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Exhibit A-3 - Form of Acknowledgement Letter <br />Page 2 <br /> <br /> <br />[Alternative to be used if Licensee does not obtain all Regulatory Approvals within 365 (366 in any leap year) days after Pole License is issued.] <br /> <br />[Date] <br /> <br />City of San Leandro <br />835 East 14th Street <br />San Leandro, CA 94577 <br />Attention: Michael Stella, P.E., Principal Engineer <br /> <br />Re: Pole License No. <br />Dear Mr. Stella: <br />This letter will confirm the following: <br />(1) that Licensee has not obtained the following Regulatory Approvals required for the <br />Permitted Use under this Pole License: <br /> ; and <br />(2) the Commencement Date of this Pole License is , 20 , which is the <br />first anniversary of the effective date of this Pole License. <br />A check or surety bond for the Security Deposit (if not already provided) and the License <br />Fee for the first License Year of this Pole License is attached [or funds for the Security Deposit <br />and the License Fee for the first License Year of this Pole License have been wired to the City]. <br />When Licensee has obtained all Regulatory Approvals, it will provide copies to the City, <br />submit all required insurance documents and information, and request that the City issue its <br />approval for Licensee to begin installation of Equipment on the License Area. <br />Very truly yours, <br /> <br /> <br />By: <br />Title: <br /> <br /> <br />Enc. <br /> <br />[ ] [List Regulatory Approvals acquired.] <br />[ ] [List other Regulatory Approvals acquired.] <br />[ ] [List other Regulatory Approvals acquired.] <br />[ ] Security Deposit by check, wire transfer or surety bond (if applicable) <br />[ ] First License Year’s License Fee <br />