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City of San Leandro <br />San Leandro Main Library Digital Inclusion Program <br />Name of Grantee: <br />Name of Project: <br />Consent Form:Page 2 <br />Dated this _________ day of __________________, 20______. <br />Signature ___________________________________________ <br />Printed Name ________________________________________ <br />Title _______________________________________________ <br />Organization or Name of Company __________________________________________________________ <br />Business Address (include street address, suite/apt. number, city, state, and ZIP code) <br />______________________________________________________________________________________ <br />Undersigned representative of City of San Leandro is duly authorized to execute this Consent Form on behalf of <br />the Grantee and to bind the Grantee to the terms, conditions, and requirements set forth by the California Public <br />Utilities Commission. <br />507