Form FCC 5620 FCC 5620 Post-Selection Review of Rural Broadband Experiment Winn

Application to Participate in Rural Broadband Experiments and Post-Selection Review of Rural Broadband Experiment Winning Bidders.

WCB_XXXX_Form 5620 Screenshots_080814

Post Selection Review of Broadband Experiment Winning Bidders - Privacy Sector

OMB: 3060-1200

Document [pdf]
Download: pdf | pdf
FCC

Auction System

Applicant/Bidder Access
FN I

__
-

-

-

I ---------- -

.--•--

Peonword
LOGIN

ForQot your Pniwrd?
__________________________________________________________-

Public Access
Auc€cil Rult
(nelet err
icir)
Actg Aoolrcetjon Serch
cnrch

-:

Lo In Informtlon
The AppIicntJ6idder Acccso cection in penoword protected, Please type your FCC Registretien
Number (FRN) nit ito nenocieted pesoword to eccns the Auction Applicetion O Bidding
oyctern An FRNlpwooword in not required or the Public ACCC$S nection o the ny tern

FRN hcrtline inforrnojop
Need en FRN?
Recjister with the FCC

Not urr IIypii heve eli FRN?
Seerch the FCC
ocetjpcigytrn detbone to deten'nnne you hevo been eooned en

FCC

Lcgod let FRN 0004579400

My Auctions Page

Spectru rn/Broadcast
File new Cr modify an exi5ting auction short-form application
Cli
here to file FCC
tro 175

Mobility Fund
File new or mcdliv an existifly auction short-form application
Chok here Ic IHe FCC Fcriro 180
File new oc modify an exitinq auction long-form application
Click here to itie FCC FIrifi 580

Rural Broadband Experiments
File new or modify an cxi5ting application to participate in the rural broadband einperinieiic
Click heO Ic hie FCC Fore t6ll
File new oc niridiFy exist.unq post-selection review materials
dliJcere to file FCC Form 56O

Online Bidding (Mock Auction)
There are no MLICK auctions available.

Online Bidding (Live Auction)
There are no LIVE auctioin available.

____________________________

Lcc,ged In FSN a

.97-O

> Wireless

>

ucopri1 > AuCOOfl ApplIcation

:Lop Cut)

Approved by 0MB (FCC Form 5610)
3060-LL66 (Notice to Aoolicants)

Auction Application Manager
-

Create or Review Applications

Approved by 0MB (FCC Form 5620)
3060-1168 (Notice to Aooljcpnts)

Create a New Form 5610 Application

__________

No new auctions

Review or Modify ExistinU Form 5610 Applications

96
FnaI Phase Closed

Charles Barkiey

Withdrawn

11/15/2013, 5:38 PM

901
Pinar Phase Closed

FCC Test

Withdrawn

8/10/2012, 5:22 PM

902
Final Phase Closed

FCC Test Corporation

Not Submitted

5/27/2014 9:13 AM

FCC Test
Long Form Filing Window Closed 4/212014, 6:00 PM

Not Submitted

11/22/2013, 2:07 PM

FCC Test Corporation
9•Q
Long Form Filing Winclcw Closed 712/2014, 6:00 PM

Not Submitted

5/27/2014, 9:13 AM

Create a New Form 5620 ApplicatIon
No new auctions
Review or Modify Exlstln

ri.

Form 5620 ApplIcations

8/10/2012, 5:22 PM

i&iian rturutrcn > At'on c,iinaton
L0a5d in: FR OOX3611S4(Q

ApplicOnt: Pine Cellular Corp
Lorg Form FiIii Cones: OD/31/2014 12:00 AM (El)
Status: Submitted

Auction 922

Your change; have been saved but NOT
SUBMITTED, In order (or yoce chCr,5CC to lake

nov ns;ECerEify C Submit your application,

WCB - Rural Broadband Experiments

Applicant Information
Applicant Legal Class Wicatlon
To determine the applicant information recuired by the FCC please provide your Leoal Classification.

