20210128Boomerang Wireless Form 555.pdf

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January 77,2A2L
:-' i :. "s: l:'l {l-::'" it; -L.L:J;l F.r': l: i :Ci,i[{iSSi-"tFi
Commission Secretary
ldaho Public Utilities Commission
472W. Washington
Boise,lD 837CI2
RE: Oocket Ns. GI{R-T-17-0I- FCC Form 555-Annual tifellne Certlflcatlon- Flled on behalf of
Boomerang Wireless, LLCdlhla enTouch Wreless
Dear Secretary,
Pursuant to FCC requirements under 47 C.F.R. $ 54.410, enclosed please find for filing in the above-
referenced docket a copy of Boomerang Wireless, LtC dlbla enTouch Wireless' FCC Form S5S - Annual
[ifeline Eligible Telecommunications Carrier Certification.
lf you have any questions regarding this filing, please contact me at [phone] or
[e-mail].
itted,
Mark
Attorney-in-Fact
Boome rang Wireless, LLC d lb I a enTouc h Wireless
Enclosures
Annull l'ifcline Eligiblc Telecommunications carrier certification Form All caniers must complele all or portionsof'all sections Form must be submitted to usAC and filed *irt rtr Federal communications commissionIMPORTANT: PLEASE Rf,AD INSTRU.TIONS FIRST
Deadline: fanuary 3t* (Annuaity)
Does the reporting company have aflitiated ETCs? yes Eil No G[
Provide o list of all l)'l cs rhal !]e alJitiated with the reporting El{', using page 4 and atlditiotwl :lwt:ts if necessary. Afliliation shall hed€tcwinsd in atcorclan<'c x'ilh secti{rn 3(il of the (ommunirutions Act. lhai sectian tleJines "afilbte" os ,,d persan lhat (directly or indireuly)ov'tr:torconlrol',isawnedorconrrollcdb!,orisunclercantmanov,nershiporconlntlrrith,anothtrperton.,,;17{/.s1c.$ tS3(2).seealwdT('.J'.R. {- 76. t 200,
Af,iliated E"I'C's SAC ffiliated ETC's Name
I
479022 143036595
Study Area Code (SAC)
( t n E I i gi h I e'lb I e co nt mwtica ! ion s
Service Provider ldentification Number (SplN)carrier (Elc) must provid( a certiJication lorm for eoch SAC through which ir provides Lifeline service).
2020 ID N/A
Recerlification Year
N/A
Stale El"C Name
NIA
DBA.
($same
Mark_eling, or Other Branding Name
as ETC name, lisl "N/A" Do not leaie blan*)
I'lolding Company Name([same as l)TC name. lnt "MA" l)o not leave blankl
ETCs Subjcc( to !he Non-Usagc llequirenrcnls
suh,v r t hc r s dc - t' nra I lei' h.v nun t t lt.
ls the EI'C subjcct lo thc non-usagc rcquiremenls? ycs @[ No HI
l/ .tes. ret-onl tlte ttttnthcr of suhst'rilters tlc-tnra!ldJbr no,r-usilge h.y rttotrtlt itt lllot"k e hel<1r,.
P a
Monllr Subscribcrs Dc-I:nrollcd lclr Non-l.Isagc
.lanuarv 3
l:cbruarv 1
March 0
April 0
Ivla.v 0
Junc 0
J uly 0
August 0
Scplcmllcr 0
Octotler 0
Novcnthcr 0
Decsntber 0'l-otal Subscribcrs 4
or olher similar legal docttntcnl. An tllJlcer !s a pcrson rvho occupics a position spccificcl in l6c corporatc by-larvs (or
panncrship agrccrncnl), ancl wottld tlpically he president. vicc prcsiclenl tbr opcrations, vice presidcll lor ilnancc,
colnplrollcr. lrcasurer, or il c(tltlparahlc position. ll'thc filcr is a solc proprictorship, the orvncr lnlst sign thc ccrtificalion.
