATION. All rinhts reserved. ACORD 25 (2015103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ACdORUP ADDITIONAL REMARKS .SCHEDULE Page of AGENCY NAMED.INSURED One Federal 5.trei t Charter Co[nhLu.r:icat'!.ons, Tnc. Boston, MA 0211D USA. 460 Atlantic ';treeL Stamford, CT b6961 EFFECTIVE DATE: 01 1 / 2 a 21 THIs ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORDFORM, FORM NUMBER: 25 FORM TITLE: Ce rt:if'i.cat e of L i ab.iIit:' Insurance Ccita Eica Ce Feercn�e: 3'l2GBS WORXEJ. S .,^,[][.iP rNSAT:UF POLTCY IN"X)?MATfnN lnsurcr Polity Numbs r Etir;rk!.vv nate E:xpira:R.cr: :1n[.b D we 0191'ii3.95 IWIjuA,W]'WYS 11'LItPeI lltr'a;�zz. £. Kc' 319 i2�:398 fAIiz: Gi 1;''1.12-2: E Wc. r51912?393 lAL..}1'I,. CU. Cr, DC,'CA, {;7, ID, I'.,;K,&S, Klr 1.Ri FlD,?iE. G Kc C19 €124 �[i (F7,1 111 il1.'2-r2R Cbartax {.'.rirgoun_icat; o"Is, 1]•.c.. 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If more- rsiar. 5r}F, arm. xllic.P: is xciled r l..m rhe ur,iterf Se ar:i:.,; ni F .erica; i.r_c f.Arr-i.'.n:iex. or pry:.Jessinr.s, Pue-ro �o nr [:FIA'dn. Svc c�tzu Iu tLuuu�u� ] © 2008 ACORD CORPORATION, All rights reserved.. The ACORD name and logo are registered marks of ACORD