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STATE OF SOUTH CAROLINA
)))
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)
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CR'Y )
)(P lease type oSubmitted
Address:
(Caption of Case)
Request for Certification of the use of UniversalService Funds Pursuant to 47 C.F.R 54.314 andTelecommunications Act Section 254 (e), FederalCommunications Commission CC Docket 96-45(Form 481); and Annual Reports for ETC -ETCAnnual Report -TAG Mobile, LLC
BEFORETHEPUBLIC SERVICE COMMISSION
OF SOUTH CAROLINA
COVER SHEET
DOCKETNUMBER. 201 7 14 C
SC Bar Number:
Telephone: 407-260-1011
Fax: 407-260-1033
Other:
Email: regulatory csilon wood.corn
NOTE: The cover sheet and information contained herein neither replaces nor supplements'he filing and service of pleadings or other papersas required by law. This form is required for use by the Public Service Commission of South Carolina for the purpose of docketing and mustbe filled out corn letel .
DOCKETING INFORMATION (Check all that apply)Request for item to be placed on Commission's Agenda0 Emergency Relief demanded in petition expeditiously
X O " "'CC 481 and CTIA Com lienee filed on behalf of TAG Mobile, LLC
NATURE OF ACTION (Check all that apply)
Electric
Electric/Gas
Electric/Telecommunications
Electric/Water
Electric/Water/Telecom.
Electric/Water/Sewer
Gas
Railroad
Sewer
X Telecommunications
Tfallsportatioil
Water
Water/Sewer
Administrative Matter
JU( tt,l ai~ 1 )
PSC SCMAlL/ Dit/lS
Affidavit
Agreement
Answer
Appellate Review
Application
Brief
Certificate
Q Comments
Complaint
Consent Order
Discovery
Exhibit
Q Expedited Consideration
Q Interconnection Agreement
Q Interconnection Amendment
Late-Filed Exhibit
PrintForm
-'etter
Memorandum
Motion
P Objection
Petition
Petition for Reconsideration
Petition for Rulemaking
Petition for Rule to Show Cause
Petition to Intervene
Petition io intervene Out of Time
Request
x Request for Certification
Request for Investigation
Resale Agreement
Resale Amendment
Q Reservation Letter
Response
Response to Discovery
Return to Petition
Q Stipulation
Prefiled Testimony Q Subpoena
Promotion +T IF
Proposed Order w~ ~er:( ~P-Protest
Publisher's Atfdav@ @p
x Report )O
CoReset Form
Pg
June 20, 2017
Jocelyn Boyd, Chief Clerk of the CommissionPublic Service Commission of South Carolina
Synergy Business Park, Saluda Building101 Executive Center DriveColumbia, SC 29210
RE: Order No. 2013-1-CertiTication of Compliance with CTIA Consumer Code forTAG Mobile, LLC
Dear Staff:
On January 29, 2013, the Public Service Commission of South Carolina issued an Order designating TAG
Mobile, LLC as an eligible telecommunications carrier ("ETC") in the state of South Carolina.
In compliance with South Carolina Commission ETC annual reporting requirements, TAG Mobile, LLC
confirms that it complies with the Cellular Telecommunications and Internet Association's (CTIA's)
Consumer Code for Wireless Service. In addition, TAG Mobile, LLC provides by attachment theadvertising material required to be submitted annually,
Please do not hesitate to contact me if you have questions or concerns.
Respectfully submitted,
Jfm Fi.'iao
Gallion
Vice President of Finance
TAG Mobile, LLC
June 20, 2017
Jocelyn BoydChief Clerk and AdministratorSouth Carolina Public Service Commission101 Executive Center Drive, Suite 100Columbia, South Carolina 29210
Re: Docket No. 2017-14-C-TAG Mobile, LLC Annual ETC Annual Compliance Reportand FCC Form 481
Dear Ms. Boyd,
TAG Mobile, LLC (TAG) was designated by the South Carolina Public Service Commission asan Eligible Telecommunications Carrier for provision of wireless Lifeline service. Pursuant toS.C. Code Ann. Regulations ) 103-690.1(B), TAG submits its Annual Report for DesignatedEligible Telecommunications Carriers with respect to Lifeline services in South Carolina. Acopy of the company's FCC Form 481 has been included. This report has also been submitted tothe OAice of Regulatory Staff.
