HomeMy WebLinkAbout05789 - WHOLESALE PAY TELEPHONE SVCS DOCUMENT TRACKING Page: 1
Report: Expired Documents Summary April 2, 2013
Condition: Oldest Date= 1 1,Groups=INFO SERVICES,ALL Services,ALL XREFs
Document# Descriotion Aooroval Date Expiration Date Closed Date
A5098 Management Control Agreement-CLETS-TechMaintenance 05/10/2005 05/01/2008
Company Name: FBI
Address: /
Contact: Insurance Department
Group: INFO SERVICES
Service: In File
xRef: INFO SERVICES
Ins.Status: No Certificate on file.
A6789 Wholesale Pay Telephone Services �+ 02/19/2009 12/31/2009�
Company Name: Cleartel Telecommunications Inc � 1 q
Address: \ J
l a
Group: INFO SERVICES Qt'i �10
Service: In File 0�
xRef: RANDY COBS (760) 322-8396
Ins. Status: Certificate and Policies are OK
A6796 Payphone Service Provider, Companion Agr A5789 vvith Cleartel... 02/19/2009 12/31/2009 „
Company Name: G-Five, LLC
Address:
Group: INFO SERVICES l /�
Service: Process
xRef: RANDY
ANDY COBB (760) 322-8396
Ins.Status: Certificate and Policies are OK
* * * * * * ENDOFREPORT * ** * * *
f-*Ib�
LOCAL SERVICE AGREEMENT FOR WHOLESALE PAY TELEPHONE
SERVICES
_ THIS AGREEMENT is made effective as of the _(( -1 day of
e�lccccr tOCl (the "Effective Date"), by and between Cleartel
Telecommdnications, Inc. and NII Communications, Ltd., (the "Company"), with
its prin ' I o c at 2855 S. Congress Avenue, Delray Beach, Florida 33445,
and J ("Subscriber"), with its principal office at
3200 E. T hauitz clll Way (this "Agreement").
RECITALS
WHEREAS, the Company is in the business of providing local, long
distance, Internet, and other telecommunication services, and desires to permit
Subscriber and Subscriber's callers access to the Company's
telecommunications network for the purpose of using certain of such services
("Services"), subject to the terms hereof, and
WHEREAS, Subscriber desires to enter into this Agreement in order to
permit its callers access to the Services;
NOW THEREFORE, in consideration of these premises and of the mutual
covenants and agreements contained herein, the parties do hereby make this
binding Agreement,
SERVICES PROVIDED BY THE COMPANY
1. Local Services. To the extent consistent with applicable federal and state
laws, rules, and regulations, the Company hereby agrees to provide, and
Subscriber hereby agrees to accept, telecommunication services for all private
pay telephones ("COCOT") associated with Subscriber that are currently under
contract with the Company, as set forth on Schedule 1 attached hereto (the
"Converted Existing COCOTs"), and those COCOTs that are converted to or
installed on the Company's network hereunder from and after the Effective Date
("New COCOTs") pursuant to service orders submitted to the Company,
substantially in the forms of Exhibit D for New COCOTs or Exhibit C for
Converted Existing COCOTs, as the case may be. Subscriber agrees to pay for
such services according to the Company's rates and tariffs as in effect from time
to time and, for covered Services as of the Effective Date, as more particularly
described on Exhibit B attached hereto. The Company retains the right to refuse
to accept any COCOT pay telephone line ordered by Subscriber.
SA r.«� i "1 14 10102008 Ver4
ACQUISITION BONUS
2. Acquisition Bonus. The Company agrees to pay a one (1) time acquisition
bonus to Subscriber for any New COCOT pay telephone line converted to or
installed on the Company's network after the Effective Date, subject to Exhibit A
attached hereto (the "Acquisition Bonus"). By way of clarification, Converted
Existing COCOTs will not be eligible for the Acquisition Bonus. The Acquisition
Bonus shall be earned and paid pursuant to the terms of Exhibit A attached
hereto and incorporated herein for all purposes.
LETTER OF AGENCY
3. Letter of Agency. Subscriber hereby selects the Company as the local
services provider for those local telephone lines associated with this Agreement.
