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Cable & Telecommunications Commission

Regular Meeting

Deerfield, IL · May 30, 2017

AgendaMinutes

Minutes

MEETING MINUTES CABLE AND TELECOMMUNICATIONS COMMISSION May 30, 2017 The Cable and Telecommunications Commission met in the Community Conference Room of the Village Hall at 7:00 p.m. on Tuesday, May 30, 2017. In attendance were: Present: Steven Robinson, Chair Alan Barasky John Chaput Greg Lapin John Sanner Ken Urbaszewski Absent: Neil Charak Adam Simon Also Present: Andrew Lichterman, Assistant Village Manager Minutes A motion to approve the minutes from the February 28, 2017 meeting was made by Commissioner Lapin and seconded by Commissioner Sanner. Commissioner Lapin and Commission Urbaszewski noted typos. The motion passed unanimously and the minutes were approved as amended. Public Comment There was no one present for public comment. Chairman Robinson briefed the Commission on an email that was sent to him and Mr. Lichterman regarding a resident’s frustration with Comcast service. Chairman Robinson noted the issue was related to the reliability of internet service and was not related to cable service. In general, the resident advocated for additional Internet Service Providers to be available in the Village to allow for greater consumer choice. AT&T Lease Negotiation Discussion The Commissioners reviewed the revised AT&T term sheet dated April 18, 2017. They also reviewed the Village’s current lease rates compared to the lease rates provided by AT&T for neighboring municipalities, noting the Village’s lease rates generally had more favorable economic terms. Mr. Lapin noted the AT&T comps lacked context since they only included annual rates and did not include annual escalators, antennae height or other information that would indicate how prime the location might be. Commissioner Chaput agreed but noted that height is less important than it used to be. Commissioner Barasky noted that the Verizon lease term expires before the AT&T lease and the Village should consider the precedent this lease agreement would set, and also inquired if the Village should negotiate with Verizon first. Commissioner Urbaszewski noted that he would like to see a minimum 10 year lease agreement and noted that lease extensions without a guarantee are not worth considering. Commissioner Page 1 of 3 Cable and Telecommunications Commission May 30, 2017 Urbaszewski also noted that the U.S. Cellular space has been vacated and that should be brought to AT&T’s attention if they are unaware of this fact. Commissioner Chaput noted that the original lease with AT&T required significant capital costs to be paid by the carrier and these costs can be avoided during a lease renewal. Commissioner Barasky made a motion seconded by Commissioner Chaput to include the following terms as a response to AT&T’s offer letter: 1) Minimum 10-year lease agreement 2) Commencing in 2020 (at the conclusion of the current AT&T lease term) 3) Annual escalators equal to the Consumer Price Index 4) No lump sum payment option to be considered at this time The motion was approved unanimously. The Commission’s consensus was that the survey of comparable rents provided by AT&T was inadequate. Accordingly, Commissioner Lapin made a motion seconded by Commissioner Sanner to ask AT&T for the following information to justify their comps: 1) Provide annual escalator rates 2) Provide date of agreement 3) Note if location is on public or private land 4) Note height of antennae 5) Note distance of antennae 6) Provide carrier coverage map The motion was approved unanimously. Mr. Lichterman noted that he would also prepare a survey of nearby municipal tower locations for the Commission’s review. To further strengthen the Village’s negotiating position, the Commission requested that Mr. Lichterman note certain items during discussions with AT&T. They requested Mr. Lichterman (1) make sure AT&T is aware that the U.S. Cellular space has been vacated, (2) remind AT&T that no tower construction costs are required during a renewal, (3) note that it is the Village’s preference to negotiate with Verizon first since their term expires prior to the AT&T term; and, (4) remind AT&T that alternative antennae installations will require a land use review process in accordance with the Village’s Zoning Ordinance. Small Cell Ordinance Mr. Lichterman reported that Senate Bill 1451 was advanced out of committee yesterday and the House is expected to vote on the bill shortly. The bill would limit municipal authority by establishing small cell sites as a permitted use. Additionally, the bill interferes with the right of municipalities to establish consistent requirements within each zoning district with regard