20220803TracFone Wireless Form 481.pdf

TRACF@NE"Legal Department
Stephen Athanson, Senior Attomey - Regulatory
9700 NW I l2th Avenue I Miarni, FL 33 178
E-Mail : sathanson(rDtracfbne.com
ilIi] I ir.r* *wireless, inc.
,t;;; giii *3 Fi'! 2: lt+
August 1,2022 (Qrnh!
VIA OVERNIGHT MAIL
Jean Jewell, Secretary
Idaho Public Utilities Commission
472W. Washington St.
Boise, lD 83720
Re: TracFone Wireless, lnc. - FCC Form 481 Report
Dear Ms. Jewell:
In accordance with the Federal Communication Commission's Lifeline Reform Order
and 47 CFR 54.422(b) please find enclosed a copy of the FCC Form 481 of TracFone Wireless
Inc. ("TracFone").
If you have any questions, please feel free to contact me at [phone], or
sathanson@trac fone. com.
Sincerely,
&*
Stephen Athanson
Regulatory Counsel
Enc.
Page 1
<01O> Study Area Code 4f 9021
<015> StudyArea Name iracFon€ lilreless, Inc
<020> Program Year 20:23
<0:n> Contact Name: Person USACshould contact
with ouestions about this data ,Jaaet Uorejoq
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Numb6r of the pe6on identifled in data line <030>
305?156522 eat
<039> Contact Email Address:
Email of the person identmed in data line <030>imoreJon0tracfone. com
FormType 84.422
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<010> Study A.ea Code
<015> Study Area Name
<020> Program Year 2023
<030> Contact Name - Person USAC should contact regarding this data Janet More onl
<035> ContactTelephoneNumber-Numberofpersonidentifiedindataline<030> 3057156522 ext
i-^-^+ ^^o - -^ ^fone. com<039> Contact Email Address " Email Address of person identified in data line <o3o> J tLtv ! e J
Select from the drop down menu or check the boxes below to note compliance with 54.313{f)(1). Privately held carriers must ensure compliance with the
financial reportingrequirementssetforthin4TCFR54.3l3(f)(2). lfurthercertifythattheinformataonreportedonthisformandinthedocuments
attached below is accurate.
(3009) Progress Report on 5 Year Plan
carrier certifies to 54.313(f)( 1)(iii)
(3010A) Certification of Public lnterest ObliSations {47 CFR $
s4.313(fX1Xi))
(30108) Please Provide Attachment
Rate-of-Return Community Anchor lnstitutions
{3012A) lndicate if the carrier newly deployed broadband
seruice to community anchor institution(s) in the
previous calendar year.
(30128) Please Provide Attachment
Using link, download template and list the number,
name and address for each community anchor
institution. Attach the document which contains the
community anchor institution details as required by
47 c.F.R. 5 s4.313(f)(1)(ii)
Name of Attached Document Listing Required
ls your company a Privately Held ROR Carrier (47
cFR 5 s4.313(f)(2)l
lf yes, does your company file the RUS annual report'
Please check these boxes to confirm that the
attached PDF, on line 3017, contains the required
information pursuant to 5 54.313(f)(2) compliance
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Telecommunications Borrowers
Underlying information subjected to a review by an
independent certified public accountant
Underlying information subjected to an officer
certification.
Document(s) with Ealance Sheet, lncome Statement
and statement of cash Flows
Attach the worksheet listing required information
Name of Attached Document Listing Required
lnformation
(3022)
(30131
{3014}
(301s)
(3016)
(3017)
(3018)
(301e)
(3020)
(302 1)
(3023)
(3024)
(302s)
(3026)
lnformation
Name of Attached Document Listing
Required lnformation
(Yes/No)
(Yes/No)
(Yes/No) O O
Name of Attached Oocument Listing Required
lnformation
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<010>StudyArea Code a?9421
<o15>StudyArea Name tiafFli. rjs:.ss, tr..
<020> Progra?rYear :i"
<Gto> conrctttann-Pe
<O39> eonbctEmailAddress-Email,lddressofpersonldentifiedindatallne<030> j*e.rrar!!.4!!!r..cs
4{XE nur.l Brorfr.nd Erqcrlm.r?t
Authorized nural Broadband Experiment (RBE) r€cipients must address Ure certlfieatlon fior publh interest
obligptions and provide a list of nerw serv€d cgmmunity anchor lnsututions.
