Form FCC Form 5634 FCC Form 5634 Uniendo a Puerto Rico Fund Connect USVI Fund Stage 2 Fix

Application for the Uniendo a Puerto Rico Fund and the Connect USVI Fund Stage 2 Fixed Support

PR-USVI Application Form 5634 5.2.23

Business or other for-profit entities

OMB: 3060-1274

Document [docx]
Download: docx | pdf

FCC Form 5634

Uniendo a Puerto Rico Fund

Connect USVI Fund

Stage 2 Fixed Support

Application Form


Estimated Time Per Response: 80 hours

[Month] 2023

Read the instructions thoroughly before completing this form. Failure to comply may cause your application for Stage 2 support to be disqualified.

1 Date Submitted:

Applicant Information

2 Applicant Legal Classification

  • Consortium

  • Corporation

  • General Partnership

  • Government Entity

  • Individual

  • Limited Liability Company

  • Limited Liability Partnership

  • Limited Partnership

  • Trust

  • Unincorporated Association

  • Other: _______________________________

3 Entity Name

4 FCC Registration Number (FRN)

5 Jurisdiction of Formation

6 Address Line 1

7 Address Line 2

8 City

9 State

10 Zip Code

11 Phone


12 Email

Contact Information

13 Name

14 Organization

15 Address Line 1

16 Address Line 2

17 City

18 State

19 Zip Code

20 Phone


21 Email


If the applicant has entered into one or more agreements relating to the applicant’s application, identify each agreement relating to the participation of the applicant in the competitive proposal process by providing an identifying name for each agreement, the name of each party to the agreement, and the type of agreement. Attach a separate exhibit that briefly describes all disclosed agreements.

22 Agreements

Agreement Identifier

Agreement Type

Name of Party

Ownership Information

For each Disclosable Interest Holder, complete and attach a Schedule A. If there are any Disclosable Interest Holders with indirect ownership of the applicant, attach a separate exhibit showing the relationship between those Disclosable Interest Holders and the applicant. If there is insufficient space to provide complete lists of Disclosable Interest Holders and FCC-Regulated Businesses below, provide those lists in attachments to this form. See 47 C.F.R. §§ 1.2112(a), 54.315(a)(1).

23 Disclosable Interest Holders


Type of Entity


Percent Interest Held

24 FCC-Regulated Businesses (Held by Applicant)


Principal Business


Percent Interest Held

Required Attachments

25 Operational History

To be eligible for participation in Stage 2 Competition, the applicant must have provided voice and/or broadband service in the territory where it is seeking Uniendo a Puerto Rico and/or Connect USVI Stage 2 fixed support since at least the time period required for filing the June 2018 FCC Form 477. In an exhibit to this application, describe the number of years it has been operating and identify the services it has provided.

26 ETC Designation

Is the applicant designated as an eligible telecommunications carrier (ETC)?

  • Yes, the applicant has already been designated as an ETC in the areas where it is seeking Uniendo a Puerto Rico and/or Connect USVI Stage 2 fixed support. The relevant designation order is attached to this application.

  • No, the applicant has not been designated as an ETC in the areas where it is seeking Uniendo a Puerto Rico or Connect USVI Stage 2 fixed support. Please select one of the following regarding the applicant’s current status as of the application filing date.

  • The applicant is in the process of applying for ETC designation in the relevant areas, and will submit the designation order and accompanying certification to the Commission upon being designated as an ETC.

  • The applicant has not yet applied for ETC designation in the relevant areas, but acknowledges that, if selected, it must obtain ETC designation within 60 days after public notice of selection to receive fixed support. Any entity that is awarded support but fails to obtain ETC designation within sixty (60) days shall be considered in default and will not be eligible to receive high-cost funding. See 47 C.F.R. § 54.1505.

27 Financial Qualifications and Project Funding Documentation

In an attachment to this application form, describe how the required construction will be funded, including financial projections that demonstrate the applicant’s ability to cover the necessary debt service payments over the life of a loan, if any. An applicant may choose to submit unaudited or audited financial statements from the prior fiscal year to support its application.

28 Network Plan, Technology Description and System Design Documentation

  • Initial Overview. In an attachment to this application form, provide at a high level how the applicant will meet its Stage 2 public interest obligations for the relevant performance tier and latency combination(s) using Stage 2 support, for example, building a new network, expanding an existing network, or deploying new or existing technology.

