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TO PROVIDE TELECOMMUNICATIONS SERVICE IN OREGON APPLICATION FOR (Oregon)

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Page 1 of 3
PUBLIC UTILITY COMMISSION OF OREGON
201 HIGH STREET SE SUITE 100
PO BOX 1088
SALEM, OREGON 97308-1088
(503) 378-8959
APPLICATION FOR CERTIFICATE OF AUTHORITY
TO PROVIDE TELECOMMUNICATIONS SERVICE IN OREGON
INSTRUCTIONS: Complete every applicable section of this application. Attach additional documents and/or sheets to
complete responses (if needed). You will be notified when the Commission receives your application, and again when
it has been processed. After accepting this application, the Commission will publish notice per ORS 759.020(2).
CLASS
IFICATION FOR WHICH APPLICATION IS MADE (check one):
Competitive Telecommunications Provider (local, long-distance, shared telecommunications service)
Telecommunications Utility
1. EXACT LEGAL NAME OF APPLICANT:
Applicant's Assumed Business Name(s), if any (e.g., dba, aka) (must be registered with the Corporation Division):
Applicant's Type of Legal Entity (e.g., corporation, limited partnership):
Business Address:
Phone:
Email:
2. NAME AND ADDRESS OF PERSON TO CONTACT FOR MORE INFORMATION REGARDING THIS APPLICATION:
Phone:
Email:
3. NAME AND ADDRESS OF PERSON TO CONTACT FOR REGULATORY INFORMATION
(Commission will send requests for information to this person):
Phone:
Email:
4. AFFILIATED INTERESTS:
Are you now or have you ever been affiliated with any provider of telecommunications service that serves Oregon?
If so, who? When? Describe affiliation. Affiliated interest is defined in OAR 860-032-0001.
5. PREVIOUS CERTIFICATES OF AUTHORITY:
List each certificate of authority previously granted by the Oregon PUC to Applicant and to each affiliated entity, under
a legal name, an assumed business name, or any other name. Include all certificates whether or not canceled. For
each certificate provide the name of entity, docket number, and order number.
Name of Entity Docket Number Order Number
FM904 REV. 7/2018
Print Form
Page 2 of 3
6. APPLICANT REQUESTS AUTHORITY TO PROVIDE THE FOLLOWING SERVICES:
a. Shared telecommunications service (STS). STS includes resale of long-distance service to
the STS provider's user group, but not to customers outside the user group. If yes,
applicant must complete items 10 and 11.
Yes No
b. Local exchange (intraexchange) switched service (i.e., local dial tone). If yes, applicant
must complete item 10.
c: Local exchange (intraexchange) nonswitched, private line service (i.e., dedicated
transmission service).
d. Interexchange, switched service (i.e., long-distance toll). If yes, applicant must complete
item 10.
Yes No
Yes No
Yes No
e. Interexchange, nonswitched, private line service (i.e., dedicated transmission service).
Yes
No
7. HOW SERVICES WILL INITIALLY BE PROVIDED:
The following is required for public notice and information purposes and does not request authority.
a. Will Applicant resell finished services of other Oregon certified carriers? (Resell means
resale of finished services, not unbundled network elements.)
Yes No
b. Will applicant construct lines, loops, wires, fiber, or other transport facilities?
Yes
No
c. Will Applicant have its own switching equipment?
Yes
No
d. Will Applicant purchase (lease) unbundled network elements from other Oregon certified
carriers?
e. Will Applicant purchase or lease network components which are not unbundled network
elements?
Yes No
Yes No
8. AREAS FOR WHICH APPLICANT SEEKS AUTHORITY:
a. Intraexchange Authority:
Alternative 1: List every local exchange in which Applicant seeks to provide local exchange (intraexchange) service.
Alternative 2: List every incumbent local exchange carrier in whose exchanges Applicant seeks authority to provide
local exchange (intraexchange) service.
Alternative 3: If Applicant seeks authority to provide local exchange (intraexchange) service within every telephone
exchange in Oregon, then specify "Statewide."
b. Interexchange Authority:
Alternative 1: List every local exchange in which Applicant seeks to provide interexchange service.
Alternative 2: List every incumbent local exchange carrier in whose exchanges Applicant seeks authority to provide
interexchange service.
Alternative 3: If Applicant seeks authority to provide interexchange service in every telephone exchange in
Oregon, then specify "Statewide."
9. DESCRIBE SPECIAL CHARACTERISTICS, LIMITATIONS, OR RESTRICTIONS THAT WILL BE PART OF
APPLICANT’S SERVICES:
