20140701Inland Cellular FCC Form 481.pdf

INLAND CELLULAR TELEPHONE COMPANY
Corporate Oftices
103 8.2nd St.
PO. Box 688
Roslyn, W498941
Telephone: [phone]
Fax: [phone]
June 30,2OL4
,?ECEiL/: i]
?0lq JUL - | pH t2r 0I
lL,.'liL*i^r i-i;
UT lL I Tl i: S" COf, ; ;,: i Sl; i C ;
Via email in .pdf fonnat to [e-mail]
Idaho Public Utilities Commission
Commission Secretar5r
472 W. Washington
P.O. Box 83720
Boise, ID 83720-0074
Please review the attached
Annual Use Certification Letter
questions, please call me at
i brooks(Einlandnet. co m.
filing and include Inland Cellular LLC in your
to USAC and the FCC. If you should have any
(509) 6+9-2500 or contact me by email at
b/VR -7/'l-o I
,NTA'IID \
CEL,.JU,ARI
Re:trIC Docket No. lO-9O - FCC Form 48l-Carrier Annual Report and
Report and Certification Pursuant to IPUC Order No. 29841
Dear Ms. Jewel:
Enclosed is a copy of the Federal Communications Commission (.FCC'),
Form 481 tl:at was electronically completed and submitted to the Universal
Service Administrative Company ("USAC"). This submission is for Inland
Cellular LLC tf/k/a Washington RSA No. 8 Limited Partnershipl@/b/a Inland
Cellular), Study Area Code 479AOT and includes all attachments that v/ere
submitted to USAC and the FCC.
Since the Company serves the Nez Perce Reservation and/or tribal
members thereof, these documents have also been sent to the Tribal Chairman.
arnes K. Brooks
Treasurer/Controller
Enclosures
ANNUAL SECTION 64.2009(e) CERTIFICATION
EB Docket No. 06-36
Annual $ 6a.2009(e) CPNI Certification for 2013
Dated: February l2r2014
Company: Inland Cellular LLC (tUb/a Inland Cellular)
Form 499 Filer ID Number:829984
Name of Signatory: James IC Brooks
Title of Signatory: Treasurer/Controller
I, James K. Brooks, certif, that I am a duly authorized officer of Inland Cellular LLC
("Inland Cellular" hereafter) and, acting as al1 agent of Inland Cellular, that I have personal
knowledge that Inland Cellular has established operating procedures that are adequate to ensure
cornpliance with the Customer Proprietary Network Information ("CPNI') rules of the Federal
Communications Commission ("Commission"), codified at 47 C.F.R. Part 64 Subpart U,
implementing Section 222 of the Communications Act of 1934, as amended.
Accompanying this certification is a statement explaining how the company's procedures
ensure that the company is in compliance with the requirements set forth in sections 64.2001 et
seq. of the Commission's rules.
Inland Cellular has not taken any actions (proceedings instituted or petitions filed by
Inland Cellular at either state comrnissions, the court systenr, or at the Commission against data
brokers) against data brokers in the past year. During the calendar year ended December 31,
2013, lnland Cellular did not acquire first-hand any information that it has identified as being
information with respect to the processes pretexters are using to attempt to access CPM.
Inland Cellular has not received any customer complaints in the past year concerniug the
urauthorized release of CPM.
INLAND CELLULAR LLC
IDAHO MARKET .479007
FIVE YEAR FORECAST NETWORK ADDITIONS
As they are known to the Company at the date of this Report, the planned investments and forecasted expenses
related to the Idaho Market (Study Area Code 479OO7) for the period January l, 2Ol4 through December 31,
2018, are listed below. Although there are plans to upgrade the data to the next generation, those upgrades are
not listed at this time since CETC's whose support is being phased-down are not required to submit a new five-
year build-out plan. The Company has listed what is known for the provisioning of voice services. The Company
expects to use all Universal Service Fund support received in order to fund the expenses related to the
provisioning, maintenance and services provided over these upgraded facilities as well as existing facilities and to
seryice the debt created in order to make these improvements; improving service quality, coverage and capacity.
The Company (SAC 479OO7l received zero ($0) in federal high-cost support for the calender year ended December
31, 2013. The Company expects that any future Universal Service Fund support will aid the Company's efforts
to continue to upgrade its network and to provide the supported services to all customers and potential
customers.
slIE 9!SSB!EI!oNluldesac Bldg, Ant, Radio
Jniontown Switch Additions (ap)
<ooskia EVDO adOition
2013
83,648
23,427
1t,zgg
M. 2015 2016 20t7 2018
lenlz EVDO addition 35,490
-ewiston-6th EVDO addition 35,490VlcGregor _EVDO addition
-CSC EVDO addition
Moscow Wf EVDO aOdition
Jniontown Switch Additions (ap)
\,lason gtOq & Ant Addition
35,490
36,965
L2llt4
1,306,405
22.i15
Nest Twin EVDO addition 12,872VlcGreqor Ant & EVDO addition 8,780
-ewiston-6th Ant, Radio & EVDO 63,605lentz Ant, Radio & EVDO
3reer Ant & Radio)rctrards Radio
-CSC Microwave addition
-ewiston-5th Microwave addition
80,367
59,286
48,476
10!7L2
10,759)rofino Ant & Radio 21,75',1/Vinchester New Site 150,000Deary New Site 150,000
TOTAL 1,939,881 300,000 0 0 0 0
FORECASTED OPERATING EXPENSES
Direct Telecommunications ExDense 1.598,206 1.591 .152 1.630.931 1.679.063 1.689.526 1.693.750
Pl ant Operation! q!q !4e4!g!ance Expense
Deoreciation Exoense
sjz,r44
847.646
1,000,171 1,332,',t74 1,345,496847,646 847,&46 847,646
1,358,951
847.646
1,372,540
847,646
Su btotal Operati nq Expenses J,JVU,J9O J,r+Jd,voy J,6 tu,/3 t J,6tz,zuo 3,E96,123 J,V tJ,VJ/
Qqq4 Telqgqrn: lqli Expense
Roaming Expense
Universal Service Fr.tnd Expense
Mobile Media Exoense
875,64s 904,643 934,6022,$5,q67 2,204,490 2,424,098476,718 489,003 503,434
41 .904 43.999 46.1 99
965,553
2,682,566
506,571
4A 50q
997,529
2,986,047
507,838
50.934
847,576
2,406,244
455,239
3q qoq
Enqineerinq 877 877 877877 877 877
Sales and Advertisino ExDense 2,087.861 2.085.090 2.083.707 2.082.324 2.O80.942 2.079.561
Customer Service Expense 919.258 868.813 844.975 821.791 799.244 777.314
Balling Expense
Accounting Expense
General & Administrative Expense
Commercr a Lguild i ng Expenses
Cost of Eouioment Sold
763,q8q
116,715
460,894
341,788
5,1 06,508
752,127 741,323 730,674
1 15,980 115,251 114,525484,820 509,988 536,463352,042 362,603 373,4815,435,691 5,786.095 6,065,839
720,',t79
113,805
564.3',!2
384,686
6,285,791
709,834
1 13,089
593,608
396,226
6,456,736
Tax Expense (Other then lncome)
TOTAL PROJECTED OPERATING EXPENSES
65,214 65,582 65,952 66,324 66,698 67,075
17,009,566 17 ,529,927 17,963,657 18,572,838 1 9,1 1 5,857 19,650,605
Filename: 140624 2014 lC BUDGET.xlsx FIVE YEAR.479OO7
FCC Form tt81 - Carrler Annual Reportlng
FCC torm tl81
oM8 Contrcl No. 3O6GO!ts6/OrriB Contlol No 3O@-Bl9
Julyr0lS
<010> Studv Area Code 4f 9001
Page 1
<015> Study Area Name WASHINGTON RSA NO. 8 LIMITED PARTNERSHIP DBA INLAND CELLULAR
<020> Prosram Year
<030> Contact Name: Person USAC should contact
with questions about this data James K. Blooks
<035> Contact Telephone Number:5096492500 ext
Number ot the identitied in data line <030>
<039> Contact Email Address:
Email ot the person identitied in data line <030> jbrooks@inlandnei com
54.313 I 9.422
Completlon I Completlon
ANNUAT REPORTING TOR ALt CARRIERS
(check box when comDlete)
<100>
<200>
<210>
Service Quality I mprovement Reporting
Outage Reporting (voice)
( cofr plete ottoch ed wotksh eet)
(compl ete o?to.hed wotksh ee ?)
