State of Idaho CERTIFICATE OF FRANCHISE AUTHORITY

Transcription

1 State of Idaho I I CERTIFICATE OF FRANCHISE AUTHORITY I, BEN YSURSA, Secretary of State of the State of Idaho, hereby certify under the seal of my office that: TIME WARNER CABLE PACIFIC WEST LLC File Number VF107 Is hereby granted authority as a system operator to provide cable service or video service in the following service area: CITY OF MOSCOW CITY OF FERNAN LAKE VILLAGE I FURTHER CERTIFY That the authority is granted to install, construct and maintain facilities within the public rights-of-way, over which the local unit of government has jurisdiction, to enable the provision of video services to subscribers to such services, subject to the applicable federal and state laws and regulations, including highway district, municipal and county ordinances and regulations. I FURTHER CERTIFY That the required fees have been paid. Franchise Authority of the above named entity is effective upon issuance of this certificate and shall expire ten (1 0) years from the date of issuance. Dated: October 10, 2012 SECRETARY OF STATE

2 288 APPLICATION FOR CERTIFICATE OF FRANCHISE AUTHORITY (Instructions on Back of Application) 2012 oc- ' I 0 c14 '"... I '' 1-i,j 7 c:.c. Pursuant to Title 50, Chapter 30, Idaho Code, the undersigned applies for authori:ra'ti9p tqprovide vid~o;~~!"'ice in the State of Idaho. 0 //,..'. : '~ ; 1.::., ': '~. - -'-~:-7Ll 1. The name of the applicant is: _T_im_e_w_ar_ne_r_c_ab_le_P_a_cifi_lc_w_e_st_LL_c 2. The address of applicant's principal place of business within Idaho is: 2305 West Kathleen Avenue, Coeur d'alene, ID The mailing address of the applicant is: Same 4. Names of the applicant's principal executive officers: Name Please see attachment A. Title 5. The name and title of applicant's primary Idaho representative: Name Correen Stauffer Title _A_re_a_G_en_er_ai_M_a_na..::g_er 6. Specific identification of the political subdivision(s) constituting the service area wherein the applicant intends to provide cable Or Video service: City of Moscow and the City of Fernan Lake Village 7. The date the applicant intends to begin providing service in the service area described above: _1_ol-:-o1_12_o1~2:-:-:-~:-- (mmlddlyyyy) 8. I verify by signing this application that: [!] All forms have been filed with the federal communications commission as required by that agency. [!] Applicant is legally, financially and technically qualified to provide video service. [!] Verification is attached to this application that comprehensive general liability insurance coverage and automobile liability insurance coverage underwritten by one or more companies licensed to do business in the state of Idaho has been procured by the applicant and will be maintained continuously as required by Idaho Code Section (3)( e). [!] Applicant has attached a list of names and mailing addresses of the governing body of each political subdivision and each local unit of government located within the service area designated in the application. The entities listed will be notified by the Secretary of State upon issuance of the certificate of franchise authority. Customer Acct # : (if using pre-paid account) Dated: October 4, 2012 t!v---- Signature: TypedName: _w,_,l_na_m_r_.g_o_e_~_.j_r. Capacity: _P"':'lreo:-si_de~nt~=~~=~~=~=~= (By an officer or general partner of applicant) Secretary of State use only IDAHO SECRETARY OF STATE 10/10/ :00 CK: CT: BH: = FRAN AUTH D 2 VF lo'i

3 APPLICATION FOR CERTIFICATE OF FRANCHISE AUTHORITY Time Warner Cable Pacific West LLC Attachment A - Officers OFFICERS William R. Goetz, Jr. Amos Smith John Keib Craig Collins Matthew Stanek David Montierth Debi Picciolo Deane Leavenworth Satish Adige David A. Christman Gary Matz William F. Osbourn Mark Schichtel Matthew Siegel Jeffrey Zimmerman Susan A. Waxenberg Ellen Alderdice Meredith Garwood President Regional Chief Financial Officer, West Region President, Residential Services, West Region President, Commercial Services, West Region President, Network Operations & Engineering, West Region Regional Vice President, Commercial Services Regional Vice President, Operations Regional Vice President, Government Relations Senior Vice President, Investments Senior Vice President & Secretary Senior Vice President, State Government Relations Senior Vice President & Controller Senior Vice President, Tax Senior Vice President & Treasurer Senior Vice President Assistant Secretary Assistant Treasurer Assistant Treasurer

4 APPLICATION FOR CERTIFICATE OF FRANCHISE AUTHORITY Time Warner Cable Pacific West LLC Attachment B - Insurance Certificate Attached.