Publlc lnt tlt oblltr8om- FOC 1+9E (p.rairaphs 2e29,78)
Pleas€ addrers Lln€ 4001 r€gading compliane€ with the Commlsslon's publk interast obligations, All RBE
partlclpants rnust Fovlde a r$ponse to une 400x.
4001. Recipieflt certifles thit it ls offering broadband meetlnS the requistte publlc lnt€rest obligatlons €onsistent
with the catagpry fur whbh they were select€d, lncludlng broadbsnd speed, latency, ussge caFcity, and r6tes that
are reasonabv comparable to rates for comparablc offeringr in utban areat.
nB€ Communlty Alrdlor lhrutsdol!3
<4OO3a> lndieate if the cerrier newly deployed broadband seMce to community anchor institutionls) in the
previous calendar year
<4003b Plear€ Provide Attichment Using linlq
downlqad template and list the number, name
ahd address for each communlty tnchor
institution. Attach the document which contains
the €onmunity anehor instltutlon deteils es
required by FCC 1+98 (parag:faph 79)
Name of Attachcd Docum€nt listlng R€quired lnformatlon
i
P.tE 15
PaBe 16
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035 >Contact Telephone Number - Number of person identified in data line <030>
<039>contact Email Address - Email Address of person identified in data line <030>
5005 Alaska Plan
(s011)
(s012)
Please indi€ate whether any terrestrial backhaul or other satellite backhaul became
commercially available in the previous calendar year in areas previously serued
exclusively by performance-limiting satellite backhaul.
lf the filing carrier identified in its approved perfomance plans that it relies exclusively on
satellite backhaul for a certain poriton of the population in its service area, indicate whether
any terrestrial backhaul or other satellite backhaul became commercially available in the
previoius calendar year in areas that were previoiusly served exclusively by satellite backhaul.
(Yes/No)
(Yes/No)
Newly Serued LoetloB or Population
(Yes/No)
Name of Attached
Document Listing
Required lnformation
<5013>
Descilpllon Of Eackhaul T€.hnolo8y
Alaska Plan Mobile Carriers' Reasonably Comparable Rate Demons$atlon
(5014a)Answer yes or no if mobile carriers receiving support from the Alaska Plan can demonstrate
compliance at the end of the five-year milestone (2022) by showing that your required stand-
alone voice plan, and one service plan that offers broadband data services, if you offer such
plans, are:
. Substantially similar to a service plan offered by at least one mobile wireless service
provider in the cellular market area (CMA) for Anchorage, Alaska, and
. Offered for the same or a lower rate than the matching plan in the cMA for Anchorage.
Alaska Plan Mobile Carriers' Reasonably Comparable Rate Demonstration Attachment
(5014b) lf'Yes' is selected for 5014a, attach a document demonstrating compliance with the s-year
milestone. lf'No' is selected for 5014a, attach an explanation of non-compliance.
D.tc Backhaul Avellable
Page 15
Pat6 17
( r902:<010> StudyArea code
.o
2n2\
Name - PeEon
<o39>Contact pe6dt :nr'.jcrl!r.sren..M
<6010>Enter the total amount of Phase ll Auction Support, if arry, the carrier
used for eepital expenditurB.
Phase ll Atr.tloll rnd New Yort Funds Cerdftatlon
<6011>Certify (elther yes or no) regarding whcther thc recipient has avaiJable
funds for all project costs that will exeeed the amount of support that will
be received for the next calendar Vear. This c€rtificataon must be ptovided
startin8 the flrst July lst after rcceiving support until the reclpienfs
penultimate year of suppor.t.
Ph.sG ll Audlon Communlty Ancftor lnsthri0ons
<6O12a> lndicate if the carrier newly deployed broadband seMce to communlty- anchor institution(s) in the previous calendar year.
.6titZb> Please Provide Attachment Using linlg download template and list the' ' number, name and address for each eomnrunity anchor institution.
Attach the document which contains the community anchor
institution details as required by FCC 1+98 (parasraph 79).
(Yes/No)
Name ofAtta€hed
Document Listing Bcquir€d
lnformatton
Phase tl Auctlon FOC Form 470 Pocdrtrs
<6013> For the filing due July 1 following full imirlementation of thh
requlrement answer y€s, no, or not applicable to thls certification request
Ph$6 ll AuGdon Post-Flml DGploym€nt Mihcone Pcrionnenc. cartmcauon
<6014> Starting the firstJuly 1st aft€r meetingthefinal s€rvice milestonq certiry
(yes, no, or not applicable) that the Phase ll-funded nefiork that the Phase ll
austion r€clpiEnt operated in the Brior year meets the relerant performance
r€gulremeflts in 5 54.309.
