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ACORD 101 (2008/01)
<br />The ACORD name and logo are registered marks of ACORD
<br />© 2008 ACORD CORPORATION. All rights reserved.
<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br />FORM NUMBER:FORM TITLE:
<br />ADDITIONAL REMARKS
<br />ADDITIONAL REMARKS SCHEDULE Page of
<br />AGENCY CUSTOMER ID:
<br />LOC #:
<br />AGENCY
<br />CARRIER NAIC CODE
<br />POLICY NUMBER
<br />NAMED INSURED
<br />EFFECTIVE DATE:
<br />25
<br />Charter Communications, Inc.
<br />400 Atlantic Street
<br />Stamford, CT 06901
<br />01/01/2020
<br />One Federal Street
<br />Boston, MA 02110 USA
<br />Certificate of Liability Insurance
<br />Certificate Reference: 310163
<br />WORKERS COMPENSATION POLICY INFORMATION
<br />Insurer Policy Number Effective Date Expiration Date
<br />-------------------------------------------------------------------------------------------
<br />D WC 12716987 (NY) 1/1/2020 1/1/2021
<br />E WC 14122396 (MA,WA,WI,WY) 1/1/2020 1/1/2021
<br />E WC 14122397 (AZ, IL,KY,NC,NH,NJ,PA,UT,VA,VT) 1/1/2020 1/1/2021
<br />F WC 14122398 (CA) 1/1/2020 1/1/2021
<br />E WC 14122399 (AOS) 1/1/2020 1/1/2021
<br />G WC 14122400 (FL) 1/1/2020 1/1/2021
<br />Insurer G: Illinois National Insurance Company
<br />Charter Communications, Inc. branded Spectrum, Spectrum Business and Spectrum Enterprise and their
<br />- Subsidiaries, associated, affiliated and inter-related companies;
<br />- Controlled or majority (more than 50%) owned partnerships, limited liability companies;
<br />- Interest only in (or its subsidiaries’ interest in) any other partnerships or joint ventures or limited liability companies;
<br />- Interest in (or its subsidiaries’ interest in) any company or organization coming under its active management or control;
<br />- Any entity or party required to be insured under any contract or agreement which may now exist, may have previously existed, or may hereafter be created or acquired.
<br />Bresnan Broadband Holdings, LLC, Bresnan Broadband of Colorado, LLC, Bresnan Broadband of Montana, LLC, Bresnan Broadband of Utah, LLC, Bresnan Broadband of Wyoming, LLC,
<br />Bresnan Digital Services, LLC, Bresnan Microwave of Montana, LLC, Bright House Networks Information Services (Alabama), LLC, Bright House Networks Information Services
<br />(California), LLC, Bright House Networks Information Services (Florida), LLC, Bright House Networks Information Services (Indiana), LLC, Bright House Networks Information
<br />Services (Michigan), LLC, Bright House Networks, LLC, CC Systems, LLC, CCH II, LLC (CCHII), Charter Advanced Services VIII (MN), LLC, Charter Communications Entertainment
<br />I, LLC , Charter Communications Holding Company, LLC, Charter Communications Holdings, LLC, Charter Communications Operating, LLC, Charter Communications VI, L.L.C.,
<br />Charter Communications VII, LLC, Charter Communications, Inc., Charter Communications, LLC , Charter Fiberlink - Alabama, LLC, Charter Fiberlink - Georgia, LLC, Charter
<br />Fiberlink - Illinois, LLC, Charter Fiberlink - Maryland II, LLC, Charter Fiberlink - Michigan, LLC, Charter Fiberlink - Missouri, LLC, Charter Fiberlink - Nebraska, LLC,
<br />Charter Fiberlink - Tennessee, LLC, Charter Fiberlink CC VIII, LLC, Charter Fiberlink CCO, LLC , Charter Fiberlink CT-CCO, LLC, Charter Fiberlink LA-CCO, LLC, Charter
