Loading...
Crown Castle-CS211006T H E C I T Y O F COPPELL ;A_* 7!� E �- 'rata a g t PUBLIC RIGHTS-OF-WAY MANAGEMENT ORDINANCE REGISTRATION FORM Submit completed form to the. Engineering Dept., Town Center, 265 Parkway Slid.,. Coppell, TX, 750.19 This registration form is. required by. Sec. 6-1.4-3 of `the City of Coppell Cade ofMunicipaI Ordinances: It is. to be renewed every other year ley March L This document does not take the place of obtainIng'a Right -Of - Way Use Permit.prior to Performing any work. in the public right-of-way. 1. Date of Submittal: 9 ! 17 12021 2. Name and Address of Service Provider (Include all na►nes used ivithin the. last 5 years): Crown Castle .Fiber LLC Other Names:. FPL FiberNet, Fibeniet Direct Texas LLC, Crown Castle. NG Central 3. is Provider certified by the Texas Public Utility Commissiion? (} NO ) YES if YES, Certificate Number 60988 4. Does Provider have. a Valid License or Franchise Agreement with the City of Coppell? N ND. YES if YES, Ordinance Number Date Approved 1 5. Provide Two .Business Contacts. (Qnernust.be within the Dallas/Fort Worth area): Jen Young Alex Rodriguez. Na,tte Network Pen -nit :Specialist Title 6191 N STHWY. 1.61 Suite. 200 Irving TX 75038: Address 972-457-9152 TClepf+af+e. Name. Network Permit Specialist Title 6.19.1 .N ST HWY 161. Suite 2001rv..ing.TX 15638. Address 97.27457.9145 Telephone 6. Provide Two Emergency Contacts (Must be available AT ALL TIMES): SCN NOC Name 2417 Support Title 2000 Corporate Dr Canonsburg PA 15317 Address 888-632-0931 Telephone (No Charge to the City) SCN NOC Name 2417 Support Title 2040 Corporate Dr Canonsburg PA 15317 Address 866-553-4237 Telephone (No Charge to the City) 7. Have the names, 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? ( ) YES k ) NO if NO, Reason: They have yet to be determined; will amend when applicable 8. Has proof of insurance meeting the requirements of Sec. 6-14-3 S.4(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)? iX) YES { ) NO if'NO, Reason: 9 � Jennifer Young (I 9117121 Signature of Applicant Printed Name Date FOR CITY USE ONLY i (I REGISTRATION ACCEPTED Comments: ( ) REGISTRATION DENIED _A P I I�It•� r! 1 Signature of City Representative Printed Name Date Provider shall indemnify and forever hold harmless against the City of Coppell each and every claim, demand, or cause of action that may be made or come against it by reason of or if any way arising out of the closure, blocking, excavating, cutting, tunneling, or other work by the provider under permit from the City, if such permit is granted .Page 1 of 1 AC p 1 0 �' CERTIFICATE OF LIABILITY INSURANCE PATE (MMIQDIYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,. THE :INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 03/31/2021 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 A1=FORDED 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 policy(les) must have ADDITIONAL INSURED' provisions or he endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies rhay require an endorsement_. A statement on this certifleate does not confer rights to