Certification of com liance with CTIA Consumer Code 103.690.1 aTAG Mobile, LLC certifies it is in compliance v 4th all applicable service quality and consumerprotection requirements and standards, including the CTIA Consumer Code for Wireless Service,as it is required to do pursuant to 47 C.F.R. II 54.202(a)(3).
L~if Iq R *Hi
R.103-690.1 b 3 Dnfulfilled Service Re uestsRESPONSE: TAG did not have any unfulfilled service requests in South Carolina in 2016.
R, 03 90.1 4 Com la tsor Troub eRe rts er1000 andsets or ccess LinesRESPONSE: TAG received 0 complaints or trouble reports in 2016.
R.103-690.1 Com 'lienee with A lieable Service uali Standards and Consu er~t'RulRESPONSE i TAG hereby certifies that it complies with applicable service quality standards andconsumer protection rules, as designated by the Commission.
R.103490.1 6 bili to Function in Km en SituationsRESPONSE; TAG's Lifeline services remain functional in emergency situations. TAG utilizesthe extensive and well established Sprint and Verizon Wireless networks and facilities to provideTAG's mobile services. The Sprint and Verizon Wireless networks are capable ofmanagingtraffic spikes that may occur during emergency situations and can reroute tra6ic in the event ofdamaged facilities. Our underlying carriers also have sufficient back-up power to ensurefunctionality. TAG's customers receive tbe same functionality as our underlying carrier'scustomers do.
R.103%90.1 Non-Incumbent LKC Local Usa e lansRKSPONSEi This section does not apply to TAG because TAG is a wireless ETC.
R.103-690.1 b 8 K ualAccessto Lou Distance CarriersRESPONSE: TAG hereby acknowledges that the Federal Communications Commission mayrequire it to provide equal access to long distance carriers in the event that no other eligibletelecommunication carrier is providing equal access within the service area.
R.103490.1 b 9 Number of Lifeline CustomersRESPONSE: As of December 31, 2016, TAG provided wireless Lifeline service to 304customers in South Carolina.
R.103-690.1 0 Lif line Verification Surve or Cert16ca "on
RESPONSE: TAG has submitted a copy of the company's FCC 481 with the Commission andthe Office of Regulatory Staffwhich included their certification.
If you IIave any questions regarding this filing, please contact Mark Lammert at (407) 260 1011or roguery csilongwood.corn.
Respectfully submitted,
Siao'Vice PrTAG
/lionsident ofFinanceobile, LLC
FCC Forrp 4 1-Carrier Anneal RePOrtfng N M& 'M "uk«&24 m«r tm24 " „sw 1. 4OMe Comfsln&006&0MDoma rona«r nn M604812
-. '-;. Data CollectlonFormi 4««b '.-~44& e, "'. ' 2,4&NM22
Page 1
&010& 5t Area Code
&015&,gtu Area Name
&020» Pro ram Year
&030& Contact Name: Person I/5AC should contactwith uestlons about this data
242022
220 nM224 scc
2010
n 22 Mmmrk
«035& l'Con act Telephone Number: 4022401ms M 1.Nu beret the erson Identified In data line «030&
«039& Contact Email Address:Email of the erson.identified,ln data gne «030&
Form Type 5 4 . 4 22
Page 1
Page 2
(EOO) SeEOI&a Outage Repgitlng (Voice)
Data Cogection Form
'CC Form CB(Vqh)6 dont ro) No., 306009(lg/0 MR Control No) 30600329
lu)r (0(3
&010& Study Area Code
&015& Study Area Name
&02ib Program Year
«030& Contact Name -Person USACshoukl contact regarding this data
rao i". &it sscsetsn rk t rc
«033& Conte«t Telephone Number-Number of rsonldentirredin data line c03ir
&039& Contacbgmail Address - Email Address of person Identified In data gne «030& "metes~~it momm. ce
&210& For the prior calendar year, were there any reportable vote service outagesy
&220 &a& &bt& &II2& &b3& &bo& &&1& &6& &e&
NOAS
ReferenceNumber
outage Stan outage Start outage End
Date Time, DateOutage End
TimeNumber of
Customers Affected Trmll Nllmber ofClntorllels
911 FacrTnies
Affected(Yes / IIo)
Sendce OutageDescription (Check
ag that ap )
Did This OutageAffem Multiple
Study Areases/No)
Ssrlllce OutageResolution
PreventativeProcedures
Page 2
Page 3
I300) Uiifulfifled Service Beq'ue'st
Data CollectloD FormtFCC Fofm clffQMB Cqntrot No. 30F010986/0MB Control(fo. 30600813
-Bulf gq(3
&Btlo smdfg4iea code
015» Studr Area Nellie
&020 Program Year
&030 Contact Name ~ Person USAC should contact r ardin this data
2&se22
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lr»ra ie»sere&035» ContsmTele honeNumber-Numtmrof ermnidentdtedtndstatine 030» se»2cetoll esc.