<br />Fiberlink MA-CCO, LLC , Charter Fiberlink MS-CCVI, LLC, Charter Fiberlink NC-CCO, LLC , Charter Fiberlink NH-CCO, LLC, Charter Fiberlink NV-CCVII, LLC, Charter Fiberlink
<br />NY-CCO, LLC, Charter Fiberlink OR-CCVII, LLC, Charter Fiberlink SC-CCO, LLC , Charter Fiberlink TX-CCO, LLC , Charter Fiberlink VA-CCO, LLC, Charter Fiberlink VT-CCO, LLC ,
<br />Charter Fiberlink WA-CCVII, LLC, Charter Gateway, LLC, Charter Helicon, LLC, Coaxial Communications of Central Ohio LLC, DukeNet Communications, LLC , Falcon Cable
<br />Communications, LLC, Insight Blocker LLC, Insight Communications Company LLC, Marcus Cable Associates, L.L.C., Spectrum Advanced Services, LLC, Spectrum Captive Holdings,
<br />LLC, Spectrum Gulf Coast, LLC, Spectrum Management Holding Company, LLC, Spectrum Mid-America, LLC, Spectrum Mobile LLC, Spectrum New York Metro, LLC, Spectrum NLP, LLC,
<br />Spectrum Northeast, LLC, Spectrum Oceanic, LLC, Spectrum Pacific West, LLC, Spectrum Reach, LLC, Spectrum RSN, LLC, Spectrum Security, LLC, Spectrum Southeast, LLC,
<br />Spectrum Stamford, LLC, Spectrum TV Essentials, LLC, The Helicon Group, L.P., Time Warner Cable Business, LLC, Time Warner Cable Enterprises LLC, Time Warner Cable
<br />Information Services (Alabama), LLC, Time Warner Cable Information Services (Arizona), LLC , Time Warner Cable Information Services (California), LLC, Time Warner Cable
<br />Information Services (Colorado), LLC, Time Warner Cable Information Services (Hawaii), LLC, Time Warner Cable Information Services (Idaho), LLC, Time Warner Cable
<br />Information Services (Illinois), LLC, Time Warner Cable Information Services (Indiana), LLC, Time Warner Cable Information Services (Kansas), LLC, Time Warner Cable
<br />Information Services (Kentucky), LLC , Time Warner Cable Information Services (Maine), LLC, Time Warner Cable Information Services (Massachusetts), LLC, Time Warner Cable
<br />Information Services (Michigan), LLC, Time Warner Cable Information Services (Missouri), LLC, Time Warner Cable Information Services (Nebraska), LLC, Time Warner Cable
<br />Information Services (New Hampshire), LLC, Time Warner Cable Information Services (New Jersey), LLC, Time Warner Cable Information Services (New Mexico), LLC, Time Warner
<br />Cable Information Services (New York), LLC , Time Warner Cable Information Services (North Carolina), LLC, Time Warner Cable Information Services (Ohio), LLC, Time Warner
<br />Cable Information Services (Pennsylvania), LLC , Time Warner Cable Information Services (South Carolina), LLC, Time Warner Cable Information Services (Tennessee), LLC, Time
<br />Warner Cable Information Services (Texas), LLC , Time Warner Cable Information Services (Virginia), LLC, Time Warner Cable Information Services (Washington), LLC, Time
<br />Warner Cable Information Services (West Virginia), LLC, Time Warner Cable Information Services (Wisconsin), LLC, Time Warner Cable, LLC, TWC Administration LLC, TWC Sports
<br />Newco LLC
<br />...and any corporation or other business organization other than a joint venture in which the Named Insured shown in the declarations has or acquires during the policy
<br />period an ownership of more than 50% and which is domiciled within the United States of America, its territories or possessions, Puerto Rico or Canada.
<br />DocuSign Envelope ID: 1FAA0AF4-3445-4898-A26A-1F70B9FC5DD8
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