Fillable CITY OF TUCSON DEPARTMENT OF TRANSPORTATION POLE RESERVATION (City of Tucson)

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CITY OF TUCSON DEPARTMENT OF TRANSPORTATION POLE RESERVATION (City of Tucson)

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CITY OF TUCSON
DEPARTMENT OF TRANSPORTATION
POLE RESERVATION CONTRACT
POLE LOCATION (Coordinates
(WGS1984, decimal degrees to eight (8)
digits)):
LEGAL STREET ADDRESS (if known):
DATED:
The City of Tucson Department of Transportation ("TDOT") hereby grants a Pole Reservation to:
("APPLICANT") for the "SUBJECT LIGHT POLE" as described
above and shown on:
EXHIBIT "A"
Pima County, Arizona, upon the following terms:
1. The Pole Reservation shall commence on (Commencement Date) and shall
continue for 90 calendar days as hereinafter provided.
2. During the time of this Pole Reservation, Applicant shall be allowed to evaluate location,
prepare plans, and have required Small-Cell submittal documents accepted for review and
permitting to replace Subject Light Pole with a Small Wireless Facility (SWF) equipped light
pole only, and for no other purpose. No other application shall be accepted for the
reserved location during this time.
3. This Pole Reservation shall terminate at midnight (12:00 a.m.) on the 90th calendar day
from Commencement Date, or upon TDOT acceptance of Applicant’s complete application
for pole replacement, including an mutually-executed Site License Agreement (SLA).
4. The non-refundable, non-transferrable fee of $ 500.00 (Fee) is due and payable with this
Pole Reservation Contract. Failure to pay Fee will result in no Pole Reservation and
possible loss of Subject Light Pole for pole replacement and/or SWF attachment.
5. Applicant shall attach, as Exhibit A, an aerial image depicting the exact pole location for
each Pole Reservation Contract submitted. Pole Reservations will not be processed
without both exact coordinates and the aforementioned exhibit.
6. Applicant shall be responsible for acquiring all necessary permits to conduct the
replacement of Subject Light Pole, and Applicant shall be responsible for complying with all
zoning and code requirements as established by the City Planning and Development
Services Department, TDOT, and any other City, County and/or State Code(s) or Statute(s)
that may apply.
7. Applicant acknowledges that neither payment of Fee nor submission of a Pole Reservation
Contract confer any right whatsoever to have a pole replacement application approved or
permits granted for the location reserved. No rights are granted or implied other than
those specifically listed herein.
8. Applicant hereby acknowledges and agrees that this right of replacement is being granted
at Applicant’s request for the purpose stated above and any and all expenses (including
permit fees) shall be borne solely by Applicant.
9. Applicant hereby acknowledges and agrees that a pole reservation does not guarantee the
location is approvable to replace Subject Light Pole with a Small Wireless Facility.
Applicant:
BY:
Date
PRINT NAME
TITLE
TELEPHONE
ADDRESS LINE 1
ADDRESS LINE 2
TDOT:
CITY OF TUCSON, ARIZONA
Date
SIGNATURE
SIGNATURE
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CITY OF TUCSON DEPARTMENT OF TRANSPORTATION POLE RESERVATION (City of Tucson)

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Completed 5 August 2020

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