Subscriber has the authority to authorize the Company and the Company is
hereby authorized to act in the full capacity of a local services provider in terms
of providing all local exchange services, exchange access service, and moves,
adds, and changes as may be further directed. Subscriber shall complete and
execute a Service Order Request for new lines, a copy of which is attached
hereto as Exhibit D, to identify its election of presubscribed long distance carriers
with respect to any new lines installed pursuant to this Agreement. With respect
to any pre-existing lines converted to the Company for local exchange service
pursuant to this Agreement, Subscriber shall complete the Letter of Agency, a
copy of which is attached hereto as Exhibit C, to authorize the change in local
service provider to the Company, and, additionally and at Subscriber's discretion,
to select the Company as the intraLATA and/or interLATA presubscribed long
distance carrier for such lines. In the event Subscriber does not elect the
Company for their intraLATA presubscribed long-distance carrier and/or
interLATA presubscribed long-distance carrier, the Company will make no
change to the presubscribed long distance carriers identified by Subscriber's
previous local exchange carrier prior to conversion of local service. Such service
will include an automatic freeze or hold on any further requests to change
Subscriber's pre-subscribed long distance carrier(s) whereby no request for
change shall be processed except those required in writing and signed by the
authorized representative executing this Agreement. Subscriber understands
that each line can have only one local services provider. Subscriber represents
under penalty of law that it has authorized this assignment on behalf of the
account listed herein and that the contracted telephones are not subject to any
other contract.
TERMINATION AND CANCELLATION
4. Term. This Agreement shall commence on the Effective Date and shall
continue in full force and effect through December 31, 2009. Each Converted
Existing COCOT and each New COCOT shall be governed by this Agreement
from and after the Effective Date and shall carry the minimum term commitment
SA Page of 1d 10102008 Vcr4
elected by Subscriber on Exhibit B attached hereto. If Subscriber has elected the
"month to month" option, then all COCOTs shall carry a month to month term; if
Subscriber has elected the "December 31, 2009" option, then all Converted
Existing COCOTs shall carry a December, 2009 term and each New COCOT
shall carry a minimum term commitment equal to the number of months
remaining under the term of this Agreement as of billing commencement date
(i.e., until December 31, 2009). The Company may increase its rates for
Services at any time upon 30 days' written notice to Subscriber (the "Notice
Period"); provided, however, if, during the term of this Agreement, the Company
increases its monthly local access base rate for existing subscribed Services by
greater than 5% in excess of the rates outlined in Exhibit B, Subscriber may elect
to terminate the affected Services upon written notice to the Company within the
Notice Period with no penalty. If Subscriber terminates any subscribed Service at
any time for any reason other than for such an increase in the rates set forth
above, or if Subscriber otherwise terminates this Agreement (and with it, all
subscribed Services), then Subscriber will repay (i) any applicable prorated share
of any Acquisition Bonus received in accordance with this Agreement; and (ii)
any discount received by Subscriber during the term of this Agreement outlined
in Exhibit B. Notwithstanding anything to the contrary contained herein, the
Company has the right to cancel this Agreement (or any line) for any reason by
giving thirty (30) days written notice to Subscriber or upon twenty-four (24) hours
written notice in the event the Company determines that Subscriber is operating
in violation of federal, state or local laws or regulations, in a manner contrary to
the terms and conditions of this Agreement, or in a manner that jeopardizes the
quality of the Company's Services or network integrity.
PAYMENT
5, Payment. The Company will provide monthly invoices covering the next
month's basic Service and any charges incurred above the basic Service for the
prior month. Such invoices are due and payable upon receipt. Payment is
considered late if not received within twenty (20) days of invoice date. The
Company reserves the right to interrupt or disconnect service for non-payment of
charges not received within twenty (20) days. In the event Subscriber disputes
any current charges, the Subscriber agrees to pay all amounts not in dispute and
to notify the Company in writing of such dispute within twenty (20) days of the
invoice date. The Company will postpone the interruption or cancellation of such
service until such dispute is resolved to the Company's satisfaction.
TAXES AND BENEFITS
6. Taxes and Benefits. The Subscriber is not entitled to, and the Company
shall not make any deductions or withholding for, unemployment insurance,
health care insurance, workers' compensation, or any other benefits, nor shall
any withholding be made for federal, state or local taxes, including FICA. The
Subscriber shall apply for and obtain, in its own name, an Employer Identification
Number from the Internal Revenue Service, and the Subscriber shall be solely
SA Pagc3or14 10102008 Ver4
responsible for any and all applicable tax remittances. The Company shall report
all bonuses paid to Subscriber on a Form 1099.
DIAL AROUND COMPENSATION
7. Dial Around Compensation. The Company represents and warrants that it
will comply with telecommunications industry standards pertaining to the
timeliness and the submission of Subscriber's pay telephone automatic number
identification ("ani") to a data base for validation purposes. Subscriber agrees to
timely provide the Company with the names of Clearinghouses and entities, in
writing, that Subscriber is currently receiving its compensation for dial around
service.
