Form CF10 "Application for a State-Issued Certificate of Franchise Authority to Provide Cable and/or Video Service" - Florida

What Is Form CF10?

This is a legal form that was released by the Florida Department of State (Secretary of State) - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2017;
  • The latest edition provided by the Florida Department of State (Secretary of State);
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CF10 by clicking the link below or browse more documents and templates provided by the Florida Department of State (Secretary of State).

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Download Form CF10 "Application for a State-Issued Certificate of Franchise Authority to Provide Cable and/or Video Service" - Florida

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INSTRUCTIONS FOR FILING A STATE-ISSUED CERTIFICATE OF FRANCHISE
AUTHORITY TO PROVIDE CABLE AND/OR VIDEO SERVICES IN FLORIDA
It is recommended that you read Chapter 610, Florida Statutes, before applying for a
State-Issued Certificate of Franchise of Authority to Provide Cable and/or Video Service.
1.
Enter the official/legal name of the cable or video service provider.
2.
Enter the street address of the principal place of business of the cable or video service provider.
3.
Enter the Federal Employer Identification Number or the Department of State, Division of Corporations’
document number.
4.
Enter the name, address, and business telephone number of the contact person to whom
questions or concerns may be addressed.
5.
Attach the signed and notarized affidavit which includes the description of the service area
consistent with s.610.104(2)e(5)a & b, Florida Statutes.
The filing is good for 5 years and will expire on the 5 year anniversary date
unless renewed.
Submit the application and affidavit along with a check made out to the
Department of State for $10,035.00 (s610.104(11)&(12) to :
MAILING ADDRESS:
STREET ADDRESS:
Cable and/or Video Franchising
Cable and/or Video Franchising
Division of Corporations
Division of Corporations
PO Box 6327
Clifton Building
Tallahassee, Florida 32314
2661 Executive Center Circle
Tallahassee, Florida 32301
Any further inquiries concerning this matter should be directed to the Cable and/or Video Franchising
Section by calling (850) 245-6010 between the hours of 8:00am- 5:00pm or writing to the address above.
INSTRUCTIONS FOR FILING A STATE-ISSUED CERTIFICATE OF FRANCHISE
AUTHORITY TO PROVIDE CABLE AND/OR VIDEO SERVICES IN FLORIDA
It is recommended that you read Chapter 610, Florida Statutes, before applying for a
State-Issued Certificate of Franchise of Authority to Provide Cable and/or Video Service.
1.
Enter the official/legal name of the cable or video service provider.
2.
Enter the street address of the principal place of business of the cable or video service provider.
3.
Enter the Federal Employer Identification Number or the Department of State, Division of Corporations’
document number.
4.
Enter the name, address, and business telephone number of the contact person to whom
questions or concerns may be addressed.
5.
Attach the signed and notarized affidavit which includes the description of the service area
consistent with s.610.104(2)e(5)a & b, Florida Statutes.
The filing is good for 5 years and will expire on the 5 year anniversary date
unless renewed.
Submit the application and affidavit along with a check made out to the
Department of State for $10,035.00 (s610.104(11)&(12) to :
MAILING ADDRESS:
STREET ADDRESS:
Cable and/or Video Franchising
Cable and/or Video Franchising
Division of Corporations
Division of Corporations
PO Box 6327
Clifton Building
Tallahassee, Florida 32314
2661 Executive Center Circle
Tallahassee, Florida 32301
Any further inquiries concerning this matter should be directed to the Cable and/or Video Franchising
Section by calling (850) 245-6010 between the hours of 8:00am- 5:00pm or writing to the address above.
APPLICATION FOR A STATE-ISSUED CERTIFICATE OF FRANCHISE AUTHORITY
TO PROVIDE CABLE AND/OR VIDEO SERVICE
1.
Official name of the cable or video service provider:
2.
Street address of the principal place of business of the cable and/or video service provider:
3.
Federal employer identification number or the Department of State’s document number:
4.
Name, address, and business telephone number of an officer, partner, owner, member, or
manager as a contact person for the cable or video service provider to whom questions or
concerns may be addressed:
Name:
Title:
Address:
Business telephone number:
5.
Duly executed affidavit attached (notarized and signed by an officer, partner, owner or
managing member).
This application and affidavit must be submitted with an application fee of $10,000.00 and an
accompanying fee of $35.00 and mailed to the State-Issued Certificate of Franchise Authority for Cable
and/or Video Service at the following address:
MAILING ADDRESS:
OVERNIGHT COURIER:
Cable and/or Video Franchising
Cable and/or Video Franchising
Division of Corporations
Division of Corporations
PO Box 6327
Clifton Building
Tallahassee, Florida 32314
2661 Executive Center Circle
Tallahassee, Florida 32301
CF10 (5/17)
AFFIDAVIT
E. (State-Issued Cable Franchise)
STATE OF FLORIDA
COUNTY OF _________________
I,
, am employed with
in an
official capacity as (officer, partner, owner, managing member)
and do hereby attest to
the facts stated herein from my personal knowledge. I hereby swear and affirm that the following statements are true and
correct:
1)
The applicant is fully qualified under the provisions of Chapter 610, Florida Statutes, to file this application and
affidavit for a certificate of franchise authority.
2)
The applicant has filed or will timely file with the Federal Communications Commission all forms required by that
agency in advance of offering cable or video service in this state.
3)
The applicant agrees to comply with all applicable federal and state laws and regulations, to the extent such state
laws and rules are not in conflict with or superseded by the provisions of Chapter 610, Florida Statutes, or other
applicable state law.
4)
The applicant agrees to comply with all state laws and rules and municipal and county ordinances and regulations
regarding the placement and maintenance of communications facilities in the public rights-of-way that are generally
applicable to providers of communications services in accordance with s. 337.401, Florida Statutes.
5)
The description of the service area consistent with s. 610.104(2)(e) 5a & b, Florida Statutes, for which the applicant
seeks a certificate of franchise authority is:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
6)
Applicant’s principal place of business: ________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Names of the applicant’s principal executive officers: _____________________________________________
_________________________________________________________________________________________
Physical address sufficient for purposes of Chapter 48, Florida Statutes: ______________________________
________________________________________________________________________________________
7)
The applicant will file with the Department of State a notice of commencement of service within (5) five
8)
Business days after first providing service in each area described.
9) The applicant will notify the Department of State of any change of address or contact person.
10) The applicant’s system shall comply with the Federal Communications Commission’s rules and regulations of
the Emergency Alert System.
Signature
Printed Name and Title
Sworn to affirmed and subscribed before me on this ________ day of _________________________, 20________,
By _______________________________________, personally known ______ or produced identification
(Name of Affiant)
type of identification produced
Print, type or stamp name of notary and commission expiration
(SEAL)
CF10 (5/17)
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