Cmrs Psap Certification Review

CMRS PSAP CERTIFICATION REVIEW

PSAP: ______

Mailing Address: ______City: ______

Zip: ______County: ______PSAP Admin.Phone # ______

e-mail address: ______Fax #: ______

Location (if other than Mailing Address): ______

Contact Name: ______Title: ______

e-mail address: ______Phone #: ______Fax #: ______

Is this a: (circle one) Local PSAP Regional PSAP If this is a Regional PSAP - list below jurisdictions served:

PSAP currently providing: (circle one) Enhanced 9-1-1 Basic 9-1-1 ______

Under what authority does the PSAP operate: (circle one) ______

Agency Local/Regional Board Fiscal Court City Government

______

Authority Name: ______

Authority Head's Name: ______Phone #: ______Fax #: ______

1. Telephone Company providing 9-1-1 service: ______

Company Contact: ______Phone #: ______Fax #: ______

2. Other Telephone Company providing 9-1-1 service: ______

Company Contact: ______Phone #: ______Fax #: ______

Remarks:______

______

I certify to the best of my knowledge that the information contained in this application and attachments is accurate and correct.

Name (printed) ______Title: ______

______Date: ______

Signature

PSAP: ______

Wireless call count: ______% of total 911 calls: ______Wireline call count: ______% of total 911 calls: ______

Call Counting method employed: Management software provided by Telco Manual from logging printer Manual by call takers

Carriers delivering wireless 911 calls: ______Phase 0 Phase I Phase II

Challenges facing carriers implementing wireless:______

______

Addressing standard employed?: 5.28 feet per number mileage other ______

Source of centerlines: Local ADD (DOT) Vendor Other______

Source of map address data: Local ADD Vendor Other______Address data type: Range Points

911 equipment type: ______

PSAP equipment list: ______

______

Wireline database?: Off-site On-site Wireless 3rd party database connections: ______

# telecommunicators: Full time ______Part time ______

# call taking postions available:______# call taking positions normally staffed:______

# TDDs ______TDD type ______Wireline surcharge amount: ______last changed:______

Primary 911 Signalling Capability: CAMA ISDN other______

digit capability for 911 controller: 8 / 10 / 20 # wireline 911 trunks:______# separate wireless trunks:______

# of secondary Dispatch centers served:______Do they have E911 ability: Yes No

Backup 911 site: ______

Backup abilities: 911 trunks CAD Radio: Mobile / Portables Admin Phone # ______

Use / Anticipated use of CMRS Funds in the current fiscal year: ______

______

Comments:______

-Page 1 of 2

Attach additional sheets as necessary This form may be reproduced Updated July 14, 2003