ROW use registrationCOFFELL
RIGHT-OF-WAY MAINTENANCE USE FEE
Ordinance No. 2001-944, Sec. 6-14-3.
Registration Form for Service Provider
Registration expires March 1 of every other year after the calendar year in which the ftrst
registration occurs. If registration is not renewed by the expiration date, after written notice
from the City, the facilities of the service provider will be deemed to have been legally abandoned.
Service Provider (include any business name provider operates under or has
operated under for past 5 years)
PUC Certificate Number (for certificated telecommunications providers)
City of Coppell License Ordinance No.
Contact Names/Numbers
Contractor(s) Name
Contact Information
Emergency Contact
Liability Insurance Carrier
(Sec. 6-14-3 (h))
Attach proof of coverage
Plans of Record provided to Engineering Dept. for existing facilities Y N
For proposed facilities __Y--N
Forward registration form and fee to Engineering Dept., City of Coppell,
255 Parkway Blvd., Coppell TX 75019
IFOr office Use only
Registration Fee of $250.00 paid __
/ / Receipt No,