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					                                      COLLOCATION APPLICATION FORM
                                      DECOMMISSION - Version 3                                 4

                                    Qwest Collocation Web Site Addresses:
               Application Forms: http://www.qwest.com/wholesale/pcat/collocation.html#apform
                                          Go to this site for a complete listing of Collocation Applications.


                 Collo Classifieds: http://www.qwest.com/wholesale/pcat/colloclassifieds.html
                                         Listing of vacated CLEC (Competitive Local Exchange Carrier) sites (space
                                         and cabling) that may be available to CLECs wishing to establish a new
                                         presence in a Central Office. A CLEC wishing to apply for a site and facilities
                                         posted in the Collo Classifieds should incorporate the Available Inventory
                                         found on the web site into this application, along with any requested changes.


                  Mailing Address: RFSMET@Qwest.com (address to submit applications)

              Product Information: http:www.qwest.com/wholesale/pcat/collocation.html#order
                                          Go to this site if you do not see the product you are interested in, e.g.
                                          Adjacent Collocation, Facility Connected Collocation, Transfer of
                                          Responsibility, Decommission/Cancellation, Remote Collocation, etc.


           New CLEC Information: http:www.qwest.com/wholesale/clecs/newcustquestionnaire.html
                                         To do business with Qwest as a CLEC or Reseller, a New Customer
                                         Questionnaire must be completed by you or a representative from your
                                         organization. Your Qwest Service Manager will assist you with this process.


           The previous version of this application will only be accepted for thirty (30) calendar days after the new
           version is posted to the web site. To access current forms, refer to the applications forms web site
           address listed above.


I.     GENERAL ORDERING INFORMATION
       A. CLEC IDENTIFICATION
          1. CLEC Name
          2. CLEC ACNA Code
          3. CLEC Contacts                                                                 CLEC Project Manager
             a. Name
             b. Address
                 1). Street
                 2). City
                 3). State/Zip Code
             c. Toll Free Tele #
             d. Facsimile Number
             e. Title
             f.  e-mail address




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      4.   Billing Information               Recurring Billing             Non-Recurring (if different)
           a. Billing Name
           b. Billing Name ACNA
           c. Address
                1). Street
                2). City
                3). State/Zip Code
           d. Toll Free Tele #
           e. Facsimile Number
           f.   Title
           g. e-mail address

  B. DATE APPLICATION SENT TO Qwest

  C. CUSTOMER INTERCONNECT CONTRACT NUMBER

  D. TARIFF/CONTRACT ORDERING INFORMATION (check one)
             Interstate Tariff
             State Tariff
             Interconnection Contract

  E. Qwest WHOLESALE PROJECT MANAGER
     1. Name
     2. Telephone Number
     3. E-mail address

  F. CENTRAL OFFICE LOCATION
     1. Central Office Name
     2. Street Address
     3. City
     4. State
     5. 8 Character Central Office CLLI

  G. CLEC SITE INFORMATION
     1. 11 Character CLEC CLLI Code of the site to be decommissioned
     2. Original Job ID (BAN #)
     3. Unrelated Sites:
        a. Does the CLEC have other sites in this Central Office that
            will not be decommissioned? (Yes/No)
        b. If Yes please enter the 11 character CLEC CLLI Code(s) of
            the site(s) to remain.

  H. SECURITY ACCESS REQUIREMENTS
     Enter the date Security Access to the Central Office will no longer be required.




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        I.   COLLOCATION TYPE (check one)
                   Virtual
                   Caged Physical
                   Cageless Contiguous Physical
                   Cageless Non-Contiguous Physical
                   ICDF Collocation (the only CLEC material associated with ICDF Collocation are CLEC
                   placed jumpers at the ICDF)
                   Shared Caged Physical Collocation (attach a Letter of Authority from the sharing CLEC)
                   Adjacent Collocation (also see Other below)
                   Facility Connected Collocation
                   Other (please specify to the right)

II.     DECOMMISSIONING DETAIL
        A. Attach e-mail indicating that end users were notified of the discontinuance of service.
        B. In the case of CLEC-to-CLEC, attach a copy of the agreement letter of termination with your
           partnering CLEC.
        C. Decommissioning CLEC disconnect Service Order submission detail:
                                                     Date
                                                   Submitted
                            Service                (Mo/Dy/Yr)              Project Name (if applicable)
                Unbundled Network Elements
                Administrative Lines
                Finished Services
                Splitter Collocation




                Note:   The decommissioning CLEC should have placed service orders to disconnect
                        their services, to be effective prior to submitting the decommissioning order.
        D. Material Removal/Recovery:
           1. General Information
              a. CLEC is to make arrangements with the Qwest Wholesale Project Manager to recover
                    CLEC equipment removed by Qwest, e.g. Virtual and Common Area Splitter Collocation.
              b. Miscellaneous material such as CLEC cabling will not be returned to the CLEC unless
                    requested, in which case removal costs will be billed to the CLEC.
           2. Enter the anticipated date of CLEC equipment removal.
           3. Virtual Collocation Equipment
              a. Does the CLEC require an inspection of their Virtual equipment? (Yes/No)
              b. Virtual Equipment (enter all known data):
                                                                                           Location
                              Manufacturer/Model Number             Quantity      Bay      Panel       Block




                c.   Does any of the equipment being removed use a frame return? (Yes/No)




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       4.    Common Area Splitter Collocation Equipment (enter all known data):
                                                                                        Location
                           Manufacturer/Model Number          Quantity      Bay         Panel         Block




       5. CLEC-to-CLEC Direct
          a. Does the decommissioning CLEC have CLEC-to-CLEC Direct? (Yes/No)
          b. If Yes please attach a map that details the CLEC-to-CLEC route.
          c. Note: the CLEC is responsible for the removal of decommissioned
               CLEC-to-CLEC Direct cabling.
      6. Other
          Removal of CLEC facilities associated with products such as Microwave Entrance
          Facilities, Adjacent Collocation, etc. will require additional coordination with Qwest,
          to be handled on an Individual Case Basis.
   E. Entrance Facilities Detail
      1. Copper Entrance and Shared Fiber: CLEC is responsible for the removal of CLEC
          facilities to the Point of Interface (POI).
      2. Express Fiber: Qwest will mine Express Fiber from the POI through to the CLEC site
          in the Central Office.

III. NOTES




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                                 THANK YOU FOR YOUR APPLICATION




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