to placement of structures. Permit fees would also be capped by the proposed legislation. The Northwest Municipal Conference opposes the bill for these reasons. The Illinois Municipal League has taken no position on the matter. Page 2 of 3 Cable and Telecommunications Commission May 30, 2017 Tower Inspection Services Mr. Lichterman reported that staff received three quotes for tower inspection services and verified that the incumbent contractor, SAC Wireless, is offering a competitive price. Prices were as follows: Contractor Bi- Annual Inspection 3rd Party Inspection Service Service Rate Rate SAC Wireless $2,800 $2,400 Wigdahl Construction $6,900 $4,000 Deerfield Construction $8,000 $5,000 Comcast Annual Report At the previous meeting Chairman Robinson inquired if it would be possible for Comcast to report the total value of credits that were provided to Deerfield customers in 2016. Mr. Lichterman reported that Comcast has advised that the Annual Report is regulated by the IL Attorney General’s Office. Comcast noted that the 121 billing complaints may very well have not involved any complaints about credits. Comcast further noted that their issuing of credits is a function of their business practice and not related to the Annual Report. Comcast concluded by noting that the true indicator from the Annual Report is that the level of complaints has remained very low given the thousands of video customers they have in the Village. Adjournment Commissioner Barasky made a motion to adjourn. The motion was seconded by Commissioner Lapin. The motion was unanimously approved. The meeting was adjourned at 8:10 PM. Respectfully submitted, Andrew S. Lichterman Assistant Village Manager Page 3 of 3

Agenda

AGENDA VILLAGE OF DEERFIELD CABLE & TELECOMMUNICATIONS COMMISSION Tuesday, May 30, 2017 7:00 PM Community Conference Room I. CALL TO ORDER– 7:00 PM II. APPROVAL OF MINUTES A. February 28, 2017 III. PUBLIC COMMENT IV. AT&T LEASE AGREEMENT PROPOSAL REVIEW/DISCUSSION A. AT&T Term Sheet – Dated April 18, 2017 B. Lease Survey C. Current Lease Agreement – Dated January, 11, 2010 V. ADJOURNMENT Next Meeting Date – TBD DRAFT MEETING MINUTES CABLE AND TELECOMMUNICATIONS COMMISSION February 28, 2017 The Cable and Telecommunications Commission met in the Community Conference Room of the Village Hall at 7:00 p.m. on Tuesday, February 28, 2017. In attendance were: Present: Steven Robinson, Chair John Chaput Neil Charak Greg Lapin John Sanner Adam Simon Ken Urbaszewski Absent: Alan Barasky Also Present: Andrew Lichterman, Assistant Village Manager Paul Diambri Service Mr. Diambri recently resigned from the Commission. Chairman Robinson expressed his gratitude to former Chairman Paul Diambri, on behalf of the Commission, for his years of service to the Village. Minutes A motion to approve the minutes from the October 27, 2015 meeting was made by Commissioner Charak and seconded by Commissioner Lapin. The motion passed unanimously. Public Comment There was no one present for public comment. Telecom Lease Advisor Proposal The Commission reviewed the Telecom Lease Advisor proposal. Commissioner Simon noted that it is his opinion there is little chance the tower will become obsolete. Commissioner Lapin concurred noting there will be more demand in the future. Commission Chapin noted there would be little to gain from accepting the Telecom Lease Advisors proposal at this time. Chairman Robinson inquired about the amount of notice the Village would receive if a carrier were to cancel. Commissioner Simon confirmed 6-month advance notice is required. Commissioner Simon also noted that it is unlikely to have further consolidation amongst the remaining carriers. Commissioner Simon made a motion to deny the Telecom Lease Advisor proposal. Commissioner Lapin seconded the motion. The motion passed unanimously. Page 1 of 3 Cable and Telecommunications Commission February 28, 2017 AT&T Lease Negotiation Discussion The Commissioner reviewed the AT&T lease proposal noting that it lacked specifics. The Commission requested that AT&T provide further explanation and clarity regarding proposed contract terms such as “fair” early termination rights, and “per touch” rent upcharges. Additionally, the proposal simply stated AT&T wants “rents reduced to competitive rates” with “reduced annual escalators” but did not offer examples. The Commissioners requested that Mr. Lichterman request a detailed proposal from AT&T that includes specific rent rates and escalators. Chairman Robinson noted that the negotiated terms of this contract would likely be used as a benchmark for other upcoming lease negotiations. Mr. Lichterman noted he would solicit a specific proposal from AT&T and bring this matter to the Commission for further