«039» Contact Ern»II Address-EnuB Address of erwn Identitiedin data line &030» seoul»cns nell muse.&oe
&300» UnfuNged seqdce request (voice)
&420» Detag on attempts (soke)
Name of Attached Document
&320» Unfulfilled service request (broadband)
&330» Detailbn attempts (broadband)
Name of Attached Document
Page 3
PM 4
emfmumBhmpht p Ccm ~PI
rscm df'OMII Cmlru xh &repmpppMEmmu x, mpc&np
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&010& Study Area Cede
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4
«010& Piogram veer
&030&'pntlict Name- Person USAC should mntact regarding this data
&035&ntact Telephone Number - Number of person Identiged In data fine30&
&039&
act from the drop down list to Indicate how you would like to reportce complaints izero or greater) for volte telephony service In the prior
+ dar year for each senrlce area In which yov are designated an ETC forany cgltles you own, operate, lease, or otherwise utglze.
CIrnplalnts per 1000 customers for fixed voice
Complaints per 1000 custonpers for mobde voice
htact Em ad Address - Email Address of person Identiged1n data Ene ~.„4~,cc
&430&
Select from the drop&fown llst to Indicate how you would Eke to reportend&sacr customer complaints frero or greateri for broadband sendce inthe prior calendar year for each service area In which you are designatedan ETC for any fadgties you own, operate, lease. or otherwise utgha.
Complaints per 1000 customers for fixed broadband
&4S0& «qmplalnts per 1000 customers for mobge broadband
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Page 7
. ]?00) Price tffferfn~rfcktffnggfofctaRate Dpta! Data Coiiection Form&
IptiC FOrm 481
'QQBgontroh)or 306D0986/0MB Conttol fto. 3060-0819' atfr*2013
&010& Stud Area Code
&015& StudY Area Name
«020& Program Year
20 7072
220 2 btt LLC
2022
&030& Contact Name - Person VSAC should contact regarding this data Rara ta&035& Contact Telephone Number- Number of person identified in data line «030& 4072601021
&039& Contact fmailAddress-EmallAddressofpersonidentlfledin data line&030& m I co~0 sta peas.
&701& Resldantlallocal5arvice charge Elfective Date
&702& Single State wide Residentlall»calsenri«0 Charge
&760& .&at& &52& ', &aan 5 '622 " " " &bt& &bs&
State Gaha eiRE sac lcttct Rate peResidential local
'erviceRate state subscriber Un0 char e state universal service Fee total 2 line Ratesand 7
Page 7
(yt ) Bfoadbrand Price Offmthgst-
CdtteFtton Form
Page 8
FCCForfn481F
,OMB Control No. 306ts0986/0MB Cohtrol No. 3060-'0819
. 3July 2/33
«Dli& Study ALaa Code
«033& Smdy Area Name
&02ir Mrogmm Year
&03ir contact Name person UsAc should contamregardln this data
assess
Tao Homle LLC
sotsH k L C
&033& Canted Tblephone Number-Number et person identified in data line «03ib&039& Contact EmaB Address -Email Addressof personidentifledin data line &030& M 1 comm tt
&711&
Page 8
Page 9
(800) Operating Bompanies
Beta Cogectlon FormFCC Form dgtOMB Control rfoc 30600986/OMB Control No. 3060'-0819
July 2013
9010& Stud Area Code
4013& Stu Area Name
402lr. Program Year
4030& Contact Name - Person USAB should contact regsnling this dale
24SO22
2ela
n ar rc4033& Contact Telephone Number - Number of person Identlfled In data line 4030& 44
4039& Contact Emag Address - Email Address of person identified in data line 4030& m 1 te c 11o
cglo Reportl Carrier Sau neutl, SSC
4811& Holding Comparer ~ye c pity o om. &uu
4812& 0 crating Com an rao mu11e, sse
Page 9
Page 10
(sdb) Tribal lands Repoftfna
Data Collsctlorl'Forpf OMacoeuyll(o. 3050:093)EDMlfcoetrofgo, Sosoosto
4 .*~..., . &vly 2013
&0202 Siu Area Code
&025& Stud Area Nam«
&020& Program Year
&030& Coetau None. Person UsAc shouldronisrt r &rein ihii data
&035& Contin Telephone Noeber - Number of nonidentwee Ie dais line «03O
dr39& runisci Emaa Address ~ Emae Address of perronidentified In dais fine &03ci
&900& Does the figng entity offer tribal land services7 (Y/N)
i&sess
rko uo&il~ iscieieu k so&rettiorisoiom axi.
