ADTRAN NetVanta 900 Series Hardware Installation Manual page 5

NetVanta 950 IAD
Affidavit for Connection of Customer Premises Equipment
For the work to be performed in the certified territory of ___________________ (telco name)
State of ________________
County of ________________
I, _______________________ (name), ____________________________________ (business address),
____________________ (telephone number) being duly sworn, state:
I have responsibility for the operation and maintenance of the terminal equipment to be connected to 1.544 Mbps and/or
________ subrate digital services. The terminal equipment to be connected complies with Part 68 of the FCC rules except
for the encoded analog content and billing protection specifications. With respect to encoded analog content and billing
protection:
( ) I attest that all operations associated with the establishment, maintenance, and adjustment of the digital CPE with respect to
analog content and encoded billing protection information continuously complies with Part 68 of the FCC Rules and
Regulations.
( ) The digital CPE does not transmit digital signals containing encoded analog content or billing information which is intended
to be decoded within the telecommunications network.
( ) The encoded analog content and billing protection is factory set and is not under the control of the customer.
I attest that the operator(s)/maintainer(s) of the digital CPE responsible for the establishment, maintenance, and
adjustment of the encoded analog content and billing information has (have) been trained to perform these functions by
successfully having completed one of the following (check appropriate statements):
( ) A. A training course provided by the manufacturer/grantee of the equipment used to encode analog signals; or
( ) B. A training course provided by the customer or authorized representative, using training materials and instructions
provided by the manufacturer/grantee of the equipment used to encode analog signals; or
( ) C. An independent training course (e.g., trade school or technical institution) recognized by the manufacturer/grantee of the
equipment used to encode analog signals; or
( ) D. In lieu of the preceding training requirements, the operator(s)/maintainer(s) is (are) under the control of a supervisor
trained in accordance with _________ (circle one) above.
I agree to provide ______________________ (telco's name) with proper documentation to demonstrate compliance with the
information as provided in the preceding paragraph, if so requested.
_________________________________Signature
_________________________________Title
_________________________________ Date
Transcribed and sworn to before me
This ________ day of _______________, _______
_________________________________
Notary Public
My commission expires:
_________________________________
61200788L1-34B
to 1.544 Mbps and/or Subrate Digital Services
© 2004 ADTRAN, Inc.
Hardware Installation Guide
5