consideration at the next meeting. Small Cell Ordinance The Commission reviewed various template small cell ordinances. Commission Simon noted his preference would be amend the Village’s Right-of-Way ordinance to incorporate small cell regulations rather than creating new a stand-alone ordinance for small cells. The Commissioners suggested including items such as height limitation and dispersion requirements into the ordinance, for example. There was consensus from the Commissioners to move forward with amending the Right-of-Way ordinance, as noted. Mr. Lichterman stated that he would work with the Village Attorney to prepare a draft ordinance for the Commission’s review. Tower Inspection Services Mr. Lichterman reported that SAC Wireless has been the Village’s contractor for tower inspection services for the monopole for at least the last three years. The Village’s building department has historically overseen this contract. Staff would like to renew the agreement with SAC Wireless to continue these inspection services. Mr. Lichterman wanted to ensure that the Commission was apprised of these operations. Chairman Robinson requested clarification regarding the bi-annual inspection services and asked if this has historically been completed. Mr. Lichterman noted that the Village typically has not conducted stand-alone inspections, rather the inspections have taken place in conjunction with routine carrier maintenance. Chairman Robinson recommended that due to the age of the monopole that the Village begin conduction regular inspections of the monopole, at least once a year. The Commission was supportive of staff’s recommendation to retain SAC Wireless for monopole inspection services. Comcast Annual Report The Commission review the 2016 Comcast annual report. In 2016, 221 customer complaints were reported compared to 161 customer complaints in 2015. The largest number of complaints were related to billing, charges, refunds and credits. Page 2 of 3 Cable and Telecommunications Commission February 28, 2017 Chairman Robinson inquired if it would be possible for Comcast to report the total value of credits that were provided to Deerfield customers. Mr. Lichterman will request the information from Comcast. Adjournment Commissioner Lapin made a motion to adjourn. The motion was seconded by Commissioner Robinson. The motion was unanimously approved. The meeting was adjourned at 8:23 PM. Respectfully submitted, Andrew S. Lichterman Assistant to the Village Manager Page 3 of 3 CELLULAR ANTENNA SURVEY Village of Deerfield Initial Current Annual Annual Next Increase Percentage of Carrier Type Commencement Terms Rent Rent Date Next Increase 10 years with 3 successive 5 AT&T Mobility Monopole 2009 year terms $36,000 $44,275 Dec. 2017 3% 10 years with 3 successive 5 T-Mobile Monopole 2009 year terms $33,600 $41,324 Sept. 2017 3% 10 years with 3 successive 5 US Cellular* Monopole 2009 year terms $36,000 $44,275 Aug. 2017 3% 10 years with 3 successive 5 Verizon Monopole 2008 year terms $38,400 $48,643 Oct. 2017 3% 3 years with 7 successive renwal terms of T-Mobile Water Tower 2007 3 years $24,000 $35,525 2018 4% 5 years with 4 successive 5 Verizon ** Water Tower 2016 year terms $34,560 $34,560 June. 2017 3% * Cancelled but rent continues thru 2019 ** Plus one‐time signing bonus of $5,000 AT&T COMP SURVEY Provided by AT&T Distance (mi) Location Current Rent 1.51 Highland Park $ 18,540 1.52 Deerfield $ 19,896 2.83 Northbrook $ 21,168 3.68 Northbrook $ 16,263 4.45 Northbrook $ 31,992 4.54 Lake Forest $ 33,347 5.05 Lincolnshire $ 13,487 5.15 Glenview $ 18,378 5.21 Glencoe $ 22,464 5.51 Wheeling $ 21,630 5.61 Lake Forest $ 36,501 6.05 Prospect Heights $ 25,663 7.47 Vernon Hills $ 32,549 April 18, 2017 Andrew Lichterman Village of Deerfield 850 Waukegan Rd. Deerfield, IL 60015 Re: Communications Facility located at 850 WAUKEGAN ROAD, DEERFIELD, IL 60015 Contract #: 129657 / FA#: 10006369 Dear Andrew, Thank you for responding positively to the letter that was sent to you in regards to the AT&T TOSS Program. AT&T Mobility (“AT&T”) has engaged Md7 to work with you to make the above-referenced site better for both parties. The conditions AT&T desires to implement in all new “go forward” leases are referenced in the bullet points below. We look forward to coming to a mutually beneficial agreement. Criteria for Cellular Site Retention AT&T will need the following to secure a longer-term lease with you:  $36,000.00 per year, commencing December 22, 2017  2% rent increase every year, commencing December 22, 2022  Extension of Lease through December 21, 2047  Lease provisions as listed below in order of vitality for AT&T Or  Lump Sum Payment Option: Provide a one-time lump sum payment of $475,000. In return, you will grant a fifty (50) year easement on your property and assign the lease rights and rental income under your lease with AT&T to Md7 or an affiliate of Md7.  