INDEMNIFICATION
8. Indemnification. Each party (the "Indemnitor") hereby agrees to indemnify
the other party (the "Indemnitee"), from any and all liability, claims, causes of
action, damages, demands, losses, costs or expenses, caused in any manner
from the work performed hereunder by such party. If any action, suit or
proceeding shall be commenced against, or any claim or demand be asserted
against the Indemnitee with respect of which the Indemnitee proposes to demand
indemnification, the Indemnitor will, within 30 days after receipt of demand for
indemnification from the Indemnitee, have the right to assume, at the
Indemnitor's own expense, the entire control of the defense, compromise or
settlement thereof, including the right of the selection of legal counsel, subject to
the Indemnitee's right to participate and, to the extent the Indemnitee wishes, to
direct the defense at the Indemnitee's expense and with counsel of the
Indemnitee's choice. In connection there with, each party shall cooperate fully in
all respects with the other in any such defense, compromise or settlement,
including, without limitation, making available to the party conducting the defense
all pertinent information under the other party's control. The Indemnitor shall not
settle any such claim without the prior written consent of the Indemnitee, unless
the settlement only provides for the payment of monetary amounts and the
Indemnitor has evidenced its ability to pay same to the reasonable satisfaction of
the Indemnitee, which may include depositing such monies into escrow to fund
the settlement.
SUBSCRIBER'S ACKNOWLEDGMENTS AND REPRESENTATIONS
9. Subscriber's Acknowledgments and Representations. Subscriber
represents and warrants that Subscriber is free to enter into this Agreement and
to perform each of the terms and covenants of it. Subscriber represents and
warrants that neither Subscriber nor its employees are restricted or prohibited,
contractually or otherwise, from entering into and performing this Agreement, and
that Subscriber's execution and performance of this Agreement is not a violation
or breach of any other agreement between Subscriber and any other person or
entity.
5A Pa8c4on4 10102008 Ver4
GOVERNING LAW AND REGULATORY REQUIREMENTS
10.Governing Law And Regulatory Requirements. Subscriber shall comply
with laws, rules, regulations, and tariffs affecting the Subscriber's obligations in
conjunction with the provision of the Company's Services. The Company's
tariffs, as amended, are incorporated herein by reference the same as if set forth
herein in their entirety. All disputes between the parties, except for non-payment
of invoices from the Company, shall be submitted to binding arbitration. The
laws of the State of Florida shall apply for conflicts of law purposes, and this
Agreement shall be deemed performable in Delray Beach, Palm Beach County,
Florida. Venue for Arbitration and any disputes arising under the Agreement
shall be in Palm Beach County, Florida. In the event that regulatory or legal
requirements are in any manner inconsistent with or require modification to the
terms of this Agreement subsequent to the date of execution hereof, no written
amendment or variation executed by both parties shall be necessary. Rather,
any such amendment or variation shall be effective upon mailing of written notice
by the Company via first-class, postage-prepaid mail or telephone facsimile
transmission of written notice to Subscriber. The invalidity or enforceability of
any provision of this Agreement shall not affect the validity or enforceability of
any other provisions hereof.
MISCELLANEOUS PROVISIONS
11. Miscellaneous Provisions
a. Assignment. Subscriber may not assign its rights and obligations
under this Agreement without the prior written consent of the
Company, which will not be unreasonably withheld.
b. Notice. Notice shall be deemed to have been received five (5)
business days after mailing, if sent via U.S. mail, upon electronic
confirmation of receipt, if sent via fax, or one (1) business day
following delivery to a recognized overnight courier, for next-day
delivery, if sent via overnight courier, in each case correctly
addressed hereunder. Notice should be sent to Subscriber and the
Company at the addresses listed in this Agreement, or such other
addresses as either party shall designate in writing to the other
party.
c. Attorney's Fees. If any legal action is brought by either of the
parties hereto, it is expressly agreed that the prevailing party shall
be entitled to recover from the other party reasonable attorney's
fees, in addition to any other relief as may be awarded.
d. Liability of Company. The Company shall not be liable for loss or
damage sustained by reason of delay or interruption in the Service,
whatever the reason for such delay or interruption. The Company
SA Page 5 of 14 10102008 Ver 4
shall not be liable for any act or omission of any entity furnishing
facilities or services in conjunction with the Company's Services.
e. Confidentiality. The terms and conditions of this Agreement, either
discussed before or after the execution of this Agreement, are
hereby deemed to be "Confidential Information". Neither the
Company nor the Subscriber will disclose the other party's
Confidential Information to any third party excepted as may by
required by applicable law, or as a part of a bona fide legal
proceeding.
f. Modification and Waiver. This Agreement may be modified, waived
or amended only by written instrument signed by the party against
which enforcement thereof is sought, shall be binding upon the
parties' respective successors and assigns, and constitutes the
entire agreement between Company and Subscriber with respect to
the subject matter hereof. This Agreement supersedes all oral
agreements.
