RUS 532 Rural Broadband Access Loan and Loan Guarantee Applicati

Rural Broadband Access Loan and Loan Guarantee Application
Version 2011-3
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0572-0130. The time required to complete this
information collection is estimated to average 400 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information.

United States Department of Agriculture
Rural Utilities Service (RUS), Telecommunications Programs

APPLICATION FOR BROADBAND
LOAN OR LOAN GUARANTEE

RUS USE ONLY
Borrower and Loan Designation:
APC Date:

Section A: General Information
1.

NAME & ADDRESS OF APPLICANT:

2.

REGISTERED AGENT (Address, Telephone and Fax):

3.

PHONE NUMBER:

4.

FAX NUMBER:

5.

E-MAIL ADDRESS:

6.

CONTACT PERSON:

7.

TYPE OF ORGANIZATION (Check one):

8.

TYPE of LOAN (Check one):

Corporation
Cooperative or Mutual Org.
State or Local Government

LLC
Indian Tribe or Tribal Org.
Other ________

9.

REFINANCE/ACQ.:

Cost-of-Money
Four Percent
Guarantee

Refinancing
Acquisition
Not Applicable

10. PURPOSE OF LOAN (Briefly explain the purposes for which loan funds are intended and the amount required for each purpose):

11. LOAN MATURITY REQUESTED (Check one):
Composite Economic Life of Facilities Financed

12. AMOUNT OF LOAN APPLIED FOR:

_____ years (if less than composite economic life)
13. IDENTIFICATION INFORMATION:
A. EMPLOYER TAX ID NUMBER (TIN): OR
FEDERAL EMPLOYER ID NUMBER (FEIN):
B. DUNS NO:
15. TYPE OF BORROWER (Check one):
Current RUS Borrower
New RUS Borrower

17. CONGRESSIONAL DISTRICTS (Attach as Schedule A):
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14. ORGANIZATIONAL NUMBER:

16. UPGRADE OR EXPANSION OF EXISTING NETWORK
(Check all that apply):
Upgrading existing network
Expanding existing network
Building new network
18. EXECUTIVE SUMMARY (Attach as Schedule B):
RUS FORM 532
(Rev. 3-2011)

Rural Broadband Access Loan and Loan Guarantee Application
Version 2011-3

Section B: Entity Eligibility
19. LEGAL OPINION & PROPERTY SCHEDULE:
A. LEGAL OPINION (Attach as Schedule C-1):
B. REAL PROPERTY SCHEDULE (separated into real
property, leased-property, easements, and rights-of-way)
(Attach as Schedule C-2):

20. CORPORATE STRUCTURE:
A. ARTICLES OF INCORPORATION or
ORGANIZATION (Attach as Schedule D-1):
B. BYLAWS or OPERATING AGREEMENT (Attach as
Schedule D-2):
C. BOARD OF DIRECTORS OR MANAGING
MEMBERS (Attach as Schedule D-3):
D. MANAGEMENT EXPERIENCE AND
COMPENSATION (Attach as Schedule D-4):
E. ORGANIZATIONAL CHART (Attach as
Schedule D-5):
F. PARENT AND SUBSIDIARIES, if any (Attach as
Schedule D-6):

21. BOARD RESOLUTION (Attach as Schedule E):

Section C: Area Eligibility
22. Service Area Maps and Details:
A. SERVICE AREA MAPS (Submitted through RUS’
Mapping Tool):
B. SERVICE AREA DETAILS (Attach as Schedule F-2)

23. SERVICE AREAS – EXISTING OR NEW; FUNDED OR
NON-FUNDED (Attach as Schedule G):

Section D: Other Federal Requirements
24. COMPLIANCE CERTIFICATES (Print and sign the samples provided):
A. EQUAL OPPORTUNITY AND NONDISCRIMINATION CERTIFICATION (Attach as Schedule H-1):
B. CERTIFICATION REGARDING ARCHITECTURAL BARRIERS (Attach as Schedule H-2):
C. UNIFORM RELOCATION ASSISTANCE & REAL PROPERTY ACQUISITION POLICIES (Attach as Schedule H-3):
D. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS
PRIMARY COVERED TRANSACTIONS (Attach as Schedule H-4):
E. CERTIFICATION REGARDING LOBBYING FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE
AGREEMENTS (Attach as Schedule H-5):
F. CERTIFICATION REGARDING FLOOD HAZARD AREA PRECAUTIONS (Attach as Schedule H-6):