Installment Payment Option: Provide a total payment of $565,000 paid in five (5) equal installments of $113,000 annually. In return, you will grant a fifty (50) year easement on your property and assign the lease rights and rental income under your lease with AT&T to Md7 or an affiliate of Md7. It is important for you to know that the pre-payment does not change the ownership or control of the rest of your property in any manner. In order to maintain its long-term flexibility, AT&T will also require many of the following lease provisions to address future technological and network changes:  Expansion of Permitted Use “Lessee, its personnel, invitees, contractors, agents, sublessees, or its authorized sublessees, or assigns may use the Premises, at no additional cost or expense, for the transmission and reception of any and all communications signals and to modify, supplement, replace, upgrade, expand, including but not limited to the number and type(s) of antennas, or refurbish the equipment and/or improvements thereon, or relocate the same within the Premises at any time during the term of this Lease for any reason, or in order to be in compliance with any current or future federal, state or local mandated application, including but not limited to emergency 911 communication services or for any other Md7, LLC | 10590 W est Ocean Air Drive, Suite 300 | San Diego, CA 92130 | 888.553.6599 reason. Lessor shall reasonably cooperate in obtaining governmental and other use permits or approvals necessary or desirable for the foregoing permitted use. If Lessor does not comply with the terms of this section, in addition to any other rights it may have at law, Lessee may terminate this Lease and shall have no further liability to Lessor. If Lessor does not comply with the terms of this section, Lessee will have the right to exercise any and all rights available to it under law and equity, including the right to cure Lessor’s default and to deduct the costs of such cure from any monies due to Lessor from Lessee.”  Expansion of the Premises “Lessor grants, to the extent practicable and on a space available basis, the Lessee the right to enlarge the Premises or the Lessor shall make space available on the Property for Lessee so that Lessee or its authorized sublessees may implement any necessary modifications, supplements, replacements, refurbishments, or expansions to the Communications Facility or to any equipment related thereto, or for any other reasons, as determined by Lessee in its sole discretion. Should Lessee exercise the right to expand the Premises, Lessee will pay and Lessor will accept as additional Rent under the Lease an amount equal to the then current rent calculated on a per square foot basis as multiplied by each additional square foot added to the Premises. Upon notice to Lessor, a description and/or depiction of the modified Premises ground will become part of the Lease without any additional action on the part of Lessee and Lessor; however, at the request of Lessee, the parties will execute a Memorandum of Lease in recordable form memorializing the modification of the ground space of Property, which either party may record at its option.”  Rental Stream Offer “If at any time after the date of this Amendment, Lessor receives a bona fide written offer from a third party seeking an assignment or transfer of the Rent payments associated with the Agreement (“Rental Stream Offer”), Lessor shall immediately furnish Lessee with a copy of the Rental Stream Offer. Lessee shall have the right within ninety (90) days after it receives such copy to match the Rental Stream Offer and agree in writing to match the terms of the Rental Stream Offer. Such writing shall be in the form of a contract substantially similar to the Rental Stream Offer. If Lessee chooses not to exercise this right or fails to provide written notice to Lessor within the ninety (90) day period, Lessor may assign the right to receive Rent payments pursuant to the Rental Stream Offer, subject to the terms of this Agreement. If Lessor attempts to assign or transfer Rent payments without complying with this Section, the assignment or transfer shall be void. Lessee shall not be responsible for any failure to make payments under this Agreement and reserves the right to hold payments due under this Agreement until Lessor complies with this Section.” This letter of understanding is subject in all respects to the preparation, execution and delivery of a definitive amendment in form and substance mutually agreeable to each of us. This letter will not be legally