General Partnership

Applicant Information
Agreements
Ownership
Summary

Common Quest l ona

Government Entity
Limited Liability Company

Wl:ien amy data saved
during the data entry
process?

Limited Liability Partnership

What is the difference

Individual

between a warning and an

Limited Paitneship
Trust
ffJ

Print Preview

Certify & Submit

Corporation

)

chmnty

Steps

.
.
.
. .
Applicant iriforniation identifies the applicant, its responsible parties (whee applicable), and ts auction contact party. Contact ndividu^l will be sent correspondence concerninQ application.

:

Summary

What if my Leasi

Unincorporated ASsOciation
Other

Ur?scIptr Or: Or Lv 0L C

kationiaitot sted?
What does the Oi.at ik do?

______________________

Oil:

rIOJr

i67u76u

Applicant Statia5 (not required)
What is your status? Check all that apply
I I Minority Owned Business
I I Rural Telephone Company
I I Woman Owned Business

Test Question 2 added by

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AffcSna

Aobon AppIicbrn

A

App cant: Pine CeIlu1r Corp
tong FOrn Filing Closes: 08/31/2014 12:00 AM (ET)
Status: Submitted

Auction 922

Ynrr hrge horrovnr boc NOT
SUBMETTED. Ln ordor for yo
rhnquo to toko
eferf. yer. mtiy &SabmE scar PFlictirJ

WCB - Rural Broadband Experiments

i Summary

Attachments

Eqntprev:ew

l Qtst

Applicant Information
Applicant Information

Applicant Name

Agreements
Please provide the tollowing information.

Ownership

Entity Name:

Pine Cellular Corp

Suniniary

Juristlictiori of Formation:

Georgia

Certify & Subniit

Applicant Addres5 PO Buses nrc EDt errr-rdted)

Common Questions

Chck here if addegs is I
Address Line 1:

123 Auctions Lane

Address Line 2:

Suite UOO

City:

Dallas

State:

Texas

Zip Code:

7522

When is my data saved
during the data entry
process?

What is the difference
between a warning and an

-

What is a )utisdictign of
Forma_tign'

CONTINUE )

Why is the applicants
citizenshio/iurisdictipn_pt
fprmation required?
Why are P.O. boxes not
permitted?
Test Ouestion 2 added by

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CUCtjOe Appliestien

L3r Ir FSl 176::

Appcant: Pine CeIkiJr Cotp
thng Form FHrig CLoses: 08/31/2014 12:00 Alt (ET)
Status: Submitted

Auction 922

Your thar,qes have boon saved hut NOT
SLISMETTEn. hi n,dn, tro ,eur thane. to teke
you meet Ce,tify & Submit your ap,iie.tion.

WCB - Rural Broadband Experiments

Stjrnmry

Applicant Information

AttahrneritL

iutPiviw Lj
Steps
Applica lit Imiformatiun

ResponibIe Party - Corporation

Agreements
Identify art ndlvjdual as the responsible party or the Corporation
Name:

itte:

EmaiL Address:

Lust
Davi a

Psie
3ffir r CiretTar
Officer
ArSO

Te'ephone Number:

Ownership
MI

202020 - 2020

-________ Suffix

Summary

Certify & Submit
Common Questions

yxt.
When is my data saved
during the data entry

p.dernailcom
What is the difference
bittweCfl u wrnjni arid an
error?
Do I have to liii in th
Telephone Number and EmiI
Address foiotjr rsponsible
Who i considered to be a
Responsible Party?

wowl
lost Ouesbon 2 added b

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Ea1aas v iLtDana > ActFon Appkvatvvn
• Applicant: Piae Cellular Curp

P.N

LosS torn-i Fiiiri5

Auction 922
•

WCB - Rural Broadband Experiments

I

Yvur changec have been saved but F1OT
SUBMITTED. tn order for your changes to take
eFfeot. yo. es.EC.rtity &Submit your .pplkatrnn.

