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Revised 07-2025 City of Woodburn UTILITY LICENSE APPLICATION Pursuant to Ordinance No. 2538, all person engaging in any activity within or using the City of Woodburn’s rights-of- way, or providing utility services, must first apply and be approved for a Utility license. Submit the following information and applicable fee to: City of Woodburn, Attn: ROW Program, 270 Montgomery St. Woodburn, Oregon, 97071. Application Fee (excluding small cell wireless): $300.00 Small cell wireless application fee: $500.00 for up to five sites, $100.00 each additional site 1. Name of Entity proposed to provide services (licensee/applicant). 2. Tax ID of Entity. 3. Physical address and website. 4. City of Woodburn Business Registration number or application date. 5. Authorized contact information (name, email, address, phone, etc). 6. Description of proposed activities or services (e.g. VoIP, Internet, Cable, Voice, Infrastructure Provider, Reseller (if reseller indicate whose service is being resold)). 7. Does Applicant plan to install facilities or own any facilities currently located in Woodburn? If, so provide GIS map. Does Applicant have or plan to have facilities installed underground, aerial or both? 8. Date services started or date of first ROW usage. 9. List any other municipalities in Oregon for which Applicant has an existing agreement for the provision of service(s). 10. Has the Applicant or any affiliate been found in violation by a regulatory authority? If so, identify the judicial or administrative proceeding, giving the date, name of tribunal, and result or disposition of proceeding. ---PAGE BREAK--- Revised 07-2025 City of Woodburn UTILITY LICENSE APPLICATION Page 2 of 2 11. Attach the following documentation: a. Valid certificate from the Oregon Public Utility Commission, if applicable. b. Management/organizational chart, showing the management structure including name and unique contact information (physical address, email, direct phone, etc). c. Chart or description showing the relationship to all general partners, parent corporation, subsidiaries, affiliates and all other subsidiaries of the parent corporations, include a brief description of each entity’s relationship. d. Detailed map of the City’s rights-of-way which applicant intends to use, also listing the exact linear feet or dimensions of the proposed facilities that will occupy the right-of-way. If Applicant is using a third parties’ facilities, indicate the owner(s) of the facilities to be used. I hereby certify, on behalf of Applicant, that to the best of my knowledge and belief this information is true and correct as of the date hereof. Licensee agrees to comply with all Ordinances, code, rules and regulations of the City of Woodburn. By executing this application, the undersigned affirms that she/he is an authorized representative of the Applicant with the authority to execute the ROW license application and bind applicant to all provisions of Woodburn Ordinances (including the Utility Service Ordinance), Codes, Rules and Regulations, heretofore or hereafter amended. Signature & Printed Name Title Date After reviewing the application, the City or its designee may grant the license, deny the application, or find the application incomplete and require additional information or clarification. For additional information, please contact the City's Finance Department at [PHONE REDACTED] or [EMAIL REDACTED]