Completed by Licensor Clause Samples

Completed by Licensor. Note: Attach Additional sheets if necessary. App. III-5 Appendix III Form B-1 Revised 5-11-94 AUTHORIZATION FOR FIELD SURVEY WORK Licensee NECOM LLC ---------------- In accordance with Article IV, Paragraph (A)(1) of the License Agreement, following is a summary of the estimated charges which will apply to complete a field survey covering Pole Attachment License Application Number _____________. Hours Rate/Hour Total Field Survey $ --------- ------------ --------- Plus 10% Administrative Compensation $ --------- TOTAL $ --------- If you wish us to complete the required field survey, please sign this copy below and return with an advance payment in the amount of $________________. Please note, this quote is only valid for 30 days. Licensee's Name (Print)___________________________________ Signature __________________________________________ Title __________________________________________ Date __________________________________________ The required field survey covering License Application No. _______ is authorized and the costs therefore will be paid to Licensor in accordance with Appendix I to License Agreement. App. III-6 Appendix III Form B-1 Revised 5-11-94 My anticipated date of attachment is _______________________. Licensee's Name (Print)___________________________________ Signature __________________________________________ Title __________________________________________ Date __________________________________________ App. III-7 Appendix III Form B-2 Revised 5-11-94 AUTHORIZATION FOR POLE MAKE READY WORK Licensee NECOM LLC ---------------------- Field survey work associated with your License Application No. __________ dated, ________________ 19__, for attachment to poles has been completed. Following is a summary of the make ready charges which will apply. Hours Rate/Hour Total Field Survey $ --------- ------------ --------- Plus 10% Administrative Compensation $ --------- TOTAL $ ---------