IN WITNESS HEREOF, the Company and the Subscriber have executed
this Agreement as of the Effective Date and the individuals signing below warrant
that they have authority to sign for and on behalf of the respective parties.
Company Subscriber
rr
Sigrl;ature Signature
!\ ,/ Crr�d:+,•?(,Cc k�/(ccc.Tu!� David H. Ready, City Mana5er
Name / Title (please print) Name /Title (please print)
ATTEST
By: Not to Exceed:$ 000
,lames Thompson �
City Clerk
AFFROVED AS TO FORM:
By
City Attprney
Date: Pn2c6of14 10102008 Vero
shall not be liable for any act or omission of any entity furnishing
facilities or services in conjunction with the Company's Services.
6. Confidentiality. The terms and conditions of this Agreement, either
discussed before or after the execution of this Agreement, are
hereby deemed to be "Confidential Information". Neither the
Company nor the Subscriber will disclose the other party's
Confidential Information to any third party excepted as may by
required by applicable law, or as a part of a bona fide legal
proceeding.
f. Modification and Waiver. This Agreement may be modified, waived
or amended only by written instrument signed by the party against
which enforcement thereof is sought, shall be binding upon the
parties' respective successors and assigns, and constitutes the
entire agreement between Company and Subscriber with respect to
the subject matter hereof. This Agreement supersedes all oral
agreements.
IN WITNESS HEREOF, the Company and the Subscriber have executed
this Agreement as of the Effective Date and the individuals signing below warrant
that they have authority to sign for and on behalf of the respective parties.
Company Subscriber
Sig tune Signature
RA U`,,6A&0 0 1 PC[ oz David H. Ready. ULty-Xa_n_aUr
Name/Title (please print) Name/Title (please print)
- ATTEST
4 - '�y�'^ Not to Exceed:$ ��� 0�
James Thompson '
City Clerk
APPROVED BY CITY MANAGER
APPR s To
City Ad:tbrnc
,Dat f•z$ 6x1a iorozoosv�a
Exhibit A
Acquisition Bonus
a. For each New COCOT pay telephone line converted to or installed
on the Company's network from and after the Effective Date which carries a
minimum term commitment hereunder of greater than one (1) month ("Qualifying
Lines"), the Subscriber shall earn and the Company shall pay an Acquisition
Bonus of up to Fifteen Dollars ($15.00), to be pro-rated as set forth below.
b. The Acquisition Bonus shall be credited against amounts owed to
the Company by Subscriber as stated on the first billing invoice after installation
or conversion of the Qualifying Line.
C. The Company reserves the right to change any of its
telecommunications services, including, without limitation, changes in rates and
discounts offered to Subscribers.
d. Payment of the Acquisition Bonus earned hereunder constitutes the
Company's entire obligation for payments to Subscriber under the Agreement.
Subscriber is solely responsible for all costs and expenses incurred by
Subscriber and its agents, employees and Subscribers in connection with
Subscriber's performance.
e. Subscriber acknowledges that it may have an obligation to return a
portion of any Acquisition Bonus earned hereunder pursuant to the terms of the
Agreement.
g. The exact amount of the Acquisition Bonus owed for a Qualified
Line hereunder shall be determined by the following formula-
$0.83 X No. of Whole Months Remaining in Qualified Line's term commitment
Acquisition Bonus.
m
NOL To Exceed $
Without The Express Written
Authorization of The Cit;l,
Manager.
