m6779

2 bluejag wireless.June 23, 2016

Jocelyn BoydChief Clerk and AdministratorSouth Carolina Public Service Commission101 Executive Center Drive, Suite 100Columbia, South Carolina 29210

via U.S. Mail

Re: Blue Jay Wireless, LLC Service Copy of FCC Form 481 Filingfor Study Area Code 249024 (South Carolina); Docket No. 2016-14-C

Dear Ms. Boyd:

Blue Jay Wireless, LLC ("Blue Jay") has been designated by the South Carolina PublicService Commission as an Eligible Telecommunications Carrier for provision of wirelessLifeline services.'nclosed, pursuant to FCC Rule I'7 54.422(c), is a service copy of Blue Jay'sFCC Form 481 Annual Report submission to the Universal Service Administrative Company andFederal Communications Commission with respect to Lifeline services in South Carolina.

Kidtydt t pth dpli t py fth rl'g d t iti th l d lp. tft)JPlease contact the undersigned at (972) 788-8815 if you have any questions.

Respectfully submitted,

Enclosure

Melissa SlawsonGeneral CounselBlue Jay Wireless, LLC

1)

: rl

'NBEr Application ofBlue Jay Wireless, LLCfor Designation as an Eligible telecommunicationsCarrierfor the Purpose ofOffering Lifeline Service on a Wireless Basis, Docket No. 2012-390-C, OrderDesignating Blue Jay Wireless, LLC as an Eligible Telecommunications Carrier for the Provision ofLifeline Service, Order No. 2013-167 (March 27, 2013).

4240 International Parkway, Ste. 140 ~ Car rollton, TX 75007 ~ Phone: 972-788-8860

www.BlueJayWireless.corn

EEC Form 431'- Carfter An'riuepgegortingData Gollectlon form

FCC Form 401

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Study An Name Blue Ja Wireless LLC-P agem Ve 2017

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c amciNs .p usnc I Id ontact cesrdlngthl d t Daniel Starkc t ctt hphoneNu b -Nu te fm Id ntNadlndat anscoso& 9727909934 ery,

datarke)bluej a2&Wireleaa. ComCoatamf ilAdd -E aaAddras ofa sonld ntN dl d t Ii ulslu

complete the Items below to note compEance with five year service quaBty plan (pursuant to 47 cFR 5 54.202(a)) and, for privately held carriers, ensuring

comp Ban ca with the flnanclal reporting requirements set forth In 47 cFR 5 54323(0(2). I further certify that the Information reported on this form and In

the documents attached belbw is accurate.

(3009)Progress Report on 5 Year PlanCarrier certifies to 54. 31S (fl(1)(ill)

(3010A) Mgeston C rtlflcatlon (47 CFR 5 5431SIII(t)0))

(30109) Please Pmvlde Attachment Name of Attached Document Ustlng RequiredInformation

(3012A)

(30125)

(3013)

(3014)

Community Ancho Institutions (47 CFR 554.313lfl(1)01))Please Provide Attachment

Is your company a P Ivately Held ROR Carrier (47 CFR

554413(fj(2))If yes, does your company fge the RUS annual report (Yes/No) Q Q

Name of Aaached Document Umlng RequiredInformation

Q Q(Yes/No)

(3015)

(3016)

(3017)

(3013)

(3019)

(3020)

(3021)

(3022)

(3023)

Please check these boxes to co flrm that theattached PDF, on line 301 h contains the mqulredinfo im at lou p urm ant to 5 54 313 (f)(2) compliancerequlresiElectronic copy of their annual RUS reports(Operating Report for4elecommumcatlonsBorrowers)Document(s) with Balance Sheet, Income Statementand Statement of C sh Flows

If the response is yes on gne 3014, attach yourcompany's RUS annual aport and ag requireddocumentationIf the response is no on ane 3014, Is your comrenyauditedfIf the esponse Is yes on gne 3D16, please check theboxes below to confirm your submlmlon on line3B26 puma ant to 5 54.313 (f) (2), conte fn sr

ether a copy of their audited Rnandsl statement; or(2I e Rnandal r port In a format comparable to RUS