rm iar&rrecerlorr~.coo
&910& Tribal Land(f) on which ETC Serves
&920& Tribal Government Engagement Obligation
Name of Attached Document
If your company serves Tribal lands, please select (Yes No, NA) for each these boxes
to confirm the status described on the attached PDF, on line 920,
demonstrates coordkratton with the Tribal government pursuant to
954313[a)(9) indudes:
&921&
&922&
&923&
&924&
&925&
&926&
&927&
&928&
&929&
Needs assossmeni and deployment planning with a focus on Tribal
community anchor institutions.Feasibility and sustains(SIlfty planning;
Marketing services in a culturally sensitive manner;
Compliance with Rights of way processesCompliance with Land Use permitting requirementsCompliance with Facilities Siting rules
Compliance with Environmental Review processes
Compliance with Cultural Preservation review processesCompliance with Tnbal Business and Licensing requirements.
Page 10
(1000)JDfnice anth Broadband Service Rate Qorppaia bPi)yData.Cofiection Forfn
Page 11
F$0 Fornyhft1J
iQMB Control No. 3050-0996/0MB Cop/rot Po.-30ath0819~
July 2013
&010& Study Area Code
&015& Study Area Name&020& -Program Year&030& Contact Name-Person USACshould contact regardingthis data&035& Contact Telephone Number - Number of person identified in data line &030&
249D22
220 Ho&11 ssc2010
u0 2 mm0204D72401011 ~.
&039& Contact Emag Address - Email Address of person identified in data line &030& 0 1 Done
&1000& Voice services rate compare biTity certification
&1010& Attach detaiied descdiption for voice services ratecomparability rompfiance
Name of Attached Document
&1020& Broadband comparability certification
&1030& Attach detailed descdption lor broadbandcomparability compliance
Name of Attached Document
Page 11
Page 12
I2200) No Tet('estrfd)"fyackhaolsteportirig)38(ta Co)lebtib el Fo(mr
FCCForm 481
OMJ) (ofitrol Nox 3060-098670MB 60ntro) N(i: 3()60c0819July 2/f13
&020&- Study-Area Code——&015& Study Area Name&020& Program Year&030& Contact Name - Person USAC should contact regarding thrs data
TAG II &11 &ac
xsls
ru*x I t&03$& Contact Telephone Number- Number of person identified in dataline &030& lo'a«01011 ~.&039& Contact Email Address - Email Address of person identified in data fine &030&
«1100& Certify whether terrestrial backhaul options exist(Y/N)
Please select ths sppropriate response (Yes, No, Not Applicabls) to confirm thereporling carrier offers broadband service of at feast 1 Mbps downstmam and 256 kbpsupstream within the supported area pursuant to 6 64.313(9).
Page 12
Page 13
(1200pl erma and COBtfitianTOr Lifdfitie Cukturhreip
Lifeline'ata
Col lecd oD ForBI
rFCOFo@P81'0
MBrCo'qtrol Not 3060-0986(0MB Control'No. 3060-0819 I
iuly.&15
&010& StudFAreaCode—&015& StudyArea Name&020& Program Year
&030& Contact Name - Person USAC should contact regarding this data
r st st
rxe txotl lac
&035& Contact Telephone Number- Number of person identifiedin data line&030& ssrxrs sx.