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<7010> Pha$E llAuction rcelFicntBqilormancerequlrcm€nB€erdfication (Yes/No)
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Page 19
Deta Control lto,ilo.OMB Coitrcl
rd irwh FlsdsClrt'ffc.{on
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact this data
<035>contact Telephone Number - Number of person identified in data line <030>
<039>contact Email Address - Email Address of person identified in data line <030>
<8010>
<801 1>
<8012a>
<8012b>
<8013>
<8014>
<8020>
<8030>
<8040>
<8050>
Uniendo a Puerto Rico Stage Z Fixed - Capital Expenditures
Enter the total amount of Uniendo a Puerto Rico Stage 2 fixed support, if any, the
carrier used for capital expenditures.
Uniendo a Puerto Rlco Stage 2 Fixed - Available Funds Certification
Certify (either yes or no) regarding whether the recipient has available funds for all project
costs that will exceed the amount of support that will be received for the next calendar
year. This certification must be provided starting the first July 1st after receiving support
until the recipient's penultimate year of support.
Uniendo a Puerto Rico Stage 2 Fixed - Community Anchor lnstitutions
lndlcate if the carrier newly deployed broadband service to community anchor institution(s)
in the previous calendar year.
Please Provide Attachment
Using link, download template and list the number, name and address for each community
anchor institution. Attach the document which contains the community anchor institution
details as required by 47 C.F.R. 5 54.313(e)(2XA). Allowable File Types.
Name of Attached
Document Listing Required
lnformation
Uniendo a Puerto Rico Stage 2 Fixed - FCC Form 470 Postings
For the filing due .luly 1 following full implementation of this requirement answer yes, no, or
not applicable to this certification request.
Uniendo a Puerto Rico Stage 2 Fixed - Post-Final Deployment Milestone Performance Certification
Starting the first July 1st after meeting the final service milestone, certify (yes or no) that the
Uniendo a Puerto Rico Stage 2-funded network that the Stage 2 recipient operated in the prior
year meets the relevant performance requirements in $ 54.309.
Uniendo a Puerto Rico Stage 2 Fixed - Support Reimbursement Certification
54.313(n): Recipients of Uniendo a Puerto Rico Fund Stage 2 fixed suppon shall certify that
such support was not used for costs that are (or will be) reimbursed by other sources of
support, including of federal or local government aid or insurance reimbursements; and that
support was not used for other purposes. such as the retirement of company debt unrelated
to eligible expendatures, or other expenses not directly related to network restoration,
hardening, and expansion consistent with the framework of the Uniendo a Puerto Rico Fund.
Uniendo a Puerto Rico Stage 2 Fixed - Disaster Preparedness and Response Documentation
54.313(n): Recipients of fixed support from Stage 2 of the Uniendo a Puerto Rico Fund shall
certify that they have conducted an annual review of the documentation required by section
54.1515(a)-(c) to determine the need for and to implement changes or revisions to disaster
preparation and recovery documentation.
Uniendo a Puerto Rlco Stage 2 Mobile - Support Reimbursement
54.313{n}: Recipients of Uniendo a Puerto Rico Fund stage 2 mobile support shall certify that
such support was not used for costs that are (or will be) reimbursed by other sources of
support, including of federal or local government aid or insurance reimbursements; and that
support was not used for other purposes, such as the retirement of company debt unrelated
to eligible expenditures, or other expenses not directly related to network restoration,
hardening, and expansion consistent with the framework of the Uniendo a Puerto Rico Fund.
