20240130Ziply Fiber Northwest LLC Form 555.pdf

Ziply Fiber
135 Lake Street S., Ste. 155
Kirkland, WA 98033
Jessica Epley
M. [phone]
[e-mail]

January 29, 2024

Ms. Monica Barrios-Sanchez Interim Commission Secretary Idaho Public Utilities Commission
472 West Washington Street Boise, Idaho 83720
RE: Docket No. GNR-T-24-01 Annual Eligibility Re-Certification of Lifeline Subscribers
Dear Ms. Barrios-Sanchez:
Ziply Fiber of Idaho, LLC dba Ziply Fiber (Study Area Code 474427) and Ziply Fiber Northwest, LLC dba Ziply Fiber (Study Area Code 472416) hereby provide a copy of its Annual Lifeline
Eligible Telecommunications Carrier Certification FCC Form 555 in compliance with 47 CFR 54.416 as adopted by the Federal Communication Commission (FCC) in its Lifeline Reform Order, FCC 12-11, released February 6, 2012.
Section 54.4 16(b) requires eligible telecommunication carriers (ETCs) to annually provide the results of their re- certification efforts performed pursuant to Section 54.4 10 (f) to the FCC and
the Universal Service Administrative Company (USAC). ETCs are also required to provide the results of their re-certification efforts to state commissions and relevant tribal governments.
Questions regarding this filing may be directed to me via email at [e-mail] or telephone at [phone]. Sincerely,

Jessica Epley VP – Regulatory & External Affairs

RECEIVED
Tuesday, January 30, 2024 9:40:10 AM
IDAHO PUBLIC
UTILITIES COMMISSION
Annual Lifeline Eligible Telecommunications Carrier Certification Form All carriers 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: January 31st (Annually)

472416 143004786
Study Area Code (SAC)Service Provider Identification Number (SPIN)
(An Eligible Telecommunications Carrier (ETC) must provide a certification form for each SAC that provides Lifeline service).
2023 ID ZIPLY FIBER NORTHWEST, LLC
Recertification Year State ETC Name
Northwest Fiber, LLC
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 X 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
532416 ZIPLY FIBER NORTHWEST, LLC
522416 ZIPLY FIBER NORTHWEST, LLC
522449 ZIPLY FIBER NORTHWEST, LLC
474427 ZIPLY FIBER OF IDAHO, LLC
484322 ZIPLY FIBER OF MONTANA, LLC
533401 ZIPLY FIBER OF OREGON, LLC
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Initial Certification All ETCs must complete this section.
I certify that the company listed above:
•Has policies and procedures in place to ensure that its Lifeline subscribers are eligible to receive Lifeline
services; and
•Is in compliance with all federal Lifeline certification procedures; and
•Is in compliance with the minimum service levels set forth in 47 C.F.R. § 54.408.
I am an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial BES
Annual Recertification Results
Report the results of recertification efforts for the current calendar year.
Do not leave blocks empty. If the National Verifier is responsible for conducting recertification, enter zero for blocks A - F. If the state Lifeline
Administrator is responsible for conducting recertification, report the results for each block.

A. Subscribers eligible for recertification within current calendar year
B. Subscribers de-enrolled prior to recertification attempts
C. Total number of subscribers required to be recertified (A-B)
D. Subscribers successfully recertified
E. Subscribers de-enrolled for failed recertification
F. Percentage de-enrolled for failed recertification (E/C)
I certify that the company listed above has procedures in place to recertify consumer eligibility by relying upon
notice of eligibility from: state Lifeline administrator X National Verifier
I am an officer of the company named above. I am authorized to make this certification for the SAC listed
above.
Initial BES
No Subscribers Certification Complete this section if ETC claimed no Lifeline subscribers.
I certify that my company did not claim federal low income support 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(s) listed on this form
Initial
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ETCs Subject to the Non-Usage Requirements
All ETCs 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. 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 subscribers de-enrolled by
month.

Is the ETC subject to the non-usage requirements? Yes No X
If yes, record the number of subscribers de-enrolled for non-usage by month in Block H below.

G H
Month Subscribers De-Enrolled for Non-Usage
January
February
March
April
May
June
July
August
September
October
November
December
Total Subscribers 0
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 sign the certification.
Signature Block
By signing below, I certify that the information provided is true and accurate. I am an officer of the company named
above. I am authorized to make this certification for this SAC.

Signed,

Byron E Springer Jr Byron E Springer Jr - General Counsel
Signature of Officer Printed Name and Title of Officer
[e-mail] 01-29-2024
Email Address of Officer Date
Elizabeth Brayman 4258793612
Person Completing This Certification Form Contact Phone Number
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