&039& Contact Email Address - Email Atldress of person identified in data line &030&
&1210& Terms gr Conditions of Voice Telephony Lifeline Plans
Name of Attached Oocument
&1220& Link to Public Website HITP axxm:/I .t marl ~ row& lr'~~
Please eh&«k these boxes below to congrm that the attached documentisl, on line 1210,
or the website fisted, on tine 1220, contains the required information pursuant to
5 54.422{aif2) annual reporting for ETCs receiving low-income support, carriers must
annually repon:
&1221& Information describing the terms and conditions of any voicetelephony service plans offered to Lifeline subscribers,
&1222& Details on the number of minutes provided as part of the plan,
&1223& Additional charges for toll calls, and rates for each such plan.
Page 13
Page 14
izoos) price cap cgrrlar Additional uocumeritatlon
Oats Coeettlon Furst
/ndudin Retd«s.Returnkorriafb iliatedoith Priss/co toro Earhan e Carriers
FCC F/srm 4(tOMli control No. 30$M866/OMgconaoi No. 30600319lutY 2013
«otto stu area code«013» stll nraanalllv rao n bi 1* Lt,c
«02m Pro mm Year
«030 contact Name ~ penon Ushc should«onto«t ra ardin thh data«033» conten telephone Number - Number of penon lduntiliad in data line «lao»
lassrn*k La ««
«033» ContactEmallnddrass-Emagndd assof orsonldentiflsdindalarsne«030» mmt tome tt
Select the appropriate responses below (Yes, Ho, Not Applicable) to note compliance as 6 recipient of Inwemental High Cost support, High Cost support to offset access chargereductions, and Connect America Phase II support as set forth In 47 CFR 6 54.313(b) (c) ld} ie). The information reported on this form and in the documents attached below is accurate.
Incremental Connect America Phase I reporting
&2011&
&2022&
&2023&
&2024A&
&20248&
&2025A&
3rd Year Certification 47 CFR 354,313(b)j1)(ii) - Note that for theJuly 2017 certifiCation, this applies to Roond 2 recipients ofIncremental Support.Recipient certifies, representing year three after Riling a notice ofacceptance of funding, pursuant to 54.312(c), that the locations inquestion are not receiving support under the Broadband initiativesProgram or the Broadband Technology Opportunities Program forprojects that will provide broadband with speeds of at least 4Mbps/1Mbps — 54.313(b)(2)(i). Round 2 recipients only.The attachment on line 2024 includes a statement of the total amount ofcapital funding expended in the previous year in meeting ConnectAmerica Phase I deployment obligations, accompanied by a list ofcensus blocks indicating where funding was spent. This coVersyear three -54313(b)(2)(ii). Round 2 recipients only.Round 2 Recipient of Incremental Support/
Attach list of census blocks indicating where funding was spent in yearthree - 54.313(b)(2)(il). Round 2 recipients only.Round 2 Recipient of Incremental Supporty
Name of Attached Document ListingRequired information
&20258& Attach geocoded Information for Phase I milestone reports (Round 2 foryear three) - Connect America Fund, WC Docket 10»90, Report andOrder, FCC 13-73, paragraph 35 (Ivlay 22, 2013).
Name of Attached DocumentstistingRequired Information
&2015& 2016 and future Frozen Support Certification 47 CFR 9 54.313(C)(4)
Page 14
Page 1S
(1003) Price Cap CamerArfdit)anatoocumentauon
phta collection Form
inc/odin Ratear -Reta camera'a rliatedleith'price ca tarot Eechhh dcamefp
.")CCForm481
OMB control No. 30600986/0MB contral r(f. 30600819,lair 2013
Prjce Cap Carrier Connect America ICC Support (47 CFR 3 54.313(d})&2016& Certification support used to build broadband-
Connect America Phase ll Reporting (47 CFR% 54.313(e))
&2017A& Connect America Fund Phase II recipient7
&2017C& Total amount of Phase ii support, if any, the price cap carrier used forcapital expenditures in 2016.
