Conduit/Manhole Route Availability /Development

Customer TrackingNumber:Date:

Consolidated Agreement#

Please provide a schematic outlining your proposed route. Include manholenumbers,footage, specific address information, cable designations be as specific as possible. Ourestimatesarebasedontotallinearfootage.Asampleschematichasbeenincludedinthispackage.

Choose an Option:

Check all thatapply:

I am forwarding my specific route requirements please provide cost estimatestoprovide conduit record search and manhole survey(s). Total LinearFootagerequired. (Option 1only)

I am forwarding my route requirements please provide cost estimates toprovide conduitrecordsearchandmanholesurvey(s).Ifrouteisnotavailablepleasefindan alternative route. (Option 2only)

I am writing to request a Project Meeting to discuss requirements. (Option 1, 2 &3)

I have attached a summary of items to discuss (Option 1, 2 &3)

I am writing to request assistance in developing a conduit/manhole routefor occupancytoaccommodatethefacilitiesandlocationsoutlinedonthefollowingpage(s): (Option 3)

Consolidated useonlyConsolidated useonly

Conduit/Manhole Route Availability /Development

Conduit Route – complete for (Option 1, 2 &3)

Please be advised that splices and slack are not allowed in manholezero.

Option 1, 2& 3 -Please complete the following for each different cable typeyou intend to place: (Attach additional Cable types asrequired)

ColumnABCDEFGH

CableTypeDesignation
Anewdesignationforeachdifferentcabletype / Outside Diameterininches / Weight poundsper foot / MetallicSheath or ShieldYes |No / Typeof Cable / Max. Voltageto Ground AC |DC / Max. Currentinany conductor indicate voltage / Typeof jacket
A
B
C
D
E

ColumnAChoose a designation for each different type of cable to beplaced.ColumnBOutside Diameter ofCable

ColumnCWeight per FootPound

ColumnDIndicate if Metallic Sheath orShield

ColumnEIf Coax cable show number of tubes, Fiber number ofstrands ColumnFMaximum Voltage toground

ColumnGIndicateVoltage

ColumnHEnter type of material of outer jacket or sheath (PVC, Polyethyleneetc.)

Allinformationisconfidential.ConsolidatedCorporatePolicyStatementconcerningConsolidated PrivacyPrinciples can be found on our web site at

Additional items to beconsidered:

Check all thatapply

RouteDiversity

This request is associated with a collocation/CATT request – check all that applyandattach specific information COLLOCATION/CATT ApplicationID#

Includes Manhole ZeroMH0#

Collocation/CATT request requiring multiple Zero Manhole entrances ifavailable list Zero ManholeNumbers

Manhole Breakouts to connect with non-Consolidated conduitlocations specified on the attached Manhole Breakout Request – Form2

Tiesinwithaerialroute,provideriserlicense#/informationifknown.AllRisersrequireaPoleAttachmentLicenseauthorizingtheriserattachment.

Ties into privately owned conduit system – providediagram

Other Considerations, please bespecific

Consolidated useonlyConsolidated useonly

Splice Casings/Equipment Housings to be placed inmanholes:(Attach additional equipment listings ifrequired.)

Location / Type / Height / Width / Depth / Weight

NOTE:

Prior to Consolidated issuing your license, a copy of your plan, indicating yourproposed cable route, Manhole Breakout location(s) and splice locations must be submitted tothe project manager. Consolidated will review the plan and initial all approvedManhole breakouts, and splice locations. Please be aware that all proposed Manholebreakouts and splice locations must be reviewed, field checked and approved in advance ofa license being issued. Splices are not allowed in Manhole Zero. If, due toManhole conditions, alternative locations for breakouts and/or splice locations must beidentified, Consolidated will work with you to attempt to accommodate yourneeds.

Also, a sample of cable, tags, splice casings and equipment housing(s) must besubmitted to the Project Manager, prior to placement, to ensure they complywith ConsolidatedStandards.

AuthorizedAuthorized

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