Uniendo a Puerto Rico stage 2 Mobile - Disaster Preparedness and Response Documentation
54.313(n): Recipients of mobile support from Stage 2 of the Uniendo a Puerto Rico Fund shall
certify that they have conducted an annual review of the documentation required by section
54.1515(a)-(c) to determine the need for and to implement chan8es or revisions to disaster
preparation and recovery documentation
Uniendo a Puerto Rico stage 2 Mobile - Mobile Disbursements certification
54.313(o): Recipients of Uniendo a Puerto Rico Fund Stage 2 mobile support shall certiiy that they are in
compliance with all requirements for receipt of such support to continue receiving Stage 2 mobile
disbursements
<8060>
Page 19
PaBe 20
'' OMBcontrclDBta
<010>Study Area Code
<015>Study Area Name
<020>Program Year
<030>Contact Name - Person USAC should contact regarding this data
<035>Contact Telephone Number - Number of person identified in data line <030>
<039>Contact Email Address - Email Address of person identified in data line <030>
<9010>
<9011>
<9O1)a>
<9012b>
<9013>
Connect USvl State 2 Fixed - Capital Expenditures
Enter the total amount of Connect USVI Fund Stage 2 fixed suppon, if any, the carrier used
for capital expenditures,
Connect USVI Stage 2 Fixed - Available Funds Certification
Certify (either yes or no) regarding whether the recipient has available funds for all project
costs that will exceed the amount of support that will be received for the next calendar year
This certification must be provided starting the first.July 1st after receiving support until the
recipient's penultimate year of support.
Connect USVI Stage 2 Fixed - Community Anchor lnstitutions
lndicate if the carrier newly deployed broadband seruice to community anchor institution(s)
in the previous calendar year.
Please Provide Attachment
Using link, download template and list the number, name and address for each community
anchor institution. Attach the document which contains the community anchor institution
details as required by 47 C.F.R. 5 54.313(eX2)(i)(A).
Connect USVI Stage 2 Fixed - FCC Form 470 Postings
For the filing due July 1 following full implementation of this requirement answer yes, no, or
not applicable to this certification request.
Connect USVI Stage 2 Fixed - Post-Final Deployment Milestone Performance Certification
Starting the first luly 1st after meeting the final seruice milestone, certify (yes or no) that the
Connect USVI Fund Stage 2-funded network that the Stage 2 recipient operated in the prior year
meets the relevant performance requirements in 6 54,309.
Connect USVI Stage 2 Fixed - Support Reimbursement Certification
54.313(n): Recipients of Connect USVI Fund Stage 2 fixed support shall certify that such support was
not used for costs that are (or will be) reimbursed by other sources of support, including of federal
or local government aid or insurance reimbursements; and that support was not used for other
purposes, such as the retirement of company debt unrelated to eligible expenditures, or other
expenses not directly related to network restoration, hardening, and expansion consistent with the
framework of the Connect Usvl Fund.
Connect USvl Sta8e 2 Fixed - Disaster Preparedness and Response Documentation
54.3 13(n): Recipients of fixed support from Stage 2 of the Connect USVI Fund shall certify that they
have conducted an annual review of the documentation required by section 54.1515(a)-(c) to
determine the need for and to implement changes or revisions to disaster preparation and recovery
documentation.
connect UsVl Fund Stage 2 Mobile - support Reimbursement Certification
54.313(n): Recipients of Connect USVI Fund Stage 2 mobile support shall certify that such support
was not used for costs that are (or will be) reimbursed by other sources of support, including of
federal or local government aid or insurance reimbursements; and that support was not used for
other purposes, such as the retirement of company debt unrelated to eligible expenditures, or other
expenses not directly related to network restoration, hardening, and expansion consistent with the
framework of the Connect USVI Fund. Recipients of mobile support from Stage 2 of the Connect
USVI Fund shall certify that they have conducted an annual review of the documentation required by
section 54.1515(a)-(c) to determine the need for and to implement changes or revisions to disaster
preparation and recovery documentation.
Connect USVI Fund stage 2 Mobile - Disaster Preparedness and Response Documentation
54,313(n): Recipients of mobile support from Stage 2 of the Connect USVI Fund shall certify that
they have conducted an annual review of the documentation required by section 54.1515(a)-(c) to
determine the need for and to implement changes or revisions to disaster preparation and response
documentation.
Connect USVI Fund Stage 2 Mobile - Mobile Disbursements certilication
54.313(o): Recipients of Connect USVI Fund Stage 2 mobile support shall certify that they are in
compliance with all requirements for receipt of such support to continue receiving Stage 2 mobile
disbursements.