LSA 6 0f 14 1012009 Ver 4
Exhibit B
1. Rates and Charges
Intrastate Interstate DA- DA-
zone 1 zone 2 zones 3/4 LD LD LD Local Install
CA-SBC 534.49 534.49 $34.49 $0.03 $0.04 $1.50 $1.50 $15.00
CA-Telepacific (SBC territory) $25.99 $25.99 $25 99 $0.03 $0,04 $1.50 $1.50 $15,00
CA-VZ GTE territory $27.53 $27.53 $27 53 $0.03 $0,04 $1.50 $1.50 $120,00
CA-VZ Conte[territory $48.88 $48.88 $48.88 $0.03 $0,04 $1.50 $1.50 $120,00
TX-SBC $ 37,99 $ 37.99 $ 37.99 50.07 50.07 $1.50 51.50 $15.00
OK-SBC $ 31.99 $ 31,99 $ 33,99 $0.07 50.07 $1.50 $1.50 515.00
AR-SBC 5 38,96 $ 3896 S 3896 s0 11 $0.05 $1.50 51.50 $15.00
FL-Bellsouth S 29.95 S 31.95 $ 39.95 50.07 50.04 $1.50 $1.50 $70.00
FL-VZ $ 36.99 S 44.99 S 63.99 $0,07 50.04 51.50 $1.50 $30.00
GA-Bellsouth $ 31.99 $ 33.99 $ 33.99 $0.07 $0.04 $1,50 $1.50 $70.00
SC-Bellsouth $ 32.49 S 36.99 $ 40.99 $0.10 $0.04 $1,50 $1.50 $70.00
NC-Bellsouth S 31.99 S 38.99 S 42.99 $0.14 $0.04 $1.50 $1,50 $70,00
KY-Bellsouth $ 27.99 $ 33.99 $ 39.99 $0,09 $0.04 51.50 $1.50 570.00
AL-Bellsouth $ 26.99 $ 30.99 $ 30,99 $0,07 $0,04 51.50 51.50 $70.00
LA-Bellsouth S 29.99 $ 41.99 $ 68.99 $0.07 $0,04 $1.50 51.50 $70,00
MS-Bellsouth $ 29.99 $ 32.99 S 32.99 $0.06 $0.04 51.50 51.50 570.00
MA-Verizon North S 24,99 $ 2899 5 38.99 50.06 50.04 $1.50 $1.50 $25-$100
NJ-Verizon North 5 21,99 5 2499 $ 28.99 50.06 $0.04 $1.50 $1.50 $25-$100
NY-Verizon North S 21.99 $ 24.99 $ 28.99 $0.06 $0,04 $1.50 $1.50 $25-$100
PA-Verizon North (BA) 5 24.99 $ 24,99 $ 28.99 $0.06 $0.04 $1,50 $1,50 525-$100
PA-Verizon (GTE) S 29,99 S 35.99 $ 48.99 $0.06 $0.04 $1,50 $1,50 $25-5100
VA-Verizon North (BA) S 23.99 $ 20.99 $ 43.99 $0,10 $0.04 $1,50 $1,50 525-$100
VA-Verizon North (GTE) S 31,99 S 34.99 $ 42.99 $0.10 $0.04 51.50 $1,50 525-$100
WV-Verizon North S 32.99 S 40.99 S 53.49 $0.10 $0.04 $1,50 $1,50 525-$100
MD-Verizon North ' $ 21.99 S 33.99 S 25.99 $0.10 $0.04 $1,50 $1.50 S25-$100
DC-Verizon North $ 23.99 $ 23.99 S 23.99 $0.10 $0,04 $1,50 $1,50 5254100
TX-Verizon $ 32,99 S 57.99 $ 105.99 $0.10 $0,04 51.50 $1,50 S25-S100
'Column 1 (Urban)includes both Zones 1&2 columns 2(Suburban)and 3(Rural)are Zones 3&4 respectively
Conversion $15.00
Rates include:
(a) LATA-wide one plus calling,
(b) EUCL,
(c) Long distance services billed in six second increments;
(d) Virtually Unlimited Local Directory Assistance
(10 calls per phone per month are included)
LSA 90114 1012008 Vcr4
2.Term Discount(if any) (Initial only one term: election governs all COCOTs in
service under this Agreement)
Initial Month to Month IND Discount
or-
�i Initial through 12/31/09
Term and Volume Discount Schedule
no. of lines.hilled permonth
State 0-249 250-499 500-999 1000+
AL $ 1.00 $ 1.25 $ 2.00 $ 2,00
AR $ 2.25 $ 225 $ 2.25 $ 2.50
CA $ 2.75 $ 2.75 $ 2.75 S 2.75
DC $ 1.00 $ 1,25 $ 1.50 $ 1.50
FL $ 1.00 $ 125 $ 2.00 $ 200
GA $ 1.00 $ 125 $ 2.00 $ 2.00
KY $ 1,00 $ 1.25 $ 2,00 $ 2,00
LA $ 1.00 $ 1.25 $ 2.00 $ 2.00
MA $ 1.00 $ 125 $ 1.50 $ 1.50
MD $ 1.00 $ 1.25 $ 1.50 $ 1.50
MS $ 1.00 $ 125 $ 2.00 $ 2,00
NC $ 1.00 S 1.25 $ 2.00 $ 2.00`
NJ $ 1,00 $ 1,25 $ 1,50 $ 1,50
NY $ 1.00 $ 1.25 $ 1.50 S 1.50
OK $ 2.25 $ 2,25 $ 2,25 $ 2.50
PA $ 1.00 $ 125 $ 1.50 $ 1.50
SC S 1.00 $ 1.25 $ 2.00 $ 2.00
TX $ 225 $ 2,25 $ 2.25 $ 2,50
VA $ 1.00 $ 1.25 $ 1.50 $ 1.50
WV $ 100 $ 125 $ 1.50 $ 1.50
3. Regulatory Charges
In addition to above monthly charges, the Company shall charge, and Subscriber
shall pay, any and all charges imposed by any state and federal agencies.