binding between us with respect to the proposed business relationship, but instead serves as a statement of our mutual intent to work toward entering into such an amendment. AT&T values its affiliation with you and hopes to continue a long and mutually profitable relationship in the years to come. After having reviewed these options, please contact me prior to April 25th, 2017. Please keep in mind that AT&T’s discussion process has a deadline of 90 days from your initial response. If satisfactory terms and conditions are not agreed upon through a signed amendment within this 90 day period, this will trigger AT&T’s review of alternate locations. Thank you for your consideration. Md7, LLC | 10590 W est Ocean Air Drive, Suite 300 | San Diego, CA 92130 | 888.553.6599 Sincerely, James Lefebvre Lease Consultant d: (858) 926-3898 f: 858.430.3463 a: 10590 West Ocean Air Drive, Suite 300 San Diego, CA 92130 e: jlefebvre@md7.com Authorized Agent for AT&T Mobility cc: Gregory D. Ohmer Director-Network Planning, AT&T Mobility Md7, LLC | 10590 W est Ocean Air Drive, Suite 300 | San Diego, CA 92130 | 888.553.6599 Sample Amendment Template __________ AMENDMENT TO LEASE/AGREEMENT/LICENSE THIS __________ AMENDMENT TO LEASE/AGREEMENT/LICENSE (“__________ Amendment”) dated as of the later date below is by and between __________________________, successor in interest to __________________________, having a mailing address at ____________________________________________________ (hereinafter referred to as “Landlord/Licensor”) and New Cingular Wireless PCS, LLC, successor by merger to __________________________, having a mailing address at 575 Morosgo Drive NE, Atlanta, GA 30324 (hereinafter referred to as “Tenant/Licensee”). WHEREAS, Landlord/Licensor and Tenant/Licensee (or their predecessors in interest) entered into a Lease/Agreement/License dated _______________, ____, as amended by First Amendment to Lease/Agreement/License dated _______________, ____, (hereinafter, collectively, the "Lease/Agreement/License"), whereby Landlord/Licensor leased to Tenant/Licensee certain Premises, therein described, that are a portion of the Property located at ____________________________________________________; and WHEREAS, Landlord/Licensor and Tenant/Licensee desire to extend the term of the Lease/Agreement/License; and WHEREAS, Landlord/Licensor and Tenant/Licensee desire to modify, as set forth herein, the Rent (as defined below) payable under the Lease/Agreement/License; and WHEREAS, Landlord/Licensor and Tenant/Licensee, in their mutual interest, further wish to amend the Lease/Agreement/License as set forth below. NOW THEREFORE, in consideration of the foregoing and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Landlord/Licensor and Tenant/Licensee agree as follows: 1. Term. The term of the Lease/Agreement/License shall be amended to provide that the Lease/Agreement/License has a new initial term of Five (5) years (“New Initial Term”), commencing on December 22, 2017 (“New Term Commencement Date”). As of such New Term Commencement Date, all remaining renewal terms in the Lease/Agreement/License except as set forth herein shall be void and of no further force and consequence. The Lease/Agreement/License will be automatically renewed for up to Five (5) additional Sixty (60) month terms (each an “Extension Term”) upon the same terms and conditions of the Lease/Agreement/License, as amended herein, without further action by Tenant/Licensee, unless Tenant/Licensee notifies Landlord/Licensor in writing of Tenant/Licensee’s intention not to renew the Lease/Agreement/License at least sixty (60) days prior to the expiration of the New Initial Term or the then current Extension Term. Hereafter, the defined term “Term” shall include the New Initial Term and any applicable Extension Term. Landlord/Licensor agrees and acknowledges that except that as such permitted use or other rights may be amended herein, Tenant/Licensee may continue to use and exercise its rights under the Lease/Agreement/License as permitted prior to the New Initial Term. Md7, LLC | 10590 W est Ocean Air Drive, Suite 300 | San Diego, CA 92130 | 888.553.6599 2. Modification of Rent. Commencing on December 22, 2017, the Rent payable under the Lease/Agreement/License shall be Thirty-Six Thousand and No/100 Dollars ($36,000.00) per year (the "Rent"), and shall continue during the Term, subject to adjustment, if any, as provided below. 