Date: Tue, 06 Nov 2001 14:05:54 -0700 To: wsst@qwest.com From: Carl Oppedahl Subject: Ruby Ranch Internet Cooperative Association questionnaire Cc: sgriffe@qwest.com This email follows up on Susan Griffeths' telephone call to me of yesterday. Our needs are quite simple and modest and thus there are large portions of this questionnaire that we probably cannot answer. CLEC Questionnaire NEW CLEC QUESTIONNAIRE VERSION 16 CONFIDENTIAL The information contained herein is confidential and should not be disclosed to unauthorized persons. It is meant for use by authorized representatives of Qwest, Inc. Once the form is completed, it must be forwarded to Judy Lewis — Email jllewi2@qwest.com GENERAL INFORMATION Today’s Date Customer Name: Ruby Ranch Internet Cooperative Association Telephone #: 970-468-6600 QWEST Representative: Telephone #: Corporate Name: Ruby Ranch Internet Cooperative Association Street Address: c/o Oppedahl & Larson LLP City: Dillon State: Colorado Zip Code: 80435-5088 E-mail Address: info@rric.net Fax Number: 970-468-0104 GENERAL INFORMATION Indicate the state that the data in this questionnaire will represent: Colorado Indicate the type(s) of service that the data in this questionnaire will represent: Sub-loop and shared loop. Enter your Client Identification Numbers, as appropriate: ACNA: none CIC: none OCN: none RSID/ZCID: none Reseller/CLEC I.D.: none Provide type of arrangement: Contract (Comprehensive Agreement) Arrangement Date Commission Approved: Tariff Arrangement (if applicable): not applicable. Provide Directory Listing Option and Publisher name: not applicable BILLING AND COLLECTIONS SECTION - 1 CREDIT INFORMATION Indicate your business type: Corporation Enter the month and year your business was established: May 2001. Provide any current and/or previous business service telephone number(s) of a similar business type: none. Dun & Bradstreet Number: Provide the names, titles, and residential phone numbers of owners or corporate officers (for credit purposes): Carl Oppedahl, Director, xxx-xxx-xxxx. Enter estimated monthly Service Volumes as a wholesale Customer of Qwest for Resale, Unbundled Elements, and Interconnection. An accurate forecast is important, as Qwest will use this information as one of the factors in determining whether a security deposit will be assessed and the amount of the deposit. An under-forecast of service could result in a request for an additional security deposit prior to the end of your first year of business; an over forecast could result in payment of a security deposit higher than necessary. Also, please note that previous or current service with Qwest, as a retail customer does not necessarily exclude the need for a security deposit as a Wholesale customer of Qwest. subloops: $150 (An access deposit may be required based on estimated local usage. Additional deposit may be required based on quantities and/or types of products ordered) Enter estimated dollar amounts for IntraLATA and InterLATA Toll Usage IntraLATA Toll Usage: 0 InterLATA Toll Usage: 0 Financial Contact Information Name: Carl Oppedahl Telephone Number: 970-468-6600 Title: Director Address: P O Box 5088 City: Dillon State: Colorado Zip code: 80435-5088 Hours Available: 9AM to 5 PM Time Zone: Mountain time BILLING AND COLLECTIONS SECTION - 1 BILLING INFORMATION Federal and State Sales Tax Information Please provide your Federal Tax Identification Number: 84-1591921. Are you requesting exemption on Federal Excise Tax ON COMMUNICATIONS SERVICES? Unknown Are you requesting to be exempt from applicable taxes and fees on the Telecommunication services purchased for Resell? Unknown BILLING AND COLLECTIONS SECTION - 1 SUMMARY BILLING NOTE Provide the following data necessary to support the accurate implementation and mailing of your paper Summary Bill(s). If only one type of service will be resold, fill in the appropriate account