  • Detailed Description. In an attachment to this form, describe how the technology and system design the applicant intends to use will deliver voice and broadband service, including a network diagram which must be certified by a professional engineer. The professional engineer must certify that the network is capable of delivering, to 100 percent of the locations in each minimum geographic area, voice and broadband service that meets the requisite performance requirements. See 47 C.F.R. § 54.309.

  • Entities proposing to use wireless technologies also must provide a description of their spectrum access in the areas for which they seek support and demonstrate that they have the required licenses to use that spectrum, if applicable.


29 Price and Minimum Performance Requirements

The applicant must provide the relevant information in Schedule B to this application form related to the performance levels of its broadband service offerings for each minimum geographic area the applicant proposes to serve. The applicant must also provide in Schedule B the minimum download and upload speed, usage allowance, and latency performance for the service offerings proposed for each minimum geographic area.

30 Disaster Preparation and Response Plan

The applicant is required to submit with its application a Disaster Preparation and Response Plan (DPRP) which will be reviewed for completeness. The DPRP must address in detail and provide a description how an applicant intends to prepare for and will respond to disasters in Puerto Rico and/or the U.S. Virgin Islands according to five criteria: (1) Strengthening Infrastructure; (2) Ensuring Network Divisersity; (3) Ensuring Backup Power; (4) Network Monitoring; and (5) Emergency Preparedness.

31 Letter of Credit Commitment Letter

The applicant must submit a letter from a bank acceptable to the Commission, as set forth in section 54.1508, committing to issue an irrevocable stand-by letter of credit, in the required form, to the applicant. The letter must, at a minimum, provide the dollar amount of the letter of credit and the issuing bank’s agreement to follow the terms and conditions of the Commission’s model letter of credit in Appendix B of the PR-USVI Stage 2 Order.


By signing below, the authorized officer certifies the following statements:

  1. that the applicant is in compliance with all applicable statutory and regulatory requirements for receiving Stage 2 fixed support for the Uniendo a Puerto Rico Fund or the Connect USVI Fund.

  2. that the applicant or its parent company, if the applicant is a wholly owned subsidiary, has filed a FCC Form 477 as required during the relevant time period for June 30, 2018; December 31, 2018; June 30, 2019; or December 31, 2019.

  3. that the applicant is financially and technically qualified to meet the public interest obligations of Section 54.1507 of Title 47 of the Code of Federal Regulations (47 C.F.R. § 54.1507) for each relevant performance tier and latency combination and in each geographic area for which it seeks support.

  4. that the applicant will meet the relevant public interest obligations, including the requirement that it will offer service at rates that are equal to or lower than the Commission’s reasonable comparability benchmarks for fixed wireline services offered in urban areas.

  5. that the applicant will have available funds for all project costs that exceed the amount of Stage 2 fixed support authorized by the Commission to be received for the first two years of its support term.

  6. that high-cost support will not be used for costs that are or will be reimbursed by other sources of support, including federal or local government aid or insurance reimbursements; and that support was not used for other purposes, such as the retirement of company debt unrelated to eligible expenditures.

  7. that the applicant provided service in the territory as of June 30, 2018.

  8. that the applicant acknowledges that it must be designated as an Eligible Telecommunications Carrier pursuant to section 214(e) of Title 47 of the United States Code (47 U.S.C. § 214(e)) in the area(s) in which it will receive support prior to being authorized to receive such support.

  9. that the description of spectrum access in areas for which the applicant will seek support provided in this application in the Stage 2 competitive process is correct and the applicant will retain such access for at least ten (10) years after the date on which it is authorized to receive support.

  10. that the applicant is in compliance with prohibited communications rules adopted by the Commission.

  11. that the applicant and any party to the application are not subject to a denial of federal benefits pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988.

  12. that the applicant has sole responsibility for investigating and evaluating all technical, marketplace, and regulatory factors that may have a bearing on the level of Uniendo a Puerto Rico Fund or Connect USVI Fund Stage 2 Fixed high-cost support it submits in its application, and that, if the applicant wins support, it will be able to build and operate facilities in accordance with the Uniendo a Puerto Rico Fund or Connect USVI Fund Stage 2 obligations and the Commission’s rules generally.