3. Future Rent Increase / Monthly/Annual Payments. The Lease/Agreement/License is amended to provide that commencing on December 22, 2022, Rent shall increase by Two Percent (2%) over the Rent paid during the previous year. 4. Emergency 911 Service. In the future, without the payment of additional Rent, or any other consideration, and at a location mutually acceptable to Landlord/Licensor and Tenant/Licensee, Landlord/Licensor agrees that Tenant/Licensee may add, modify and/or replace equipment in order to be in compliance with any current or future federal, state or local mandated application, including but not limited to emergency 911 communication services. 5. Acknowledgement. Landlord/Licensor acknowledges that: 1) this __________ Amendment is entered into of the Landlord/Licensor’s free will and volition; 2) Landlord/Licensor has read and understands this __________ Amendment and the underlying Lease/Agreement/License and, prior to execution of this __________ Amendment, was free to consult with counsel of its choosing regarding Landlord/Licensor’s decision to enter into this __________ Amendment and to have counsel review the terms and conditions of this __________ Amendment; 3) Landlord/Licensor has been advised and is informed that should Landlord/Licensor not enter into this __________ Amendment, the underlying Lease/Agreement/License between Landlord/Licensor and Tenant/Licensee, including any termination or non-renewal provision therein, would remain in full force and effect. 6. Notices. Paragraph/Section ___ of the Lease/Agreement/License is hereby deleted in its entirety and replaced with the following: "NOTICES. All notices, requests, demands and communications hereunder will be given by first class certified or registered mail, return receipt requested, or by a nationally recognized overnight courier, postage prepaid, to be effective when properly sent and received, refused or returned undelivered. Notices will be addressed to the parties as follows: If to Tenant/Licensee: New Cingular Wireless PCS, LLC Attn: Network Real Estate Administration Re: Cell Site # _______________ Cell Site Name _______________ (IL); Fixed Asset No.: 10006369 575 Morosgo Drive NE Atlanta, GA 30324 With a required copy of the notice sent to the address above to AT&T Legal at: New Cingular Wireless PCS, LLC Attn: AT&T Legal Department Re: Cell Site # _______________ Cell Site Name _______________ (IL); Fixed Asset No: 10006369 208 S. Akard Street Md7, LLC | 10590 W est Ocean Air Drive, Suite 300 | San Diego, CA 92130 | 888.553.6599 Dallas, Texas, 75202-4206 A copy sent to the Legal Department is an administrative step which alone does not constitute legal notice. And as to Landlord/Licensor: ___________________ ___________________ ___________________ ___________________ Either party hereto may change the place for the giving of notice to it by thirty (30) days prior written notice to the other as provided herein." 7. Charges. All charges payable under the Lease/Agreement/License such as utilities and taxes shall be billed by Landlord/Licensor within one (1) year from the end of the calendar year in which the charges were incurred; any charges beyond such period shall not be billed by Landlord/Licensor, and shall not be payable by Tenant/Licensee. The foregoing shall not apply to monthly rent which is due and payable without a requirement that it be billed by Landlord/Licensor. The provisions of this subsection shall survive the termination or expiration of the Lease/Agreement/License. 8. Memorandum of Lease/Agreement/License. Either party will, at any time upon fifteen (15) days prior written notice from the other, execute, acknowledge and deliver to the other a recordable Memorandum of Lease/Agreement/License substantially in the form of the Attachment 1. Either party may record this memorandum at any time, in its absolute discretion. 9. Other Terms and Conditions Remain. In the event of any inconsistencies between the Lease/Agreement/License and this __________ Amendment, the terms of this __________ Amendment shall control. Except as expressly set forth in this __________ Amendment, the Lease/Agreement/License otherwise is unmodified and remains in full force and effect. Each reference in the Lease/Agreement/License to itself shall be deemed also to refer to this __________ Amendment. 10. Capitalized Terms. All capitalized terms used but not defined herein shall have the same meanings as defined in the Lease/Agreement/License. IN WITNESS WHEREOF, the parties have caused their properly authorized representatives to execute and seal this __________ Amendment on the date and year below. LANDLORD/LICENSOR: TENANT/LICENSEE: ___________________, New Cingular Wireless PCS, LLC, ___________________ a Delaware limited liability company By: AT&T Mobility Corporation Its: Manager Md7, LLC | 10590 W est Ocean Air Drive, Suite 300 | San Diego, CA 92130 | 888.553.6599 By: By: Print Name: Print Name: Title: Title: Date: Date: Md7, LLC | 10590 W est Ocean Air Drive, Suite 300 | San Diego, CA 92130 | 888.553.6599