l7h.-.heckboxif no
<300> UnfulfilledService Requests
<310> Detail on Attempts (voice)
<320> Unfulfilled Service Requests (broadband)
<330> Detail on Attempts (broadband)
Number of Complaints per 1,000 customers (voice)
Fixed
Mobile
Number of Complaints per 1,000 customers (broadband)
Fixed
Mobile
Service Quality Standards & Consumer Protection Rules Compliance
140630 479007 COMPLINCE AFFIDAVIT.pdf, 7402L2 IC 829984 CPNI
CERTIFICATION.pdf, 1402t2 INUND CELLULAR CPNI OP PROCEDmES.pdf
<500> Functiona Situations
desctipttve document)
Iottoch desctiotive document]
<400>
<410>
<4ZO>
<430>
<440>
<450>
<500>
<510>
Company Price (voice)
Terrestrial Backhaul (Y/N)?
Terms and Condition for Lifeline Customers
(c ompl ete otto ched worksheet)
(com plete ottoch ed worksheet)
(co n pl e te o tto ch ed work s h e e t )
(il yes, .omplete oftoched wotksheet)
(check to indicote cetliJicotionl
descriDtive document)
( a ttoch descil pttve documentl
7A
nm
77
t / I[r\\\ss
0.0
00
{check to indicote cettilicotion)
(otto.hed desctiptive docunent)
(check to indicote certilicotion)
<610>
<700>
<7to>
<800>
<900>
<1000>
<1010>
<1100>
<1110>
<1200>
Company Price Offerings (broadband)
Operating companies and Affiliates
Tribal Land Offerings (Y/N)? O O
Voice Services Rate Comparability
(il not, check to indicote cettiJicotion)
(compl ete otto ched wotksheet)
(.omplete otto ched worksheet)
-?-rffi
Price Cap Carriers, Proceed to Prlce Cap Additional Documentation Worksheet
lncluding Rote-of-Return Corriers dffilioted with Price Cdp Locdl Exchonge Corriers
<2000> (check to indicote certilication)
<2005> (complete ottoched worksheet)
Rate of Return Carriers, Proceed to
<3000> (,,e.kto,nd,ere,tttl*oilon) !-]ISEN
.3005, ,,"-","'",
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CollectlonSorm,::..:::
July 2013 .
<015> StudyArea Name WASHINGTON RSA NO. 8 LIMITED PARTNERSHIP DBA INLAND CELLULAR
<020> Prosram Year 2 015
<030> Contact Name - Person USAC should contact resardins this data James K. Brooks
<035> Contact Number - Number of person identified in data hne <030>5096492500 ext.
<039> contact Email Address - Email Address of person identified in data line <030>brooks@inlandnet. com
TO BE COMPTETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FITING ANNUAL REPORTING ON ITS OWN BEHALF:
Certification of Officer as to the Accuracy of the Data Reported for the Annual Reporting for CAF or Ll Recipients
certify that I am an otficer ofthe reporting carri€r; my responsibilities include ensuring the accuracy of th€ annual reportint requirements for universal seryice support
ecipients; and, to the best of my knowledge, th€ lntormation reported on this form and in any attachm€nts is accurate,
{ameofReoortinpCr..;".. TIASHINGTON RSA NO. I LIMITED PARTNERSHIP DBA INLAND CBLLULAR
;ignature of Authorized officer: CERTTFTED oMrM Date
)rinted name of Authorized officer: Janes Brooks
-itle o. position of Authorized officer: Treasurer/controlrer
elephone numberof Authorized Officer' 5095492500 ext
;tudv Area Code of ReDortinE Carrier' 419041 Filins Due Date forthislorm: 01 / 07/207q
under Title 18 of the United States Code, 18 U.S.C. I 1001.
Page 13
- A8ent / Canler FCC Form 481
collecflon Form oMB contrcl No. 306o-o986/oMB contrcl No. 306s819
Juty 2013
<010> Studv Area Code
<015> StudvArea Name WASHINGTON RSA NO, 8 LIMITED PARTNERSHIP DBA INLM CELLIAR
<020>2 015
<030>should contact thrs data James K. Brooks
<035> ContactTelephoneNumber-Numberofpersonidentifiedindataline<030> 5096492500 exE
<039>Address - Email Address of person identified in data line <030>
TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING ANNUAT REPORTS ON THE CARRIER'S B€HALF:
TO BE COMPLETED BY THE AUTHORIZED AGENT:
Certification of Officer to Authorize an Agent to File Annual Reports for CAF or Ll Recipients on Behalf of Reporting Carrier
certify that (Name of is authorized to submit the lnfomation reported on behalf of the reporting carier.
lso certify that I am an omcer of the reporting carrier; my responslbilities include ensuring the accuracy of the annual data reporiing requirements provided to the authorized
gent; and, to the best of my knowledge, lhe reports and data provided to the authorized agent is accurate.
Jame of Authorized Aseht
Jame of Reportine Carrier
isneture of Authorired Offi..r:Date:
name of Authorized officer:
rtle or position of Authorized Offtcer
'elephone number of Authorized Officer:
tudv Area Code of Raoortins Cerrier FilinE Due Date for this forml
under Title 18 of the United States Code, 18 U.s.C. 5 1001
Certification of Agent Authorized to File Annual Reports for CAF or Ll Recipients on Behalf of Reporting Carrier
he data reported herein based on data provided by the reporting carrier; and, to the best of my knowledge, th€ information report€d herein is accurate,
lame of Reoortins Carrier:
lame ofAuthorized Asent or EmDlovee ofAsent
ignature of Authorized Agent or Emplovee of Agent Date
name of Authorized Aeent or Emolovee of AEent:
itle or Dosition of Authorized AEent or Emolovee of Asenl
'eleDhone number of Authorized Asent or Emplovee of Agent
tudv Area Code of Reoortins Carrier FilinE Due Date for this form
18 ofthe United States Code, 18 U.s.c.5 1001.
Page 13
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STATEMENT REGARDING OPERATING PROCEDURES
IMPLEMENTING 47 C.F.R PART 64 SUBPART U
GOYERNING USE OF
CUSTOMER PROPRIETARY NETWORK INFORMATION (CPNI)
MARCH 1,2014
The following statement explains how the operating procedures of Inland Cellular LLC,
Washington RSA No. 8 Limited Partnership and Eastem Sub-RSA Limited Partnership
(collectively "Inland Cellular" or "Company'') ensure that it is in compliance with the
Commission's CPNI nrles, as codified at 47 C.F.R. Part 64 Subpart U ($$ 64.2001-64.2011) and
is relevant to calendar year 2013. Except as otherwise indicated, flre following applies with
respect to the Commission's rules in effect both before and after the December 8,2007 effective
date of the Corrmission's April 2,2007 Report and Order in CC Docket No. 96-1 15. ,See FCC
07-22 (rel. Apr. 2,2007); Public Notice, DA07-4915 (rel. Dec. 6, 2007). This statement covers
calendar year 2013.
I. Use of customer proprietary network information without customer approval.
A. lnland Cellular may use, disclose, or permit access to CPM for the purpose of
providing or marketing service offerings among the categories of service to which the customer
already subscribes from Inland Cellular, without customer approval.
