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Home My WebLink AboutQWEST CORPORATION - CONTRACT - CONTRACT - QWEST CORPORATIONAcknowledgment Number: QWEST CORPORATION INTERSTATE PRIVATE LINE TRANSPORT SERVICES PRICING PLAN ACKNOWLEDGMENT Citv of Fort Collins Customer's Legal Name ("Customer") Customer hereby orders from Qwest Corporation ("Qwest") the Qwest Interstate Access Service ("Service") indicated below ("Acknowledgment"). Customer understands and agrees that Qwest provides Service solely under the regulations, rates, and charges of Interstate Access Tariff F.C.C. No. 1 ("Tariff'). In the event of a conflict between this Acknowledgment, Qwest Records and/or the Tariff, the Tariff prevails. Service is subject to the Credit Allowance for Service Interruptions in the Tariff which provides Customer's sole and exclusive remedv for interruptions of anv kind to the Service. SERVICE REQUESTED Choose one Service er form ANALOG/DATA SERVICES VIDEO DATA SERVICES HIGH CAPACITY SERVICES ❑ Analog Private Line Service ❑ Broadcast Video Service ® DS Level (Select Speed) ❑ Analog Voice Grade (Select Plan) ❑ HDTV -NET SDI ❑ SST/ (Select OC-N) ❑ SVDS / (Select Speed) ❑ SHNSI (Select OC-N) ❑ Digital Data / Select Speed) 11 Old Town Square, Ft Provide Service between Collins and 300 Laporte, Ft Collins (Qwest will provide and maintain the Service at the locations and quantities as requested by Customer and evidenced by Qwest records, hereby incorporated by reference.) Billing No. Circuit ID Optional Features: None Comments: Contact is Paul Simon 970-221-6632 ❑ If checked, additional Service information is attached to this Acknowledgment, however, attachments will not add to or change the regulations, rates, terms, and/or charges of the Tariff. ® If checked, Customer hereby certifies that Service listed above qualifies for exemption of the Private Line Surcharge in accordance with the Tariff under exemption category E1. Written notification will be provided to Qwest at such time the exemption is no longer applicable due to changes or re -termination of any Service. RATE PLAN The following Monthly and Nonrecurring Rates ("Rates") for Service reflect the Rates currently in effect in the Tariff. Customer understands the actual Rates will be the Rates in effect in the Tariff on the first date of installation of Service, or for existing Service, the date the service order is completed by Qwest. Customer will also pay Qwest all applicable taxes, usual and customary surcharges, and all government imposed fees and charges that relate to the Service or installation rendered hereunder, excluding the Private Line Surcharge, if Customer qualifies, and if that box is appropriately checked on this Acknowledgment. Total Monthly Rate: $251.20 as of 05/14/2007 Total Nonrecurring Rate: $610 as of 05/03/2007 Customer has selected a Pricing Plan ("Plan") which protects the Monthly Recurring Rate from Qwest initiated Rate increases for 24 months ("Plan Term"). Customer understands that if Customer disconnects Service, in whole or in part, prior to the completion of the Plan Term, the Tariffs termination liability charges may apply. If Customer: (a) cancels an order for Service prior to the date Service is available for use; or (b) is unable to accept Service within 30 business days after the original service date, the Tariffs cancellation charges may apply. Customer has chosen a Plan based on a specific term commitment and as such understands the rates provided herein are based upon Customer completing an entire Plan Term for the subject Service; therefore, ANY ADDITIONS TO SERVICE WILL REQUIRE A NEW ACKNOWLEDGMENT FORM DESIGNATING THE APPLICABLE PLAN TERM. This Acknowledgment will be governed by the laws of the state of Colorado, except with regard to matters which are within the exclusive jurisdiction of the state or federal regulatory agency. Those matters alone will be governed by the laws of the appropriate jurisdiction. Any legal proceeding arising out of, or relating to this Acknowledgment, will be brought in a United States District Court, or absent federal court jurisdiction, in a state court of competent jurisdiction, in the location of the party to this Acknowledgment not initiating the action, as indicated in the Notices section. Notwithstanding the foregoing, Qwest may initiate proceedings in Denver, Colorado to collect undisputed amounts billed. Each party, to the extent permitted by law, knowingly, voluntarily, and intentionally waives its right to a trial by jury and any right to pursue any claim or action arising out of or relating to this Acknowledgment on a class or consolidated basis or in a representative capacity. This Acknowledgment constitutes the entire understanding between Qwest and Customer with respect to Service provided herein and supersedes any prior acknowledgments, agreements, or understandings. Neither party will, without the prior written consent of the other party: (a) issue any public announcement regarding this Acknowledgment or use the name or marks of the other party or its affiliates; or (b) disclose or use (except as expressly permitted by, or required to achieve the purposes of, the Acknowledgment) the Confidential Information of the other party, during the term of the Acknowledgment and for two years thereafter. Such consent may only be given on behalf of Qwest by its Legal Department. "Confidential Information" means any information that is not generally available to the public, whether of a technical, business or other nature and that: (c) the receiving party knows or has reason to know is confidential, proprietary or trade secret information of the disclosing party; and/or (d) is of such a nature that the receiving party should reasonably understand that the disclosing party desires to protect such information against unrestricted disclosure. Confidential Copyright 0 2007 Qwest. All Rights Reserved. Page 1 of 3 vl.030107 Information will not include information that is in the public domain through no breach of this Acknowledgment by the receiving party or is already known or is independently developed by the receiving party. Customer may not assign this Acknowledgment or any of its rights or obligations hereunder without the prior written consent of Qwest which will not be unreasonably withheld. Customer may not assign to a reseller or telecommunications carrier under any circumstances and represents that it will not resell the Service. Title Ar61c V-1 P' Date V,7`0 T Qwest Corporation Authorized Signature Name Typed or Printed Date Copyright 0 2007 Qwest, All Rights Reserved. Page 2 of 3 v1.030107 Agreement Number: QWEST CIRCUIT INVENTORY BILLING TELE- PHONE NO. (BTN) ADDRESSICIRCUIT ID CIRCUIT TYPE CITY. or Channel Terminations Surcharge Exemption Code, if applicable TBD 11 Old Town Square to 300 la orte T-1 2 E6 Customer hereby certifies that Service qualifies for exemption of the Private Line Surcharge in accordance with the Tariff. Written notification will be provided to Qwest at such time the exemption is no longer applicable due to changes or re -termination of any Service. Copyright 0 2007 Qwest. All Rights Reserved. Page 3 of 3 v1.030107 FCC Surcharge Exemption Certification Form Agreement (Revised September, 2003) Company Name: City of Ft Collins Billing Address: I hereby certify that the Private Line Transport facilities shown below as surcharge exempt qualify for exempAon of the Special Access Surcharge: Customer Print Nan Title: _ Circuit Number CKL Address Locations Account Number Exempt Code # of Channels Date 1 CKL 1 11 Old Town square , Ft Collins TBD Eb 24 05/03/20 07 CKL 2 300 Laporte, Ft Collins CKLI CKL2 CKLI CKL2 CKLI CKL2 CKL 1 CKL2 CKL 1 CKL2 CKLI CKL2 CKL 1 CKL2 CKL1 CKL2 Instructions for New Service: • Ignore Circuit Number and Account Number fields Samale Form Circuit Number CKL Address Locations Account Number Exempt Code # of Channels Date CKLI CKL2 CKL1 CKL2 Instructions for Existing Service: • Fill in Circuit Number and account number field • Ignore address locations Sample Form Circuit Number CKL Address Locations Account Number Exempt Code # of Channels Date CKL1 CKL2 CKL1 CKL2