4.Adds, Moves, etc.
All services provided by the Company to Subscriber, including local dial tone
service, long distance service and non-recurring charges associated with moves, adds or
changes, shall be billed at the Company's then current Company rates as filed with the
governing regulatory authority.Any service call requested by Subscriber whereby there is
"no trouble found" or "no access" will be billed by the Company to Subscriber at the
prevailing rates.
LSA 10 of 14 1012008 Ver d
w
Exhibit C
LETTER OF AGENCY TO CONVERT EXISTING LINES
For Local and/or Lore„Distance Service
Billing Name(a g.John H Smith,Jr.)
Billing Address (e g 111 SW Main St Rd Ave Or o .0 Box Physical Address
Billing Address#2(e g t\Idg,#) Physical Address#2
City State Zip City State Zip County
1 )
Name of individual authorized to act for stonier Relation to Customer Fax Number
Daytime Phone number of individual authorized act for Customer Email Address
By signing below, I am authorizing the Cleerlel Telecom nications, Inc. and NII Communications, Ltd.to become my
new telephone service provider for the provision of the folio ing telecommunications services for the telephone Imes
listed below and/or attached to this document:
Local exchange service(to replace )
'intraLATA intrastate and intraLATA interstate long Lance service(to replace )
(this option must be chosen m order to receive the intratAT ate plan set forth in Exhibit B to the Agreement)
interLATA intrastate and interLATA interstate long distan service(to replace J
Leave intraLATA PIC at and/or interLATA PI t
I authorize Cleartel Telecommunications,Inc.and Nil Communications,Ltd.to act my agent to make this change
happen and direct my current provider(s) to work with the new provider designated ove to effect the change I
understand that I will be charged a conversion fee to switch providers If 1 later wish to re to my current telephone
company, I may be required to pay a reconnection charge to that company 1 also undorsta that my new telephone
company may have different calling areas, rates, and charges than my current telephone cc any(companies), and
that by signing below 1 indicate that I understand those differences(if any)and am willing to be bill accordingly
Telephone numbers to be converted:
Initial here if you are incorporating by attachment additional telephone numbers to be converted by this document.
I certify that I have read and understand this Letter of Agency. I further certify,that I am at least eighteen years fag e
and I am authorized to change telephone companies for services to the telephone numbers listed above d/or
incorporated by attachment.
Print Name. Title:
Signed: ante
LSA 11 01,14 1012008 Ver4
Exhibit D
PAYPHONE NEW LINE INSTALL REQUEST FORM
For Local Service
`Agent Cade: �r7�� ojC Sales Code:
*Company Name: �a/vn S�lmys *BTN:
*Contact Name: "Contact9: 760 32-z_k3Y6
Contact Email Address: Za td,, - epll 6--PeaIr44er/ ?GY- C6-.-cLay
Requested Due Date: AIZA' (ex: 03101106)
Must allow at least 10 working days, Mon-Fri
C�ttiy�yl�rc�tn �ew4er' 7&G— L4 SqS;—:,
*Location Name: *Working or Nearby#to Location
2- 77 N Cabal/-era-5
*installation Address,(Physical Address)
P 1m rr�� OA qZzb2'
'City `State *Zip
Please indicate the following:
1. *Number of Lines: 1 �7
2. *Choice of Long Distance Providers PIC N i l L-Or7l M u n 1 c,d t oA S
3. Payphone line instructions: (example: parking lot entrance, north side of
building, left payphone) r
OF CurYerr-1 L,113rkitt9 +Q,4 ?otigefj ,-(- Pliny
FAX THE COMPLETED FORM TO 1-866-495-7052 OR EMAIL
PA YPHONESOCLEARTEL.COM. All fields that have an asterisk are required
and the order will be rejected if they are not populated. This service order form
and subscribed services are subject to the terms and conditions set forth in that
certain Local Service Agreement for payphone services between the parties.
It you have any questions, please contact Customer Service @/I 1-866-660-5994
Print Name: VV4 .016 h Title: ?GC'� tn' L .
Customer Signature: 2,4 Date:
LSA 13of14 1012008 Vero
k
Exhibit D
PAYPHONE NEW LINE INSTALL REQUEST FORM
For Local Service
*Agent Code: nr� of Sales Code:
'Company Name: ���'"1 S�/rny� `BTN:
"Contact Name: 6Canc1v e4 L' -Contact#.