Inland Cellular presently offers CMRS to its custonters.
B. Inland Cellular may not use, disclose, or permit access to CPM to market to a
customer, service offerings that are within a category of service to which the subscriber does not
already subscribe from lnland Cellular, unless krland Cellular has customer approval to do so,
except as described in Section I.C.
G) Inland Cellular may use, disclose or permit access to CPM derived from
their provision of wireless service, without customer approval, for the provision of CPE
and information services.
(2) Inland Cellular may not use, disclose or permit access to CPNI to identiff
or track customers that call competing service providers.
C. lnland Cellular may use, disclose, or permit access to CPNI, without customer
approval, as follows:
(1) Inland Cellular may use, disclose, or permit access to CPNI, in its
provision of installation, maintenance, and repair services.
(2) Inland Cellular may use, disclose, or permit access to CPNI for the
purpose of conducting research on the health effects of commercial mobile radio services
("CMRS").
(3) Inland Cellular may use CPM to market services formerly known as
adjunct-to-basic services, such as, but not limited to, speed dialing, computer-provided
directory assistance" call monitoring, call tracing, call blocking, call return, repeat dialing,
call tracking, call waiting, caller I.D., call forwarding, and certain Centrex features.
D. Inland Cellular may use, disclose, or permit access to CPM to protect lnland
Cellular's rights or property; to protect its users and other carriers from fraudulent, abusive, or
unlawful use of or subscription to, Inland Cellular's services; and to render, provision, bill or
collect for services.
Iiland Cellular's operating procednres comply tyitlt these requirements and include,
but are not limited to, the provisions described below. The Company does not engage iu any
otttbottttd telemarketing. Outborutd priut arurketing, ,f any, that ruay be distributed by the
Company by mail is addrcssed to all subscribers or custorrrers withirt the opplicable geogrophic
area, zip code(s) and/or telephone uumber preftx(es), t'itltont regard to the specific services
that the subscriber or automer receives, or does tot receive, from the Contpany and/or the
Company's alfiliates. Under Contpany policy, rtone of the Contpany's affiiates is permitted to
use any CPNI of the Contpanyfor any outbourtd telemorketing or outbonrtd print marketing.
Moreover, the Contpany does not use any CPNI for any inbourrd marketing of services
that are not withirt a category of service (i.e., local, hrterexchonge, aad CMRS) to tvhich the
custorr.er alreody stthscrihes from the Company and/or orte or more of the Contpany's
afliliates. The Contpauy does not sell, or provide access to sny third party to, arty of the
Conrpauy's CPNI for purposes of marketing tlrc services of the Conryany or of any of its
affiliates, other tlrcn as permitted witlrout prior utstortrer approval with respect to tlrc
Contpany's alftliates. Ercept for CPNI made available lo other telecommunicatiotrs corriers
pursuant to tarffid or detarffid billirtg trrd collectiort aruangentents and billing and
collectiott services provided pursuant thereto, and pursuant to reciprocal roaming agreements,
the Contpaty does not provide CPNI to any third-porty"for arty purpose,
The Contpany, its employees aud ogents may moke such other uses and disclosures of,
and permit occess to, CPNI rvithout customer approval as are pennitted by applicable statute,
rule, regulation or order, Such uses, disclosures or occess nrcy include tlrcse authorized by
Sectiott 222(c) and (d) of the Communications Act of 19i4, as amended, by Sectiorr 64.2005 of
the Conmtission's rules and by orders of the Comndssiol.
Except as set forth above, the Contpany does not provide aty CPNI to any
governnrerttal entity, or to arty other third pa@, other tlrcn: purarunt to subpoena or otlrcr
lawfiil process or with the subscriber's prior written consent, or in accordance witlt the
authenticatiot and other requirement described below and in the FCC's rules, as a resalt of a
persort representing himself or herself to be the subscriber (or the subscriber's duly authortzed
agent) and having cor{irmed his or her identity or authority by providing to tlrc Conrpany
appropriate identifying informatiott (such as Social Security Number, driver's license nuntber,
tttotlter's maiden ,tatne, uset name or password, as oppropriate) or doctunentation, or
othenyise being recognized by the Contpany as being the subscriber or the sahscriber's duly
authorized ageut.
il. Approval required for use of customer proprietary network information.
A. Inland Cellular may obtain customer approval through written, oral or electronic
methods.
(l) Inland Cellular does not seek or obtain oral approval, and therefore does
not bear the burden of demonstrating that such approval has been given in compliance
with the FCC's rules.
(2) A customer's approval or disapproval obtained by Inland Cellular to use,
disclose, or permit access to the customer's CPNI, the use of CPM outside of the
customer's total service relationship with Inland Cellular must remain in effect until the
customer revokes or lirnits such approval or disapproval.
(3) Inland Cellular must maintain records of notification and approval,
whether oral, written or electronic, for at least one year.
B. Use of Opt-Out and Opt-In Approval Processes.
(1) Except where use, disclosure, or access to CPM is otherwise permitted
without prior customer approval (as described above), Inland Cellular only uses,
discloses or permits access to CPM upon opt-out or opt-in approval, consistent with
Section 64.2007 of the Commission's rules and, by December 8, 2007, with the
Comnrission's amended rules.
(2) Except for use and disclosure of CPM that is permitted without customer
approval under Section I, or that is described Section ILB, or as otherwise provided in
section 222 of the Communications Act of 1934, as amended, Inland Cellular may only
use, disclose, or permit access to its customer's individually identifiable CPM subject to
opt-in approval.
The Company currently does uot use CPNI in a manner that requires prior customer
approval. Shortld this Coutpany policy change, lnwever, the foregohtg policies will be
applicable and policies will be implemented to ensure tlut the FCC's rules are contplied ttith.
III. Notice required for use of customer proprietary network information.
A. Notification, Generally.
(1) Prior to any solicitation for customer approval, Inland Cellular must
provide notification to the customer of the customer's right to restrict use of, disclosure
of and access to that customer's CPM.
(2) Inland Cellular must maintain records of notification, whether oral, written
or electronic, for at least one year.
B. Individual notice to customers must be provided when soliciting approval to use,
disclose, or permit access to customers' CPM.
C. Content of Notice.
Customer notification must provide suffrcient information to enable the customer to make
al informed decision as to whether to permit Inland Cellular to use, disclose, or permit access to,
the customer's CPM.
(1) The notification must state that the customer has a right, and Inland
Cellular has a duty, under federal law, to protect the confidentiality of CPM.
(2) The notification must specifu the tlpes of information that constitute
CPNI and the specific entities that will receive the CPM, describe the purposes for which
CPNI will be used, and inform the customer of his or her right to disapprove those uses,
and deny or withdraw access to CPNI at any time.
(3) The notification must advise the customer of the precise steps the
customer must take in order to grant or deny access to CPNI, and must clearly state that a
denial of approval will not affect the provision of any services to which the customer
subscribes. However, Inland Cellular may provide a brief statement, in clear and neutal
language, describing consequences directly resulting from the lack of access to CPM.
(4) The notification must be comprehensible and must not be misleading.
(5) If written notification is provided, the notice must be clearly legible, use
sufficiently large type, and be placed in an area so as to be readily apparent to a customer.
(6) If any portion of a notification is translated into another language, then all
portions of the notification must be translated into that language.
(7) Inland Cellular nray state in the notification that the customer's approval
to use CPM may enhance Inland Cellular's ability to offer products and services tailored
to the customer's needs. lnland Cellular also may state in the notification that it may be
compelled to disclose CPNI to any person upon affirmative written request by the
customer.
(8) Inland Cellular may not include in the notification any statement
attempting to encourage a customer to freeze third-party access to CPM.
(9) The notification must state that any approval or denial of approval for the
use of CPNI outside of the service to which the customer already subscribes from Inland
Cellular is valid until the customer affirmatively revokes or limits such approval or
denial.
