HomeMy WebLinkAbout20230127Newmax LLC dba Interrmax Networks Form 555.pdf
151 Southhall Lane, Ste. 450
Maitland, FL 32751
P.O. Drawer 200
Winter Park, FL 32790‐0200
www.inteserra.com
March 11, 2022
Via Web Filing
https://efiling.utc.wa.gov/Form
WA UTC Electronic Filing
Washington Utilities &Transportation Comm.
https://efiling.utc.wa.gov/Form
,
RE: Newmax, LLC d/b/a Interrmax Networks
WA Copy of FCC Form 555 ‐ Annual Lifeline ETC Certification
Docket No. UT‐220002
Dear Sir or Madam:
Enclosed please find the WA Copy of FCC Form 555 ‐ Annual Lifeline ETC Certification, filed on behalf of
Newmax, LLC d/b/a Interrmax Networks. No check is enclosed as there are no remittance fees due.
This report has been filed at https://efiling.utc.wa.gov/Form
Questions regarding this filing should be directed to my attention at 407‐740‐8575. Thank you for your
assistance in this matter.
Sincerely,
Inteserra Compliance
cc: Caitlin Kling ‐ Newmax, LLC d/b/a Interrmax Networks
file: Newmax, LLC d/b/a Interrmax Networks ‐ Reporting ‐ Washington
CF/dt
RECEIVED
Friday, January 27, 2023 1:40:24 PM
IDAHO PUBLIC
UTILITIES COMMISSION
Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers must complete all or ortions
of all sections Fo m must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 31 (Annually)
479025 143027948
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certification form for each SAC through which it provides Lifeline service).
2021 ID Newmax, LLC
Recertification Yea State ETC Name
DBA, Marketing or Other Branding Name
(If same as ETC name, list “N/A” Do not leave blank)
Holding Company Name
(If same as ETC name, list “N/A” Do not leave blank)
Does the reporting company have affiliated ETCs? Yes No
Provide a list of all ETCs that are affiliated with the reporting ETC, using page 4 and additional sheets if necessary. Affiliation shall be
determined in accordance with section 3(2) of the Communications Act. That Section defines “affiliate” as “a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common ownership or control with, another person.” 47 U.S.C § 153(2). See also 47
C.F.R. § 76.1200.
Affiliated ETC’s SAC Affiliated ETC’s Name
1
ETCs Subject to the Non-Usage Requirements
All ETC’s must complete the appropriate check box. ETCs that do not assess and collect a monthly fee from their Lifeline subscribers are subject
to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number of subscribers de-enrolled by month in
Section 4. ETCs that only assess a fee but do not collect such fees are subject to the non-usage requirements and must also indicate the number of
ubscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements?Yes No
If Yes, record the number of subscribers de-enrolled for non-usage by month in Block Q below.
P Q
Month Subscribers De-Enrolled for Non-Usage
January
February
March
April
May
June
July
August
Septembe
Octobe
Novembe
Decembe
Total Subscribers
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-laws (or
partnership agreement), and would 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 si n the certification.
Initial Certification All ETCs Must file this section
I certify that the company listed above has cer ification procedu es in place to:
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 resented with documentation of each consumer’s household
income and/or pro ra -ased eli i ilit prior to his or her enrollment in Lifeline; and/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 enrollin a consumer in the Lifeline pro am.
I am an officer of the company named above. I am authorized to make this certification for the Study Area Code listed
a ove.
Initial MK
2
Minimum Service Level
I certify that the company listed above is in compliance with the minimum service levels set forth in the 47 CFR Section
54.408.
I am an officer of the compan named above. I am authorized to make this certification for the SACs listed above.
Initial MK
Annual Recertification
Do not leave em t blocks. I an ETC has nothin to re ort in a block, enter a zero.
Re ort the number of Lifeline su sc ibers due for recertification b month Januar -December
A. Subscribers eligible for recertification by anniversary month
B. Subscribers de-enrolled rior to recertification attem ts
C. Total number of subscribers ETC is res onsible for recertifying (A-B)
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
A.
0 0 0 0 0 0 0 0 0 0 0 0 0
B.
0 0 0 0 0 0 0 0 0 0 0 0 0
C.
0 0 0 0 0 0 0 0 0 0 0 0 0
Recertification Methods
State of federal database
D. Subscribers recertified through ETC access to state or federal database by anniversary month
Report the number of eligible subscri ers verified through access to a state or federal database.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
D.
0 0 0 0 0 0 0 0 0 0 0 0 0
E. Name of the data source(s) used to verify consu er eligibility:
ETC Direct Contact
F. Subscribers contacted by ETC directly to recertify (You may also use this section to report subscriber initiated recertifications).
Report the number of Lifeline subscribers the ETC contacted directly to obtain recertification of eligibility
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
F.
0 0 0 0 0 0 0 0 0 0 0 0 0
G. Subscribers who failed to recertify th ough ETC direct outreach attempt
Report the number of Lifeline subscribers de-enrolled due to ineligibility or non-response to the ETC’s outreach attempt.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
G.
