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Exhibit A-3 –Acknowledgement Letter <br />EXHIBIT A-3 <br />Form of Acknowledgment Letter [Licensee to complete and submit.] <br />[Alternative to be used if Licensee obtains all Regulatory Approvals within 365 (366 in any leap year) days after Pole License is issued.] <br />[Date] <br />City of San Leandro <br />835 East 14th Street <br />San Leandro, CA 94577 <br />Attention: Michael Stella, P.E., Principal Engineer <br />Re:Pole License No. <br />Associated Facilities License No. (if applicable)____ <br />Dear ____________: <br />This letter will confirm the following: (1) that Licensee has obtained the Encroachment <br />Permit and all other Regulatory Approvals required for the Permitted Use under this License, <br />copies of which are attached to this letter, as specified below; and (2) the Commencement <br />Date of this License is , 20 , which is the first day of the month after Licensee <br />obtained all Regulatory Approvals. <br />This letter also confirms that Licensee has submitted all required insurance <br />information to the City. A check or surety bond for the Security Deposit (if not already <br />provided) and the License Fee for the first License Year of this License is attached [or funds <br />for the Security Deposit and the License Fee for the first License Year of this License have <br />been paid to the City]. <br />Please acknowledge the City’s receipt of this letter and the items listed below, and <br />issue the City’s approval for Licensee to begin installation of Equipment on the License Are <br />by signing and returning a copy of this letter. <br />Very truly yours, <br />By: Title: <br />Enc. <br />[]Encroachment Permit <br />[][List other Regulatory Approvals.] <br />[][List other Regulatory Approvals.] <br />[][List other Regulatory Approvals.] <br />[]Insurance certificates and endorsements <br />[]Contractor’s bonds, insurance certificates, Business Licenses, and endorsements <br />[]Security Deposit by check, wire transfer, or surety bond, (if applicable) <br />[]First License Year’s License Fee <br />[]First License Year’s License Fee <br />[ ]Typical Photo-simulations (as applicable)