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MARICOPA COUNTY VIDEO SERVICE LICENSE AGREEMENT DATE OF ISSUANCE: ___________________ License #______________ This Video Service License Agreement (“License”) is entered into on _____________, Month and Day 20___, by and between the following parties: LICENSOR: MARICOPA COUNTY, a political subdivion of the State of Arizona, its agents, contractors, successor, and assigns, LICENSEE: Name of Service Provider 1, ________________, Type of Entity _______________________________ Jurisdiction of Formation ____________________________________________________ Address of Principle Place of Business ____________________________________________________ City, State, Zip Code Principle Phone Number . LICENSOR hereby grants to LICENSEE a nonexclusive Video Service License to provide video service in the Service Area described on Exhibit B attached hereto and incorporated herein by this reference, and to use and occupy the highways in the delivery of said video service, subject to the laws of this state and police powers of LICENSOR, upon the following terms and conditions: 1. LICENSEE shall: a. Pay the license fee of five percent (5%) as established by the Maricopa County Board of Supervisors, as required under A.R.S. Title 11, Chapter 14, and all other lawful fees and charges imposed by the LICENSOR. b. File in a timely manner with the federal communications commission all forms required by that agency before offering video service in the service area, including the forms required by 47 Code of Federal Regulations Section 76.1801. 1. Name and address of NAME OF Licensee SERVICE PROVIDER principal executive officers or general partners and any persons authorized to represent the NAME OF Licensee SERVICE PROVIDER before MARICOPA COUNTY can be found on Exhibit A attached hereto and incorporated herein by this reference. c. Comply with and be subject to all valid and enforceable federal and state laws. Comply with all general applicable, nondiscriminatory local laws, including highway use, mapping, insurance, performance bonds, security fund, indemnification or similar requirements that apply to the use and occupation of any highway and that conform to A.R.S. Title 11, Chapter 14. d. Comply with the public, education and government programming requirements of A.R.S. Title 11, Chapter 14. e. Comply with all customer service rules of the Federal Communications Commission under 47 Code of Federal Regulations Section 76.309(c) applicable to cable operators. f. Comply with the consumer privacy requirements of 47 United State Code Section 551 applicable to cable operators. 2. LICENSEE and LICENSOR are subject to and must comply with A.R.S. Title 11, Chapter 14. 3. The term of this License is ten (10) years and shall begin on the date of issuance. 4. LICENSEE expects to provide video service in the area identified on Exhibit B on the _____day of _______________, Month 20___. (date not required if LICENSEE is an incumbent cable operator) Name of Service Provider MARICOPA COUNTY By: ________ By: Print: ______________________ _____ Print: _____________________________ Its: ________ Its: ______________________________ Date: ________ Date: _____________________________ EXHIBIT A Principal Executive Officers, General Partners, and Persons authorized to represent LICENSEE before LICENSOR I. LICENSEE’S PRINCIPAL EXECUTIVE OFFICERS OR GENERAL PARTNERS: Name: Title: Address: Name: Title: Address: Name: Title: Address: Name: Title: Address: II. PERSON(S) AUTHORIZED TO REPRESENT LICENSEE BEFORE LICENSOR: Name: Title: Address: Phone: Fax: Email: Name: Title: Address: Phone: Fax: Email: Name: Title: Address: Phone: Fax: Email: EXHIBIT B [Service Area]