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IIavt 'I 140fif ICal i10 I[ i for Slpipirtruirn Vainagier III ease In order for Sensus to apply to the FCC on the Customer's behalf for a spectrum manager lease, Customer must complete the information below in boxes one (1) through ten (10) and certify via authorized signature. Customer's signature will indicate that Customer authorizes Sensus to file the spectrum manager lease notification on FCC Form 608 with the Customer as spectrum Lessee, and if Customer does not already have one, ownership disclosure information on FCC Form 602. Customer/Lessee Name: City of Santa Ana Attention To: Nabil Saba Name of Real Party in Interest: Street Address: 20 Civic, Center Plaza City! Santa Ana State: CA Zip: 92702 Phone 714-647-5400 Fax: I Email: NSaba@santa-ana.org Is Customer contact information same as above? ®Yes ❑No (if No, complete box 2 below) 2. Additional Customer/Lessee Contact Information Company Name: Attention To: Street Address: City: State: zip: Phone Fax: Email: 3. Customer/Lessee is a(n) (Select one) : EJ I ndivi dual I ❑ Unincorporated Association ❑Trust ®Government Entity I ❑Corporation I ❑ Limited Liability Company I ❑General Partnership ❑Limited Partnership I ❑Limited Liability Partnership I ❑Consortium I ❑ Other 4. FCC Form 602: FCC File Number of Customer's Form 602 Ownership Informatiom --. If Customer has not filed a Form 602, Sensus will file one for Customer. Please complete questions 5, 6. and 7 below if Customer does not have a Form 602 on file. Customer must complete items 8, 9 and 10 irrespective of whether Customer has an ownership report on file 5. ICustomer Tax ID: 95-6000785 6. Individual Contact For FCC Matters Please designate one individual (the Director of Public Works or similar person) who is responsible to the FCC for the operation of the FlexNet radio system. Name Nabil Saba Title: Executive Director, Public Works Agency Email: NSaba@santa-ana.org PI 714-647.5400 7. Ownership Disclosure Information If Customer/Lessee is a government entity, list the names of the Mayor and all Council Members below, as well as verify citizenship and ownership interests in any entity regulated by the FCC. Such ownership must be disclosed where a mayor/counril member owns 10% or more, directly or indirectly, or has operating control of any entity subject to FCC regulation. If any answer to Ownership question is Yes, or any answer to Citizenship question is No, provide an attachment with further explanation. US Citizen? Ownership Disclosure? Mayor: Miguel Pulido ®Yes ❑N'n ❑Yes ❑No Council Member: Vicente Sarmiento ®Yes ❑No ❑Yes ❑No Council Member: David Penaloza ®Yes ❑No ❑Yes ❑No Council Member: Jose Solorio ®Yes ❑N'o ❑Yes ❑No Confidential I Page 2 of 14 25H-148