20200701Assurance Wireless Form 481 and Affidavit.pdf

Page 1
<010> StudyAreaCode 479015
<015> StudyArea Name Aaaurucc rlr6laBs IrsA t . P
<020> Prorram Year 2021
<030> ContactName: PersonUSACshouldcontact
wtth questions about thls data
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Emall ol the pe6on identlfied in data llne <030>mdy.n, Iecarteroaprlat. cm
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<010> StudyArea Codc
<015> Study Area Namc Assrrrrn.F Wi re l FFs IISA T, P
<020> Program Year 2027.
<o3o> contact Namc - Pcrsn USAC ahould @ntact ESardln3thit data Andrew M. Lancaster
<035> contact Telcphone Numbcr - Numbcr of pcr$n ldentlflrd in drtr lln. <030> 913? 625107 exL
<039> Contact EmaitAddress - Em.itAddr€ss of percn identmed in data ltre <o3o> andy ' m ' l anca6 ter@sprint ' com
Select from the drop down menu or check the boxes below to note compliance with 54.313(fX1). Privately held carriers murt ensure compliance with the
financial reporting requirements set forth in 47 CFR 54.313{0(2). I further certify that the information reported on this form and in the documents
attached below is accurate.
(300e)
(3010A)
(30108)
(3012A)
{30128}
(3013)
(3014)
Progress Report on 5 Year Plan
carri.r ccnifics to 54.313(0(1xiii)
crrtifiotion of Public lntcrcst ObliSations (47 CFR 5
s4.313(fx1xi))
Plcasc Prcvide Attachmcnt Name of Attachcd Documrnt Listing R.quired
lnformation
Community Anchor lnstitutions {47 cFR 5
s4.313(fXlxii)l
Plcasc Prcvide Attachm€nt Name of Auached Documrnt [isting Rrquired
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ls your @mpany a Privat.ly H.ld ROR Carrier (47 cFR
5 5,4.313ffX2)l
lf ycs, dcs your company filc thc RUs annual rrport
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(3017)
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Plcase chcck thcsc boxcs to confim that thc
attached P0F, on linc 3017, contains thc requircd
information pursuant to 6 54.313(fX2l complianc.
rcquircs:
Ele€tronic copy of their annual RUS rcports
(Oprrating Report for Tel*ommuni€tions
Borrcwers)
Dsument(s) with Balance shet, ln@me statcmcnt
and statcmcnt of cash Flows
lf thr rcspons is ycs on linc 3014, attach your
6mpany's RUS annual r€port and ell required
documentation
It thc respon$ is no on line 3014, is your company
audit d?
lf thc rcspon$ is y"s on linc 3018, pleare check thc
boxcs below to confirm your submision on line
3026 pursuant to 5 94.313(f)(2), contains:
Eithcr a copy of thcir audited financial statcmcnt; or
(2) a financial rcport in a format compaEble to RUS
opcratint Report for Tclc@mmunietions Borowers
Docum.nt(s) for Balane Sheet, ln@mc Stat.mcnt
and statcmnt of Cesh Flows
Managemcnt lctt.r and/or audit opinion i$ucd by
thc indrpcnd.nt ccrtified public accountant that
pcrformcd thr company's financial audit.
lfthc rospons is no on linc 3018, plcase check thc
boxes below to confirm your submision on line
3026 pursuant to 5 54.313(f}(2), contains:
Copy of th.ir financial statcmcnt which hes bccn
subj.ct to rwirw by an indcpcndent ertificd public
acountant; or 2) a financial rcport in a format
6mparablc to RUS Opcrating Rcport for
Telecommuni6tions BorrowrE
Undcrlying information subjcctcd to a raicw by an
independ"nt certificd public acountant
Name of Attached Documcnt Listing Required
lnformation
(Ycs/No) O O
(301s)
(30201
(3021)
l3o22l
(3023)
(3024)Underlying information subjected to an offier
ertification.
(302s)Deument(s) with Balancc Shet, lncome statcmcnt
and Statement of cash Flos
Name of Attached Document Listing Required
lnformation
(3025) Attach thc worksheet listing requircd information
P.a.13
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<010>Study Arla C.dc 47r015
<o15>Study Arc. Namr
<ll20> PrErrm Y..r 2o2r<030> Contaa ttamc - P
<039>Cont ctEmailAddresr-EmallAddr6sof pcrsonldmtiltcdind.t linc<l3(> .dy.n.16c..r.ilp!rnr..6
a(xl5 Rur.l lro.dbnd E,OGdmcnt
Authoriz.d Rur.l Broadband Exp.rimGnt (RBE) rccipirnts must addrcss tlrc ccr$fication for public intcrBt obli8atlons and providc a
list of ncwly servcd community rnchor institutlons.
tubfic [ricrGst ob[truoll3 - Fcc il48 (p.qr.phs 2&29, 78)
Plc.sc .ddrss Unr 4o0l rc8.rding compli.nc. with th. commision's publk intGr.st obl'Ertirns. All RBE prrtkipsnts must provid. a
r"spons. to Linc 4001.
lml. Rccipicnt ccrtifirs that it is ofrldrf, broadband me.tinS the requisitc publk intcrcst obligrtions consistcnt with thc cltc8ory for
which thcy wrrc aclGctcd, includinS broadband spccd, latancy, usagc clp8city,.nd ratrs that ar! rr.sonably cornp.r.bh to rstrs for
cmparabla o,ffrrinls in urban arcas.
