Extracted text (via ocr_local)
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APPLICATION AND AFFIDAVIT FOR UNIFORM VIDEO SERVICE LICENSE (Pursuant to Title 9, chapter 13, Arizona Revised Statutes) Local Government: City of El Mirage I. Applicant: Date: February 25, 2020 Applicant’s Name: Cox Communications Arizona, LLC Principal Place of Business: 6205-B Peachtree Dunwoody Rd. Atlanta, GA 30328 Phone: 623-594-1000 Address: 1550 W Deer Valley Rd City/Town: Phoenix State: AZ Zip: 85027 Type of Entity: LLC Jurisdiction of Formation: Delaware Email: swrcableadministrator@cox.com Il. Applicant’s principal executive officers or general partners: Name: Patrick Esser | Title: President Address: 6205-B Peachtree Dunwoody Rd. Atlanta, GA 30328 Name: Jennifer Hightower | Title: Vice President Address: 6205-B Peachtree Dunwoody Rd. Atlanta, GA 30328 Name: Perly McBride | Title: Vice President Address: 6205-B Peachtree Dunwoody Rd. Atlanta, GA 30328 Name: John Wolfe | Title: Executive Vice President & Region Manager Address: 1550 W Deer Valley Rd. Phoenix, AZ 85027 III. Person(s) authorized to represent Applicant before Local Government: Name: John Wolfe | Title: Executive Vice President & Region Manager Address: 1550 W Deer Valley Rd. Phoenix, AZ 85027 Phone: 623-328-3121 | Fax: 623-322-7918 | Email: swrcableadministrator@cox.com Name: Susan Anable | Title: Vice President, Government & Public Affairs Address: 1550 W Deer Valley Rd. Phoenix, AZ 85027 Phone: 623-328-3121 | Fax: 623-322-7918 | Email: swrcableadministrator@cox.com IV. Check one pursuant to Arizona Revised Statutes Section 9-1411(C)(4): kK] Applicant is an Incumbent Cable Operator as provided in Arizona Revised Statutes, Section 9-1401(13). Oo Applicant is not an Incumbent Cable Operator. The date on which the Applicant expects to provide Video Services in the Service Area identified below under Section 9-1411(C)(5) is: Date: V. For All Applications: Applicant will timely file with the Federal Communications Commission all forms required by that agency before Applicant offers Video Service in the Service Area, including the forms required by 47 Code of Federal Regulations Section 76.1801. The term of the uniform video service license shall be (not to exceed ten years): 10 Years . Applicant agrees to pay all lawful fees and charges imposed by Local Government as provided in Arizona Revised Statutes, Section 9-1414(B)(4). . Applicant agrees to notify Local Government in writing of changes to the above information within thirty days after the change occurs as provided in Arizona Revised Statutes, Section 9- 1414(B)(2). Provide an exact description of the Service Area as set forth in Arizona Revised Statutes, Section 9-1411(C)(5), as identified by a geographic information system digital boundary meeting or exceeding national map accuracy standards. Select one: The Service Area consists of all the territory within the Boundaries of Local Government: YES The Service Area consists of all the territory within the area described on attached Exhibit A. [VERIFICATION AND RECEIPT ON FOLLOWING PAGE] Applicant Verification I certify that the information contained in this application for a video service license in the City of El Mirage is true and correct. | further affirm that I am authorized by Cox Communications Arizona, LLC to file this application on behalf of applicant and to bind the applicant with respect to the representations made in Section V, Paragraphs A through D of this application. A copy of the authorization is attached to this application. Name and Title (printed): John W9lfe, Executive Vice President & Region Manager winaare Te Wot f 9d [16 /do2o a — Local Government Receipt The foregoing Application and Affidavit for Uniform Video Service License was received by Local Government this _A7®day of ZEBRUA Ry, 200; at_B:35 PM. City of El, Mirage, an Arizona municipal corporation (“Local Government”) YY —GHARON ANTES Print Name L2itY CLERK Title . 3 (0000. NEL MIRAGE KD El Address ZL MIRAGE, AZ ©5346 City, State, Zip @L3-S1b - 2943 oL3- 816-4602 ee 2/2. Date