Pnflt Proviow

Applicant Information

Steps
Applicent Inrormation

Contact Information

Areenients
Ownership

Contact individual will be sent correspondence conceminQ application,
Name:

ocn: Olt/al/2014 12:00 AM (El)

Status: Submitted

hrt
Pine

HI

Loc
Walter

Suffix

Summary
Certify & Submit

Ext.

Telephone Number: 202

020

- 2020

Fax Number:

202

020

- 2020

Email Address:

pwemallcom
error

Contact Address (P0 oxea are not ptr,nifled)

What is the contact
inlormation used for?

Click hete if address is located outside th iS.

Address Line 1:

123 AUstons Less

Address Line 2:

Suite 100

OuLQUId,aI contact would
rather conirnunicate via
ohone or fax. Do I nood to
enter their ema address?

-

Why are P.O. boxes not
ermittd

City:

Test Ouesbon 2 added by
State:

DistrlctofColunybla

Zip Code:

20024
(COWYINUE b

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Applicant: Pine Cellular Corp
Long form i1ng CIooe: 06/35/2004 12:00 AM (ET)
Status: Submitted

Auction 922

Yo..,r thng.a So beer
ved bot SOT
SUBMLTTEO In oda' to, your uhn.a to tIP.,

.ff.t, yu m5 C.rtify & Sobmit or ppIintIorl

WCB - Rural Broadband Experiments

Summary

Agreements

Steps
Applicant Information

Agreements with Other Pnrtle end Joint Bidding Arrerigements
_
Has the apphnt €fltered into partnerships, joint ventures, consortia or other agreements, arrangements or understandings of any kind relating to the bcenses being auctioned, including

any such agreements relating to the post-auction market Structure?
- No
' Yes

(Ti ueIt)

Athosoo

Agreements
Ownership
Summary

_________

(coinu'l)

Certiff & Submit

Common Questions
WheniLmvdata_1avd
urino th data entry
obtest?
What is the difference
beteen a warniria and an
error?
What is the soecdlc rule
governing agreements,
arranoements arid the like?
Test Question 2 added by

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t±ain2

Auction Aptilication
Applicant: Pne Cdluter Corp
Long Form Fitir

Auction 922

StvtLI

CIOu: O8/lf?Q4 E2OO AM (El)

Sin t,nntttrnt

Your changes have been saved bst NOT
SJBMITTEO. To order tor your charres to lake
effect, you mast Certify & 5sbmit your apptncation.

WCB - Rural Broadband Experiments

Sijmmry

Aqreernents

Attachments

Print Preview

B

Steps

Creute New Agreement

Applicant [rib rmstion
Agreements

iderAify all parties ';iLh wham Applicant has entered into partnershipsr joint venturean consortia or other agreements arrangements or understandings of any kind relating to the licenses
being auctioned, including any such agreements relating to the post-auction market structure.

Ownership

Provide an identiflying name for your agreement.

Certify & Submit

Agreement !dentillet.

Agreement 1

Summary

Common Questions

Add Parties

When is sw data sac
during the datct entT\
ptgcesc?

4..

Add u to three pamas below. You may add more pattws Inter.

Party To Aqreernent
Select either Entity OR Individual:
Entity

Entity

Name:
FREd:

Sndividual

Do I blase to orovrde an F_CC
Registration Number (FREd) for
my agreement party?

Individual
(Search FRN)

t!L__

Name:

IC St Question 2 added by

Low

FRN

rch FRN

Party To Agreement
Select either Entity OR Individual:
Entity

Entity

Individual

-

Name:
FRN:

Ier_ch [RN)
Fl,

Individual

Mt

taut

Name:
ERN:

What does the Search [RN
link do?

(Search FRN)

Aurtioa AppI;cnon
Lirri: F.N

:y_

• ApplicoM. Pine Cellular Corp
Lang loin Filinç CIooe
Status Submitted

Auction 922

Oe/31/2014 12:00 AM (ET)

Your rharige hv been zaved but NOT
SUBMITTED, In order or your rharwe to take
affant, you nuitCertily&Sabmit poor

WCB - Rural Broadband Experiments

thients

Agreements

pcuittesww

Qjjj

Steps
Applicant Information

Edit Agreement Identifier

Agreements
Agreement Identifier
Agreement Identifier:

AgresmnI 1

-

Ownership
.

