Verizon Wireless Inbound Collocation Application

Verizon Wireless InBound Collocation Application

VERIZON WIRELESS
Region:Georgia / Alabama
Real Estate Manager: Mike Mankin / Date Received:
Consultant:Kris Doyle / Phone: / 404-422-2249 / Revision Dates:
Doyle Consulting, Inc. / e-mail: /
Please submit applications to:
/ VzW Site Name
VzW Site Number
APPLICANT INFORMATION
Applicant (Carrier): / Primary Contact Name:
Applicant Site Name: / Company Name:
Applicant Site Number: / Primary Contact Number:
Req. Date For Receipt of Agreement: / Primary Contact Fax:
Proposed Installation Date:
Proposed ON AIR Date:
Applicant Entity Name on Agreement: / Primary Contact Address:
Notice Address for License:
Billing Address: / Primary Contact Email:
ADDITIONAL CARRIER INFORMATION
Leasing Contact Name/Number:
RF Contact Name/Number:
Legal Review Contact Name/Number:
Construction Contact Name/Number:
Emergency Contact Name/Number:
VERIZON WIRELESS TOWER INFORMATION
Latitude: / N / Existing Tower Type:
Longitude: / W / Existing Tower Height (ft AGL):
Existing Antennas and Centerlines:
Site Address: / County: / State:
GL Market #:
Location code: / Contract #:
SCOPE OF WORK
Brief description:
GROUND SPACE
Proposed Configuration
Equipment Enclosure Type: / BTS Cabinets/Number of BTS Cabinets:
Outdoor Shelter
Other:
Total Ground Space Dimensions (HxWxD)(ft): / ’ x ’ x ’
Cabinet/BTS/Shelter Pad Dimensions (HxWxD)(ft): / ’ x ’ x ’
Concrete Pad Dimensions (HxWxD)(ft): / ’ x ’ x ’
Cabinet/Shelter Manufacturer/Model:
Proposed Configuration
Sector / Sector 1 / Sector 2 / Sector 3 / Sector 4 / AUX
Desired RadCenter (ft AGL)
Antenna Quantity
Antenna Manufacturer
Antenna Model
Weight (lbs per antenna)
Antenna Dimensions (HxWxD) (in)
ERP (watts)
Antenna Gain (dB)
Orientation/Azimuth (Degrees)
MountMfg and Model
Mount Height (On Tower)
Auxiliary Equipment Mfg , Model & No.
Mounting Height
Transmit Frequency (MHz)
Receive Frequency (MHz)
Number of Coax Cables Per Antenna
Diameter of Coax Cables (in)
Type of Service (i.e CDMA, GSM, TDMA, PAGING):

Please Note: “AUX” can be used for Microwave, TTA, LNA, GPS, or E911 antenna information.

Proposed Configuration
Required Voltage and Total Amperage:
Electrical Service Provider: / Electrical Service Telephone Number:
GENERATOR INFORMATION
Proposed Configuration
Generator Ground Space Requirement (HxWxD)(ft): / ’ x ‘ x ‘ / Fuel Type
(Natural Gas, Diesel):
Generator Owner
(Applicant/Tenant, SpectraSite): / Fuel Tank Location: / Attached Separate None
Capacity (KW): / Fuel Tank Size (Gallons):
All applications are subject to Verizon Wireless approval. Applications will remain valid for a period of six (6) months from the Date of Submittal on page one of application; except as otherwise provided in the applicable Master Lease Agreement between Verizon Wireless and Customer, if any.
Verizon Wireless Real Estate Use Only
Current Landlord notice address:
New In Bound / Amendment
Initial Term: / Rent Change (if any):
# of Extensions: / Commencement:
Length of Extensions: / New Escalations:
Rent: / Additional terms/comments:
Commencement:
Escalations:
Additional terms/comments:

Verizon Wireless In Bound Collocation Application Page 1 of 2

06.19.09