I, the individual identified as the applicant’s certifying representative below, am authorized to make these certifications on behalf of the applicant and declare under penalty 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.

32 Signature

33 Date

34 Printed Name of Authorized Officer

35 Title/Position of Authorized Officer

36 Phone Ext.

36 Email

38 Employer

Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act, 47

U.S.C. Secs. 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. Sec. 1001.


Part 3 of the Commission’s Rules authorize the FCC to request the information on this form. The purpose of the information is to determine whether applicants can meet the terms and conditions of Uniendo a Puerto Rico Fund and Connect USVI Fund Stage 2 fixed support. The information will be used by the Universal Service Administrative Company and/or the staff of the Federal Communications Commission, to evaluate this form, to provide information for enforcement and rulemaking proceedings and to maintain a current inventory of applicants. No authorization for support can be granted unless all information requested is provided. Failure to provide all requested information will delay the processing of the application or result in the application being returned without action. Information requested by this form may be made available for public inspection after the Commission staff completes its review. However, consistent with the Commission’s limited information procedures in place for the Uniendo a Puerto Rico Fund and the Connect USVI Fund, certain information may be withheld from routine public inspection even after support is authorized. If a request for public inspection under the Commission’s rules is made for an applicant’s information, the applicant will be notified and then must justify the continued confidential treatment of the information if it objects to the disclosure.

The public reporting for this collection of information is estimated to average 80 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the required data, and completing and reviewing the collection of information. If you have any comments on this burden estimate, or how we can improve the collection and reduce the burden it causes you, please write to the Federal Communications Commission, AMD-PPM, Paperwork Reduction Act Project (3060-1274), Washington, DC 20554. We will also accept your comments regarding the Paperwork Reduction Act aspects of this collection via the Internet if you send them to [email protected]. PLEASE DO NOT


Remember - You are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060-1274.


U.S.C. 552a(e)(3) AND THE PAPEWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

FCC Form 5634 Schedule A

Uniendo a Puerto Rico Fund; Connect USVI Fund

Basic Information

Provide the information on this Schedule A for one Disclosable Interest Holder of the applicant. Separate Disclosable Interest Holders require separate copies of Schedule A. Disclosable Interest Holders that do not have an FCC Registration Number (FRN) are not required to provide an FRN below.

1 Entity or Individual Name

2 Disclosable Interest Holder Legal Classification

  • Consortium

  • Corporation

  • General Partnership

  • Government Entity

  • Individual

  • Limited Liability Company

  • Limited Liability Partnership

  • Limited Partnership

  • Trust

  • Unincorporated Association

  • Other: _______________________________

3 FCC Registration Number (FRN)

4 Jurisdiction of Formation/Country of Citizenship

5 Address Line 1

6 Address Line 2

7 City

8 State

9 Zip Code

Type of Interest in Applicant

10 Check all that apply.

  • Direct Ownership Interest in Applicant

  • Indirect Ownership Interest in Applicant

  • Officer

  • Director

  • Key Management Personnel

  • Management Contract

  • Other: _______________________________

Type of Ownership Interest in Applicant

11 If the disclosable interest holder has an ownership interest in the applicant, check all that apply below.

  • Common Stock (specify)

  • Voting

  • Non-Voting

  • General Partnership Shares (specify)

  • Managing

  • Non-Managing

  • Limited Partnership Shares (specify)

  • Insulated

  • Non-Insulated

  • Membership Shares

  • Option to Acquire Equity

  • Proprietorship

  • Preferred Stock (specify both voting and convertible types)

  • Voting

  • Non-Voting

  • Convertible

  • Non-Convertible

  • Warrant

  • Other: _______________________________

FCC-Regulated Businesses

If there is insufficient space to provide a complete list of the Disclosable Interest Holder’s FCC-Regulated Businesses below, provide a complete list in an attachment.

12 FCC-Regulated Businesses (Held by Disclosable Interest Holder)


Principal Business


Percent Interest Held

Application—Disclosable Interest Holder Information

FCC Form 5634 Schedule B

Uniendo a Puerto Rico Fund; Connect USVI Fund

Application – Price and Network Performance Data


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified0000-00-00
File Created2023-08-30

© 2024 | Privacy Policy