Co.tlnunltyAndro? ltlstlt to.E-FCCL.gt lp.r.gt ph 791
/m8r. RBE p.rt'xipants must provide thc number, namet rnd rddrcsses of community .nchor imtihrtiom to
whkh thcy n*ly dapbyed broadbend servkc in the prrcedh[ cal.nd.ryc.r. On thls lln!, pbas? rGpond
(y.3 - .ttach n.w community amhoB, rc - no ncw rnchorsl to indic.t. whcthcr tii3 list will b. prcvidcd.
It yc. to tlqBA, ph.3. prouldc. ]C pots. ror tldl3E.
4qBb. Provid.the numbcr, names and.ddrcss.s
of community anchor institutions to whkh th.
r.cipient n.wly b.8rn prorklin8.cce3s to
broadband scruk in the pr.ccding c.hndar ycar.
Namr of Att ch.d Documrnt UitinS Rcquirrd lnformation
Ps 15
P* 16
<010>Study Area Code
<015>
<020>
Area Name
Year
&ryuc. ri!.1... usa !. P.
<030>Contact Name - Pc6on USAC should contact this data
<035>Contact of id€ntified data line
<039>ContactEmailAddress-EmailAddressofpersonidentm€dindataline<030> .dy.h.1.nc..r.!,+r1.t co
Sooi Alaska Plan
(s011)
(s012)
Please indicate whether any terrestrial backhaul or other satellite backhaul became
commercially available in the previous calendar year in areas previously seNed
exclusively by performancejimiting satellite backhaul.
lf the filint carrier identified in its approved perfomance plans that it relies exclusively on
satellite backhaul for a certain poriton of the population in its service area, indicate whethet
any terrestrial backhaul or other satellite backhaul became commercially available in the
previoius calendar year in areas that were previoiusly served exclusively by satellite backhaul.
O.slBlon Ot L.kh.ul Tchmlo0
(Yes/No)
(Yes/No)
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<010> StudyArea Code 419015
<015> StudyArea Name Aaaurance lli,leless usA L.P
<020> ProgEm Y.ar 2027
<olo>contact Namr - Pcrsn UsAc should .ontad r.rrrdint this data Andrew M. Lucaster
<035> ContactT.laphoncNumbcr-Numb.rofpcrsonidcntificdindatalinc<030> 913?6261.0? ext.
<039> ContactEmailAddr.ss-EmailAddressofperpnidentifiedindatalinr<030> ady.m.lecasrcresDrlnE.c@
TO 8E COMPLEIED 8Y IHE REPORNNG CARRIE& IF TI{E REPORTING CARRIER IS FITING ANNUAT REPORTING ON ITS OWN BEHAIF:
Certmcatlon of Offlcer as to the Accuracy of the Data Reported for the Annual Reportint for CAF or tl Reclplents
I GGrdfy thrt I am an offic?r of tha rGportln! carrlcr my rasponslbllldB lndud. Gnsurln! th. acaracy of thc annual rGpordn3 aaqulrcmcnts ior unlycrsal sarylcc support
radplGnts; an4 to thc bcst of my knmlad3c, th! lnfomatlon rcponcd on thb iom rnd ln any rttadrmlnts ls acuratc.
Nameof ReDortinrcarricr. Aaaurance wlre1e65 usA L'P
sisnaturc of Authorized officcr: CERTTFTED oNLrM Oatc 06/29/2o2o
Printed name of Authorized officer: Lary tlelana
ntle or position of Authorized officcr: vice Presldent
Ielephone number of Authorized officer: 91379{1452 ext
Studv Araa Crde of Rercrtins Carier: 479015 Filim Dua Date for this formi M / 0a/ 2020
PGrsonswillfullymakingfdlcrtatrmentsonthlsfomonb.punishadbyffnGoriorfclturtunderthGCommunic.tionsAqtof 1934 47U.5.C.55502,503(b),orfinGorimprisnmcnt
undcrfitb 18 ofthc Unit.d St.t.s Codc, 18 U.s.c. ! 1001.