&2018& Attach the number, narries, and addresses of community anchorinstitutions to which the carrier newly began providing access tobroadband service in the preceding calendar year -54 313(e)(1)(ii)(A)
Name of'Attached Document ListingRequired Information
&2019& Recipient certifies that it bid on category one telecommunications andInternet access services in response to all FCC Form 470 postings seekingbroadband service that meets the «onnectivity targets for.the schools andlibraries universal service support program for eligible schools andlibraries located within any area m a census block where the carrier isreceiving Phase II model-based support, and that such bids were at ratesreasonably comparable to rates charged to eligible schools and libraiies inurban areas for comparable offerings - 54.313(e)(1)(ii)(C}
Page 13
~ N
uilo
Oils
(ndyAmsc d
Nudy ams Name
P, g V r
4 t NN ms-p No Usncslwvlcconwctmmmrmlhisdsw
T)(G h)phile LLC&018
(dark 1 ammertdias e teaT hnh N be ~ N b fP Ide tinedi dstsgns cso 4072601011 eict,
regalatorjigkoe ilottgwooc(. Com
Select from IIIC drop down menu or check the boxes below to rtote compBancn with 54.313(f){1). privately held carriers must ensure compgance with thelinn nels( repqrtlng requlremene set fonh In 47 CFR 54813(f){2), I further certify that the information reported on this form and In the documentsattached belrIw is accurate.
(3009)
(3010A)
(30103)
(3012AI
(30128)
(3013)
(3014)
dxogress Report on 5 year PlanCs ter cenlfles to 54.3130)ltl(30
)ertglcsuon ol pubgc Interest obggatlons {47 cFA 5Ss.aga(f)(1)0))Please Provide Attachment
Community Anchor Institutions l47 CFR 55)1313(fl(1)00)please provide Attachment
ls your company a Privately Held ROII Canter (47 CFR
584423(I)(2))If yes, does your company 3 le the RUS annual report
Name of Attached Deo mt Dating Requiredinformation
Notre of Altadiiid Diiixirrisrit Umrig Riiqulrndliikxiiintloii 0 0
lyesfNOJ 00
(3015)
(30161
l3017)
(3018)
(3019)
(3020)
(3022)
(3022)
(3023)
Please check these boxes to confirm that theattached PDF, on gne 3D17, contains the requiredInformation pursuant to 5 54 313(f)(2) ccm p genesrcrlolres:Electronic copy of their annual RUS sports(Operating Report for TelecommunicationsBbrrowers)Document( ~) with Balance Sheet, income Statementand Statement of Cash Flows
If e response is yes an gne S014, attach yourmpany's RUS annual report and ag requiredcumentatlon
e response ls no on gne 3014, Is yeur companyeodltcd INIhe response Is yes on line 3018, please check theagnes below to confirm your cubmlsslon an line3026 pumuant to 5 54.313(fl(1), contains:ether a copy of their audited financial Itatemanti or(I) a financial report ln s format comparable to RUS
O)rerattng Report for Telecommunlcatlo s BorrowersDocument(s) fnr Balance Sheet income Statementand Statement of Orch Flows
Manegem nt letter and/or audit opinion lssu ed by
the Indcpendentcertgled pubgc accountant thatperformed the comp ny's Rnsnclsl audit.If the response ls no on Sne 3013, please *eck tl eboxes below to congrm your submission on gne3026 pumuant to 5 54313(0 (2 j, contains:Copy of thefr financial statement which has bosnsubject to review by en Independent csmmod pubgc~younta nt; or 1) s financial report In s formatcomparable to RUS Operating Report forTa) ecommur l«stlone Borro wars
U deriving information subjected to a review by anIn aoandant certified puhac accountant
hieme of Attached Documerx U sting Requimdinformation
(yes(No) Q Q
(3024) Urjderlvlng Information subjected to an oglcercofdgcallpii,
(3025) Document(s) with Balance Sheet, Income Statementar(ff statement of Dish Flows
(3026) Attach the wormheet gating requlmd Info matlon Name ofAttached Document Ustlng Requiredliiforiiiat oi
s'u ls
'Page 12
(post Rate ot Relmdcdt lm Adedtrml oocumenbalon icantmuedj
Octa Coaecaon n