Summary
Certify & Submit
(t
Common QuesUon;
When is my data asued
duria the data entry
Drocess?
What is the difference
between a warning and an
error?
Test Question 2 added by
Ramya

0 AvstIon Applicaijer,

lSciiisi °

Applicant: Pine Cellular Corp
LollO Form FiIjrr

Auction 922

CIotes; 00/31/2014 12;00 AM COT)

Status: Submitted

Your changes have been s,ved but NOT
SUBMItTED In order for yoo hces to take
too meet CertiFy &Sabn,it your appflrahen.

WCO - Rural Broadband Experiments

il Summary

Agreements

Attachments

Print Preview

Steps

Add Parties to this Agreement

Applicant inlormatieri

Ajreoinrrt: Agreenient 1

Açjreemerits
Ownership
Summary

Add Parties

Certify & Subnt:t
Common Questions

Add up to three parties below. You may add more partes rater.

When is my data saved
durina the data entry
process7

Party To Agveement
Seled either Entity OR Individual:
Name:
Entity

Entity

ERN:

Test Ouestmn 2 added by

$earchFRNl
_____________ Mi

Individual

What is the dference
between a warnino and an

Individual

Let

Solfs

NJme
FRN:

-

____________-

--

(Serrh FRN1

Party To Agreement
Select either Entity OR Individual:
Entity

Entity

individual

Name:
FRN:

(Search FRN1
Mi

IndMdual

Lei

Svlfvr

Name:

FRN:

-

-

-

(Search FRNI
(ThsstT

Party To Aqreemertt
Select either Entity OR Individual:

Entity

individual

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&tiii 'jg1tiQfli> Aiotion Applicabon

Logcd In FRN 0O137k13

Apphcent: Pine Cellular Corp
Long Form Filing Closes 08/31/2014 12:00 AM (El)
StatuS: Submitted

Auction 922

1

WCB - Rural Broadband Experiments

l Summary

Ownership

Your chngez have been iev.d but HOT
SUSHI ITTFO. Jim ode Jm your uhengen to take
effect you rn..t CertIfy & SubnIt your

ê Attachments

Pnnt Preview
Steps

View/Edit Ownership Oi5closure Information

Applicant Information
Agreements

Applicant Summary

Ownership

Add Disciosebic J,ir

Summary

A

Certify & Submit

EL

IIoldertp Apulicant
usIness to ADolicent

yew all FCC Reoulated Businesses o the

&ucant

Disdosable Interest Holders of this Applicant
You currently have specified 1 Disclosable Interest Holder(s)
Disciosoble Interest Holder: Sun Networlt_Cprooratlpn
You cur'evtly hove opecified

FCC R uiated Businesses held by this Disdosbln Ivterest Molder

Igg

FCC Regulated Businesses of this Applicant
You currently have specified 2 FCC Regulated Business(eS)
-

- FCC Regulated BuskHess: another test

QIJIL

1.,ctjn

epIktion

Applicant: Pine Cellular Corp

L1. F'1I

LnnO Form Filire CIost: 08131/2014 12:00 AM (El)

Auction 922

Status: Submitted

I

WCB - Rural Broadband Experiments

lSummarv

Ownership

Vn
bas be s.ved bt UCT
SLSMITTED. In nrdnr kr y rnhungon Ia taka
na tCeriFy&Sabmilynnr ypIination.
Attachments

Pnot Prenww

Steps

Add DiscJosable Interest Holder

ApIicant nforrnatron
Areernents

Disdosable Interest Holder Name and Type
--

Select either Entity OR Individual:

Ownership

______________

) Entity

SuOinia

-

Individual

Certify & Sub mit
Entity

Name
Common Question5
Type:

___________
- -

________

----.-Ii

-

When is niy data saved
the data ent

--_____________

-

process?

