Notification for Spectrum Manager Lease. In order for Sensus to apply to the FCC on the Customer’s behalf for a spectrum manager lease, Customer must complete the information below in boxes one (1) through ten (10) and certify via authorized signature. Customer’s signature will indicate that Customer authorizes Sensus to file the spectrum manager lease notification on FCC Form 608 with the Customer as spectrum Lessee, and if Customer does not already have one, ownership disclosure information on FCC Form 602. Is Customer contact information same as above? Yes No (If No, complete box 2 below) Customer/Lessee is a(n) (Select one): Individual ǀ Unincorporated Association ǀ Trust Government Entity ǀ Corporation ǀ Limited Liability Company ǀ General Partnership Limited Partnership ǀ Limited Liability Partnership ǀ Consortium ǀ Other FCC Form 602: FCC File Number of Customer’s Form 602 Ownership Information: . If Customer has not filed a Form 602, Sensus will file one for Customer. Please complete questions 5, 6, and 7 below if Customer does not have a Form 602 on file. Customer must complete items 8, 9 and 10 irrespective of whether Customer has an ownership report on file. Customer Tax ID: ▇▇-▇▇▇▇▇▇▇ Name ▇▇▇▇▇ ▇▇▇▇▇ Title: Director of Santa ▇▇▇▇ Water Email: ▇▇▇▇▇▇@▇▇▇▇▇▇.▇▇▇ Phone: ▇▇▇-▇▇▇-▇▇▇▇ If Customer/Lessee is a government entity, list the names of the Mayor and all Council Members below, as well as verify citizenship and ownership interests in any entity regulated by the FCC. Such ownership must be disclosed where a mayor/council member owns 10% or more, directly or indirectly, or has operating control of any entity subject to FCC regulation. If any answer to Ownership question is Yes, or any answer to Citizenship question is No, provide an attachment with further explanation. US Citizen? Ownership Disclosure? Mayor: ▇▇▇▇ ▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇ ▇▇▇▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇▇ ▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇▇ ▇▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇ ▇▇▇▇▇▇▇ Yes No Yes No 1) Is the Customer/Lessee a foreign government or the representative of any foreign government? Yes No 1) Has the Customer or any party to this application had any FCC station authorization, license, or construction permit revoked or had any application for an initial, modification or renewal of FCC station authorization, license or construction permit denied by the Commission? Yes No 2) Has the Customer or any party to this filing, or any party directly or indirectly controlling the Customer or any party to this filing ever been convicted of a felony by any state or federal court? Yes No 3) Has any court finally adjudged the Customer or any party directly or indirectly controlling the Customer guilty of unlawfully monopolizing or attempting to unlawfully monopolize radio communication, directly or indirectly, through control of manufacture or sale of radio apparatus, exclusive traffic arrangement, or any other means or unfair methods of competition? Yes No 1) The Customer/Lessee agrees that the Lease is not a sale or transfer of the license itself. Yes 2) The Customer/Lessee acknowledges that it is required to comply with the Commission’s Rules and Regulations and other applicable law at all times, and if the Customer/Lessee fails to so comply, the Lease may be revoked, cancelled, or terminated by either the Licensee or the Commission. Yes 3) The Customer/Lessee certifies that neither it nor any other party to the Application/Notification is subject to a denial of Federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C § 862, because of a conviction for possession or distribution of a controlled substance (See Section 1.2002(b) of the rules, 47 CFR § 1.2002(b), for the definition of “party to the application” as used in this certification.) Yes 4) The Customer/Lessee hereby accepts Commission oversight and enforcement consistent with the license and lease authorization. The Lessee acknowledges that it must cooperate fully with any investigation or inquiry conducted either by the Commission or the Licensee, allow the Commission or the Licensee to conduct on-site inspections of transmission facilities, and suspend operations at the direction of the Commission or the Licensee and to the extent that such suspension of operation would be consistent with applicable Commission policies. Yes 5) The Customer/Lessee