Contact Email Address: ccrtd ��6h � u/m rin S— cc� . av
Requested Due Date: As4io (ex: 03101106)
Must allow at least 10 working days, Mon-Fri
/a�fn _5�alcan 7(0- 32-3- 0qL(9
`Location Name: "Working or Nearby#to Location
�oQ pct/m s Aa4
*Installation Address:(Physical Address)
I l i �if{ GJZZ6�
'City 'State `,Zip
Please indicate the following.
1. *Number of Lines:
2. "Choice of Long Distance Provider PIC _Nll L"om.hunlero�s
3_ Payphone line instructions. (example: parking lot entrance, north side of
building, left payphone)
FAX THE COMPLETED FORM TO 1-866-495-7052 OR EMAIL
PAYPHONES(t7CLEARTEL.COM. All fields that have an asterisk are required
and the order will be rejected if they are not populated. This service order form
and subscribed services are subject to the terms and conditions.set forth in that
certain Local Service Agreement for payphone services between the parties.
If you have any questions, please contact Customer Service @ 1-866-660-5994
Print Name: k1()Jk1C 10 (& Title:__ 7�_;4ft4y� &&Ac(
Customer Signature: Date:
LSA 13 of 14 1012009 Ver 4
k
Exhibit D
PAYPHONE NEW LINE INSTALL REQUEST FORM
For Local Service
*Agent Code: nr Qf Sales Code:
*Company Name: Al ' 5OPrfnS3 *BTN:
'Contact Name:_ 410(4 �t56L "Contact#: 790,3 z z^ P3 f 1,
Contact Email Address:_jec(Ady - etl�Lco_ ealm4erlrngy- cc_ gbv
,t
Requested Due Date: f-f Sf1P (ex: 03101106)
Must allow at least 10 working days, Mon-Fri
e%, +d Lasatsue.lax 766_ 3z0- NS'7. .'3zz-3r07
*Location Name: �/*Working or Nearby#to Location
&rner �� Tdckm C_6ctrtY6Yi y�renaS_,.,
*installation Address:(Physical Address)
AM a� G�� �lzz�2-
"City *State *Zip
Please indicate the following:
1. 'NumberofLines: -2
2. 'Choice of Long Distance Provider., PIC A111 CornM n e04rons
3_ Payphone line instructions: (example: parking lot entrance, north side of
building, left payphone)
FAX THE COMPLETED FORM TO 1-866-495-7052 OR EMAIL
PAYPHONES(DCLEARTEL.COM. All fields that have an asterisk are required
and the order will be rejected if they are not populated_ This service order form
and subscribed services are subject to the terms and conditions set forth in that
certain Local Service Agreement for payphone services between the parties.
If you have any questions, please contact Customer Service @ 1-866-660-5994
Print Name: le V Title: _&Cpk_"_ t 'aotrQ
Customer Signature: Date: T (l�l�r z�
LSA 13 of 14 1012008 Ver 4
'c
Exhibit D
PAYPHONE NEW LINE INSTALL REQUEST FORM
For Local Service
*Agent Code: L'r7� Uf Sales Code:
*Company Name: �aAm S��my3 *BTN:
*Contact Name: 4a"at� . e,56L *Contact tf: 7,60 32-2- k3 Y 6
Contact Email Address, `�a"d,y . ��6hC��a/m�prl�9S c° •?av
Requested Due Date: ASA-0 (ex: 03/01/06)
Must allow at least 10 working days, Mon-Fri
42u( �60-3�3 - quBG t3�3-O/4�3
'Location Name: *Working or Nearby#to Location
.3t-� Al Az(m 6 Lon
*installation Address:(Physical Address)
?/"V,I5 errnas YA
*City *state *Zip
Please indicate the following:
1. *Number of Lines: a2
2. *Choice of Long Distance Provider. PIC Nl l �'ori M u n Irons
3, Payphone line instructions: (example: parking lot entrance, north side of
building, left payphone)
p P fn{a Ocivi� e d� otic�w
FAX THE COMPLETED FORM TO 1-866-495-7052 OR EMAIL
PAYPHONES[a)..CLEARTEL.COM. All fields that have an asterisk are required
and the order will be rejected if they are not populated. This service order form
and subscribed services are subject to the terms and conditions set forth in that
certain Local Service Agreement for payphone services between the parties.
It you have any questions, please contact Customer Service @ 1-866-660-5994
Print Name: �[crtio�i �a�h Title.r&AQ� C' Vluc .