Initial C'crlificatior. .ttt tit('s nrult (.ort!)l{,t(, ttlts sL..tntt
lccrtily that thc conlpan)' listed atxrvc has certillcation proccciures in plaec to:
lhal. lo the besl o1'tn1' ktlorvlcdge, the cot'npany was prcscntcd u,ith clqcurlentatiorr ql'each consunlcr's lrorrschold
incontc and/or progranr-bitscd cligibilit,v prior to his or hcr crtrollntcnt in l,ileline : itnd/or
I)) Conlirrn contiutncr eligibility [r.r,rclving up()n accclis to a stale clatahasc and/rtr nglicc ol'cligihility, Iiorn lhc slale
Lit'clirrc adtninislrator prior lo cnrolling a cor.rsl.rner in thc Lil'clinc prograut.
I aln an oll'icr:r ol'lhe ctlrnpittlv rtatlrcd atrovc. I aln autltorizcd to rnakc this ccrliljcation firr thc Studv Arca (locle listecl
ll:lor'c.
TSlnitial
?
An n ual l{tcrrtifi ca1 ion
l)ttrnttlr'nvtrtty;rthlocks. l./ ttttl.l( hrr.vrkttltirt!tot,.,p{)t.rintrhlutk,t,nr(t.r:.)t.t}.
l{cprrrt the nutnhi;r ol'l itllirrc suhseribers tluc liu'rcrcrtiljr:rlir)n b1 rrrrntlt (.llrrgur.t-l)eccrll.xrr)
A. SLrlrreribrrs r:li!:illle li)r rcccrlillculion ht trrrrilqrrarr rnouth11. Srrbstrihcrs tiu-*niollctj priUr 11, 19."11111..,t,r,il trltcnrpts( . 'l,ri.rl nurnlrcr or'suhscri1*lr I. I(' is respurrsiblil lirr rr:ccrtil'r.inp (.,1-1r,1
lieccrlilication Mcl hotls
Slatc of ferleral rlalabascl). Suhscribcrs rccr'rlilicri lhrotrgit l: l(':reicsr l() stale r)r lbtl:rirl dat;rlr;rse bl urinircrsrrrr rr:.rrth
lltc rturrbcr ol'rrttrsr ribers r crrllcii I J(ettJ $ sl;rtt ul lideral
\arnr ol tlre dala vrirrcc(s) useJ lu rcril\ ctrnsrjltrr cligihilirl:
U'!'(' Direcl ('onlatr
ltr i tl:c rrl I rli'llrc sirhrcrr t!e I lt'clrtiirtrd dr 1(,0hltut rtrclU 0l'
(i \rrhstriherr lrlrrr lililetl t{} rerarlr,\ tlrr.upir l. I( tlir*i:t t}urrcirall ,ll!llilr
!h[ Iutthr'r !J ] rle!rrr srrlrslrrlrcrr rit-cntollcJ J l() It tlr Irr lhc lr I ( .r trrrh
3
,lan
0
I"ch Ilar ,\ pr llny ,lun Jul
0
r\ug stp Oct \ol l)cr Ie ar
"l otll
0 0 0 0 0 0 0 0 0 0 0l10000000000000
0 0 0 0 0 0 0 0 0 0 0 0 0
.luu l;rh \lar ,\pr l\l ar .lun .lul ,\ug sep Ocl \ol
l).0 0 0 0 0 0 0 0 0 0 0
l)ec
0 0
Yca r'l otal
Jan
0
l"ch
0
llar
0
,lpr
0
l
1
I
Ilav Jun .l ul ,t ug s.p
0 0 0 0
Oct i\or
0 0
l)cr
0 0
\"ra r
I olul
lan \ol
(0
Ftb
0 0
Ila r 1pr
0
lun
0
1ta1
0
,l ul Sr,,
0 0
,\ug
0
( )r(
0 0
I)cc
0 0
Icar
I otaI
ll. Subscribcr* rvho rcccrtificd through li'l'C elin:c't outrcach rucnrpt
thc l'el inc subscribsrs that lllC's
'l'hird P*rt1,
I. Sutrscrihcrs rvhose eligihility wcs rcviervcd by state adminislrator. thirtl pafl),&dministrator, or USAC
thc numbrr of l"rfeline contactcd & slBle udminirtrator or USAC for the of rcce(ification.