Name of Attached
Document Listing Required
lnformation
<9014>
<9020>
<9030>
<9040>
<9050>
<9060>
Page 20
PaSe 21
<010>Study Area Code
<015>Study Area Name
<020>
<030>
<039>
Contacl Name - P€rson
Contacl
contact data
Number -<030>
- Email Address of person identified in data line <030>
<10010>
<10011>
<10012i>
<10012b>
<10013>
<10014>
RDOF Capltal Expenditures
Startint the fi6t July 1st after receivint support until the July lst after the reciPient's
support term has ended, recipients of Rural DiSital Opportunity Fund support must submit
the total amount of support, if any, the recipient used for capital expenditures in the
previous calendar year. This is required by 47 C.F.R. 5 54,313(el(2)(iXB).
RDoF Available Funds certlfication
Please provide a response (either yes or no) to this certificatlon request for any recipient of
Rural Oigital opportunity Fund support that the recipient has available funds for all project
costs that will exceed the amount of support that will be received for the next calendar
year, This certification must be provided staning the first July 1st after receivint support
until the recipient's penultimate year of support, as required by required by 47 C.F.R. 5
sa.313(e)(2)(ii).
RDOF community Anchor lnstitutions
Recipients of Rural Digital Opportunity Fund support must attach a list containing the
number, names, and addresses of community anchor instltutions to which the ellSlble
telecommunications carrier n€wly beSan providing accss to broadband seruice in the
preceding calendar year. This filing is required by 47 C.F.R. S 5a.313(eX2Xil(A).
Please Provide Attachment
Uslng linlg download template and llst the number, name and address for each community
anchor institution. Attach the document which contains the community anchor institution
detalls as required by 47 c.F.R. 5 54.313(e)(2XiXA).
Name of Attached
Document Listing
Required lnformation
RDOF FCC Forn 47O PostingE
For the filing due July 1st following full implementation of this requirement, please provide
a response (either yet, no, or not applicable) to this certification request. Recipients of Rural
DiSital Opportunity tund must respond affirmatively that they bid on €ategory one
telecommunications and lnternet access seruices in response to all FCC Form 470 postings
seeking broadband service that meets the connectivity targets for the schools and libEries
univeEal seruice support program for ellglble schools and libraries (as described in 5
54.50U located within any area in a c€nsus block where the carrier is receiving Rural DlSital
Opportunity Fund, and that such bids were at rates reasonable comperable to rates charged
to eligible schools and libraries in urban areas for lnstructions for Completing FCC Form 481
OMB Control No. 306G0986 (High-Cost) OMB Control No. 306G0819 (Low-lncome)
November 2o2o Page 44 comparable offerings. This filing is required by 47 C.F.R. 5
5a.313(eX2XiXC). This certification will not be required until theJuly 1st followinB the E-
Rate program year that this obligation has been fully implemented. ModernizinS the E-Rate
ProgEm for Schools and Libraries et al., WC Oocket. Nos. 13-184, 10-90, 29 FCC Rcd 15538,
75565-6'l , paru.72 .20L4l.
ROoF Post-final Deployment Mllestone P€dotmance Cenlflcatlon
Starting the fi.stJuly lst after a Rural Digital Opportunity Fund recipient meets its final
service milestone until the July 1st after the support recipient's support term has ended,
please provide a response (either yes, no, or not applicable) that the Rural DiSital
Opportunity Fund-funded network that the support recipient operated in the prior year
meets the relevant performance requirements in 47 C.F.R. 5 54.309. This filing is required by
a7 c.F.R. 5 9.313(eX2Xiii).
Iiill
Page 21
Page 22
Data Collectlon
FgCFoitrt tBl
ouEGmtrclI{or
<010> Study Area Code 41 9o2t
<015> Study Area Name lracFone Wireless, Inc
<020> Program Year
<030> ContactName-PersonUSACshouldcontactregardingthisdata ianer I'iorejon
<035> ContactTelephoneNumber-Numberofpersonidentifiedindataline<030> 3051156522 e]:t-'
<039> Contact Email Address - Email Address of person identified in data line <030>'i mo rF i onG tra. f one - com
TO BE COMPTETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FITING ANNUAT REPORTING ON ITS OWN BEHALF:
certification of officer as to the Accuracy of the Data R€ported for the Annual Reporting for cAF or Ll Recipients
certify that I am an officer of the reportlng carrier; my responsibilities include ensuring the accuracy ofthe annual reporting requirements for universal seruice support
'ecipients; and, to the best of my krowledte, the information reported on thls form and ln any attachments ls accurate.
iisnatureof Authorizedofficer: CERTrfrED ONLTNE Date ot /i2 -r :;
\ame of ReoortinE carrier. TracFone rr'iireless, rnc
trinted name ofAuthorized officer: Alex Pis-Dudot
Officer. Ac.rountirg Fnecutirre Di rect!ror
number ofAuthorized officeri 3056402063 ext
Area Code of a-qa)lLarfler:Due Date forthis fotn ag / a1 /2422
under Title 18 ot the united States code, 18 u.s.c. 5 1001.
