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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />EXHIBIT A <br />WIRELINE ATTACHMENT APPLICATION AND PERMIT <br />[Solely for Wireline Attachments that will not be attached or connected in any way to <br />Existing Attachments in the Supply Space] <br />Governmental Entity <br />TYPE OF APPLICATION , <br />(Check One) New Foreign Date submitted by Licensee <br />❑ Make -Ready <br />❑ Non Make -Ready Existing Removal <br />Date received by FPL <br />I. APPLICATION <br />In accordance with the terms of the Linear Facilities Pole Attachment Agreement dated December , 2018, by <br />and among the City of Vero Beach, the School Board of Indian River County, and Indian River County and Florida <br />Power & Light Company (the "Agreement'), application is hereby made for permit to make Attachment to the <br />following poles. <br />Location City: <br />Pole Numbers <br />County: <br />, Florida <br />Pole Locations (Indicate which poles require Make -Ready Work) <br />Terms not defined in this Application shall be as defined in the Agreement. <br />The undersigned entity certifies that the attachments shall be in compliance with the latest edition of the National <br />Electric Safety Code and FPL requirements. <br />Licensee: <br />By: <br />NAME (PRINT) <br />SIGNATURE <br />TITLE <br />PHONE <br />FAX <br />E-MAIL <br />II. PERMIT Estimated Make -Ready Cost <br />Permit Granted , <br />(Subject to your approval of Make -Ready Work Cost) $ Payable in advance. <br />Permit Denied , <br />Permit Number <br />Total Previous Poles <br />