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Ordac tlblllo, 90600966/OMgtn t sino 90604nta ~ P2-
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Fhlanchl Data Iannlary
(3022) Revenue
(3023) opecsttng Espeltses
(3023) (tet income
(3030) Telephone Plant in Seniice(TPIS)
(3031) Total Assets
(3032) Total Debt
(3033) Total Equity
(3034) Dividends
tie emnrnchedoocume \tnnaammc«br~
(4oosl lioral sraedbsmlbrpcrlmsnt Addltlmut Documcgtatlon' ''rtp Perm48 ( ''",',
DabrCOEeCtiarifvr(ey, " r6'. u,',,r 4 ONBCuttiefNB.3060.tlyaa/OEta central ps."3040;0319
&s ts
&010&
&D15&
c010&
St Area CodeStrrdy Area Nllrlla
Pro nun Year
c030& ' contact Name- person 05Ac should contsa regarding this data&035& contact'relephoneNumber-Number of rson,identified.in dateline&030&«039& I Contact EmaE Address. Emag Addram ofpemon ldentiged In data line &DSD& v, . n urn&
40DS Rural B)osdbend Experiment
Autlmrlted Rural Broadband Experiment (IIBE) recipients must address the certlfkstl on lor pub 9c Interest obpgatlons, pmvide a Bat of newiy servedcommunity /cher Insthutkns, snd provide a gst of lacatlons where broadband has bosn deployed,
pubgc Intwem Dbflgagens -FCC SA 98 (pmagraphs 16 19, 78)Please address Une 4001regsrdlng compiknc» with the Commission's publk Interest obggapuns. Ap RBE participants must provides response to Une 4MI.
4001. Redplant cartgles!hat It k oNering broadband te the Identified lacations meeting the reuulslte pub acInterest oblk)Iles consistent with Bre category for which they were selected, Indudlng broadband speed.l atencv, usagE capsdty, and rates that are reasonably comparable to rates for comparable otferlngs In urban&remi
CommunltyAnchorlnstltntiens-FCC14 98 (paragraph 79)
4003a. R BE partlupants mutt pmvtde the r umber, names, snd addresses of community anchor Instttutlons towhich they newly depioywl broadband service In the preceding calendar year. On this 0ne, please respond(yes — attach new csnununlty anchors, no-no new an&bow) to Indicate whether this gst wgl be provided.
If yac to 4003IL phase pwwlda a respense fer 4M38.
4003b Provide the number, names enrl addresses Name of Ana«hml Document Listtng Ilenulred Informstlonof community anchor instltuuons lo whkh therecipient newly began providing access tobroadband service In tha preceding calender year.
Broadband Depfoyment Locadmis - fCC 14 98 (paragraph 80)
40044 Attn&ice fist of geccoded locatlens towhtch broadband has been deployed as of theiune 1st Immqdtstely precedIng the inly 1st f8in3deadgne fer
)efCC Farm 481
4004b. Attachevhlence dcmomtratkg that therecipient Is meegng the rsisvsnt pubEc serviceobggatlons fo( th» identified locstlom. Materialsmust at least datag the prldng, offered broadbandspeed end deth usage sgowancas avaEahle In therelevant geographic area.
Name of Attached Document'Listing Reuulred Information
Name of Attached Document Listing Required Information
sw ts
Pace 19
PIIIBcstfoBTRBBBrtÃr,cbffldt ™Data Cogecson Form
IFCC F 401DMB Co/ftfhFJIO 5060.090$/0MB Control Nor 3060e019
calp& Stud Arcs Code
«013& Ru Ares Name
co?0& prhgrlrlhyc4rr
c030& CnntarbNsme ~ Pemon UIAC should contact almrdlngthic data
144443
TAO uobtte I '
3414
c035& contact Tele hone Number-Numb r of erconldantlfled In date 0 e coso& &oTmotell em,
«039& conte Emss Address - Ema0 Addrem of coon Idcntmedln data sne coao& re 1 co el I d, eo
TO BE COIRPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IB FIONG ANNUAL REPORTING ON ITB OWN BEHALFI
Certification of Officer as to the Accuracy of the Data Reported for tha Annus I Reporting for CAF or LI Recipients
I entify that I ant an hisser of the c*ponlng carrier; my respondbs itic c fndude enctmngchs sccmacy sf \he annual reporung requirements for unlcersal cendce supportrecipients; and, thuhe best of my en on ledge, the inhmna don reported «n the form snd In «ry slcachmmts is accurate.