type. Sub-loops: yes. Ruby Ranch Internet Cooperative Association c/o Oppedahl & Larson LLP P O Box 5088 Dillon, CO 80435-5088 Qwest OUTPUT - SECTION 2 Daily Usage: not applicable Co-Carrier Usage: not applicable Sustained Usage: not applicable CRIS Summary Bill CRIS ALL REGIONS Paper Loss Report/Completion Report: not applicable Directory Assistance List: not applicable (DAL) Directory Assistance Listings Database: not applicable CONTACT INFORMATION FOR ELECTRONIC CRIS BILL OUTPUT Contact Name: Carl Oppedahl Contact Number: Type of service(s): subloops, shared loops Output Preference: Paper (automatically provided) and FTP or WEB Technical Contact Name: same as above. OSS NOTIFICATION (Operation Support Systems) Contact Name: Carl Oppedahl Contact Number: Contact email address: carl@rric.net Contact’s Fax Number: not applicable NETWORK OUTAGE NOTIFICATION CONTACT INFORMATION Contact Name: Carl Oppedahl Contact Number: Contact email address: carl@rric.net Contact’s Fax Number: not applicable INPUT TO Qwest - SECTION 3 Provide this information to establish Interconnect Mediated Access (IMA). Various order input options are available to CLECs. These range from electronic order input via IMA/GUI or IMA/EDI to manual input via faxed orders. The following System Administration contact information must be provided. ADMIN Name: Carl Oppedahl ADMIN Number: Fax Number: not applicable Mailing Address: P O Box 5088 City State Zip Code: Dillon, CO 80435-5088 E-mail Address: carl@rric.net Estimated Number of Interconnect Mediated Access Users: 2 Provide this information for manual processing of information. Name: Carl Oppedahl Telephone Number: 970-468-6600 Fax Number (For LSRC): Co-Carrier Usage Return is a file that is input to Qwest for further investigation and correction, if appropriate. The specifics for the establishment of Co-Carrier usage return are outlined in Section 2. Facility Based Service LIS Trunks, Collocation and Associated Products Please indicate the Method of Input Electronic Fax Mail Electronic Input Are you currently using ordering software to submit ASRs to Qwest? No. If no, please indicate Method of Input Mail Input Contact Name: Carl Oppedahl Contact Number Mailing Address: P O Box 5088, Dillon, CO 80435-5088 NoteIf you plan to submit ASRs, please provide a valid CCNA/ACNA in Section 1 of this questionnaire. CUSTOMIZED ROUTING Not applicable. ACCESS/BILLABLE INFORMATION WORKSHEET Not applicable. CONTACT LIST - SECTION 4 Residence Accounts Please provide your Customer Service Center business days, hours, and telephone numbers for direct referrals of end users. If CLEC has multiple offices please provide information as appropriate. Orders, billing, repair: Location: Dillon, CO Days: M-F Hours: 9-5 Time Zone: Mountain Telephone Number: 970-468-6600 List the holidays your Customer Service Centers are closed: all federal holidays. Please provide any other names, addresses and/or telephone numbers that would be important to Qwest: none. CONTACT LIST - SECTION 4 Business Accounts Orders, billing, repair: Location: Dillon, CO Days: M-F Hours: 9-5 Time Zone: Mountain Telephone Number: 970-468-6600 List the holidays your Customer Service Centers are closed: all federal holidays. Please provide any other names, addresses and/or telephone numbers that would be important to Qwest: none. DLR (DESIGN LAYOUT REPORT) - SECTION 5 LIS TRUNKING AND UNBUNDLED LOOP CLEC is responsible for getting Design Routing Code (DRC) from Telcordia. Qwest will not process any electronic requests for orders without DRC code if CLEC is requesting Design Layout Reports. Will you be requesting Design Layout Reports? Unknown How will you expect your Design Layout Reports to be sent: fax 970-468-0104 If you requested Design Layout Reports please provide your Design Routing Code (DRC)(3 characters) Will the same code be used for delivery of all Design Layout Reports? Yes.