acknowledges that in the event an authorization held by a Licensee that has associated with it a spectrum leasing arrangement that is the subject of this filing is revoked, cancelled, terminated, or otherwise ceases to be in effect, the Customer/Lessee will have no continuing authority to use the leased spectrum and will be required to terminate its operations no later than the date on which the Licensee ceases to have any authority to operate under the license, unless otherwise authorized by the Commission. Yes 6) The Customer/Lessee agrees the Lease shall not be assigned to any entity that is not eligible or qualified to enter into a spectrum leasing arrangement under the Commission’s Rules and Regulations. Yes 7) The Customer/Lessee waives any claim to the use of any particular frequency or of the electromagnetic spectrum as against the regulatory power of the United States because of the previous use of the same, whether by spectrum lease or otherwise. Yes 8) The Customer/Lessee certifies that it is not in default on any payment for Commission licenses and that it is not delinquent on any non-tax debt owed to any federal agency. Yes First Name: ▇▇▇▇▇ MI: Last Name: ▇▇▇▇▇ Suffix: Title: Director of Santa ▇▇▇▇ Water Customer Name: City of Santa ▇▇▇▇ Signature: Date:
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Notification for Spectrum Manager Lease. In order for Sensus to apply to the FCC on the Customer’s behalf for a spectrum manager lease, Customer must complete the information below in boxes one (1) through ten (10) and certify via authorized signature. Customer’s signature will indicate that Customer authorizes Sensus to file the spectrum manager lease notification on FCC Form 608 with the Customer as spectrum Lessee, and if Customer does not already have one, ownership disclosure information on FCC Form 602. 1 Customer/Lessee Name: City of Santa ▇▇▇▇ Attention To: ▇▇▇▇▇ ▇▇▇▇▇, Director of Santa ▇▇▇▇ Water Name of Real Party in Interest: Street Address: ▇▇ ▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ City: Santa ▇▇▇▇ State: CA Zip: 95404 Phone: ▇▇▇-▇▇▇-▇▇▇▇ Fax: ▇▇▇-▇▇▇-▇▇▇▇ Email: ▇▇▇▇▇▇@▇▇▇▇▇▇.▇▇▇ Is Customer contact information same as above? Yes Additional Customer/Lessee Contact Information No (If No, complete box 2 below) 2 Company Name: Attention To: Street Address: City: Customer/Lessee is a(n) (Select one): Individual ǀ Unincorporated Association ǀ Trust Government Entity ǀ Corporation ǀ Limited Liability Company ǀ General Partnership Limited Partnership ǀ Limited Liability Partnership ǀ Consortium ǀ Other FCC Form 602: FCC File Number of Customer’s Form 602 Ownership Information: . If Customer has not filed a Form 602, Sensus will file one for Customer. Please complete questions 5, 6, and 7 below if Customer does not have a Form 602 on file. Customer must complete items 8, 9 and 10 irrespective of whether Customer has an ownership report on file. Customer Tax ID: ▇▇-▇▇▇▇▇▇▇ Individual Contact For FCC Matters Please designate one individual (the Director of Public Works or similar person) who is responsible to the FCC for the operation of the FlexNet radio system. Name ▇▇▇▇▇ ▇▇▇▇▇ Title: Director of Santa ▇▇▇▇ Water Email: ▇▇▇▇▇▇@▇▇▇▇▇▇.▇▇▇ Phone: ▇▇▇-▇▇▇-▇▇▇▇ Ownership Disclosure Information If Customer/Lessee is a government entity, list the names of the Mayor and all Council Members below, as well as verify citizenship and ownership interests in any entity regulated by the FCC. Such ownership must be disclosed where a mayor/council member owns 10% or more, directly or indirectly, or has operating control of any entity subject to FCC regulation. If any answer to Ownership question is Yes, or any answer to Citizenship question is No, provide an attachment with further explanation. US Citizen? Ownership Disclosure? Mayor: ▇▇▇▇ ▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇ ▇▇▇▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇▇ ▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇▇ ▇▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇ Yes No Yes No Council Member: ▇▇▇▇ ▇▇▇▇▇▇▇ Yes No Yes NoNo Alien Ownership Questions (if the answer is Yes, provide an attachment explaining the circumstances)
1) Is the Customer/Lessee a foreign government or the representative of any foreign government? Yes NoNo Basic Qualification Information
