Small Cell Wireless Facilities License Application

INTRODUCTION

This application form is for a Small Cell Wireless Facilities License to construct, maintain, and operate small cell facilities and/or support structures in the City’s rights-of-way in accordance with Chapter 23, Article VII, Division 3 of the Code of Ordinances of the City of Huntsville, Alabama (Ordinance No. 20-270A) as such may be amended from time to time. A copy of the City’s Code of Ordinances can be accessed online at: https://library.municode.com/al/huntsville/codes/code_of_ordinances

An application cannot be processed until it has been completed.

If the Applicant believes that certain questions are either not relevant or are inapplicable, please set forth the basis for such belief. Please provide any additional information believed to be useful to the City in processing an application. To the extent any information provided is confidential or proprietary, please clearly and conspicuously mark it as such.

PART 1: GENERAL INFORMATION

1.1 Please provide the correct legal name of the Applicant (the legal entity to whom the License will be granted):

Is the entity a corporation, partnership, limited liability company or some other form of legal entity? Please choose one.

Corporation

Partnership

Limited Liability Company

Names and titles of each general or limited partner, or controlling shareholder(s):

The current officers or directors of the Applicant, and the names of any parent entities:

State of Formation

1.3 Name(s), address(es) and form(s) of legal entity of any affiliate(s) of Applicant that will be installing or operating any of the small cell facilities and/or support structures covered by the License.

1.4 Does the Applicant or any of its affiliates have a current franchise, license, or use agreement from the City authorizing it to construct, maintain, and operate small cell facilities and/or support structures in the City’s rights-of-way?

Yes

Please identify the ordinance number:

1.5 Is the Applicant or any of its affiliates currently involved in any disputes before any federal, state, or local regulatory agency that would adversely impact the Applicant’s ability of to legally construct, maintain or provide facilities or services in the City?

Yes

Please describe:

Position/Title

Phone Number

PART 2: APPROVALS, ETC.

2.1 Has the Applicant obtained all necessary federal and state licenses, authorizations and certifications necessary to install its proposed small cell facilities and/or support structures in the City and to provide its proposed wireless communications services over those facilities?

Yes

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2.2 If the Applicant has not yet obtained all such necessary licenses, authorizations, and certifications, provide an explanation of the steps that the Applicant has taken, or intends to take, to obtain them.

PART 3. CERTIFICATIONS OF APPLICANT.

I, the undersigned, hereby certify that

Applicant is duly organized, validly existing entity, and in good standing under the laws of the State of formation, is qualified to do business under the laws of the State of Alabama, and has the power and authority to own its properties, to carry on its business as now being conducted, to execute and deliver the acceptance of the license it is applying for, to carry out the transactions contemplated hereby, and to perform and carry out all obligations on its part to be performed under and pursuant to that license.

Applicant has, or will have as of the date of the grant of the license, adequate financial resources to install the small cell facilities and/or support structures in accordance with the provisions of Chapter 23, Article VII, Division 3 of the City Code, and knows of no technical or legal impediment which would prevent it from performing as contemplated in said division.

Applicant is not prohibited by any agreement or applicable law from executing and accepting a license.

All corporate actions and consents required on Applicant’s part to execute and deliver the acceptance of the license have been completed, or will be completed before acceptance of the license.

The undersigned is authorized to execute this Application on behalf of the Applicant. I understand that if there are material omissions of information requested by this Application or any deliberately or materially false or misleading answers given to questions on this Application, the City may revoke the license it has granted in reliance on the answers provided by Applicant to this Application. Further, appropriate legal action may be taken as may be provided for under applicable law.

Dated:

By:

Title/Position:

Email:

Signature

First Name

Last Name

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