Operating Report for Telecommunications BonuwersDocument(s) for Balance Sheet, Income Statementand Statement of tush Flows

Management letter and/or audit opinion Issued bythe independent certified pubgc accountant thatperformed the companVs financial audit.If the response I'o on gne 3DSB, please check theboxes below to a nflrm your submission on gne3D26 pursuant to 5 54.313lfl(1), containerCopy of their financial statement which has beensubject to review by an Independent certified pubgcaccountant; or 2) a financial repok In a formatcomparable to RUS Operating Report forTelecommunications BorrowarsUnderlying Information subJected to a review by anIndependent certlqed pubgc accounts t

Name of Attached Document Ustlng RequiredInformation

(Yes/No) Q Q

(3024) Underlying inform tlon subjected to an officercertification.

(3025) Document(s) for Balance Sheet, I orna Statementand Statement of Cash Flows

(3026) Attach the wo ksheel gating mqulred informauon Name of Att chad Document Umlng Requir dInform tl n

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(4408)Rurs) aro s Eband Esp@rment Arfdttl on a I no em ants((SDstr Co)lectiorl Form,

Fccvonn 43LDMS&ant dl No. SOM09aa/DMS cemml No. 3modstsJuly 1013

&010& Stud Area Code&013& StudyArea Namec020 Pro ram Year&030& contact Name- Person USAC should contact regarding this data&033& contact Tele hone Number ~ Number of person Identgled In&tufa Sne &030&

&039& Contact Email Address - Emag Address of person identified In data Rne &030&

4003 Rural Broadband Experiment

Authorlred Rural Broadband Drperlment (RBE) recipients must address the certification for public Interest obBgatlons, ptovlde a gst of newly servedcommunity anchor institutions, and provide a Rst of locations where brcudband has been deployed.

Pub 8c Interest ObR get lone - FCC 14 98 (paragraphs 26-29, 78)Please address Une 4D01 regarding compgance with the Commission's public Interest obRgatlons, Ag RBE participants must provide a response to Une 4001.

4001. Recipient cermtes that it Is offering broadband to the IdentIRed Mcatlons meeting the reaulslte pubRcIntere*obggstions consistent with the category for which they were selected, Including broadband speed,latency, usage capacity, and rates that are reasonably comparable to rates for comparable offerings in urbanIlrallsf

Comm un hy Anchor Ins0tutl one — FCC 14D8 (paragraph 79)

4003n. RBE participants must provide the number, names, and addresses of community anchor institutions towhich they newly deployed broadband service In the precedirlg calendar year. On this line, please respond(yes -attach new community anchors, no — no new anchors) to Indicate whether this list wrg be provided.

If yes to 4003rh please proulde a response for 40038,

4003b. Provide the number, names and addressesof community anchor Institutions to which theredplent newly began providing access tobroadband service In the preceding calendar year.

Name of Attached Document Listing Required Information

Broadband Deployment Locations -FCC 1408 (paragraph 80)

4004a. Attach a list of geocoded locations towhkh broadband has been deployed as of theJune 1st immediately preceding the July 1st fgingdeadline for the FCC Form 481.

Name of Attached Document Listing Required Information

4D04b. Attach evidence demonstrating that therecipient is meeting the relevant pubgc serviceobggatlons for the identlfred locations. Materialsmust at least detail&he prldng, offered breadband'ame of Attached Document Listing Required Informationspeed and data usage allowances available in therelevant geographic area.

Page 10

Nlflcbtlun -Reporting CarrierDbta Coilectlonporm

FCC ForniASI0MB Control No. 30606996/UMS Control.No. 30606219luis 2013

&010& Area Code

colg& Stud Area Name

&oiik Pmgcam Scar

«030& ContacLName - Person USAC should«0 tact regarding this data

24 9a24

31 ayutcin ccc201'I

0 t1 St k

c033& contact Telephone Number - Number of mon Identified In data gne &IBO& 922ysaees« e.