0 0 0 0 0 0 0 0 0 0 0 0 0
3
H. Subscribers who recertified throu h ETC irect outreach attem t
Report the number of Lifeline subscribers that successfully recertified through ETC’s outreach attempt
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
H.
0 0 0 0 0 0 0 0 0 0 0 0 0
Third Party
I. Subscribers whose eli ibilit was reviewed b state administ ator, third art administrator, or USAC
Report the number of Lifeline subscribers contacted by a state administrator, third party administra or, or USAC for the purpose of recertification.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
I.
0 0 0 0 0 0 0 0 0 0 0 0 0
J. Name of third party administrator used to verify subsc iber eligibility:
K. Subscribers de-enrolled as a result of a third part recertification attemp
Report the number of subscribers as a resul of ineligibility or non-response to outreach from a state administrator, third part administrator, or USAC.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
K.
0 0 0 0 0 0 0 0 0 0 0 0 0
L. Subscribers who recertified throu h a state administrator, hird par a ministrator, or USAC’s recertification effor
Report the number of subscribers that recertified through a request from a state administrator, third party administrator, or USAC
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
L.
0 0 0 0 0 0 0 0 0 0 0 0 0
Certification:
Recertification Method: Database
I certify that the company listed above has procedures in place to recertify consumer eligibility by relying on a database. I
am an officer of the compan named above. I am authorized to make this certification for the SAC(s) listed above.
Initial MK
4
Recertification Method: ETC
I certify that the company listed above has procedures in place to recertify the continued eligibility of all of its Lifeline
subscribers, and that, to the best of my knowledge, the company obtained signed certifications from all subscribers attesting
to their continuing eligibility for Lifeline. I am an officer of the company named above. I am authorized to make this
certification for the SAC(s) listed above.
Initial MK
Recertification Method: Third Party
I certify that the company listed above has procedures in place to recertify consumer eligibility by relying on an
administrator. I am an officer of the company named above. I am authorized to make this certification for the SAC(s)
listed above.
Initial MK
No Subscribers
I certify that my company did not claim federal low income support for any Lifeline subscribers for the current Form 555
data year. I am an officer of the company named above. I am authorized to make this certification for the SAC listed
above
Initial MK
M = (G+K)
N = (D+F+I) O = M/N*100
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent of subscribers due for
recertification who were de-enrolled
0 0 0
Signature Block
By signing below, I certify that the company listed above is in compliance with all federal Lifeline certification
procedures. I am an officer the company named above. I am authorized to make this certification for the Study
Area Code (SAC) listed above.
Signed,
Mike Kenned , President/CEO
Signature of Officer Printed Name and Title of Officer
mkennedy@intermaxteam.co
Email Address of Officer Date
Shannon Atha 208-415-1764
Person Completing this Certification Form Contact Phone Number
5
Affiliated ETCs
SAC ame
n/a
6
Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers must complete all or ortions
of all sections Fo m must be submitted to USAC and filed with the Federal Communications Commission
IMPORTANT: PLEASE READ INSTRUCTIONS FIRST
Deadline: January 31 (Annually)
529027 143027948
Study Area Code (SAC) Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certification form for each SAC through which it provides Lifeline service).
2021 WA Newmax, LLC
Recertification Yea State ETC Name
DBA, Marketing or Other Branding Name
(If same as ETC name, list “N/A” Do not leave blank)
Holding Company Name
(If same as E C name, list “N/A” Do not leave blank)
Does the reporting company have affiliated ETCs? Yes No
Provide a list of all ETCs that are affiliated with the reporting ETC, using page 4 and additional sheets if necessary. Affiliation shall be
determined in accordance with section 3(2) of the Communications Act. That Section defines “affiliate” as “a person that (directly or indirectly)
owns or controls, is owned or controlled by, or is under common ownership or control with, another person.” 47 U.S.C § 153(2). See also 47
C.F.R. § 76.1200.
Affiliated ETC’s SAC Affiliated ETC’s Name
1
ETCs Subject to the Non-Usage Requirements
All ETC’s must complete the appropriate check box. ETCs that do not assess and collect a monthly fee from their Lifeline subscribers are subject
to the non-usage requirements. ETCs subject to the non-usage requirements must indicate the number of subscribers de-enrolled by month in
Section 4. ETCs that only assess a fee but do not collect such fees are subject to the non-usage requirements and must also indicate the number of
ubscribers de-enrolled by month.
Is the ETC subject to the non-usage requirements?Yes No
If Yes, record the number of subscribers de-enrolled for non-usage by month in Block Q below.
P Q
Month Subscribers De-Enrolled for Non-Usage
January
February
March
April
May
June
July
August
Septembe
Octobe
Novembe
Decembe
Total Subscribers
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-laws (or
partnership agreement), and would 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 si n the certification.
