2. 
3. Application for Annual Right of Way Facilities Work Registration
   1) It shall be unlawful for any occupant, or person on behalf of such occupant, to conduct facilities work on the rights-of-way without first being registered with the City. 2) If an occupant has a valid franchise agreement with the city, the franchise agreement shall be considered registration. 3) Each registration shall be valid for the calendar year in which it was approved and will expire on December 31 of such year, unless it expires earlier pursuant to Section 30-61 of Ordinance NO. 7462. 4) Each occupant who conducts facilities work in the rights-of-way shall file an annual registration statement on this form. 5) Any material changes or modifications to the certificates of insurance, bonding or other information that affects the registrant's activities in the public rights-of-way shall be submitted to the City within 30 days of such change or modifications.
7. Company Name*
   Identity and legal status of applicant, including related affiliates that are or may conduct facilities work
9. Name, address, telephone number, e-mail address and fax number of the contact person responsible for the accuracy of this application. This person shall also serve as the applicant's agent
11. First and Last Name*
13. Phone Number Office*
15. Cell Phone Number*
17. Email Address*
19. Business Mailing Address*
21. List of contact persons, including the name, address, telephone number, email address and fax number for the following areas: right-of-way maintenance, right-of-way construction, administration and legal*
23. Emergency Point of Contact
25. First and Last Name*
27. Phone Number Office*
29. After Hrs. Phone Number*
31. Email Address*
33. Insurance Requirements*
    Certificate's of insurance on Commercial General Liability (CGL) with limits of insurance of not less than $1,000,000.00 each occurrence and $2,000,000.00 Annual Aggregate and on Auto Liability with limits of at least $1,000,000.00 each accident with the City named as additional insured, and proof of worker's compensation coverage are to be provided unless determined by the City as not applicable and this paragraph so noted initialed. All coverage's for Sub-Contractors, whether under the Contractor's policies or under separated policies shall comply with all of the requirements set forth in the Certificate of Liability Insurance example, provided by City Administrative Staff. Contractor hereby certifies and warrants, to Owner that all of its contracts with Sub-Contractors require the Sub-Contractors to comply with the requirements set forth in the Certificate of Liability Insurance Example
35. $50,000 Maintenance/Performance Bond*
37. Description of facilities works that registrant intends to offer or provide or is currently offering or providing, to any person or entity in the city.*
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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field