&099& Contact Emag Address-Emagaddress 0 emonldentlfle*ln data gna &030& d c kent Scales .c o

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING ANNUAL REPORTING ON ITS OWN BEHALF:

Certl(ication of Officer as to the Accuracy of the Data Reported for the Annual

Repofflng

fo CAF or LI Recipients

I certify that I am en ofBeer of the reporting carrier; my respenslbgltles Include ensuring the accuracy of the snnual reporUng requirements for universal sendce supportedplents: and, to the b«t of my knowledge, the information reported on this form snd In any attachments Is accurate.

Name of neportln

Carrier'ature

of Authorlted Ufficen M/23/2016

Printed name of Authorized ONcer:

tie or position of.Authorimci ONceri opo

elephone number of Authodmd Ufflcen 922yaesass

Study Area Code oLAeportlng carrleri 249024 Fginspueusteforthisform: cw/ol/2016

p no wisfuaym klngf haunt ma tsonthlil rmcanbapimlibedbyflneorforf Itursimde thsco municatio sActof1934, 47uscN902909ibi orrineorl plm mentunderTIuetsofth 0 Itrdstatmmds,tau,s.cP1001,

Page 10

Page 21

CGtlffcatlon -ytgent (CarrierData Cogectlon Form

FCCso u 481'ps

control No. 306D0986/DMS codkofNrd 3080os19July 2IDS

xolo stud are coda

c015 Stu Area Name

cozo&. pro ram year

&030 Contact Name - PersonJJSAC should co tact e ardlng this data

149024

3 U 2 y trisul a

2017

Da t 1 szackFT23884834'xr .

c03s contact Tele hone Number ~ Numbor of rson IdentroecLln data zne&030

&OM& contactEmsgAddress.ErnagAddrassof r onld ntdwdlndatssnc&D3D dsr. kebl Jayvzz I s,co

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING ANNUAL REPORTS ON THE CARRIER'5 BEHALF:

Certification of Officer to Authorize an Agent to Fife Arrnusi Reports for CAF or U Recipients on Behalf of Reportiffg Carrier

I c erg fy that (Nnme or Agent) la authcuhad to submit the intormatlon mportod on bshsg of thb rsporgng canter. I

also cemfy that I am sn oificer of tho raporgng canfaff my rssponslhgklim Include ensuring Uto scw racy of pw annual dais reporlin0 roq Irornents provldod to tho authorhodagenh and, to the bast of my knowlodgo, the mpone end dais provided to the authorized agent ls accurate.

Name of Authorized Age u .Nameofge ortln canterSignature of AuthorlzedDNcar:

pnr ted n me cf A Ihorlred officer:

Tele or mltlon ofAuthorhed,DNce .

ele hme number of Authorlz d oftlcar:

St d Area Codanf Re ortl Csrrlec Flzllg Dire Dshr frrr tflk forrrr

Date:

pars swlofugvmazlnsf lr n t m t o thl f nb punlrbwlbynmorfodutur uwh ti co~ tio swc fll34 47050 53502 503(b) * gnsorlmprl m ntdrTlti Isoftl U ltwtswte cols,tsU.s.cflocl.

TO BE COMPLETED BY THE AUTHORIZED AGENT:

Certlficetlon of Agent Authorized lo File Annual Reports for CAF or U Redplents on Behalf of Reporting Carrier

1 as agent for the rsputting carrlor, wutgy that I am authorhedfo sldmlt the snnuslreprirts fa arrlvsrsalsemke sujipaw edplents on babel(ot the reporpng carrier; I have providedthe data reported herein based on data provided by the reporting csnlsrl and, to the best ofmy haowledga, the Info enation reported herein Is accurate.

amp of Re rtln CsnlsrNsmeofAmh hzedAge thrm:

51 nature of Authorhed nt or.Em le e of ent:

Nameof Authorized snt E plo ee:

Ttl or osltlonofAuthorlred ntorzm I eof ent

ele honenumberofAuthorlzed into Em conf nn

Stud Are Code of Renortln Carrier. Nlh Du Dau focthlsfom I

Data:

peoo s Slf oyneldmfl st t tso thhf m nb p bhwbvc hditu w wih 8 wmk nuwt934,4tuscN502,503ib),ornn orlmnrbonm ntv d rTltl18oftheunzedzlst &cod,lsuxcslnol

Plrga 21

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