the certi#iCate holder in lieu of such endorsement(s). PRODUCER CONTACT Crown Castle international Willis: Towers Watson Northeast, Inc. NAME: _ PHONE ---- c/a 26 Century Blvd G,N¢ .P,O, .Sox 345191.. E-MAIL COIRe_est@Cr_a_w_ncastle.:com___ _ ADDRESS: _ .._ Nashville, TN 372305191 USA _ INSURER S AFFORdING COVERAGE NAIL# _ �.INSURERB INSUR_ERA_: Federal Insurance Company20281 W INSURED : National^Un onv:Fire' insurance Company of P 19445 Crown Castle:. international f .w--..-.---.-._... .....__._...._.._..._..w...-.-..-w._._...w__ ...-.— - --- - See Attached Named Insured. List INSURER C_ National) Fire L Marine Insurance- Company 20479• INSURER Q • AIU Insurances C4mpariy 19399 5220 Augusta Dr'. suite 600 Houston, TX 77057 --.._..____....'-,_..,,...._-__......._....__.._.....-_......_-__......._._.._..._.__-_..._.._....._........._._.,.,..._..... _._._�_____..,,..._..... W[x� ~ w INSURER E :� 3505 33 35.LTD .INSURER F COVERAGES CERTIFICATE NUMBER: W20540064 REVISION NUMBER: 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. LTR11SR- .--------rADi7L SUER .....,..._.........._...._._._.____.__...___.......... POL.ICY EFF ' • POI.TCY XP¢....._....-..........._.._......w......._._...._..__......._._.._....w......._...-.._....__..._.._._..... TYPEOFINSURANCE POLICYNUMBER MMiDDIYYYY MMIDDIYYYY I LImrrs ACCORDANCE WITH THE POLICY PROVISIONS. X :COMMERCIAL:GENERALLIABILITY AUTHORIZED REPRESENTATNE I CITY.MANAGER OFFICE EACH OCCU R RE N C E, $ 1,000,000 CLAIMS MADE OCCUR E DAMAGE TO RENTED PREMISES (Ea occurrence)....... 1,000,000 A €MED EXP. (Any one person) $ 10,000 INJURY$ iii 1,000,000 ,_„_._.�.... W[x� ~ w 3505 33 35.LTD 04/01/202104/01/2022PERSONAL&ADV GEN'LAGGREGATE LIMIT AFPLIES PER:------- GENERALAGCGREGA7E $ 2; 000:, 000 X PRO= PCJECT LOC € PRODUCTS; COMPiCP AGG $ OTHER:--- I Al1TdMOBILELIA6ILITY [ COMBINED SINGLE LIMIT $. 1,000,000 X ANY AUTO. � i � BOD)LY INJURY (Per.person) t $ 8j_ OWNED: g AUTOS 0i�1LY AUTOS SCHEDULED CA 703DB44 04/01/2021. 04/03 /2022 gpplLY INJURY (Per acciden;) S -- HIRD ED: NON-OWNE _ _ __ PROPERTY DAMAGE r._ AUTOS ONLY. AUTOS.ONLY 4r accldenlZ___-T. ___ S E C X UMBRELLALIASX OCCUR I EACHOCCURRENGE t 5;0.00.,0D0 T EXCESS LIAB 47�1MO-303445-07 04/01/2021 04/91/2022 AGCREGLATE -----s — - -- - - - -- 5,D00,0DO• =--- — __ YDEC x I ETENTION S 25 , 000 I WORKERS COMPENSATION X STAT[ITR I_ORH AND EMPLOYERS' LiABIL1TY. Y I�N _....... ...._ ....._..V ... .................._..._..._.........._,..........-,...._. D ANYPROPRieTORIPARTNER/EX1wCUTIVE OFFIGERIMEMaEREXCLUAEIJ? Na NIq04/0.1/2021:.D.4/01/2622...._......._......-..-_.._.-.. WC 016393106 E.L..EACH ACCIDENT -_.-....._-.....-.-_..._.........-. S. 1,000,000 (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ 1,DDo,DDO If yes,.describe under DESCRIPTION -OF OPERATIONS below ---_ E.L. DISEASE -POLICY LIMIT _ __- ] ,DOD, ❑D0 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES .(ACORD 101, Additional Remerks.Schedule,may be attached 11 mare space Is required) SU 14843595 -- 440 NORTH DENTON.TAP, COPPELL, TX 75619 CERTIFICATE. HOLDER CANCELLATION ©1988-2016. ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD SR sn_ 20920331 atctc'! 2040505. SHOULD ANY OF THE. ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION. DATE' THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE City of Coppell CITY.MANAGER OFFICE COPPELL; TX 75019 ©1988-2016. ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD SR sn_ 20920331 atctc'! 2040505. Crown Castle International Corp. Consolidated Subsidiaries as Named Insureds 2417 Chesapeake Holdings, LLC Crown Castle GT Corp. 2417 Mid -Atlantic Network of Virginia, LLC Crown Castle GT Holding Sub LLC 2417 Mid -Atlantic Network, LLC Crown Castle International Corp. Access Fiber Group Holdings LLC Crown Castle International Corp. de Puerto Rico Access Fiber Group, Inc. Crown Castle Intemational LLC AirComm of Avon, L.L.C. Crown Castle Investment Corp. Atlantic Coast Communications LLC Crown Castle Investment II Corp. CA - CLEC LLC Crown Castle MM Holding Corp. CC Castle International LLC Crown Castle MM Holding LLC CC Edge LLC Crown Castle MU LLC CC Edge Solutions LLC Crown Castle MUPA LLC CC Finance LLC Crown Castle NG Atlantic LLC CC FN Holdings LLC Crown Castle NG Central LLC CC Holdings GS V LLC Crown Castle NG East LLC CC Site Acquisitions II LLC Crown Castle NG Networks LLC CC Sunesys Fiber Networks LLC Crown Castle NG West LLC CC TM PA LLC Crown Castle Operating Company CC Towers Guarantor LLC Crown Castle Operating LLC CC Towers Holding LLC Crown Castle Orlando Corp. CC TS LLC Crown Castle PR LLC CCATT Holdings LLC Crown Castle PR Solutions LLC CCATT LLC Crown Castle PT Inc. CCATT PR LLC Crown Castle Puerto Rico Corp. COGS Holdings Corp. Crown Castle Services LLC COPE Acquisitions LLC Crown Castle Solutions LLC CCPR VI Tower Newco LLC Crown Castle South LLC CCS & E LLC Crown Castle TDC LLC CCT2 Holdings LLC Crown Castle TLA LLC CCTM Holdings LLC Crown Castle Towers 05 LLC CCTM1 LLC Crown Castle Towers 06-2 LLC CCTM2 LLC Crown Castle Towers 09 LLC CCTMO LLC Crown Castle Towers LLC Chesapeake Fiber, LLC Crown Castle USA Inc. Coastal Antennas LLC Crown Communication LLC ComSite Venture, Inc. Crown Communication New York, Inc. Coverage Pius Antenna Systems LLC Crown Mobile Systems, Inc. Cross Connect Solutions, Inc. (PA) DAS Development Corporation Crown Atlantic Company LLC Fiber Technologies Networks, L.L.C. (NY) Crown Castle AS LLC Fibernet Direct Florida LLC Crown Castle Atlantic LLC Fibernet Direct Holdings LLC Crown Castle Augusta LLC Fibernet Direct TEL LLC Crown Castle BP ATT LLC Fibernet Direct Texas LLC Crown Castle CA Corp. Fibertech Facilities Corp. (NY) Crown Castle Fiber Holdings Corp. {formerly LTS Group Holdings LLC} Fiberlech Holdings Corp. Crown Castle Fiber Enterprise LLC {formerly Sunesys Enterprise LLC} Fibertech Networks, LLC Crown Castle Fiber LLC f/kla Lightower Fiber Networks II, LLC Freedom Telecommunications, LLC Crown Castle GS III Corp. Global Signal Acquisitions II LLC Crown Castle GT Company LLC Global Signal Acquisitions III LLC Crown Castle International Global Signal Acquisitions IV LLC Global Signal Acquisitions LLC Global Signal GP LLC Global