1) Has the Customer or any party to this application had any FCC station authorization, license, or construction permit revoked or had any application for an initial, modification or renewal of FCC station authorization, license or construction permit denied by the Commission? Yes No
2) Has the Customer or any party to this filing, or any party directly or indirectly controlling the Customer or any party to this filing ever been convicted of a felony by any state or federal court? Yes No
3) Has any court finally adjudged the Customer or any party directly or indirectly controlling the Customer guilty of unlawfully monopolizing or attempting to unlawfully monopolize radio communication, directly or indirectly, through control of manufacture or sale of radio apparatus, exclusive traffic arrangement, or any other means or unfair methods of competition? Yes NoNo Customer/Lessee Certification Statements
1) The Customer/Lessee Customer/▇▇▇▇▇▇ agrees that the Lease is not a sale or transfer of the license itself. Yes
2) The Customer/Lessee acknowledges that it is required to comply with the Commission’s Rules and Regulations and other applicable law at all times, and if the Customer/Lessee fails to so comply, the Lease may be revoked, cancelled, or terminated by either the Licensee or the Commission. Yes
3) The Customer/Lessee certifies that neither it nor any other party to the Application/Notification is subject to a denial of Federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C § 862, because of a conviction for possession or distribution of a controlled substance (See Section 1.2002(b) of the rules, 47 CFR § 1.2002(b), for the definition of “party to the application” as used in this certification.) Yes
4) The Customer/Lessee hereby accepts Commission oversight and enforcement consistent with the license and lease authorization. The Lessee acknowledges that it must cooperate fully with any investigation or inquiry conducted either by the Commission or the Licensee, allow the Commission or the Licensee to conduct on-site inspections of transmission facilities, and suspend operations at the direction of the Commission or the Licensee and to the extent that such suspension of operation would be consistent with applicable Commission policies. Yes
5) The Customer/Lessee acknowledges that in the event an authorization held by a Licensee that has associated with it a spectrum leasing arrangement that is the subject of this filing is revoked, cancelled, terminated, or otherwise ceases to be in effect, the Customer/Lessee will have no continuing authority to use the leased spectrum and will be required to terminate its operations no later than the date on which the Licensee ceases to have any authority to operate under the license, unless otherwise authorized by the Commission. Yes
6) The Customer/Lessee Customer/▇▇▇▇▇▇ agrees the Lease shall not be assigned to any entity that is not eligible or qualified to enter into a spectrum leasing arrangement under the Commission’s Rules and Regulations. Yes
7) The Customer/Lessee waives any claim to the use of any particular frequency or of the electromagnetic spectrum as against the regulatory power of the United States because of the previous use of the same, whether by spectrum lease or otherwise. Yes
8) The Customer/Lessee certifies that it is not in default on any payment for Commission licenses and that it is not delinquent on any non-tax debt owed to any federal agency. Yes The Customer/Lessee certifies that all of its statements made in this Application/Notification and in the schedules, exhibits, attachments, or documents incorporated by reference are material, are part of this Application/Notification, and are true, complete, correct, and made in good faith. The Customer/Lessee shall notify Sensus in writing in the event any information supplied on this form changes. Type or Printed Name of Party Authorized to Sign First Name: ▇▇▇▇▇ MI▇▇: Last Name: ▇▇▇▇▇ Suffix▇▇▇▇▇▇: Title: Director of Santa ▇▇▇▇ Water Customer Name: City of Santa ▇▇▇▇ Signature: Date:: FAILURE TO SIGN THIS APPLICATION MAY RESULT IN DISMISSAL OF THE APPLICATION AND FORFEITURE OF ANY FEES PAID. WILLFUL FALSE STATEMENTS MADE ON THIS FORM OR ANY ATTACHMENTS ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT (U.S. Code, Title 18, Section 1001) AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. Code, Title 47, Section 312(a)(1)) AND/OR FORFEITURE (U.S. Code Title 47, Section 503). Part 2: AMI AGREEMENT
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