J. Namc ofthird party a.lnrinisrraror used to vcrily subscribcr cligibilirl':
K. Subsr:ribcrs tlc-cnrolled as a result of a third party reccrtification altgmpt
thc numhcr ofsubseribers as a rcsult ofr to outrsach ti'om a slate adnrrnistrctot third admin Or USAC
1,. Suhscribcrs rvho rccettilied lhruugh u state administrator. third party adminislrator. or TJSAC's reoeflification eflbrl
thc number ofsubscribcn thar rec$rti,'icd a a administrat{}r or l,iSAC
Certilicrtion:
Recertificati{)r Mcthod: Drtabnse
I certify that lhe company tislcd above has procedures in place to recertily consunrer eligibility by relying on a darabase. t
am an ofllcer of lhe company named above. I am authorized to make this certificarion for the .SA'CtstlisGd abovc.
Initial
4
Jrn ['cb Mer Apr Iltay Jrn Jul Aug scp 0ct Nor Dec Ycrr
Tolalll0000000000000
Jan F'eb l!'l ar Ap.Mry .lun Jul Aug liep 0ct Nov Dcc Ycrr
I 0 0 0 0 0 0 0 0 0 0 0 0 0
Jan !'eb Nltr Apr May Jun Jul Aug sep Oct Nov llec Year
'I'olrl
K.0 0 0 0 0 0 0 0 0 0 0 0 0
.lnn Feb Mrr Apr l\la1'Jun Jul Aug sep Oct Nov Dcc l'ce r'I'otel
t..0 0 0 0 0 0 0 0 0 0 0 0 0
Recertificslion Method: ETC
I cenify thal the company listed above has procedures in place ro recenify the continued eligibility of allof its Lifelincsubscribcrs. and thal, to the best of my knowledge, thc company obrained si[ned cerrificalions iro* "it subscribers attestingto their continuing eligibility for Lifeline, I am an officei oi the company named above. I am authorized to make thisccrtificalion fbr the SAC(s) lisled above.
Initial
Rccertilication Method: Third plrty
I ccrlify that the company_ listed above has procedures in place ro recerlify consumer eligibiliry by relying on anadministrator. I am an officer of the company named above" I am authorized to makc rtrG certit1carion roitrre inctu)listed above.
Initirl
No Subscribcrs
I.cerlify that my company did nol claim l'ederal low income support for any Lifeline subscribers lor the curenl Form S55data year' I am an officer of lhe company named above. I am auihorized to make this certification for the sAC listedabove,
Initiet TS
Signaturc lllock
By signing bclow, I certify that the company listcd above is in compliance rviltr all federal l,ifeline cerlificalionprocetlures' I am an officer of thc company named abovc. I am aulhcriied lo rnake this ccrlification lor the StudyArea Codc (SAC) listed above.
Signed,
'l'odd Shores VP of l;inance & Acc0ur Todd Shores VP of Finance & Ar
Signature of 0lllcer
tshores@readywi reless. oom
l'.mail Addrcss ol0fficcr
Mark Lammert
Pcrson Chmplctinp Thrs (-crtilicariorr ltrrm
Printod Name and'l'itlc of 0fficEr
Jan 28,2021
llale
407-794-3488
Contrct l)honc Numbcr
M * (G+K,x - (f'ir+t)O * lltlllrtfil
'l'olal number ofrubscribcrr de-cnrolled rs
r resuh of rccertillcrtion
'fotrl numher of subscribcrc UTC it
rcsponsible for reccrtifying
Perccnt ofsubrcribcrs dur for
rcccrlification who werc dc-rnrolled
0 0 0.0%
5
Affiliated ETCs
SAC Name
6