9.1. TRS shall be designed to provide a means whereby a deaf, hard of hearing or speech impaired person using a text telephone (TT) can communicate with a non-TT user over the existing telecommunication network. All applications for a TRS certificate must demonstrate an understanding of and ability to comply with all operational, technical and functional standards prescribed by the Commission on Form 5.1. All applicants for a TRS certificate must submit a fully completed Form 5.1, with attachments addressing all standards. FORM No. 5.1
APPLICATION FOR A CERTIFICATE OF CONVENIENCE AND NECESSITY TO PROVIDE
TELECOMMUNICATION RELAY SERVICE (TRS)
State of West Virginia
Public Service Commission
Charleston
Case No. __________________
Application of __________________________________________________ for a certificate of convenience and necessity to provide telecommunication relay service for customers within the entire State of West Virginia. Applicant proposes to provide TRS from facilities located and manned (within) (outside) the State of West Virginia.
Basic information required to be submitted:
1. Applicant's full name and address: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
2. Applicant's Telephone number: _______________________________________________________________3. Applicant's Tax ID numbers: Federal: ___________________ West Virginia: _______________________4. If applicant is owned or controlled by a parent company, provide the information required in paragraphs 1 through 3 above for the parent. Name and Address: ________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Telephone number: __________________________
Tax ID numbers: Federal: _______________________________ West Virginia:__________________________
Application of________________________________________________________________________________.
5. Specific location(s) of TRS facility: ___________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
_________________________________________________________________________________________
6. Provide the date proposed by the applicant for initiation of service under the certificate: ___________________________________________________________________________________________
Form 5.1, page 2
Application of ___________________________________________________________.
7. If the applicant, or an affiliate, presently operates any TRS facility, this Application must include attachments listing the location of such facility(ies) and the names, titles, addresses and telephone numbers of contact persons for each facility at the State's equivalent to the PSC.8. Provide an organizational chart showing the staffing and lines of authority for key personnel to be used, including subcontractors. Also provide a complete description of the personnel, including supervisory personnel, necessary for increasing levels of call volumes and a discussion as to how such personnel will be screened, selected and trained.9. Provide the following financial information for the applicant, its parent company (if applicable) and any contractor or subcontractor which is expected to receive ten percent (10%) or more of the total revenues from the service (if applicable): 1. Audited Financial Statements for the most recent two (2) years.2. Letter of reference or financial commitment from primary banking source.3. Any rating agency reports or investment advisories issued during the past (2) two years.10. Provide a statement detailing applicant's managerial expertise in the telecommunications industry and in dealing with the deaf, hearing impaired and speech impaired communities.11. Provide a statement detailing applicant's technical expertise in the telecommunications industry and in dealing with telecommunications as related to the deaf, hearing impaired and speech impaired communities.12. Attach a complete description of the TRS facilities to be used, the general staffing and operations of the facilities and any problems and solutions to said problems the applicant perceives in providing full TRS in compliance with all requirements of the Public Service Commission.13. Appendix A to this form provides a full and complete description of operational, technical and functional standards required by the Public Service Commission. Applicant must address, on attachments hereto, the standards set by the Commission and clearly describe how the applicant will meet or exceed these standards. Mandatory standards must be met under all circumstances. Required standards must be met unless specifically waived by the Commission in the Order granting the certificate. Enhancements will be considered by the Commission in determining the desirability of each application for TRS.14. Attach a complete description of the rates and charges proposed by the applicant. Rates must be structured on a per minute basis for the time (measured in fractional minutes) necessary to complete a call. This time shall include call set-up, call wrap-up and actual conversation time. Proposed rates must be structured as follows: Form 5.1, page 3.
Calls Per Month | Price Per Minute for all Minutes |
0 to 3,999 | |
4,000 to 5,999 | |
6,000 to 7,999 | |
8,000 to 9,999 | |
10,000 to 11,999 | |
Over 12,000 | |
Enhanced functions and any proposed outreach to customers should be priced separately and include a description of how these enhancements will be furnished.
(Add a verification page signed by an authorized officer of applicant. Verification must indicate an understanding and full agreement to comply with the provisions of paragraph 6 of the Commission's Rules Governing Certification and Operation of Telecommunication Relay Service.)
VERIFICATION
State of West Virginia
County of Kanawha, ss.
____________________________, a duly authorized representative of ___________________________________, the Applicant named in the foregoing application, being duly sworn says that the facts and allegations therein contained are true except so far as they are therein stated to be on information, and that, so far as they are therein stated to be on information, he/she believes them to be true.
________________________________________________
Affiant
Taken, sworn to and subscribed before me this the _______ day of __________________, 2_____.
________________________________________
Notary Public in and for said County
My commission expires on the ______ day of _____________, 2_____.
Appendix A to
PSC FORM 5.1