?age 22
Page 23
Certifi cation - ASpnt / C.rrl.,
Data Collection Fomr
FOCFomtl8l
O{raCont ol ]{o.
D@mb.r2Ot0
::m5axl985/oMB Conrrol Irlo. 306G089,
<010> Study Area Code
<015> Studv Area Name Tra:aora b;irel":.s, Irl
<020> Program Year
<030> Contact Name - Person USAC should contact regarding this data iire: 11r:,!r r I
<035> contactTelephoneNumber-Numberofpersonidentifiedindataline<030> :ir!l:'-'5:: ',ir'
<039> contactEmailAddress-EmailAddressofpersonidentifiedindataline<030> lm:reloni''r'rrcrin' ('nl
TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING ANNUAL 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
cgnifythat(Nam9o'AEent)isauthorizedtosubmittheinformationreportodonbghalfofthereportin9carrier.lrtsocertitytiattam"nlrn"",ottn","heaccuracyoftheannualdatareportingrequirementsprovidedtotheauthorized
igenti and, to the bost of my knowlodg€, tho roports and data provided to tho aulhorizod agont is accurate, .
\ame of Authorized AEent:
\ame of Reoortins Carrier:
;iRnature of Authorized Officer:Datel
Printed name of Authorized Officer:
title or oosition of Authoriu ed Officer:
Ielephone number of Authorrzed Officer:
ttudy Area Code of Reporting Carrierl Filing Due Date for this form:
under Title 18 of the United Stares Code, 18 U.S.C. 5 1001.
TO BE COMPTETED BY THE AUTHORIZED AGENT:
Certification of Agent Authorized to File Annual Reports for CAF or U Recipients on Behalf of Reporting Carrier
the data reported herein based on data provided by the reporting carrier; and, to the best ol my knowledSe, the information reported herein is accurate.
Name of Reoortinp Carrier:
Name of Authorized Agent Firm:
Sipnature of Authorized Apent or Emolovee of Aqent:Date:
Name of Authorized Asent Emolovee:
fitle or position of Authorized Aeent or Employee of Agent
Teleohone number of Authorized Asent or Emolovee of Asent:
Studv Area Code of ReDortine Carrier:Filins Due Date for this form:
18 ofthe United States Code,18 U.S.C. 5 1001
Pdse 23
i
P{4 24
<O1(}> StldyArdcade
Tra!f.r@ rlr.l.E!, lii.<Ol$ StudyAEaName
<O2O, ProgramYer 2ara
<03D contaet Nare - Ptron usAcshould contsd regrrdingthl5d.ta
<035> eont.ct T€lephffie flumber - Numli€t of p€mn identifi.d in dat llne dr30>
<o39> Contact Em.il Addrs - Emall AddEss of penon idrntirhd ln drta llne <O3O> su.ejq.e!rarrJn..'!n
I cenify undcr panalty of perjury that no unlversal servlce support has b6en or will be used to purdrrs€,
obtain, maintsin, improve, modlfy, or otherwlse suppott any equipm€nt or selices produced or provided
by any company designated by the Federal Communicauons Commission as poEing a national security
threat to ihe integrity of commuiications netwolts ol the @mmunic.tions supply chain since th€
effectlve date of the desi8nttions.
Name of Attached Documem listing Rcquired
Yes !f.l:
Hr1i
Pl6ase Provide Waiver Document
Allowable File Type (pdf onlyl lnfomatlon
I certify that no F€deral subsidy made available thrclgh a prggram adminislered by the commassion ttat
provides funds to be used for th. capltal expendituret necessary for the ptovision ot advanced
communicatlons $Mc€s has baen or will be used to purchase, rent, lease, or otterwlse obtain, any
covered communlcatloRs equipm€nt or seryice, or maintain any covered communicatioB equipment dr
servlce previously purchased, rented, leascd, or othetwis€ obtaln6d, as required by 47 CF.R. I 54.10.
Allowable File Type (Bdf only)
Name ofAttachEd Dodment Ustint Required
lnformatlm
Yes
l,
I
!
Page 24
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