(10) Inland Cellular's solicitation for approval must be proximate to flre
notificatiou of a customer's CPNI rights.
D. Notice Requirements Specific to Opt-Out.
Inland Cellular must provide notification to obtain opt-out approval through elechonic or
written methods, but not by oral communication (except as provided in paragraph F of this
section). The contents of any such notification must comply with the requirements of paragraph
C of this section.
(1) Inland Cellular must wait a 30-day minimum period of time after giving
customers notice and an opportunity to opt-out before assuming customer approval to
use, disclose, or permit access to CPM. Inland Cellular may, in its discretion, provide for
a longer period. Inland Cellular must notifu customers as to the applicable waiting period
for a response before approval is assumed.
(i) In the case of an electronic form of notification, the waiting period
shall begin to run from the date on which the notification was sent; and
(ii) ln the case of notification by mail, the waiting period shall begin to
run on the third day following the date that the notification was mailed.
(2) lnsofar as Inland Cellular is using the opt-out mechanism, it must provide
a Notice to its customers every two years.
(3) If krland Cellular uses e-mail to provide opt-out notices, it must comply
with the following requirements in addition to the requirements generally applicable to
notification:
(i) Inland Cellular must obtain express, verifiable, prior approval from
consumers to send notices via e-mail regarding its service in general, or CPM in
particular;
(il) Inland Cellular must allow customers to reply directly to e-mails
containing CPNI notices in order to opt-out;
(iiD Opt-out e-mail notices that are returned to Lrland Cellular as
undeliverable must be sent to the customer in another form before Inland Cellular
may consider the customer to have received notice;
(iv) Inland Cellular must ensure that the subject line of the message
clearly and accurately identifies the subject matter of the e-mail; and
(v) Inland Cellular must make available to every customer a method to
opt-out that is of no additional cost to the customer and that is available 24 hours
a day, seven days a week. Inland Cellular may satisff this requirement through a
combination of methods, so long as all customers have the ability to opt-out at no
cost and are able to effectuate that choice whenever they choose.
E. Notice Requirements Specific to Opt-In.
Inland Cellular may provide notification to obtain opt-in approval through oral, written,
or electronic methods. The contents of any such notification must comply with the requirements
of paragraph C of this section.
F. Notice Requirements Specific to One-Time Use of CPM.
(l) Inland Cellular may use oral notice to obtain limited, one-time use of
CPNI for inbound and outbound customer telephone contacts for the duration of the call,
regardless of whether Inland Cellular uses opt-out or opt-in approval based on the nature
of the contact.
(2) The contents of any such notification must comply with the requirements
of paragraph C of this section, except that Inland Cellular may omit any of the following
notice provisions if not relevant to the limited use for which Inland Cellular seeks CPNI:
(r) Inland Cellular need not advise customers that if they have opted-
out previously, no action is needed to maintain the opt-out election;
(it) Inland Cellular need not advise customers that they may share
CPM with their affiliates or third parties and need not name those entities, if the
limited CPNI usage will not result in use by, or disclosure to, an affiliate or third
party;
(iii) hrland Cellular need not disclose the means by which a customer
can deny or witlidraw future access to CPM, so long as lnland Cellular explains
to customers that the scope of the approval hland Cellular seeks is limited to one-
time use; and
(iv) Inland Cellular may omit disclosure of the precise steps a customer
must take in order to grant or deny access to CPM, as long as Inland Cellular
clearly communicates that the customer can deny access to his CPM for the call.
The Conpany currently does not ase CPNI in a manner that reqaires prior custorrrer
approval Sltottld this Contpany policy chauge, however, the foregoirtg policies v'ill be
applicable and Inland Cellular will intplenteut policies to ensure that the FCC's rules are
contplied with.
IV. Safeguards required for use and disclosure of customer proprietary netrvork
information.
A. Inland Cellular must implement a system by which the status of a customer's
CPNI approval can be clearly established prior to the use of CPM-
B. Effective December 8,2007,Inland Cellular may release call detail information
during a customer initiated telephone contact only if reasonable authentication procedures are
complied with and (1) the customer provides Inland Cellular with a pre-established password, (2)
Inland Cellular, at the customer's request, sends the call detail information to the customer's
address ofrecord provided the address ofrecord has been associated with the account for at least
thirfy (30) days, or (3) when Inland Cellular calls the telephone number of record to disclose the
call detail information. Inland Cellular is permitted to create a back-up customer authentication
method for lost or forgotten passwords. Inland Cellular is also prohibited from releasing call
detail information during a retail visit without the appropriate password or valid photo
identification.
However, if the during a customer-initiated telephone contact, the customer is able to
provide without assistance from Inland Cellular personnel all of the call detail information
necessary to address a customer service issue (i.e., the telephone number called, when it was
called, and if applicable the amount charged for the call), then Inland Cellular persomel are
permitted to proceed with its routine customer care procedures with respect to such call detail
information.
C. Not later than June 8, 2008, Inland Celluiar must authenticate a customer without
readily available biographical or account information prior to allowing the customer on-line
access to CPM related telecommudcation service account. Once authenticated, the customer
may only obtain on-line access to CPNI related telecommunications service account through a
password.
D. Effective December 8, 2007, Inland Cellular is required to notiff customers
immediately when a password or back-up means of authentication for lost or forgotten
passwords, on-line account, or address of record is created or changed. Such notification is not
required when the customer initiates service, including the selection of a password.
E. Business customers are exempt from the password requirements which became
effective December 8, 2007, ifi the customer is contractually bound to Inland Cellular, is
serviced by a dedicated Inland Cellular account representative as the primary contact, and within
the contact hrland Cellular is responsible to address its CPM obligations. Ii at any point, the
business customer must go through a call center to reach a customer service representative, then
the exemption does not apply.
F. Inland Cellular trains its personnel as to when they are and are not authorized to
use CPNI, and lnland Cellular must has an express disciplinary process in place.
G. Inland Cellular must maintain a record, electronically or in some other manner, of
its own and its affiliates' sales and marketing campaigns that use its customers' CPM. Inland
Cellular shall maintain a record of all instances where CPNI was disclosed or provided to third
parties, or where third parties were allowed access to CPNI. The record must include a
description of each campaign, the specific CPM that was used in the campaign, and what
products and services were offered as a part of the campaign. Inland Cellular shall retain the
record for a minimum of one year.
H. Inland Cellular must establish a supervisory review process regarding its cornpliance
with the FCC's CPNI rules for outbound marketing situations and maintain records of its
compliance for a minimum period of one year. Specifically, sales personnel must obtain
supervisory approval of any proposed outbound marketing request for customer approval.
I. Effective December 8, 2007, Inland Cellular must take reasonable measures to
discover and protect against attempts to gain unauthorized access to CPM, which may include
encryption of its databases. Inland Cellular must properly authenticate a customer prior to
disclosing CPNI based on a customer-initiated telephone contact, on-line account access, or an
in-store visit. Inland Cellular must take measures to protect CPNI stored in its internal databases
from potential unauthorized access, and evaluate and increase its security measrues should it
discover an increase in attempts to gain access to unauthorized information.
J. hrland Cellular must provide written notice within five business days to the FCC of
any instance where the opt-out mechanisms do not work properly, to such a degree that
consumers' inability to opt-out is more than an anomaly.
(1) The notice shall be in the form of a letter, and shall include Inland
Cellular's ntune, a description of the opt-out mechanism(s) used, the problem(s)
experienced, the remedy proposed and when it will be/was implemented, whether the
relevant state commission(s) has been notified and whether it has taken any action, a
copy of the notice provided to customers, and contact information.
@ Such notice must be submitted even if Inland Cellular offers other
methods by which consumers may opt-out.
K. Effective December 8,2007,Inland Cellular has a general duty to first inform
federal law enforcement agencies, followed up by notification to affected customers, after
reasonable determination of a breach of its customers' CPNL
(1) Inland Cellular must file an elechonic notification to the United States Secret
Service (USSS) and the Federal Bureau of Investigation (FBI) within seven (7) business
days through the central reporting facility furnished by the Commission.
