Common use of Unauthorized Attachment Fee Clause in Contracts

Unauthorized Attachment Fee. Three (3) times the annual Pole Attachment Fee, per Pole containing an Unauthorized Attachment. For District Use ‐ Permit No. Superseded Permit No. Licensee’s Business Name: Application to: ☐ Attach to Utility Pole(s) ‐ No. of Poles: ☐ Overlash ‐ No. of Poles: ☐ Remove Attachment(s) ‐ No. of Poles: Description of Proposed Activity: The Permit Application Fee is enclosed in the amount of $ . A Pre‐Construction Survey, certified by a Professional Engineer in the State of Washington, has been submitted to the District in accordance with Articles 1.19 and 6.3. ☐ Yes ☐ No If No, please provide additional information: A map clearly indicating the poles related to this Application is enclosed. ☐ Yes ☐ No If No, please provide additional information: Licensee understands and acknowledges that Pole Attachments authorized under this Application are subject to the terms and conditions of the District’s Joint Use Standards, which may be amended from time to time. Initial Date Licensee understands and acknowledges they are responsible for obtaining from the appropriate public and/or private authority or other appropriate persons any required authorization to construct, operate and/or maintain its Communications Facilities on public and/or private property before it occupies any portion of Poles in accordance with the Pole Attachment License Agreement referenced above. Copies of the required permits are attached. Initial Date Licensee hereby requests the District to process this Application and initiate the steps necessary to prepare a Make‐Ready Estimate, should such work be necessary. By: _____________________________________ (Signature) Print Name: _______________________________ Title: ____________________________________ Date: ___________________________________ Public Utility District No. 2 of Grant County, Washington Attn: Joint Use Administrator, Moses Lake Local Office PO Box 878 Ephrata, WA 98823 Email the Pre‐Construction Survey to: ▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Permit Application Fee in the amount of $________ received. ☐ Yes ☐ No Pre‐Construction Survey approved? ☐ Yes ☐ No Make Ready work required? ☐ Yes ☐ No If Yes, the District has received Licensee’s payment for the Make‐Ready Work: Amount: Date Received: Permission is hereby granted to Licensee to attach and/or vacate poles specified in this Application. Public Utility District No. 2 of Grant County, Washington By: ____________________________________ Print Name: ______________________________ Title: ___________________________________ Date: ___________________________________ The Licensee shall provide the following information for each Pole with their Application for Permit: The minimum vertical clearance under all loading conditions measured from the proposed cable to ground level on each conductor span shall be stated above. Variations in topography resulting in ground elevation changes shall be considered when stating the minimum vertical clearance within a given span. Proposed loading data [provide similar data for each cable proposed]: • Weight data (cable and messenger) o Vertical weight, bare = [#/ft] • Tension data (final tensions on messenger) o NESC maximum load for area of construction: [lbs]

Unauthorized Attachment Fee. Three (3) times the annual Pole Attachment Fee, per Pole containing an Unauthorized Attachment. For District Use ‐ Permit No. Superseded Permit No. Licensee’s Business Name: Application to: ☐ Attach to Utility Pole(s) ‐ No. of Poles: ☐ Overlash ‐ No. of Poles: ☐ Remove Attachment(s) ‐ No. of Poles: Description of Proposed Activity: The Permit Application Fee is enclosed in the amount of $ . A Pre‐Construction Survey, certified by a Professional Engineer in the State of Washington, has been submitted to the District in accordance with Articles 1.19 and 6.3. ☐ Yes ☐ No If No, please provide additional information: A map clearly indicating the poles related to this Application is enclosed. ☐ Yes ☐ No If No, please provide additional information: Licensee understands and acknowledges that Pole Attachments authorized under this Application are subject to the terms and conditions of the District’s Joint Use Standards, which may be amended from time to time. Initial Date Licensee understands and acknowledges they are responsible for obtaining from the appropriate public and/or private authority or other appropriate persons any required authorization to construct, operate and/or maintain its Communications Facilities on public and/or private property before it occupies any portion of Poles in accordance with the Pole Attachment License Agreement referenced above. Copies of the required permits are attached. Initial Date Licensee hereby requests the District to process this Application and initiate the steps necessary to prepare a Make‐Ready Estimate, should such work be necessary. By: _____________________________________ (Signature) Print Name: _______________________________ Title: ____________________________________ Date: ___________________________________ Public Utility District No. 2 of Grant County, Washington Attn: Joint Use Administrator, Moses Lake Local Office PO Box 878 Ephrata▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇, WA 98823 ▇▇ ▇▇▇▇▇ Email the Pre‐Construction Survey to: ▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Permit Application Fee in the amount of $________ received. ☐ Yes ☐ No Pre‐Construction Survey approved? ☐ Yes ☐ No Make Ready work required? ☐ Yes ☐ No If Yes, the District has received Licensee’s payment for the Make‐Ready Work: Amount: Date Received: Permission is hereby granted to Licensee to attach and/or vacate poles specified in this Application. Public Utility District No. 2 of Grant County, Washington By: ____________________________________ Print Name: ______________________________ Title: ___________________________________ Date: ___________________________________ The Licensee shall provide the following information for each Pole with their Application for Permit: The minimum vertical clearance under all loading conditions measured from the proposed cable to ground level on each conductor span shall be stated above. Variations in topography resulting in ground elevation changes shall be considered when stating the minimum vertical clearance within a given span. Proposed loading data [provide similar data for each cable proposed]: • Weight data (cable and messenger) o Vertical weight, bare = [#/ft] • Tension data (final tensions on messenger) o NESC maximum load for area of construction: [lbs]