Signal Holdings III LLC Global Signal Holdings IV LLC Global Signal Operating Partnership, L.P. Global Signal Services LLC GoldenState Towers, LLC GS Savings Inc. GSPN Intangibles LLC High Point Management Co. LLC ICB Towers, LLC InWDurce Fl, LLC InSITE Fiber of Virginia LLC InSITE Solutions LLC Interstate Tower Communications LLC Intracoastal City Towers LLC IX2 Center, LLC . Consolidated Subsidiaries as Named Insureds IX2 Wilshire, LLC JBCM Towers LLC Light Tower Clearinghouse LLC Light Tower Fiber New York, Inc. (NY) Light Tower Holdings LLC Light Tower Management, Inc. Light Tower Metro Fiber LLC Lightower Fiber Infrastructure Corp. Lightower Fiber Networks I, LLC Lightower Fiber Networks II, LLC n/k)a Crown Castle Fiber LLC LL 01-18, LLC LTS Buyer LLC LTS Group Holdings LLC n/kla Crown Castle Fiber Holdings Corp LTS Intermediate Holdings A LLC LTS Intermediate Holdings B LLC LTS Intermediate Holdings C LLC Md7 Capitol One, LLC Mobile Media California LLC Mobile Media National LLC Modeo LLC MW Cell REIT 1 LLC MW Cell TRS 1 LLC NEON Transcom, Inc. NewPath Networks Holding LLC NewPath Networks LLC NY - CLEC LLC OP 2 LLC OP LLC P3 CHB -1, LLC P3 Holdings 2014 LLC P3 DASA -1, LLC P3 PBA -1, LLC PA - CLEC LLC Pinnacle San Antonio L.L.C. Pinnacle St. Louis LLC Pinnacle Towers Acquisition Holdings LLC Pinnacle Towers Acquisition LLC Pinnacle Towers Asset Holding LLC Pinnacle Towers Canada, Inc. Pinnacle Towers III LLC Pinnacle Towers Limited Pinnacle Towers LLC Pinnacle Towers V Inc. PR Site development Corporation PR TDC Corporation Princeton Ancillary Services II LLC Princeton Ancillary Services III LLC Radio Station WGLD LLC RGP Tower Group, LLC Shaffer & Associates, Inc. Sidera Networks UK Limited (UK) Sidera Networks, Inc. Sierra Towers, Inc. Sunesys Enterprise LLC n!k!a Crown Castle Fiber Enterprise LLC Sunesys of Massachusetts, LLC Sunesys of Virginia, Inc. Sunesys, LLC Thunder Towers LLC Tower Development Corporation Tower Systems LLC Tower Technology Company of Jacksonville LLC Tower Ventures ill, LLC TowerOne 2012, LLC TowerOne Allentown 001, LLC TowerOne Bethlehem 001, LLC TowerOne Doylestown, LLC TowerOne East Rockhill 001, LLC TowerOne Marple, LLC TowerOne Middletown 001, LLC TowerOne Middletown 002, LLC TowerOne Middletown 003, LLC TowerOne North Coventry, LLC TowerOne Partners, LLC TowerOne Richland, LLC TowerOne Upper Pottsgrove 002, LLC TowerOne Upper Pottsgrove, LLC TowerOne Warminster 001, LLC TowerOne Warrington 002, LLC Crown Castle International Corp. Consolidated Subsidiaries as Named Insureds Towers Finco II LLC Towers Finco III LLC Towers Finco LLC TriStar Investors LLC TVHT, LLC WA - CLEC LLC WCP Wireless Lease Subsidiary, LLC WCP Wireless Site Funding LLC WCP Wireless Site Holdoo LLC WCP Wireless Site Non -RE Funding LLC WCP Wireless Site Non -RE Holdco LLC WCP Wireless Site RE Funding LLC WCP Wireless Site RE Holdco LLC Wilcon Holdings LLC Wilcon Operations LLC Wilshire Connection, LLC Wilshire Services, LLC Wireless Funding, LLC Wireless Realty Holdings ll, LLC Wireless Revenue Properties, LLC Yankee Metro Parent, Inc.