ADTRAN Total Access 916 Hardware Installation Manual page 9

Total Access 900 Series Hardware Installation Guide
Affidavit for Connection Of Customer Premises Equipment to 1.544 Mbps And/or Subrate Digital
Services
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 blocks):
( ) A training course provided by the manufacturer/grantee of the equipment used to encode analog signals; or
( ) 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
( ) 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
( ) 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:
_________________________________
61210916L1-34A Copyright © 2005 ADTRAN, Inc.
Affidavits
9