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25H - AGMT FOR METER READING AND MANAGEMENT
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11/17/2020
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25H - AGMT FOR METER READING AND MANAGEMENT
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Last modified
11/12/2020 5:27:31 PM
Creation date
11/12/2020 3:23:03 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Finance & Management Services
Item #
25H
Date
11/17/2020
Destruction Year
2025
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Part 1: Notification for Spectrum Manager Lease <br />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 <br />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 <br />Form 608 with the Customer as spectrum Lessee, and if Customer does not already have one, ownership disclosure information on FCC Form 602. <br />Customer/Lessee Name: City of Santa Ana <br />Attention To: Nabil Saba <br />Name of Real Party in Interest. <br />Street Address. 20 Civic Center Plaza <br />City. Santa Ana <br />State CA <br />Zip: 92702 <br />Phone. 714-647-5400 <br />Fax <br />Email. <br />NSaba@santa-ana.org <br />Is Customer contact information same as above? ®Yes ❑No (If No, complete box 2 below) <br />2. <br />Additional Customer/Lessee Contact Information <br />Company Name: <br />Attention To'. <br />Street Address: <br />City: <br />State: <br />Zip: <br />Phone: <br />Fax: <br />Email: <br />3. <br />Customer/Lessee is a(n) (Select one): El Individual I ❑ Unincorporated Association I ❑Trust <br />®Government Entity I El Corporation I ❑ Limited Liability Company I El General Partnership <br />❑Limited Partnership I ❑Limited Liability Partnership I ❑Consortium I ❑ Other <br />FCC Form 602: FCC File Number of Customer's Form 602 Ownership Information: . If Customer has not fled a Form 602, Sensus will file one for <br />Customer. Please complete questions 5, 6, and 7 below if Customer does not have a Form 602 on file. <br />Customer must complete items 8, 9 and 10 irrespective of whether Customer has an ownership report on file. <br />Customer Tax ID: 95-6000785 <br />Individual Contact For FCC Matters <br />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. <br />Name Nabil Saba <br />Title: Executive Director, Public Works Agency <br />Email: NSaba@santa-ana.org <br />Phone: 714-647-5400 <br />7. <br />Ownership Disclosure Information <br />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 <br />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 <br />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 <br />with further explanation. <br />US Citizen? <br />Ownership Disclosure? <br />Mayor: Miguel Pulido <br />®Yes El No <br />❑Yes ❑Na <br />Council Member: Vicente Sarmiento <br />®Yes El No <br />❑Yes ❑Na <br />Council Member: David Pensioza <br />®Yes El No <br />❑Yes ❑No <br />Council Member: Jose Solorio <br />®Yes El No <br />❑Yes ❑No <br />Confidential I Page 2 of 14 <br />25H-148 <br />
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