(2) Inland Cellular is prohibited from notiffing customers or the general public of
the breach until seven (7) business days have passed after notification to the USSS and
FBI unless under certain specified circumstances: (a) Inland Cellular identifies an
"exhaordinary need to notify customers" before that period or O) An ongoing or
potential investigation or national security requires customer disclosure to be potentially
delayed for up to thirfy (30) days. Inland Cellular must notifo the affected customer(s)
after the applicable period.
(3) Inland Cellular must maintain a record, whether elechonically or in some other
ulanner of any breaches discovered, notifications made to the USSS or FBI and
notifications made to customers. The record must include, if available, dates of discovery
and notification, a detailed description of the CPM that was the subject of the breach, and
the circumstances of the breach. Records must be maintained for a two (2) year period.
Inland Cellulor's operating procedures contply with all of the above requirements,
iucluding tlnse lhat became elfective December 8,2007. With respect to online authenticotion
I
iu particalar, Inland Cellular lrus implentented ,neasures to ensure contpliance by the
applicable Jane 8, 2008 deodlirta Company personnel are trained as to rvhen thqt are and are
not authorized to use CPNI.
V. Supplemental Information
Effective December 8, 2007, the FCC's rules require that the annual certification filed
pursuant to 47 C.F.R. $ 64.2009(e) disclose any actions taken against data brokers and a
summary of all consumer complaints received in the previous calendar year regarding the
unauthorized release of CPM. Inland Cellular is not aware of any consumer complaints
regarding the unauthorized release of CPM and has not taken action against any data brokers.
MEMORANDUM OF UNDERSTANDING
WASHINGTON RSA # 8 LIMITED PARTERNSHIP d/b/aINLAND CELLULAR
and NBZ PERCE TRIBE
This Memorandum of Understanding (hereinafter "Agreement") is benveen the Nez
Perce Tribe ("Tribe") and Inland Cellular Telephone Company as general pailner of and
on behalf of Washington RSA #8 Limited Partnership. d/brnlnland Cellular ("lnland
Cellular"). a rnobile conrmunications provider. This Agreement is intended to outline a
murual understanding that will mutually benc'fit both the Tribe and Inland Cellular
through establishing a process tbr cooperation between Inland Cellular and the Tribe to
enl:ance the wireless communications across the Nez Perce Tribe's Reservation that is
within the licensed service area of Inland Cellular.
RECITALS
WHEREAS. Inland Cellular owns. operates and maintains a FederalCommunications
Commission licensed mobile communications network: and
WI-IEREAS. the Tribe owns. operates and maintains a not-tbr-profit fixed rvireless
communications network: and
WHEREAS. the Tribe has need to expand its fixed wireless communications coverage
rvithin the boundaries of the Nez Perce Resenation and desires expansion of mobile
cornmunications within the boundaries of the Nez Perce Reservation: and
WHEREAS. Inland Cellular and the Tribe hereby nrutually agree lhat it is desirable to
collaborate in better utilizing the resources of atl parties while providing additional
communications capacitl' within the Nez Perce Reservation; therefore.
tN CONSIDERATION of the mutual promises contained herein" the parties hereto do
mutually understand as follows:
The Tribe:
The Tribe will pursue funding to continue to build-out its tixed wireless equipment
("infrastructure") which includes tower locations ("Sites'") to unserved and underserved
areas across the Nez Perce Reservation.
The Tribe shall maintain its existing and any newly constructed fixed wireless
infrastnrcture.
The Tribe may resell Inland Cellular"s mobile communications services and establish a
retail outlet rvithin the Nez Perce Reservation. The term "resell" in this context may
mean either becoming an agent of Inland Cellular or becoming a non-facilities based
reseller of mobile communications service. Either "resell" option will have a contract
governing the respective details.
Inland Cellular
Inland Cellular will pursue funding to continue to build-out its mobile communicalions
equipment ("infrastructure") which includes tower locations ("Sites") to unserved and
underserved areas across the Nez Perce Reservation that are within the Iicensed service
area of Inland Cellular.
Inland Cellular shall nraintain irs existing and any nervly constructed mobile
c ommu n i cat ions i nfrastructure.
The Tribe and Inland Cellular (singularly. Party: collectively. Parties):
In the pursuit of funding to continue the build-out of fixed wireless and mobile
communications infrastructures across the Nez Perce Reservation. the Parties agree lo
mutually support each other's endeavors with third party financing, Such support shall
be in the form of wrinen encouragement to third parties and shall not bind or encumber
the other Party monetaril.v-: there shall be no monelary support involving third party
{inancing rvhich includes but is not limited to letters of credit. loaning. co-signing or
rnortgaging.
When funding is establislred by either Party, the Parties mutually agree to work together
ir: determiuing mutually beneficial Sites tbr placenrent of tixed wireless and mobilc
infrastructures. Ifa Site is established by either Party that has not been agreed to bcing
beneficial to the other Partl', the other Party shall not be bound to co-locate infrastructure
at that Site. Acknorvledgemeni that a Site is mutually beneficial or not, must be in
rwiting.
Ownership of any land that is purchased for a Site shall alrvays be considered to be
owned by the purchaser of record. The Parties shall each bear the cost (capital
investnrent. installation, maintenance. etc.) of their respective infi:astructure. Co-location
of infrastructure benefits both Parties. Mutually agreed upon co-location rates will be
applied to new Sites.
TERM
This Agreement term shall be five years. The Agreement rvill be reevaluated prior to
additional five year increnrents unless either party gives notice of its intent to terminate
the Agreement. The renerval evaluation slrall consider all terms and conditions of the
Agreement. The Agreement may only be modified by rvrinen agreemert with updated
signatures by both parties.
TERMINATION
This Agreement nray be terminated only upon 90 days uritten notice by either party to
the other. and then only because of a breach of the Agreement or because the recited
purpose of the contract becomes inapplicable.
PARTIES
Both parties shall carrl'out their responsibilities under this Agreement as independent
agencies and neither. by virtue of this Agreement. shall be regarded as an agent of the
other.
NOTICES
Any notices under this Agreement shall be in rvriting and delivered in person or by public
or private courier sen'ice (including the U.S. Postal Service Express Mail) or certified
rnail with return receipt requested or by facsimile or by cmail. All notices shall be
addressed to the parties at the following addresses or at such other addresses as the
parties may hom time to time direct in writing.
For the Tribe:
Nez Perce Tribe Technology Sen'ices
120 Bever Grade
P.O. Box 365
Laprvai. ID 8i540Attn: Danae Wilson
Email: [e-mail] _Phone: [phone]Fax: [phone]
For Inland Cellular:
Inland Cellular Telephone Company
103 South 2nd Street
P.O. Box 688
Roslyn. WA 98941Attn: James K. Brooks
Email: jbrooks(rlinlandnct.conr
Phone: [phone]F-ax: 509-649-3300
SEVERABILITY
The terms of this Agreement are severable such that if any tenn or provision is declared
by a court of competent jurisdiction to be illegal, void, or unenforceable, the remainder of
the provisions shall continue to be valid and enforceable.
IN WTTNESS WHEREOF, the parties agree to the provisions set forth herein as
evidenced by the signatures of their authorized representatives below:
NEZ PERCE TRIBE:
-/-;<-,/vlz.
Silas Whitnan, Chairman
lZ-11 -12-
Allen Slickpoo, Jr., Secretary
R TELEPHONE COMPAITIY:
State of WASHINTON
County of KITTITAS
) CERTTFTCATTON By ELIGIBLE TELECOMMUNICATTONS CARRTER)ss oF coMPLIANcE WITH SERVICE QUALIWAND CUSTOMER) PRoTECTTON, ABtLtW TO REMATN FUNCTTONAL tN
EMERGENC]ES, AND USE OF FEDERAL HIGH-COST SUPPORT.
