Affidavit (Appendix A) - Cisco VPN 3000 User Manual

•
If the telephone company requests that you supply the FCC Certification number and REN of the device you are
connecting, please supply the FCC Certification numbers from all component and host devices that have a direct
PSTN connection (i.e. have a REN stated on the label) and the highest REN.
•
If at any time the ownership of this component device is transferred to someone else (whether independently or
as part of a system), supply this manual to the new owner.

Affidavit (Appendix A)

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 telecommunication 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
be successfully having completed one of the following: (Check appropriate blocks).
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
Subscribed and sworn to before me
This
____________________________________________
Notary Public
My commission expires:
VPN 3000 Concentrator Series User Guide
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 proceeding training requirements, the operator(s)/maintainer(s) is (are) under the control of a
supervisor trained in accordance with ___________________(circle one) above.
day of , 20____
Regulatory Agency Notices
B-11