SGS SGS North America Inc 620 Old Peachtree Road SUITE 100 Suwanee, United States Georgia 30024 Applicant Declaration Applicant Name Legal Business BTI Wireless Address 11205 Knott I\ venue - Suite A, Cypress, CA 90630 United States Grantee Code WBK FCCID Authorized Contact Name WBKCR650 Ron Poulin Contact Email ron.poulin@Jbtiw ireless.com Contact Phone 760-712-3512 certify I, the undersigned, that I am an authorized signatory for the Applicant and therefore declare;
a) in accordance knowledge and belief with 47CFR2.911
(d), all of the statements herein and the exhtsattached hereto are true and correct to the best of my b) in accepting this application a Grant of Equipment
, the Applicant is responsible for Authorization issued by a TCB, under the authority of the FCC, as a result of the representations made in
(1) labeling the
(2) compliance
(3) compliance equipment statement of the equipment with the exact FCC ID as specified to the applicable labeling technical in this application, rules, rules, with the applicable pursuant c) if the Applicant that production 1s not the actual units of this equipment with 47 CFR 2.909 and KDB394321, the Applicant to comply with the FCC's technical has read, understood of the equipment, manufacturer appropriate will continue requirements and agrees to accept that they are arrangements have been made with the manufacturer to ensure the responsible d) 1n accordance party and agree to abide by their responsibilities as specified under 47 CFR 2.909 and KDB394321 e) in accordance with ISO 17065, FCC KDB641163, FCC KDB610077, KDB394321 and RSP-100, the Applicant has read, understood, accepts and agrees to abide by the post market surveillance understands, shall make provisions upon request shall,
(1) the Applicant
(2) the Applicant
(3) the Applicant accepts and agrees that to always have a production by SGS, at the Applicant's requirements. a sample may be requested sample available FCC and/or ISED as instructed. for evaluation, software The sample shall include review, certification required and audit surveillance expense, provide devices, all support for surveillance testing ISED uponequestby SGS, FCC and/or product sample of the requested a production cables. of products software, accessories by SGS. certified to SGS, or other hardware or f) neither the Applicant nor any party to the application is subject to a denial of Federal that includes FCC benefits, pursuant Abuse Act of 1988, 21 U S.C. 862 because of a conviction or distribution of a controlled benefits, for possession to Section substance See 5301 of the Anti-Drug 47CFR 1.2002(b) for the definition has read, understood, of a "party"
accepts g) the Applicant for these purposes and agrees to abide by the SGS North America, lnc.(TCB
) terms and conditions Link to CFRs. htt s //www fcc ov/wireless/bu Link to KDBs: https //apps Link to RSP-100:
Link to the CoveedList: Covered List fcc qov/oetcf/kdb/index cfm htt s //www 1c c ca/e1c/s1te/smt-
st nsf/en /sto 1130 html eau-d1v1s1ons/technol 1es-s stems-and-1nnovat1on-d1v1s1on/rules-re ulallons-t1tle-47
[BTIWireless) receiving
("the applicant") certifies authorization that the equipment to section pursuant an equipment 2.903 of the FCC rules. fowhichauthorization is sought is not "covered"
equipment prohtedfrom
[BTIWireless]
that, as of the date of the filing of the application, the applicant
[ 1s not] identified on the Covered list, established pursuant producing
"covered'
equipment
(heapplicant"
to150002, as an entity
) certifies Applicant Signature:
Pnnt Name: Ron Poulin Title: VP of Business Development
"vL'"/us1/c>cla1,1t1u111<.1rn1v, uu SI111,f
, Jul1y 1/1<j0/11/
QSF27-14-04 Rev 1.0 Rev. Feb 6, 2023 Page 1 of 1 Date:2023-02-14 Original Issue:
Jan. 4, 2021