1eah FRN)

What is the difference
between e waminQ and an
Frp
Individual

Name:

What is a Disdosable

--

Interest Holder (DIH)'

ech

Is the FRN reguired?

cA*cs)

_________
___

Test Ouestion 2 added by

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ApplIc.tIon

S- (gg_Q5

Applicarrh Pine CelIuar Carp

Long Fsrn FiIin CIosr5: 05/31/2014 12:00 AM (ET)
Status: Submitted

Auction 922

Your changes have teen need but NOT
wJsMrrTeD. Irr order for ou rharrge to take
yoo n,uet Certify & Sebmit eur apprirahon.

WCB - Rural Broadband Experiments

______

pttachments

EjPeviw

Qjjfl

Ownership

Add FCC Regulated Business to Applicant
FCC Rejulated Business

ppIiclt rifomsation

Agreements
Ownership

_________________________________________________________________________

ldentfy entities in which the pplicant h3s an interest. You may select ectities already submitted or begin entenng the intorniabon below.
-.
FCC Regulated Business

-

-

Summary
..

Principal Business

FRN

Cefy & Submit
Percent of Interest Held

by Applicant

_______

Common Qutions
When is my data saved
dUring the deta entry
orocess?
What i the difference
between e warning anti an
Whpt does the Search FRN
Unk do?
What is an FCC Regulated
Business (ERg)?

(SearCh FRN

(Search FRN)

_________--

Is the ERN recjuired?

__________-.

What does Percent of
Interest Held' refer to?

Must art indirect ownershio
interest oercerltape be
inCKitisd in "Percent f
Interest Held'?
Test Question 2 added by
Remve

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> uctiorr Applietioo

Lo5ged In: FRN 021376c!24

5pplicriL: Pine CeIIuIdr Corp
Long Form Wrrg cros: 08/3112014 12:00 AM
5tstu Suhrviit*ed

Auction 922

T)

Vor
heve c.n ed trvt NOT
SUBMITTcD. n order For soor rhorrgeo to take
foot yoi n,t Certify Submit 50w appiicat$an,

WCB Rural Broadband Experiments

E Summary

Ownership

i! Attachments

Print Preview
Step5

Copy FCC Regulated Business to Applicant

Appcant Information
Agreements

Soled Entities

-

Ownership
Summary

Below sa list of enttties already entered for this application. You may associate any of these entities with this Applicant, by checking those that apply.

Certify & Submit

Eribties 1-2 of 2

Common Questions

- Aripicant Cirriclosoble Interest Holder

When is my data saved
durinothe data sntrf
process'

- Di0cosohlE lntOr•.st Holder FCC Regulated Business
- Appliczir Cjtliote

What is the difference
bBLeen a warning and
error'
What is an FCC Regulated
gusiness (FRO)?

What does Percent of
interest Held refer to?
Must an indirect ownership
interest percentage be
included in Percent of
interest He'd"?
It_Questsn 2 added by
(CONTINUE

rnia

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c 'rt _••L'

.a r
______________

LR4.) IIIj*J

__________________

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.uutIoo Apphctloo
y

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Applicaor: Pine Cellular Corp
Lorl Form FiliOg Closes 06f3I/014 12:00 AM (ET)
Sstos: Submitted

Auction 922

Your Ch.flyeu has. be,n .aocd but NOT
SUBMITTED. I, ordar For your cliro to take
•f.ct you r,,ot Certify & Submit your ppEirator,

WCB - Rural Broadband Experiments

WnmL

Print Preview
Print Application
Print th data you hare added to the Auction Application by selecting from the list below.
Chcl COntinue to open a printable page.
L.l Applicant Information
Agreements
!J Ownership
ti Certify & Submit
[] Attachment List

ri

Attpcbrnen

Prjnt Preview

ZQtJJI

Steps
PriCt Atachrnents

Click on a link below to open a POP to print.
Indirect Ownership - Indirect Ownershio
Audited Financial Statements - Financial
ETC Designation -

Applicant information
Agreements
Ownership
Summary
Certify & Submit

Common QuestIons
IestQusation 2 added by

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Lo55e In: FSN 0013

rsisi > ttsiaos S Auction Application

::i

Applicant: wert
Initial Pijing Closes: OB/31/2054 6:00 P14 (ET)

Auction 199

Status: Submitted
Your changes have bean sand but NOT
SUBMITTED. Iv order for your charrgo to take
effect, you wont Ctify&Subnt yovr applicatIon.