Name nf qe m tamer TAO nhblle l&C
0 cmmof Amhonloif Ofhcer; CSATIPIao Oublua
printed harm of Amhontcd Dfeccr: 91 so Orlllloh
Title or pontlon of'/unhoritcd DNce T."s hl Tlhmm
el*phone number oiAuthorhed Dfecen ~ calsscccr cnc.
44/33/lair
tud Areacodeotaamrtln carrier Msall Faire Due Dale fm'lhic foml 47/41/1417
partem wsfosy mating labs nctcmcmc en tbrl form can lm punished by hm sr forhlt re unde lhc communnctienc Act sf 193c, 47 U I c N 501 503(bi e linc or imp Ice huntunder Tab ls niche Dnaed It la&cod, ls 0 I c I 1001.
page Is
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Cerlffpcalfon Ttgent /CarrierData cogewlon Form
FCC (ofnkcetDlvlg Conlr83'No. 3060095EFDfda Control Nm 3050&329
*, O', Luly 21DSw w.
colo Stud Area Coda
can» Surd It N.me
cO20& a my sr
4030& cmwd Neme - Pencn IJSAC chould contact regarding thi» data
249lr12
TAu N btl uuc
13 4
cuss& DnrltactTele hens Number -Number of rum ldenugedln dsts Sno 403t» ~07M01011 enc.
cosa» contsmEmasAddress ~ EmesAddremof emonldentwedi dct grecow *w"2 1 *Ts
TO BE COMPLETED BY THE REPORTBCG CARRIER, D: AN AGENT IS HONG AHHVAL REPORTS ON THE CARIRLRB BEHAM:
Certification of Offlcer to Authorlce en Agent to Fffe Annual Reports for CAF or Ll Rectpfents on Behatf of Reporting Carrier
I sons'y that (Rema or Agent) la aulhewed to submit Iha lntomnaon wported an b half ef We ropamng canter. I
also canlfy Ihat I sm sn oificer of Ihe re pawns santon my wspencawulos Include eneum 0 we icmnwp of Ilw ennwl dst~ repewng wqulwnwnts pwvldod to lhe eulhancedagent; and, to Ihsweet of my knowlosge, tho reporls and dsw ptovldad to Iha authorised agmd la ecewats.
Name 4 t Authwired
NsmeofRe Center.
N lit»a ot Audmdred Dglcer".
printed name ofArfdimuad Dnl car.
tls nr osldon ofmnhorbed Dglcen
els hone numbernd Authorised Dgicer:
Stud Aran Code oSAe ordn Carrion Hi DueDsteterthlcfamr
Dltn
swo lntlfvlly ktwblertato tso thlrlsr snlnp IWSdbvwemwdumwwcmtl cmnn I«elmActef1934.47U*cffw7,503(ll.o eneorl sruonmwtunc«im lsmmeunaedSmieecmle,uludcsw01.
ITO BE COMPLETED BY THE AVTHORRED AGENT:
Certification of Agent Authorfced to Fffe Annuaf Repotts for CAF or Ll Recipients an BehaV ef Repoctfng Carrier
I ec agent for the pa ling carrier cergfy that I sm euthortled mmbndktho snauelreporw fer unlvemsl ccwlcecwpmtredplonm on behalf of the repmtlng ca«lec Issue pnmldedtbevfsta niported ercln ha sod on deca provided by the reporting carrier; end, to the best ot my luwmlmtge, the Infennstlon wpmtcd herein lc «ccurste.
NemeofRa ortfn Carne
Nemeoflwthorfwi ant Firm,
51 nature of Authorlred ant or 1 ploy of Ag t.
NemeofAulhorlmd entEmpt ee:
tie or Nlorr ofA th kwd Ac tor F»r I 4 of Acortt
ele hcmenumbarotAuth NedA5 ntorEm I sof ent:
1 A»mcodew4 wm10 bn FSI»IRDile Drltrl for ddofmnc
Date:
pa n ngf svmsklruul u tan t thhr m nbep nlhwbye mtafm mcmiwcanw nlcnl *Art I1914 47uccs53e2 503tbl, 5 lwn t w tltlw Itl mmwstm cess,nludw51001
I
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