5 ACORD TM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 9/21/2012 7:33:47 PM 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 ORAL TER 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 policy(ies) must 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). PRODUCER MARSH USA, INC. Contact Name: 1166 Avenue of the Americas Phone No: 1 Fax No: New York NY Producer Producer Customer No: INSURERS AFFORDING COVERAGE INSURED TIME WARNER CABLE PACIFIC WEST LLC INSURER A: New Hampshire Ins. Co DBA TIME WARNER CABLE INSURER B: Insurance Co. of the State PA COLUMBUS CIRCLE INSURERC: ACE American Insurance Company NEW YORK NY INSURERD: Navigators Insurance Company INSURERF: COVERAGES CERTIFICATE NUMBER NAIC# INSURERE: National Union Fire Ins Co of Pittsburgh 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. INSR ADDL SUBR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE INSRD WVD POLICY NUMBER (MM/DDNYYY) (MM/DDNYYY) LIMITS GENERAL LIABILITY GL /1/2012 1/1/2013 EACH OCCURRENCE $ 3,000,000 ~ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 E :::J 0 CLAIMS-MADE OCCUR MED EXP (Any one $ 10,000 person) PERSONAL & ADV INJURY :::J $ 3,000,000 GENERAL AGGREGATE $ 20,000,000 E GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 5,000,000 0 POLICY D PROJECT DLoc $ AUTOMOBILE LIABILITY CA (AOS) 1/1/2012 1/1/2013 COMBINED SINGLE LIMIT $ 5,000,000 ANY AUTO (Ea accidenl) ~ CA (VA) ALL OWNED AUTOS CA (MA) BODILY INJURY :::J (Per person) $ SCHEDULED AUTOS :::J BODILY INJURY HIRED AUTOS :::J (Per accident) $ :::J NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) $ I~ UMBRELLA LIAB ~OCCUR XOO G /1/2012 1/1/2013 EACH OCCURRENCE $ 25,000,000 c :::J EXCESS LIAB D CLAIMS-MADE AGGREGATE $ 25,000,000 I=::J DEDUCTION $ I RETENTION $ A A WORKERS COMPENSATION we (AOS), we 1/1/2012 1/1/ WCSTATU- DOTH- AND EMPLOYERS' LIABILITY Y/N (CA), WC (FL), TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE we (MN), we ~ N/A E.L. EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? (ND,WA,WI,WY) we (OR-Ins. B) E.L. DISEASE- EA $ 2,000,000 Mandatory in NH? EMPLOYEE WC (MA-Ins. B) If yes describe under E.L. DISEASE- POLICY LIMIT $ 2,000,000 SPECIAL PROVISIONS below OTHER Excess WC OH ($1M Retention) we /1/2012 1/1/2013 Workers Camp - Statutory 1,000,000 A Excess WC OH ($1M Retention) we /1/2012 1/1/2013 Employers Liability 1,000,000 D Excess Auto Only NY12EXC V 1/1/2012 1/1/2013 Each Occurrence 2,500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS EVIDENCE OF INSURANCE COVERAGE CERTIFICATE HOLDER CANCELLATION IDAHO OFFICE OF THE SECRETARY OF STATE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 450 N. 4TH STREET BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED BOISE ID IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2009/09) AUTHORIZED REPRESENTATIVE ~~ ~ ACORD CORPORATION. All r1ghts reserved.

6 APPLICATION FOR CERTIFICATE OF FRANCHISE AUTHORITY Time Warner Cable Pacific West LLC Attachment C - Local Units City of Moscow Stephanie Kalasz City Clerk 206 East Third Street Moscow, ID Phone: (208) Fax: (208) City of Fernan Lake Village Cindy Espe City Clerk PO Box 1775 Coeur d'alene, ID Phone: (208) Fax: (208)