10. OPERATOR SERVICES:
a. Operator service includes, but is not limited to, billing or completion of third-party billing calls, person-to-person
calls, collect calls, and credit card calls. See OAR 860-032-0001.
Will Applicant directly offer operator services?
Yes
No
b. ORS 759.690(1)(d) defines "operator service provider" as a person who furnishes operator
service under contract with a call aggregator. ORS 759.690(1)(a) defines a call aggregator
as a person who furnishes a telephone for use by the public, i.e., transient use.
Will Applicant be an "operator service provider" as defined in ORS 759.690(1)(d)?
Yes
No
AUTHORITY REQUESTED
FM904 REV. 7/2018
Page 3 of 3
11. SHARED TELECOMMUNICATIONS SERVICE:
Shared Telecommunications Service (STS) service is defined in OAR 860-032-0001. STS includes resale of
long-distance service to the STS provider's user group, but not to customers outside the user group.
a. Provide the address of the building where shared service will be provided through privately owned customer
premises equipment. If Applicant intends to serve a user group located in two or more buildings, include an
electronic copy of a map clearly showing the locations to be served by the Applicant. The information on the map
must be precise and legible and include street names and the city where the building(s) is(are) located.
b. An STS si
te or location consists of one building, or a complex of buildings or a campus on contiguous property.
An STS provider may interconnect separate sites in order to aggregate toll traffic. An STS provider may not
interconnect separate sites in order to provide local exchange service between those sites.
If serving buildings at separate sites, will applicant interconnect the buildings in order to
aggregate toll traffic?
c. Describe the user group or association at the STS location.
Yes No
NOTE: Applicant must apply to PUC for additional authority in order to add s
ubsequent STS sites.
As a condition of a certificate of authority, applicant must comply with all applicable Commission rules and state law,
as well as conditions listed in the certificate. For your convenience, following is a summary of some conditions from
OAR 860 Divisions 32 and 33. Additional conditions may be specified in the certificate.
Certificate holder must:
• Provide only the telecommunications service authorized in the certificate.
• Respond in a timely manner to Commission inquiries.
• Notify the Commission of changes to the certificate holder’s name, address, email, or telephone number.
• Maintain its books and records according to the applicable rules of the Commission, and keep its books and
records open to inspection by the Commission to the extent necessary to verify information required of the
certificate holder.
• Meet service standards set forth in applicable Commission rules, including OAR 860-032-0012.
• Submit required reports in a timely manner, and timely pay all Commission taxes, fees, assessments, access
charges, and subsidies pursuant to Oregon law or Commission rules, orders, tariffs, or price lists.
• Pay an annual fee to the Commission pursuant to the Commission’s rules. This fee will be based on the certificate
holder’s annual gross retail intrastate revenues and will be no less than $100 per calendar year. Certificate holder
must collect the fee by charging an equitable amount to each retail customer and describe the amount of the
apportioned charge on each retail customer’s bill, pursuant to the Commission’s rules.
• Pay a quarterly amount to the Oregon Universal Service Fund based on a Commission-approved surcharge
percentage assessed on all retail telecommunications services sold in Oregon pursuant to ORS 759.425(4).
• Ensure that the Residential Service Protection Fund surcharge is remitted monthly to the Commission. This
surcharge is assessed against each paying retail subscriber at a rate that is set annually by the Commission.
Applicant understands that all services provided by Applicant must comply with all applicable
Commission rules and state law, and with conditions of the certificate (check box at left).
CONDITIONS OF A CERTIFICATE OF AUTHORITY
Electronic Signature of Person Authorized to Represent Applicant
Typewritten Name
Title
Date
FM904 REV. 7/2018
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TO PROVIDE TELECOMMUNICATIONS SERVICE IN OREGON APPLICATION FOR (Oregon)

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Completed 21 July 2020

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