Arizona Annual Report PDF Details

The Arizona Annual Report is a comprehensive annual report that outlines the success of the department. It discusses programs, projects and activities undertaken by the Department in 2016 to preserve and protect our natural resources for future generations. The report also includes information about how we use our resources responsibly to provide meaningful outdoor recreation opportunities for all Arizonans. The Arizona Annual Report has been published annually since 1945 when it was first produced by the State Parks Board. In 1974, responsibility for producing this publication shifted from state agencies to local governments through an agreement with the Governor's Office of Highway Safety (GOHS). Today, each county produces its own edition of this document that summarizes their efforts to maintain or improve safety on roads throughout their jurisdiction.

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QuestionAnswer
Form NameArizona Annual Report
Form Length14 pages
Fillable?No
Fillable fields0
Avg. time to fill out3 min 30 sec
Other namesarizona corporation commission annual filing, az corporation commission annual report, arizona corporation commission annual report, arizona corporation commission annual report form 2020

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ARIZONA CORPORATION COMMISSION

UTILITIES DIVISION

ANNUAL REPORT MAILING LABEL – MAKE CHANGES AS NECESSARY

Please click here if pre-printed Company name on this form is not your current Company name or dba name is not included.

Please list current Company name including dba here:

__________________________________________________________________________

ANNUAL REPORT

FOR YEAR ENDING

12

31

2020

FOR COMMISSION USE

ANN 03

20

COMPANY INFORMATION

Company Name (Business Name) _________________________________________________________

Mailing Address ____________________________________________________________________________

(Street)

_________________________________________________________________________________________

(City)(State)(Zip)

__________________________________________________________________________________________

Telephone No. (Include Area Code)Fax No. (Include Area Code)Cell No. (Include Area Code)

Email Address______________________________________________________________________________

Local Office Mailing Address _______________________________________________________________

(Street)

__________________________________________________________________________________________

(City)(State)(Zip)

__________________________________________________________1-800-___________________________

Customer Service Phone No. (Include Area Code)

Website address ___________________________________________________________________________

MANAGEMENT INFORMATION

Management Contact:_________________________________________________________________________________

(Name)(Title)

_______________________________________________________________________________________________________________________

(Street)

(City)

(State)

(Zip)

 

 

 

Telephone No. (Include Area Code)

Fax No. (Include Area Code)

Cell No. (Include Area Code)

Email Address______________________________________________________________________________

Regulatory Contact:___________________________________________________________________

(Name)

(Street)

(City)

(State)

(Zip)

 

 

 

Telephone No. (Include Area Code)

Fax No. (Include Area Code)

Cell No. (Include Area Code)

Email Address______________________________________________________________________________

2

Statutory Agent:__________________________________________________________________________

(Name)

________________________________________________________________________________________________________________________

(Street)(City)(State)(Zip)

____________________________________________________________________________________________________________

Telephone No. (Include Area Code)Fax No. (Include Area CodeCell No. (Include Area Code)

Attorney:________________________________________________________________________________

 

 

(Name)

 

 

 

 

 

(Street)

(City)

(State)

(Zip)

_______________________________________________________________________________________________________________________

Telephone No. (Include Area Code)Fax No. (Include Area Code)Cell No. (Include Area Code)

Email Address:_____________________________________________________________________________

Important Changes During the Year

Yes __ No __

For those companies not subject to the affiliated interest rules, has there been a change in ownership or direct control during the year?

If yes, please provide specific details in the box below.

Yes __ No __

Has the company been notified by any other regulatory authorities during the year that they are out of compliance?

If yes, please provide specific details in the box below.

3

OWNERSHIP INFORMATION

Check the following box that applies to your company:

Sole Proprietor (S)

Partnership (P)

Bankruptcy (B)

Receivership (R)

CCorporation (C) (Other than Association/Co-op) Subchapter S Corporation (Z)

Association/Co-op (A) Limited Liability Company

Other (Describe)______________________________________________________________________

COUNTIES SERVED

Check the box below for the counties in which you are certificated to provide service:

STATEWIDE

APACHE

GILA

LA PAZ

NAVAJO

SANTA CRUZ

COCHISE

GRAHAM

MARICOPA

PIMA

YAVAPAI

COCONINO

GREENLEE

MOHAVE

PINAL

YUMA

4

SERVICES AUTHORIZED TO PROVIDE

Check the following box(es) for the services that you are authorized to provide:

Resold Long Distance/Interexchange Telecommunications Services (RLD) Resold Local Exchange Telecommunications Services (RLEC)

Facilities-Based Long Distance/Interexchange Telecommunications Services (IXC) Facilities Based Local Exchange Telecommunications Services (CLEC)

Facilities Based Private Line Telecommunications Services Alternative Operator Service Provider

Other (Specify)______________________________________________________________________

STATISTICAL INFORMATION

TELECOMMUNICATION UTILITIES ONLY

Total number of residential local exchange access lines

Total number of residential local exchange customers

Total number of business local exchange access lines

Total number of business local exchange customers

Total quantity of phone numbers assigned to Company

Total phone numbers assigned to Customers by Company

Total number of long distance residential customers

Total number of long distance business customers

Total intrastate local exchange revenue from Arizona operations

Total intrastate long distance/interexchange revenue from Arizona operations Total intrastate revenue from Arizona operations

Total intrastate income from Arizona operations

Value of Company’s total assets in Arizona Value of Company’s total assets

(Value of Company’s total assets in Arizona)/(Value of company’s total assets)

Current amount of deposits, prepayments, and advances from customers

(not including monthly service bills)

Current amount of performance bond

Current amount of Irrevocable Sight Draft Letter of Credit

Check box if Company is current on payments for:

Regulatory Assessment

AZ Universal Service Fund

AZ 911/E911

Circuit

Voice over Internet

Switched

Protocol (“VoIP”)

_______________

________________

_______________

________________

_______________

________________

_______________

________________

__________________________________

RetailOther

_______________ ________________

__________________________________

__________________________________

$_________________________________

$_________________________________

$_________________________________

$_________________________________

$_________________________________

$_________________________________

%_________________________________

$_________________________________

$_________________________________

$_________________________________

AZ Telephone Relay Service

5

UTILITY SHUTOFFS/DISCONNECTS

MONTH

Termination without Notice

R14-2-509.B

Termination with Notice

R14-2-509.C

OTHER

TOTALS →

OTHER (description):

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

6

VERIFICATION

AND

SWORN STATEMENT

VERIFICATION

STATE OF ________________

I, THE UNDERSIGNED OF THE

Intrastate Revenues Only

COUNTY OF (COUNTY NAME)

NAME (OWNER OR OFFICIAL) TITLE

COMPANY NAME

DO SAY THAT THIS ANNUAL UTILITY REPORT TO THE ARIZONA CORPORATION COMMISSION

FOR THE YEAR ENDING

MONTH

DAY

YEAR

12

31

2020

HAS BEEN PREPARED UNDER MY DIRECTION, FROM THE ORIGINAL BOOKS, PAPERS AND RECORDS OF SAID UTILITY; THAT I HAVE CAREFULLY EXAMINED THE SAME, AND DECLARE THE SAME TO BE A COMPLETE AND CORRECT STATEMENT OF BUSINESS AND AFFAIRS OF SAID UTILITY FOR THE PERIOD COVERED BY THIS REPORT IN RESPECT TO EACH AND EVERY MATTER AND THING SET FORTH, TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF.

SWORN STATEMENT

IN ACCORDANCE WITH THE REQUIREMENT OF TITLE 40, ARTICLE 8, SECTION 40- 401, ARIZONA REVISED STATUTES, IT IS HEREIN REPORTED THAT THE GROSS OPERATING REVENUE OF SAID UTILITY DERIVED FROM ARIZONA INTRASTATE UTILITY OPERATIONS DURING CALENDAR YEAR 2020 WAS:

Arizona Intrastate Gross Operating Revenues Only ($)

$___________________________

(THE AMOUNT IN BOX ABOVE

INCLUDES $_________________

IN SALES TAXES BILLED, OR COLLECTED)

**REVENUE REPORTED ON THIS PAGE MUST INCLUDE SALES TAXES BILLED OR COLLECTED. IF FOR ANY OTHER REASON, THE REVENUE REPORTED ABOVE DOES NOT AGREE WITH TOTAL OPERATING REVENUES ELSEWHERE REPORTED, ATTACH THOSE STATEMENTS THAT RECONCILE THE DIFFERENCE. (EXPLAIN IN DETAIL)