Initial Certification All ETCs Must file this section
I certify that the company listed above has cer ification procedu es in place to:
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 resented with documentation of each consumer’s household
income and/or pro ra -ased eli i ilit prior to his or her enrollment in Lifeline; and/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 enrollin a consumer in the Lifeline pro am.
I am an officer of the company named above. I am authorized to make this certification for the Study Area Code listed
above.
Initial MK
2
Minimum Service Level
I certify that the company listed above is in compliance with the minimum service levels set forth in the 47 CFR Section
54.408.
I am an officer of the compan named above. I am authorized to make this certification for the SACs listed above.
Initial MK
Annual Recertification
Do not leave em t blocks. I an ETC has nothin to re ort in a block, enter a zero.
Re ort the number of Lifeline su sc ibers due for recertification b month Januar -December
A. Subscribers eligible for recertification by anniversary month
B. Subscribers de-enrolled rior to recertification attem ts
C. Total number of subscribers ETC is res onsible for recertifying (A-B)
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
A.
0 0 0 0 0 0 0 0 0 0 0 0 0
B.
0 0 0 0 0 0 0 0 0 0 0 0 0
C.
0 0 0 0 0 0 0 0 0 0 0 0 0
Recertification Methods
State of federal database
D. Subscribers recertified through ETC access to state or federal database by anniversary month
Report the number of eligible subscribers verified through access to a state or federal database.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
D.
0 0 0 0 0 0 0 0 0 0 0 0 0
E. Name of the data source(s) used to verify consu er eligibility:
ETC Direct Contact
F. Subscribers contacted by ETC directly to recertify (You may also use this section to report subscriber initiated recertifications).
Report the number of Lifeline subscribers the ETC contacted directly to obtain recertification of eligibility
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
F.
0 0 0 0 0 0 0 0 0 0 0 0 0
G. Subscribers who failed to recertify th ough ETC direct outreach attempt
Report the number of Lifeline subscribers de-enrolled due to ineligibility or non-response to the ETC’s outreach attempt.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
G.
0 0 0 0 0 0 0 0 0 0 0 0 0
3
H. Subscribers who recertified throu h ETC irect outreach attem t
Report the number of Lifeline subscribers that successfully recertified through ETC’s outreach attempt
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
H.
0 0 0 0 0 0 0 0 0 0 0 0 0
Third Party
I. Subscribers whose eli ibilit was reviewed b state administ ator, third art administrator, or USAC
Report the number of Lifeline subscribers contacted by a state administrator, third party administra or, or USAC for he purpose of recertification.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
I.
0 0 0 0 0 0 0 0 0 0 0 0 0
J. Name of third party administrator used to verify subsc iber eligibility:
K. Subscribers de-enrolled as a result of a third part recertification attemp
Report the number of subscribers as a resul of ineligibility or non-response to outreach from a state administrator, third part administrator, or USAC.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
K.
0 0 0 0 0 0 0 0 0 0 0 0 0
L. Subscribers who recertified throu h a state administrator, hird par a ministrator, or USAC’s recertification effor
Report the number of subscribers that recertified through a request from a state administrator, third party administrator, or USAC
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year
Total
L.
0 0 0 0 0 0 0 0 0 0 0 0 0
Certification:
Recertification Method: Database
I certify that the company listed above has procedures in place to recertify consumer eligibility by relying on a database. I
am an officer of the compan named above. I am authorized to make this certification for the SAC(s) listed above.
Initial MK
4
Recertification Method: ETC
I certify that the company listed above has procedures in place to recertify the continued eligibility of all of its Lifeline
subscribers, and that, to the best of my knowledge, the company obtained signed certifications from all subscribers attesting
to their continuing eligibility for Lifeline. I am an officer of the company named above. I am authorized to make this
certification for the SAC(s) listed above.
Initial MK
Recertification Method: Third Party
I certify that the company listed above has procedures in place to recertify consumer eligibility by relying on an
administrator. I am an officer of the company named above. I am authorized to make this certification for the SAC(s)
listed above.
Initial MK
No Subscribers
I certify that my company did not claim federal low income support for any Lifeline subscribers for the current Form 555
data year. I am an officer of the company named above. I am authorized to make this certification for the SAC listed
above
Initial MK
M = (G+K)
N = (D+F+I) O = M/N*100
Total number of subscribers de-enrolled as
a result of recertification
Total number of subscribers ETC is
responsible for recertifying
Percent of subscribers due for
recertification who were de-enrolled
0 0 0
Signature Block
By signing below, I certify that the company listed above is in compliance with all federal Lifeline certification
procedures. I am an officer the company named above. I am authorized to make this certification for the Study
Area Code (SAC) listed above.
Signed,
Mike Kenned , President/CEO
Signature of Officer Printed Name and Title of Officer
mkennedy@intermaxteam.co
Email Address of Officer Date
Shannon Atha 208-415-1764
Person Completing this Certification Form Contact Phone Number
5
Affiliated ETCs
SAC ame
n/a
6