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Exhibit A-3 –Acknowledgement Letter <br />[Alternative to be used if Licensee does not obtain all Regulatory Approvals within 365 (366 in any leap year) days after Pole and/ or Associated Facilities 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: __[X]_____ Pole License <br /> __[X]___ Associated Facilities (Choose one) <br />License No. ____________ <br />Dear ___________: <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 License: <br />; <br />and <br />(2)the Commencement Date of this License is , 20 , which is <br />the 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 <br />License Fee for the first License Year of this License is attached [or funds for the Security <br />Deposit and the License Fee for the first License Year of this Pole License have been wired <br />to the City]. <br />When Licensee has obtained all Regulatory Approvals, it will provide copies to the <br />City, submit all required insurance documents and information, and request that the City <br />issue its approval for Licensee to begin installation of Equipment on the License Area. <br />Very truly yours, <br />By: Title: <br />Enc. <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