PaSe 19
Page 20
fCC Fdlr atl
oi,l, control I{o. a[i0{s6loi/18 cortrol rG $6o{!il,6lhcfb(l Forrn frrt
<o10> Studv Area Code 479015
<015> Studv Area Name Assurance Wireless usA L.P
<O2O> Prosram Year 2027
<030> Co^tactName-PersonUSACshouldcontactregardingthisdata hdlew M. LancasLer
<oqs> contectTeleohoneNumber-Numberofoersonidentifiedindataline<o3o> 913?62510? ext
<039> Contact Email Address - Email Address of person identified in data line <030> andy. m. lacasterosplint . com
TO BE COMPTETED BY THE REPORTING CARRIE& IF AN AGENT 15 FILING ANNUAT REPORTS ON THE CARRIER'S BEHALF:
Certification of Officer to Authorize an Agent to File Annual Reports for CAF or Ll Recipients on Behalf of Reporting Carrier
cer0fv that (Name of Aqent) 13 authorlzed to submlt the Informatlon reponed on behalf of the reportlng carrier
atsocerurytiattam"n-om""eaccuracyoflheannualdatareportingrequlrementspIovidedtothgauthorlzed
agsnt; and, to lho bost of my knowledge, the reporb and data provlded to the authorlzed agent ls accur8te.
Namp of Authorized Acent:
Name of Reoortinr Carrier:
sisnature of Authorized officer:Date:
Print..l nam. of Auth6ri2ed Offi.er:
fitle or bosition of Authorized Offlcer:
feleDhone number of Authorized Offlcer:
Studv Area Code of Rercrtinc Carrier:Filinc Due Date for this form:
under Tille 18 of the United States Code, 18 Lj.S.C. 5 1001.
TO BE COMPtfiED BY THE AUTHORIZED AGENT:
Certification of Agent Authorized to File Annual Reports for CAF or Ll Recipients on Behalf of Reporting Carrier
:he data r€ported hereln based on data proylded by the reportint carrier; and, to the b€st of my lnowledge, the lnfomation reported herein ls accurat€,
\,lame of Reportinc Carrier:
{am. of Authorized Acent Firm:
;irnature of Authorized Acent or Emolovee of Aqent:Date:
!ame of Authorized Aaent EmDlovee:
fflc 6r b6sition 6f Authori?pd Ar.nt or Eh6lovee of Asent
[eleohone number of Authorired Arent or Emolovee of Asent:
itudv Area Code of Re@rtinr Carrier;Filinr Due Date for this form:
18 of the United States Code. 18 U.S.C. 6 1001.
Page 20
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State of lbnras CERTIFEANON BY EUGIBLE TELECOMMUNICATIONS CARRIER
OF COMPLIANCE IAIfi SERVICE QUAL]TYAND CUSTOMER
PROTECTION. ABILITYTO REMAIN FUNCTIONAL !N EMERGENCIES,
AND USE OF FEDERAL HIGH.COST SUPPORT.
County of Johnron
AFFIOAVIT OF BUSINESS OR CORPORATE OFFICER
The ldaho Public Utilities Commission Order No. 29&41 requirea thd Elagibl€ Telecommunications Canierr
(ETC) cediff thd it b complhnt with applicable service quall$ stardards and consumer protoc{ion rulcs; and
ETCs must demonsbate the ability to ramain functional in emergencieg. ln addition, the Gommissaon must rile
an annual ccrtification with the USAC and the FCC that all bderal high+ost support prcvided to ETCs within
the SHe of ldaho wil! be used only for the provislon. maintenanco, and upgradhg of frilitiea and services for
which the support is intended. nccordingly, the undem[ned states and vedfres under oath the following:
1. ! am an offcer d Acsnancp 4frpless U$4. [.P. . an el{ghle telccommunications canbrior
rcceMng fedenal uniroreal seMce support under section 214(e) of the Teboonrnunbationg Act of lg96
in the state of Haho.
2. N'A
3. Assuranrr ltfioless USA, L,P.is comprylng with +plicable seryice quality etrandards and
consum€r protec{ion rules of thc Fcdeol Cormunbalions Commission and thc ldaho Publrc utilties
Conrmiseion.
4. I cedifr to the Commieoion that the Company ie able to ramain functional in enrergnndes ar rct forth in
Cornmissbn Oder !tlo. 29&41 and in 47 C.F.R. S 54.202(aX2).
5. N'A
6. This vcdftcation and affidavit is pradded to be the ldaho Public tltilities Conmission to enable the IPUC
to certiff to the FCC that 6dera! univercal sericc Bupport receivod by thg digible caniers ln the state
wll be used h a mannor consistsnt with Section 251(e) of the Telecommunications Act.
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Date
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for residing at
My Gommbaion expires 6t -. ''oA t
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SUBSCRIBED AND Stt/ORN to bcfore rne this . adh Oay ol
EVEtYll ltl. VERtOll
ilolrry Publlc - Strl! ot l(lma.
lly Aooo'nlment Frprrcs at'!!" rorl