ExteNet Systems-CS181024Submit
T H E a C 1 T Y • O F
:OPPELL
PUBLIC RIGHTS-OF-WAY MANAGEMENT ORDINANCE
form to the
REGISTRATION FORM
it., Town Center, 265 Parkway Blvd.
11, TX, 75019
This registration form is required by Sec. 6-14-3 of the City of Coppell Code of Municipal Ordinances. It is
to be renewed every other year by March]. This document does not take the place of obtaining a Right -Of -
Way Use Permit prior to performing any work in the public right-of-way.
1. Date of Submittal: 09 28 2018
2. Name and Address of Service Provider (Include all names used within the last 5 years):
ExteNet Systems
3. Is Provider certified by the Texas Public Utility Commission?
60769
NO
OYES
if YES, Certificate Number,
4. Does Provider have a Valid License or Franchise Agreement with the City of Coppell?
Under Chapter 284, franchise agreements are
(X) NO () YES if YES, Ordinance Number not needed.
Date Approved
5. Provide Two Business Contacts (One must be within the Dallas/Fort Worth area):
Dia Kuykendall
Name
Regional Manager, External Relations
Title
901 Main Street, Dallas, TX 76227
Address
214-727-9676
Telephone
Daniel Alvarado
Name
Title
Implementation Manager
901 Main Street, Dallas, TX 76227
Address
214-682-7057
Telephone
6. Provide Two Emergency Contacts (Must be available AT ALL TIMES):
Daniel Alvarado Dia Kuykendall
Name Name
Implementation Manager Regional Manager, External Relations
Title Title
901 Main Street, Dallas, TX 76227 901 Main Street, Dallas, TX 76227
Address Address
214-682-7057 214-727-9676
Telephone (No Charge to the City) Telephone (No Charge to the City)
7. Have the names, addresses, and contact information for all known contractors or subcontractors
that will be working in the public right -of --way on behalf of the Provider been furnished to the
City?
(4 YES ( ) NO if NO, Reason, See attached
8. Has proof of insurance meeting the requirements of Sec. 6-14-3 B.4(h) of the Public Rights -Of -
Way Management Ordinance been furnished to the City (the City must be named as an additional
insured on the policy by using endorsement CG 20 26 or broader)?
(K) YES ( ) NO if NO, Reason:
Signature of Applicant
REGISTRATION ACCEPTED
Signature of City Representative
Dia Kuykendall
Printed Nam
e
FOR CITY USE ONLY
09/28/2018
Date
Comments:
( )REGISTRATION DENIED
Printed Name
/o zk lB,
Date
Provider shall indemnify and forever hold harmless against the City of Coppell each and every claim, demand, or cause of
action that may be made or come against it by reason of or if any way arising out of the closure, blocking, excavating,
cutting, tut:neling, or other work by the provider under permit from the City, if such permit is gratttetl.
Extenet Systems Contractors for DFW Area
World Fiber Technologies
652 Wildlife Boulevard
Grand Prairie, TX 75050
Bruce Potter
(770) 619-0118
T&D Solutions
1010 US 80 Frontage Road
Mesquite, TX 75149
Cory Close
956-421-2670