Customer Signature: L Date: t 0 l0�
LSA 13 of 14 1012008 V er 4
Exhibit D
PAYPHONE NEW LINE INSTALL. REQUEST FORM
For Local Service
'Agent Code: `jr�y>, aT Sales Code:
`Company Name: Alf S5f f4.33 *BTN:
'Contact Name: 'Contact#: 7�60 322" k3 F 6
Contact Email Address:-_�CAdz - (!z1"6 04alm4erin s'- C6--_5 av
Requested Due Date_ A-s,{P (ex. 03101106)
Must
allow at least 10.M1working days, Mon-Fri
f f�il'r ti� Y Ite Loq 7ZC_ 711,E -C), ss
`Location Name: *Working or Nearby#to Location
'Installation Address:(Physical Address)
P41rn r,';,s� 9-Zz 6 Z'
`City `State - "Zip
Please indicate the following:
1. *Number of Lines: 2 �r
2. "Choice of Long Distance Provider, PICAjl Lortn-mun.eArows
3. Payphone line instructions: (example: parking lot entrance, north side of
building, left payphone)
FAX THE COMPLETED FORM TO 1-866-495-7052 OR EMAIL
PAYPHONES CLEARTEL.COM- All fields that have an asterisk are required
and the order will be rejected if they are not populated. This service order form
and subscribed services are subject to the terms and conditions set forth in that
certain Local Service Agreement for payphone services between the parties.
If you have any questions, please contact Customer Service @ 1-866-660-6994
Print Name: — jecjv a-c" Title:5�6n_� �4cQ
Customer Signature: � Date: l�/��o�
LSA 13 of 14 1012008 VeT 4
Exhibit O
PAYPHONE NEW LINE INSTALL REQUEST FORM
For Local Service
Agent Code: nr of Sales Code:
*Company Name: �/a� *BTN:
*Contact Name: Andy C ,51aL "Contact#: 76p 32z �3Y6
Contact Email Address: eltndz . enloh0 4c,/r,4 rin S—ea, av
Requested Due Date: As,4io (ex. 03/01/06)
Must allow at least 10 working days, Mon-Fri 3 ZS- S17V
C/ 43ys
3z?- g
76a- 7d--- 3z7- r2��
*Location Name: 'Working or Nearby#to Location qt b •- 76�S-
3 yop C. �al ui Fz Can p� Lit h-9v
Ib- 6?9�
*Installation Address.(Physical Address)
Gd�m S rrn91 9ZZ62-
3 i F-37D�f
*City *state Zip 3Zx �(p6 R
3.2 qa��
Please indicate the following: I G - 76s S
1. *Number of Lines: —1 '7 _ r{i 6-to 75
2. *Choice of Long Distance Provider PIC // C'orh M u n cajro�s Yrh`7675"
3. Payphone line instructions: (example_ parking lot entrance, north side of r116� 7q {'
building, left payphone)
/7 v ea
FAX THE COMPLETED FORM TO 1-866-495-7052 OR EMAIL
PAYPHONEScJCLEARTELLCOM. All fields that have an asterisk are required
and the order will be rejected if they are not populated. This service order form
and subscribed services are subject to the terms and conditions set forth in that
certain Local Service Agreement for payphone services between the parties.
If you have any questions, please contact Customer Service @ 1-866-660-5994
Print Name: r(a eLdv Title: L C
Customer Signature: !�C � C Date: r t / d fr
LSA 13 of 14 1012008 Ver 4
t
Exhibit D-'I
LONG DISTANCE PRESt1BSCRIPTION REQUEST FOR NEW LINE INSTALLS
I hereby direct my local service provider to program my Presubscribed Interexchange
Carrier(PIC) as follows for those lines attached to this Service Order
INTRALATA
NII Communications, Ltd. and Cleartel Telecommunications, Inc.—
services billed in 6 second increments at $0.000 per minute for
intraLATA intrastate calls, and $0,000 per minute for intraLATA
interstate calls, or as may otherwise become effective in the
Company's tariffs from time to time. You must select this option to
receive these rates for intraLATA from,Nll Communications, Ltd. and
Cleartel Telecommunications, Inc.
OR
❑ Please enter the Carrier Identification Code ("GIG") of your preferred
intraLATA long distance carrier above. You are solely responsible
for establishing a service and billing relationship directly with this
carrier. You will not receive NII Communications, Ltd. and Cleartel
Telecommunications, Inc. rates if you select this option.
INTERLATA
NII Communications, Ltd. and Cleartel Telecommunications, Inc. —
services billed in 6 second increments in accordance with Exhibit B
for interLATA intrastate calls, and interLATA interstate calls, or as
may otherwise become effective in the Company's tariffs from time
to time.
OR
Please enter the Carrier Identification Code ("CIC") of your preferred
❑ interLATA long distance carrier above. You are solely responsible
for establishing a service and billing relationship directly with this
carrier.
OR
NONE(No PIC) on the InterLATA Long Distance.
Subscriber Signalure Company Name
Subscriber Name(printed) Billing Telephone Number
Date Commission Code
LSA 14 of 14 1012008 Ver 4