Telecommunications Companies Annual Report - Washington Utilities And Transportation Commission - 2009 Page 3

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Online Annual Report Certification
I acknowledge that the foregoing Annual Report has been submitted electronically; that, to the best of my
knowledge, information and belief, all statements of fact contained in all attached schedules are true and
said report is a correct statement of the business and affairs of the above-named respondent in respect to
each and every matter set forth therein during the period from January 1, 2009, to December 31, 2009,
inclusive. I agree that my name typed in lieu of my handwritten signature shall be sufficient to deem the
report complete.
Authorized By:
Please Type Full Name Here
Authorized Date:
Please Type Full Date Here
SECTION V -- OPTIONAL
Companies that have been granted minimal regulation of their bundled telecommunications services
under
RCW 80.36.332
may use this section to certify compliance if so required by Commission order.
CERTIFICATION AS TO BUNDLED SERVICES
I am an officer of or attorney for _______________________________ (the “Company”)
and hereby certify (or declare) under penalty of perjury under the laws of the State of Washington
that as of the date of execution of this document, the Company’s packages or bundles of
telecommunications services that are offered on a minimally regulated basis comply with
RCW 80.36.332
and with UTC Order #__ in Docket UT-__________.
The foregoing is true and correct:
Name (Printed)
Title
Signature
Date
3

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