AFFIDAVIT OF BUSINESS OR CORPORATE OFFICER
The ldaho Public Utilities Commission Order No. 29841requires that Eligible Telecommunications
Carriers certify that it is compliant with applicable service quality standards and consumer protection
rules; and ETCs must demonstrate the ability to remain functional in emergencies. ln addition, the
Commission must file an annual certification with the USAC and the FCC that all federal high-cost support
provided to ETCs within the State of ldaho will be used only for the provision, maintenance, and
upgrading of facilities and services for which the support is intended. Accordingly, the undersigned states
and verifies under oath the.following:
'1. I am an officer of lnland Cellular LLC (f/Ua Washington RSA No. B Limited Partnership), an eligible
telecommunications carier for receiving federal universal service support under section 214(e) of the
Telecommunications Act of 1996 in the state of ldaho.
2. I am familiar with the Company's day-to-day operations in the state of ldaho and with the State's
service quality standards and consumer protection rules as set forth in Commission Order No. 29841.
3. lnland Cellular LLC is complying with appticable service quality standards and consumer protection
rules of the Federal Communications Commission and the ldaho Public Utilities Commission.
4. I certify to the Commission that the Company is able to remain functional in emergencies as set forth in
Commission Order No. 29841 and in 47 C.F.R. S 5a.201(aXz).
5. I also certiff that all federal universal service support funds received by lnland Cellular LLC during the
current calendar year will be used in a manner consistent with section 254(e); that is, for the provislon,
maintenance, and upgrading of facilities and services for which the support is intended. The company will
contlnue to comply for the period of January 1,2015, through December 31,2015, to be eligible for
federal universal service fund support
6. This verification and affidavit is provided to be the ldaho Public Utilities Commission to enable the
IPUC to certify to the FCC that federal universal service support received by the eligible carriers in the
state will be used in a manner consistent with Section 25 @) of the Telecommunications Act.
SUBSCRIBED AND SWORN to before me this 30th dav of June.)-( .dro,a"Pt-bPamela R. Nelson [Printed/Type]
NOTARY PUFLIC, i4and for the State of Washington,
residing at L\lt'(tr,rl.
PATT,IEI.A R. NELSON
NOTARY PUBLIC
STAIE OF WASHINGToiI
COilIyllSSlON EXPIRES
Date: June 30.2014
R9,
.,; My Commission expires 5v{':L4, SntS
Ability to Remain Functional in Emergencies Certification
S54.313(aXG)
EfCs must demanstrate that it has a reasonable amount of back-up power fo ensure functionality without
an erternal power source, is able to re-route traffic around damaged facilities, and is capable of managing
traffic spikes resulting frcm emergency situations.
l, James K. Brooks, being of lawful age, state that I am Treasurer/Controller of
lnland Cellular LLC (f/lora Washington RSA No. 8 Limited PartnershipXsAC 479007)
("Company"), that I am authorized to execute this certification on behalf of the
Company, and that the facts set forth in this certification are true to the best of my
knowledge, informatioR and belief.
On this basis, the Company certifies to the ldaho Public Utilities Commission,
pursuant to 47 C.F.R. S 64.2009(e), that the Company's operating procedures are
adequate to ensure compliance with the Customer Proprietary Network lnformation
rules and regulations as set forth in 47 C.F.R. SS 64.2001 through 64.2009 and the
Cellular Communications and lnternet Association's Consumer Protection Code for
Wireless Service.
The Company is able to remain functional in emergencies as set forth in
Commission Order No. 29841 and in 47 C.F.R. 554.201(aX2), as such standards relate
to functionality of wireless carriers in emergency situations. The Company further
certifies that it maintains back-up power to ensure functionality without an external
power source in the forms of auxiliary generators and batteries in its central office and
auxiliary generators and/or batteries at its cellular tower locations. The Company also
certifies that it constantly monitors traffic on its tower locations and that it's switching
capability is more than adequate to manage the traffic of its subscribers.
The Company further certifies, depending upon the circumstances of the outage,
that it is able to re-route traffic around damaged facilities. All lnland Cellular subscribers
are defaulted to roam on competitors should an lnland Cellular signal cannot be
obtained.
I certify under penalty of perjury under the laws of the State of ldaho that the
foregoing is true and conect.
Dated this 3Qh day of June, 2014 al Roslyn, Washington.
reasurer/Controller
lnland Cellular LLC
FCC Form 555
December 2013
Approved by OMB
3060-08 I 9
Annual Lifeline Eligible Telecommunications Carrier Certification Form
All caniers must complete all or portions of all sections
Form must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: lanuary 31il (Annuatly)
ldaho
State
(An Eligibte Teleconnumicstions Carrier (ETC) nrnsl prvide a certiJicalionfornr/or each slale fu v,hich it provides Ldeline sen,ice),
479407 lnland Cellular LLC (f/Ua Washington RSA No. 8 L.P.)
Study Area Code(s) (SAC)
lnland Cellular Telephone Company
Holding Company Name(s)DBA, Marketing or Other Branding Name(s)
Affiliated EfCs (include names and SACs, attach See list of Affiliated ETCrsadditional sheets
Provide a list of oll ETCs lhat are afiiliated vith the reporting ETC. Afilialion shall be deternined in aceordonce with seclion 3(2) of the
Connmnicaliotu Acl. Tlnt Sectiotr defines "afiiliate " as "a person that (direclly or indirectly) orwts ar controls, is owned or controlled by, or
is under conmon ot'nership or contol with, another person " 17 U,S.C. S I 53@. See also 47 C.F.R. S 76.12A0.
For purposes of this filing, an officer is an occupant of a position listed in the article of incorporation, articles of
formation, or other similar legal document. An officer is a person who occupies a position specified in the corporate
by-larvs (or partnership agreement), and rvould typically be president, vice president for operations, vice president for
finance, comptroller, treasurer, or a comparable position. If the filer is a sole proprietorship, the owner must sign the
certification
Section l: All ETCs MUST COMPLETE SECTION I- Initial Certiticatlon
I certiff that the company listed above has certification procedures in place eitherto:
A) Review income and program-based eligibility documentation prior to enrolling a consumer in the Lifeline
program, and that, to the best of my knowledge, the company was presented with documentation of each
consumer's household income and/or program-based eligibility prior to his or her enrollment in Lifeline or
B) Confirm consumer eligibility by relying upon access to a state database and/or notice of eligibility from the
state Lifeline administrator prior to enrolling a consumer in the Lifeline program.
I am an officer of the g@any named above. I am authorized to make this certification for the Study Area(s)
listed above. lnitial (5fu/
/
ETC Name(s)
lnland Cellular
Approved by OMB
3060-08 1 9FCC Form 555
Dcember 2013
Section 2: All ETCs MUST COMPLETE SECTION 2-Annuol Recertilication
Do not leave emply columns. If an ETC has nolhing to reporl in a cohunn, enler a zero.
A B C
Numbcr of
Subrcrihcrs Claimcd on
Februrry FCC Form(r) tl97
ofcurrcni Form 555
calcrdnr yerr
Numbcr of Lincs Clcimcd on
Fcbrurry FCC Forn{s) 497
ofcurrcnl Form 555
calcndrr ycar provldcd to
lYlrtlinr Rcscllcrr
Numbcr of Subrrrlbcrs chlmtd
on thc Fcbruary FCC Form(s)
497 thst wcrc inilirlly curollcd ir
currcnt Form 555 cllcudar ycor
62 0 t9
Inilial the certiJications belov lhal apply to yout ETC and conrplete lhe tables corresponding to the certiJication belov. Depending
on the slaIe, BOTH CERTIFICITION A AND B MAY APPLY.
