Infrastructure Grant

(% of total project cost)

Broadband Infrastructure Revolving Loan Account

(% of total project cost

Applicant(s) Funds

(% of total project cost

A. With Loan

     

Unserved Areas

70%

20%

10%

Underserved areas

60%

20%

20%

B. Without Loan

     

Unserved Areas

70%

0%

30%

Underserved areas

60%

0%

40%

ESTIMATED TIMELINE FOR SUBMISSION AND EVALUATION

 

 

 

Start date

# of days

Description

 

 

 

For Unserved and Underserved Areas

 

 

Day 1

 

Deadline to submit funding requests

Day 7

7 days after submission of applications

Areas applied for, by Applicant Name, CBG's and shapefile, will be posted on the Commission's CASF website

Day 22

14 days after web posting of CBGS, zip codes and maps

Deadline for submitting letter challenges

Day 40

40 days from receipt of application

Evaluation of proposals without challenges 25

Day 42

42 days from receipt of application

CD responds to funding requests without challenges (through letter to applicant informing the applicant that application has been evaluated and that the project qualifies for CASF funding; however, Final Approval will be by Commission resolution)

Day 64

42 days after submission of letter challenges

CD responds to funding requests with challenges (through letter to applicant informing the applicant that application has been evaluated and that the project qualifies for CASF funding; however, Final Approval will be by Commission resolution)

Day 84 or earliest Commission date after 84 days

84 days from date of submission of application

Resolution(s) adopted by Commission approving funding application(s) without challenges

Day 106 or earliest Commission date after 106 days

106 days from submission of application

Resolution(s) adopted by Commission approving funding application(s) with challenges

1 Application of:

Name of Applicant

 
 

for CASF Funding pursuant to Decision_____

 

(Insert the full legal name of applicant in blank above; see instruction 1; attach fictitious names, if any)

Street address:

 
 
 

Telephone: ( ) Fax No.: ( ) E-Mail:

2 Applicant is:

A corporation (attach good standing certificate)

·

(Check only one;

A general partnership (attach good standing certificate)

·

see instruction 2.)

A limited liability partnership (attach good standing certificate)

·

 

A limited liability company (attach good standing certificate)

·

 

A general partnership

·

 

A sole proprietor

·

 

A trust

·

 

Other (describe)

·

 

Attach name, street address, and telephone number of applicant's registered agent for service of process

 
 

Attach list of the names, titles, and street addresses of all officers and directors, general partners, trustees, members, or other persons authorized to conduct the business of applicant at a similar level

 
 

Attach list of all affiliated entities (see instruction 2)

 

3 Legal domicile

California

·

of applicant is:

Other (identify):

·

(Check only one; see instruction 3.)

 

4 Applicant will provide service:

In specific portions only (attach description and map)

·

(Check only one; see instruction 5.)

 

5. Applicant will

True

·

provide: broadband service only

Not true

·

(Check only one; see instruction 6.)

 

6. For the past 10 years, no affiliate,

True

·

officer, director, general partner, or

Not true

·

person owning more than 10% of applicant, or anyone acting in such a capacity whether or not formally appointed, held one of these positions with any company that filed for bankruptcy or has been found either criminally or civilly liable by a court of appropriate jurisdiction for a violation of § 17000 et seq. of the California Business and Professions Code or for any actions which involved misrepresentations to consumers, and to the best of applicant's knowledge, is not currently under investigation for similar violations.

 

(Check only one; see instruction 2.)

 

7. To the best of applicant's knowledge, neither

True

Not true

·

·

applicant, any affiliate, officer, director, partner, nor owner of more than 10% of applicant, or any person acting in such capacity whether or not formally appointed, has been sanctioned by the Federal Communications Commission, or any state regulatory agency for failure to comply with any regulatory statute, rule or order, or convicted by any court for any criminal activity for the past 10 years.

 

8. Applicant has

True

·

the required financial capability and technical

Not true

·

expertise to build a broadband infrastructure and operate and maintain a broadband service.

 

 

Name:

 
 

Title:

 
 

Dated:

 

Street

 

Address

 
   

Telephone No.

 

Fax No.

 

 

1. Project Summary

 

2. Type of Funds Requested (Check one only):

   

Grant

   

Grant Amount: _________

   

Grant/Loan Combination

   

Grant Amount: _________

   

Loan Amount: _________

 

3. Area Applied for

   

Unserved

   

Underserved, with existing broadband service below advertised speed of 6 mbps download and 1.5 mbps upload, Broadband infrastructure whether existing or ongoing construction not CASF funded

   

Underserved, with existing broadband service below advertised speed of 6 mbps download and 1.5 mbps upload, Broadband infrastructure whether existing or ongoing construction CASF funded

 

4. CPCN / U-Number / CPUC Registration Proof (As a single document)

   

Applicant's U-Number and/or Proof of applicant's Certificate of Public Convenience and Necessity (CPCN)

   

Proof of CPCN application pending approval, or CPCN Application Number (in the absence of a CPCN)

   

CPUC registration Number (wireless carriers)

 

5. Information Sheet with a Certificate of Good Standing issued by the CA Secretary of State attached

 

6. Organizational Chart, Company History and Readiness to Build, Manage and Operate Broadband

   

Organizational Chart

   

Company History

   

Readiness to Build, Manage and Operate Broadband

 

7. CASF Key Contact Information

   

First Name

   

Last Name

   

Address Line1

   

Address Line2

   

City

   

State

   

Zip

   

Email

   

Phone

 

8. Key Company Officers (list up to 5)

   

Title

   

First Name

   

Last Name

   

Email

   

Phone Number

   

Resumes of key officers and management personnel

 

9. Current Broadband Infrastructure Description

   

Description of the provider's current broadband infrastructure within 5 miles of the proposed project, if applicable.