SIGNATURE OF OWNER OR OFFICIAL

TELEPHONE NUMBER

SUBSCRIBED AND SWORN TO BEFORE ME

A NOTARY PUBLIC IN AND FOR THE COUNTY OF

THIS

 

DAY OF

(SEAL)

MY COMMISSION EXPIRES____________________________

COUNTY NAME

MONTH

20__

 

 

SIGNATURE OF NOTARY PUBLIC

7

VERIFICATION

AND

SWORN STATEMENT

RESIDENTIAL REVENUE

STATE OF ARIZONA

I, THE UNDERSIGNED

OF THE

INTRASTATE REVENUES ONLY

COUNTY OF (COUNTY NAME)

NAME (OWNER OR OFFICIAL)

TITLE

 

 

COMPANY NAME

DO SAY THAT THIS ANNUAL UTILITY REPORT TO THE ARIZONA CORPORATION COMMISSION

FOR THE YEAR ENDING

MONTH DAY YEAR

12 31 2020

HAS BEEN PREPARED UNDER MY DIRECTION, FROM THE ORIGINAL BOOKS, PAPERS AND RECORDS OF SAID UTILITY; THAT I HAVE CAREFULLY EXAMINED THE SAME, AND DECLARE THE SAME TO BE A COMPLETE AND CORRECT STATEMENT OF BUSINESS AND AFFAIRS OF SAID UTILITY FOR THE PERIOD COVERED BY THIS REPORT IN RESPECT TO EACH AND EVERY MATTER AND THING SET FORTH, TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF.

SWORN STATEMENT

IN ACCORDANCE WITH THE REQUIREMENTS OF TITLE 40, ARTICLE 8, SECTION 40- 401.01, ARIZONA REVISED STATUTES, IT IS HEREIN REPORTED THAT THE GROSS OPERATING REVENUE OF SAID UTILITY DERIVED FROM ARIZONA INTRASTATE UTILITY OPERATIONS RECEIVED FROM RESIDENTIAL CUSTOMERS DURING CALENDAR YEAR 2020 WAS:

ARIZONA INTRASTATE GROSS OPERATING REVENUES

$_________________________

(THE AMOUNT IN BOX AT LEFT INCLUDES $_____________________________

IN SALES TAXES BILLED, OR COLLECTED)

*RESIDENTIAL REVENUE REPORTED ON THIS PAGE MUST INCLUDE SALES TAXES BILLED.

SUBSCRIBED AND SWORN TO BEFORE ME

A NOTARY PUBLIC IN AND FOR THE COUNTY OF

THIS

 

DAY OF

 

 

 

(SEAL)

MY COMMISSION EXPIRES

SIGNATURE OF OWNER OR OFFICIAL

TELEPHONE NUMBER

NOTARY PUBLIC NAME

COUNTY NAME

MONTH

20__

 

 

SIGNATURE OF NOTARY PUBLIC

8

FINANCIAL INFORMATION

Income Statements:

Attach to this annual report a copy of the company’s year-end (Calendar Year 2020) financial statements.

Alternative templates are provided for this information. Please select one from Figure 1A, Figure 1B or Figure 1C.

(All Facilities-Based CLECs, Facilities-Based IXCs, Facilities-Based Access Line Providers & Facilities-Based Private Line Providers must submit FIGURE 1C)

Arizona Administrative Code, R14.2.1115.F, states that one of the items required in this Annual Report is a statement of income for the reporting year

Balance Sheets:

Alternative templates are provided for this information. Please select one from Figure 2A or Figure 2B.

(All Facilities-Based CLECs, Facilities-Based IXCs, Facilities-Based Access Line Providers & Facilities-Based Private Line Providers must submit FIGURE 2B)

Arizona Administrative Code, R14.2.1115.F, states that one of the items required in this Annual Report is a balance sheet as of the end of the reporting year

ALL INFORMATION MUST BE ARIZONA-SPECIFIC AND REFLECT OPERATING

RESULTS IN ARIZONA.

9

Docket No. _____________________Year Ending: 12-31-20

Company Name: ___________________________________________________

FIGURE 1A

Account Description

$ Amount

Revenues:

Expenses:

Operating Income:

Net Income:

Attachment 1

10

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