25. FEDERAL DEBT
A. IS THE BORROWER DELINQUENT ON ANY FEDERAL DEBT Examples of debts include, but are not limited to, delinquent taxes,
guaranteed or direct government loans (more than 31 days past due) and other administrative debts:

No
Yes (if yes, provide explanation with Schedule I)
B. OUTSTANDING FEDERAL DEBT (Attach as Schedule I):
The Federal Government is authorized by law to take any or all of the following actions in the event that a borrower's loan payments become delinquent or the borrower
defaults on its loan: (1) Report the borrower's delinquent account to a credit bureau; (2) Assess additional interest and penalty charges for the period of time that payment
is not made; (3) Assess charges to cover additional administrative costs incurred by the Government to service the borrower's account; (4) Offset amounts owed to the
borrower under other Federal programs; (5) Refer the borrower's debt to the Internal Revenue Service for offset against any amount owed to the borrower as an income
tax refund; (6) Refer the borrower's account to a private collection agency to collect the amount due; and (7) Refer the borrower's account to the Department of Justice
for litigation in the courts. All of these actions can and will be used to recover any debts owed when it is determined to be in the interest of the Government to do so.
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RUS FORM 532
(Rev. 3-2011)

Rural Broadband Access Loan and Loan Guarantee Application
Version 2011-3

IMPORTANT: If you believe the following information contained in Schedules I through R-6 is Business Proprietary Information,
pursuant to Executive Order 12600, please indicate so at the top of each page.

Section E: Financial and Marketing Information
26. EQUITY:
A. APPLICANT’S EQUITY (Refer to
Schedule M4-a):
B. INVESTOR PROPOSAL (Attach as
Schedule J-1):
C. STATE/LOCAL GOVERNMENT BOND(Attach as Schedule J-2):
28. COMPETITIVE ANALYSIS:
A. EXISTING PROVIDERS (Attach as
Schedule L-1)
B. STRATEGIC PLAN (Attach as
Schedule L-2)

27. RESEARCH DATA & MARKET ANALYSIS:
A. RESEARCH DATA (Attach as Schedule K-1):
B. MARKET ANALYSIS (Attach as Schedule K-2):

29. FINANCIAL POSITION:
A. HISTORICAL FINANCIAL STATEMENTS for last three years with full
footnotes & disclosures (Attach as Schedules M-1)
(Certified financial statements are required if available):
B. SCHEDULE OF DEBT AND EQUITY FUNDING (Attach breakdown as
Schedule M-2):
C. SUBSCRIBER PROJECTIONS AND SERVICE TIERS (Attach as
Schedule M-3):
D. PRO-FORMA 5 YR. FINANCIAL FORECAST (Attach as
Schedule M-4A):
E. PRO-FORMA FINANCIAL ASSUMPTIONS (Attach as Schedule M-4B)
F. ADDITIONAL CASH REQUIREMENT(Attach as Schedule M-5):
G. DEPRECIATION SCHEDULE (Attach as Schedule M-6):

Section F: Network Design
30. NETWORK DESIGN
A. NETWORK DESIGN (Attach as Schedule N-1):
B. SERVICE METRICS AND NETWORK MANAGEMENT (Attach as Schedule N-2):
C. NETWORK DESIGN CERTIFICATION (Attach as Schedule N-3):
31. NETWORK DIAGRAMS:
A. EXISTING NETWORK DIAGRAM (Attach as Schedule O-1):
B. PROPOSED NETWORK DIAGRAM (Attach as Schedule O-2):
32. PROJECT COSTS:
SUMMARY OF PROJECT COSTS = Total from Details (Attach as Schedule P):

$_____________

33. ENVIRONMENTAL REPORT (Attach as Schedule Q):
34. LICENSES AND AGREEMENTS (Attach as Schedule R):

CERTIFICATION
The undersigned certifies that the information contained herein is accurate and complete to the best of his knowledge and belief.
SIGNATURE OF AUTHORIZED OFFICIAL

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TITLE

DATE

RUS FORM 532
(Rev. 3-2011)