Crown Castle-CS181220
PUBLIC RIGHTS-OF-WAY MANAGEMENT ORDINANCE
REGISTRATION FORM
Submit completed form to the Engineering Dept., Town Center, 265 Parkway Blvd., Coppell, 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 1. 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: ______/______/______
2. Name and Address of Service Provider (Include all names used within the last 5 years):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
________________________________________________________________________________
3. Is Provider certified by the Texas Public Utility Commission?
( ) NO ( ) YES if YES, Certificate Number_____________________
4. Does Provider have a Valid License or Franchise Agreement with the City of Coppell?
( ) NO ( ) YES if YES, Ordinance Number_____________________
Date Approved ______/______/______
5. Provide Two Business Contacts (One must be within the Dallas/Fort Worth area):
____________________________________ _____________________________________
Name Name
____________________________________ _____________________________________
Title Title
____________________________________ _____________________________________
Address Address
____________________________________ _____________________________________
Telephone Telephone
Crown Castle Fiber LLC
2000 Corperate Drive
Canonsburg, PA 15317
Other Names: FPL FiberNet
Fibernet Direct Texas LLC
Crown Castle NG Central LLC
60988
Michael DePaola
Government Relations Specialist
6191 State Highway 161 - Suite 200, Irving, TX 75038
972-457-9145
Jennifer Young
Project Coordinator
6191 State Highway 161 - Suite 200, Irving, 75038
972-457-9152
12 20 2018
6. Provide Two Emergency Contacts (Must be available AT ALL TIMES):
____________________________________ _____________________________________
Name Name
____________________________________ _____________________________________
Title Title
____________________________________ _____________________________________
Address Address
____________________________________ _____________________________________
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?
( ) YES ( ) NO if NO, Reason: _______________________________________________
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)?
( ) YES ( ) NO if NO, Reason: _______________________________________________
_________________________________ _________________________________ ___________
Signature of Applicant Printed Name Date
a
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, tunneling, or other work by the provider under permit from the City, if such permit is granted.
FOR CITY USE ONLY
( ) REGISTRATION ACCEPTED ( ) REGISTRATION DENIED
Comments:_______________________________________________________________________
_________________________________________________________________________________
______________________________ _________________________________ _________
Signature of City Representative Printed Name Date
SCN NOC
24/7 Support
2000 Corperate Drive, Canonsburg, PA 15317
888-632-0931
SCN Fiber NOC
24/7 Support
2000 Corperate Drive, Canonsburg, PA 15317
866-553-4237
They have yet to be determined we will amend when applicable
Michael DePaola 12/20/2018