A) I certiff that the company listed above has procedures in place to recerti$ the continued eligibiliry of all of its
Lifeline subscribers, and that, to the best of my knorvledge, the company obtained signed certifications from all
subscribers attesting to their continuing eligibility for Lifeline. Results are provided in the chart below. I am an
officer company named above. I am autlrorized to make this certification for the Study Area(s) listed above.
AND/OR
In the space belov, please list the prog'arn eligibility data sowces, such as ETC access to q state database and/or notice of
eligibility from the state Lifeline administrator or the Universal Seryice Adminislrotive Contpany (USAC), and indicale for vhich
qualfuing programs (e.g., SillP, SS, lhese sources are used lo verily subscriber eligibility. If any of subsuibers are
subseEtenlly contacled direclly $y 11't" ETC in an atlempl to recertify eligibility, those subscribers should be listed in columns D
through I as appropriate and nol in colwnrc J through L.
B) I certiff that the company listed above has procedures in place to re-certiry consumer eligibility by relying on
Action Partnership Association (CAPA) of ldaho . Results are
provided in the chart below. I am an officer ofthe named above. I am authorized to make this
certification for the Study Area(s) listed above.
OR
C) I certifo that my company did not claim federal lorv income support for any Lifeline subscribers for the February
Form 497 data month for the current Fonn 555 calendaryear. I am an officer of the company named above. I am
authorized to make this certification for the Study Area(s) listed above. Initial _
Number of
Subscribcrs ETC
Contactcd Dircctly
to Reccrtify
Eliglbility Through
Attcststion
Numbcr of
Subscribers
Numbcr ofSubscribers
Do'cnrolled or
Schcduled to be Dc-
Enrolled ar a Result of
Non-Rcsponse or
Number of
Subscribers Who
Dc-Enrolled Prior
to Rccertification
Attempt
Number ofSubccribcrs
\Yhose Eligibilily was
Revicrved By State
Administrntor
ETC Acccsg to Eligibility
Dntr or bv USAC
Numbcr of
Subscriberg De.Enrolled or
Schcdulcd to bc Dc-Enrolled as a
Rcsult of Finding of Incligibility by
Statc Administrator, ETC .{ccess to
Numbcr of Subscribcrr Who
DeEnrolled Prior lo
Rereriification Attcmpt
Approved by OMB
3060-0819FCC Form 555
December 2013
Section 3: ALL ETCS MUST COMPLETE SECTION 3 - De-enroll percentage
Ithat is the percentage of subscribers de-enrolledfor this ETC?
Section 4: ALL ETCS MUST COMPLETE APPROPRIATE CHECK BOX; PRE-PAID ETCS MUST
COMPLETE ALL OF SECTION 4
Is the ETC Pre-Paid?
,* f] *" V A Pr*Paid ETC does not assess or collect a nonthlyfeefrom its Lifeline srbscribers)
If yes, record the numbet of subscribers de-enrolledfor non-usage by month in column S below.
Non-Usage Results Applicable to Pre-Paid ETCs:
R s
Month Suhscrihers T)e-Enrnlled for Nnn-f lsese
January
February
March
April
May
June
July
Auzust
September
October
November
December
Sienrature Block: ALL ETCS MUST COMPLETE SIGNATURE FIELDS
By signing below, I certifu that the company listed above is in compliance with all federal Lifeline certification
procedures. I am an officer of the company named above. I am authorized to make this certification for the Study
Area(s) listed above.
M N o P= N+O O=f(P+llltil00l
Numbcr of
Subrcribcn Clliocd
oa Februrry FCC
Forn{s) 497
(From Colunu A)
Numbcr ofSubscribers
Dc- Enrollcd or
Schcduled to bc De-
Enrollcd sr e Rcrult of
Non-Rerponse or
Iocligibility
(From Colwn H)
Numbtr ofSubscrlhrrs
Dc- Enrollcd or
Schedulcd to bc Dc-
Enrollcd ar r Rrsult of
I Fiudlng of larligibilily
(From Column K)
Tolal Numbcr of
Subrcriberr De-Eorolhd
or Schcdulcd lo bc Dc-E
nrollcd
Pcrccnlrgc of Subscrlbrn
Dc-Enrolled or Schcdulcd lr
be Dc-Enrollcd lhrt scrc
Chlmed on thr
Fcbrurry FCC Form(r) .lr7
62 0 0 0 0
Approved by OMB
3060-08 I 9FCC Form 555
December 2013
Person Completing this Certification Form
Printed Name of Officer
01t30t2014
James K. Brooks
Date
[phone]
Contact Phone Number
ETC ldentification
SAC ETCName
472423 lnland Teleohone Company
522423 lnland Telephone Company
473007 lnland Collular LLC (frua Washington RSA No. E L.P.)
529003 lnland Cellular LLC (f/k/a Washlngton ESA No. 8 L.P.)
529004 lnland Cellular LLC (UUa Eastem Sub-RSA L.P.)
Hol C )anv Namefs
SAC Holdine Company Name
472421 Woslem Ellte lncorporatod Services
522423 W€stEm Ellte lncorporated SeMces
479007 lnland C€llular Telephono Company
529003 lnland Cellular Telephon€ Company
529004 lnland Cellular TelEphon€ Compeny
DBA. Ma or Other Brandins Namefs
SAC Name
472423 lnland Networkg
522423 lnland Networks
479007 lnland Callular
s29003 lnland Cellular
s29004 lnland Csllular
Approved by OMB
3060-0819FCC Form 555
December 2013
Affiliated ETCs
SAC Name
522423 lnland Telephone Company (d/b/a Inland Networks)
472421 lnland Telephone Company (d/bra lnland Networks)
s29003 lnland Cellular LLC (f/Va Washinslon RSA No. 8 L.P.Xdft/a lnland Cellularl
52S004 lnland Cellular LLC (f/Ua Easlem Sub-RSA LP.Xdtt/a lnland Cellular)
INLAND CELLULAR
1332 G Street
Lewiston, ID 83501
(2Oq 794-0245; (8OOl 244-4822
Fax [phone]
LIFELINE HOUSEHOLD WORKSHEET
Your household is everyone who lives together at your address as one economic unit (including children and people who are not related to you).
Theadultsyoulivewitharepartofyoureconomicunitiftheycontributetoandshareintheincomeandexpensesofthehousehold. Anadultis
any person 18 years of age or older, or an emancipated minor (a person under age 18 who is legally considered to be an adult). Household
expenses include food, health care expenses (such as medical bills) and the cost of renting or paying a mortgage on your place of residence (a
house or apartment, for example) and utilities (including water, heat and electricity). lncome includes salary, public assistance benefits, social
security payments, pensions, unemployment compensation, veteran's benefits, inheritances, alimony, child support payments, worker's
compensation benefits, gifts, and lottery winnings
Spousesanddomesticpartnersareconsideredtobepartofthesamehousehold. Childrenundertheageof 18 livingwiththeirparentsor
guardiansareconsideredtobepartofthesamehouseholdastheirparentsorguardians. lfanadulthasnoincome,orminimal income,andlives
with someone who provides financial support to that adult, both people are considered part of the same household.
You have heen osked to complete this Worksheet becouse someone else currently receives o Lifeline-supported service at your dddress. This
other person moy or moy not be o pdrt ol your household. Answer the questions below to determine whether there is more than one
household residing ot your address,
1) Does your spouse or domestic partner (that is, someone you are married to or in a relationship with) already receive a Lifeline-discounted
phone? (check NO if you do not have a spouse or partner)' lves Ero
> lf you checked YES, you may not sign up for Lifeline because someone in your household already receives Lifeline. Only ONE Lifeline discount is
allowed per household.
> lf you checked NO, please answer question #2.
2l Other than a spouse or partner, do other adults (people over the age of 18 or emancipated minors) live with you at your address?
A. Aparent lves E*oB. An adult son or daughter lves E*o
c. Another adult relative (such as a sibling, aunt, lves Eto
cousin, grandparent, grandchild, etc..)