WCB - Rural Broadband Experiments

Summary

Summary

Print Preview
Steps
Applicant Information

Summary Overview

A0reements
Ownership

Choose a stop Iist€d below to review your provided information.
Applicant Information

C VWIID4T

Agreements

(vIEWIAT)

Ownership

C Vt*WiID13

Attachments

C V!WlEDl!3

Summary
Certify & Submit
Common Questions
What it 1 certify and any of
the certifiCations_are false?

CHECK PRRORS

When is my data aavad
during the data entry
process?

Onc2 •.i orc confident that the application is ready for certification and submission, click on the "Continue To Certif' button below.
4 EACK

Attachments

(CONTINUE TO CERTIFY)

What is the difference
between a warning and an
error?
What does the Check Errors
button do?
Test question 2 added by
TEST123 aIert(1234
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FCC

>

5fOfl5 n A..iution Application

Logecl In: FRN 000572072 (ggQ)

1pplcant: xvc Corp
Initcal Film5 Closes: Q8/fl12014 6:00 PM (€1)
Status: Submibted

Auction 199

Your chances have been saved but NOT
suvhrrrrvn. Err erder mr puw charrges to Lake
yes mest Cortay& Sebnet your pphcetion.

WCB Rural Broadband Experiments

Summary

Certify & Submit
Certify Auction Application

i Attachments

Print Preview
Steps
Applicant Information

-

-

-

--

Dy clicking the Submit button below, I certify the following:

Agreements
Ownership

(1) This application discloses all real parties in interest to any agreenlents involving the 4pplicants participation in the competitive bidding.

Summary

Certify & Submit
(2) The Applicant, each party capable of controlling trw Applicant, and each party that ma be controlled by the Applicant or by a party capable of controlling the Applicant have complied with
and will continue to comply with Section 121OO2 of Title 47 of the Codp of Federal Regulations.
(3) The Applicant is financially and technically capable of providing service in each area for which it seeks support.
(4) The Applicant has available funds for all project cOsts that exceed the amount to be received ft-em the Rural Broadband Cxperiments.
(5) The Applicant Will offer service in supported areas at rates that are within a reasonable range of rates for similar service plans Offered by voice and broadband providers in urban areas
(6) The Applicant either (a) has been designated as art Eligible Telecommunications Carrier pursuant to Section 214(e) of Title 47 of the United States Code (47 USC 214(e)) in areas for which
ml will seek support OR (b) will obtain designation as an Eligible Telecommunications Carrier pursuant to Section 214(e) of Title 47 of the United States Code (47 USC 214(e)) iO areas for which
it will seek support.
If the Applicants proposal includes the use of spectrum access, the descnption of this spectrum access in areas for which the Applicant will seek support provided in this application to
participate in competitive bidding is correct.
(8) The Applicant and arty party to this application are not subject to a denial of federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988.
(9) The Applicant shall meet the threshold reguirements for each category of bid that the Applicant Submits.

wnar is cue oirterence
between a warning and an
error?
Is it necessary to read pit of
these certifications?
Who is authorized to certify?
After I fill out my application
electronically, is it
automatically submitted to
the FCC?

By clicking the Submit' button below, I, the individual identified as the Applicants certifying representative below, declare under penalties of perjury that, based on all the information
available to the Applicant, all the information provided in or with this application including the certification statements above, are true and correct.

After I submit ow Form 175
once, are any later chancies
automatically submitted to
the FCC?

Signature

Tett question 2 added by
t-urNt

Person Certifying:

first

Signature:
Title:

mcK )

directgr

MI

Last
last

SuIfcx


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