   

List showing number of households per CBG and Zip Code

 

10. Current Broadband Infrastructure

   

Shapefile (.shp) of current service area.

 

11. Proposed Broadband Project Description

   

Description of proposed broadband project plan for which CASF funding is being requested, including the type of technology to be deployed

   

Project size (in square miles)

   

Download speed capabilities of proposed facilities

   

Upload speed capabilities of proposed facilities

 

12. Proposed Broadband Project Location

   

Geographic locations by CBG(s) where broadband facilities will be deployed:

   

List of CBG(s) and,

   

ZIP Codes that intersect the proposed project.

 

13. Proposed Broadband Project Location Shapefile

   

Shapefile (.shp) showing boundaries of the specific area to be served by the project.

 

14. Assertion that area being proposed is Unserved or Underserved Area. This includes figures, in mbps, of the current:

   

(a) average download speed by CBG(s);

   

(b) average download speed by ZIP Code(s);

   

(c) average upload speed by CBG(s) and;

   

(d) average upload speed by ZIP Code(s).

 

15. Estimated Potential Subscriber Size

   

Estimated number of potential broadband households in proposed project location.

   

Estimated number of potential broadband subscribers in proposed project location.

   

Documentation of assumptions and data sources used to compile estimates.

   

Adoption Plan

 

16. Deployment Schedule

   

Milestone Start and Ending Date

   

Milestone Description

   

Milestone Comments

   

Milestone Risks

 

17. Proposed Project Budget

   

a detailed breakdown of cost elements;

   

the source of cost elements;

   

amount of cost elements;

   

availability of matching funds to be supplied by applicant; and

   

the CASF funds requested.

 

18. Economic Life of Assets to be Funded

 

19. Local Government and Community Support (optional)

 

20. Performance Bond Documentation (to be submitted after project award)

 

21. Proposed Pricing

   

Proposed recurring retail price per MBPS for applicant's proposed broadband service(s).

   

Initial service connection charges, if any and any bundling of equipment in the proposed pricing.

   

Other recurring costs

   

Other non-recurring costs

 

22. Price Commitment Period

 

23. Financials

 

a) CPA Audited / Attested Financial Statements for the last three years

(if applicant has been in existence for less than three years, provide financial statements for as long as applicant has been in existence, e.g. one or two years)

   

Balance Sheet

   

Income Statement

   

Statement of Cash Flows

 

b) Pro Forma Financial Forecast over 5 years

   

Balance Sheet

   

Income Statement

   

Statement of Cash Flows

 

c) Annual EBIT (Earnings Before Income and Tax) projection over 5 years

 

d) Schedule of all outstanding and planned debt

 

e) Collateral Documentation (include depreciation schedule of assets

 

f) Equity Requirement of 20% of the loan amount (For Grant / Loan Combination only) Equity requirement of 20% should be sustained throughout the life of the loan: 5 years

 

g) Minimum TIER Requirement of 1.5 (For Grant / Loan Combination only)

The Minimum TIER Requirement of 1.5 should be sustained throughout the life term of the loan: 5 years

 

24. Proof of Voice Service

   

Availability of basic voice service that meets FCC standards for E-911 service and battery, including:

   

Listing of types of services offered;

   

Timeframe of offering.

 

25. CEQA Compliance

   

Proponent's Environmental Assessment (PEA)

 

26. Notarized Affidavit

18 Wireless broadband means a wireless high-speed internet access or connection provided to households, businesses and/or anchor institutions that meet the speeds and program guidelines set forth in this decision. Wireless broadband can be mobile or fixed.

19 a) Total Project Cost x 20% equals amount of facility improvements benefiting both Unserved and Served areas: ($2,500,000 x 0.20 = $500,000),

20 D.07-12-054, Ordering Paragraph 16, pp. 62-63

21 Communications Division will provide instructions on how to sign up for this distribution list to parties in the CASF rulemaking proceeding (R.10-12-008) and post these instructions on the Commission website as soon as practicable.

22 This file format is compatible with ArcGIS software used by the Commission.

23 A CASF award includes both a grant and loan amounts.

24 As referenced in section V, each "broadband project" is defined as deployment encompassing a single contiguous group of Census Block Groups (CBGs).

25 The evaluation period may be longer for applicants applying for a loan as the evaluation will include financial eligibility review which may be performed by an external government financial institution.

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