D. An adult roommate lves Ero
E. Othe, ttt E*o
> lfyoucheckedNOforeachstatementabove,youdonotneedtoanswertheremainingquestions. Pleaseinitial lineB,below,andsignanddatethe
worksheet.
> lfyou checked YES, please answer question #3.
3) Do you share living expenses (bills, food, etc.) and share income (eitheryour income, the other person's income or both incomes
together) with at least one of the adults listed above in question #2?
[vrs E*o
> lfyoucheckedNO,thenyouraddressincludesmorethanonehousehold. PleaseinitiallinesAandBbelow,andsignanddatetheworksheet.
> lf you checked YES, then your address includes only one household. You may not sign up for Lifeline because someone in your household already
receives Lifeline.
CERTIFICATION
Please initiol the certificotion below ond sign ond date this worksheet which must occompany your Lifeline opplicotion.
A. I certily that I live ot dn address occupied by multiple households.
B. I understand that violotion of the one-per-household requirement is ogdinst the Federal Communicdtions Commission's rules ond may
result in me losinq my Lifeline benefits, and potentiolly, prosecution by the United Stotes Government.
SIGNATURE
Filename: 140630 LIFELINE CERT|FlCATlON.xlsx LIFELINE CERTIFICATION Page 3 of 3
En
INLAND CELLULAR
1332 G Street
Lewiston, ID 83501
(2oq 794-o24s; (800) 2a8-8822
Fax [phone]
CERTIFICATION BY CUSTOMER IN ORDER TO RECEIVE FEDERAL LIFELINE SUPPORT
STATE ELIGIBILITY (Subscriber signature not required)
I certify that I am qualified through the:
Community Action Partnership Association of ldaho (CAPAI) (See email confirmation)
Washington Department of Social and Health Services (DSHS) - Case #
INCOME ELIGIBILITY
I certify that my household income is at or below 135% of the federal poverty guidelines and therefore I qualify for Lifeline Support
under the federal income requirements and have provided proof of my qualifications.
FEDERAL ELIGIBILITY
I certify that I qualify for Lifeline Support and am currently one or more of the programs listed that I have checked below.
Medicaid
Temporary Assistance for Needy Families (TANF)
Supplemental Security lncome (SSl)
Federal Public Housing Assistance (FPHA) or
Section 8
participating inE
E
E
Federal Public Housing Assistance (FPHA) or
Section 8
(5NAP)(Food Stamps)
Low lncome Home Energy Assistance Program
(LIHEAP)
National School Lunch Program's free lunch program
Head Start (lncome eligible)
Medicaid
tl
E
E
EEE
E Supplemental Nutrition Assistance Program
(SNAP)(Food Stamps)
Low lncome Home Energy Assistance Program
(LIHEAP)
National School Lunch Program's free lunch program
TRIBAL LIFELINE ELIGIBILITY Tribal ldentification Number
I certify that I qualify for tribal Lifeline Support, as I reside on land that meets the Bureau of lndian Affairs definition of "reservation" (any federally
recognized lndian tribe's reservation, Pueblo, or Colony including former reservations in Oklahoma, Alaska Native regions, and lndian Allotments)
AND participate in one of the following programs:
Bureau of lndian Affairs General Assistance
Tribal Administered Temporary Assistance for Needy Families
(TTANF)
Temporary Assistance for Needy Families (TANF)
Food Distribution Program on lndian Reservations
Supplemental Security lncome (SSl)
lncome Eligibility (See lncome Eligibility)
E Supplemental Nutrition Assistance Program
SUBSCRIBER CERTIFICATION
It is understood that by participating in the Lifeline program, the support that I receive is not actual payment to me but a discount on my monthly
billed service. Participating in Lifeline does not protect me from collection procedures if I do not pay my phone bill. lfully understand that this
discount, as well as the criteria for participation in the Lifeline Program, may change and I may no longer qualify, or the amount of support may
increase or decrease.
As the Certifying Subscriber, I certify that, (i) the service is for me and not a member of the household; (ii) I am not listed as a dependent on
someone else's tax return; and, (iii) the service address is my primary residence. I further certify that the service that I receive from lnland
Telephone Company is my main line of service and neither I nor anyone in my household receives Lifeline Support for any other
telecommunications service. Further, I understand that Lifeline is a federal benefit program that provides a monthly discount on either home or
mobile telephone service and ONLY ONE Lifeline discount is allowed per household. Members of a household are not permitted to receive Lifeline
Supportfrommultipletelecommunicationscompanies. lunderstandthatviolationoftheone-per-householdrequirementwill resultinde-
enrollment from the program and possible fines and imprisonment. As the Certifying Subscriber claiming income eligibility, I certify that the
documentation I have provided accurately represents: (i) my household income and the number of persons in my household; or, (ii) proof of
participation in an eligible program.
Filename: 140630 LIFELINE CERTlF|CAT|ON.xlsx LIFELINE CERTIFICATION
E
fI
E
EEE
Page 1 of 3
INLAND CDLLULAR
1332 G SEeet
kwiston, ID 83501
(2081 798-0245; (aoQ 248-8822
Fax [phone]
I certify that I will notify lnland Cellular within 30 days,(i) if for any reason I should no longer participate in any of the eligible programs or qualify by income,
and or (ii) if I move from the address provided on this form. lf my address listed above is temporary, I certify that I will verify my address to lnland Cellular
every 90 days. I understand that if I fail to respond to an attempt to verify my address within 30 days, my Lifeline support may be terminated. I understand
that if I fail to give notice as required, I am subject to penalties, including de-enrollment, being barred from the program and fines and imprisonment.
I understand that Lifeline Support is not transferrable and that I may not transfer my service to any individual, including another eligible Lifeline Support
recipient. lfurtherunderstandthatifmyservicegoesunusedfor60days,myservicewillbesuspendedsubjecttoa30dayperiodinwhichlmayusethe
service or contact lnland Cellular to confirm that I want to continue receiving the service.
Further, I fully understand that in order to continue to receive this support, I must annually, or more often, certify my eligibility and provide proof of eligibility.
I understand that my failure to timely re-certify will result in de-enrollment and termination of my Lifeline benefits.
I fully understand that the Lifeline Program is administered by the Universal Service Administration Company (USAC) under the guidance and
authority of the Federal Communications Commission (FCC)and that all of the information that I have supplied pertaining to my eligibility will be
shared with USAC and the FCC and I give my consentto do so.
I certify that the information provided on this form is true and correct to the best of my knowledge under penalty of perjury and if I have provded
any misleading statements in order to receive support, I will be liable for any support received, my service may be discontinued, it may result in de-
enrollment and my being barred from the program and I would be subject to state and federal fines and imprisonment.
SIGNATURE OF APPLICANT
APPLICANT (PRINTED)
SOCIALSECURITY NUMBER
SERVICE ADDRESS
xxx-xx-DATE OF BIRTH
BILLING ADDRESS
and Cellular - Customers serving area
E EASTERNSUB.RSA,WA
E wAsHrNGroN RsA No.8, wA
;NATURE OF CUSTOMER SERVICE REPRESENTATIVE
INTED NAME OF CUSTOMER SERVICE REPRESENTATIVE
E TDAHoRSAI-82
t] rDAHo RSA 2-82
Fcdctol Povcttv Guidetine fil o llst of occcptobtc documentotlil lil lncome ellElblllv.
TELEPHONE NUMBER NUMBER OF PERSONS IN FAMILY OR HOUSEHOLD
lnland Cellular will keep the information contained in this form confidential, except as required by federal or state law. AIL INIORMATION COMptETED ON
THIS FORM IS SUBJECT TO STATE AND FEDERAI. PERJURY PENATTIES.
Filename: 140630 LIFELINE CERTlFlCATlON.xlsx LIFETINE CERTIFICATION Page 2 of 3