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Transition
Administrator
The Official Reconfiguration Manager
FCC 800 MHz Band Reconfiguration
ADR Waiver of Privilege and Confidentiality Form
Form #: TA — 7.1
Page 2 of 3
INSTRUCTIONS FOR COMPLETING
WAIVER OF PRIVILEGE AND CONFIDENTIALITY FORM
The Federal Communications Commission ("FCC") has authorized 800 MHz Transition
Administrator, LLC ("TA") to assist 800 MHz stakeholders in resolving disputes involving the
negotiation and implementation of Frequency Reconfiguration Agreements. The TA is also
authorized to mediate other disputes involving the 800 MHz reconfiguration process, including
disputes involving interference to public safety licensees. In addition, the TA may mediate
disputes involving the clearing of the 1.9 GHz band. If the parties are unable to resolve a
dispute which the TA has mediated, the TA is required to submit the record of the dispute,
together with a recommended resolution, to the FCC for de novo review.
A number of states have adopted the Uniform Mediation Act ("Act") which, inter alia, prohibits
the disclosure of mediation communications to a third party. "Mediation communications"
include oral and written statements made, and other information disclosed, during the course of
mediation proceedings. The Act's privilege and confidentiality provisions are subject to waiver
pursuant to Sections 3(c) and 5(a), respectively. Mediation communications may also be
protected by other statutory and common law privileges. This waiver form expressly waives all
such rights and privileges in order to permit the TA to comply with its obligation to submit a
complete record and recommended resolution of unresolved disputes to the FCC for its review.
This waiver form does not apply to disclosures by the TA or TA Mediators to any person other
than the parties to the mediation and the FCC, nor does it apply to any communications or other
information not disclosed to the TA or a TA Mediator, e.g., confidential communications with
your attorney.
By executing this form, you also agree not to call any TA Mediator as a witness or to subpoena
any records of a TA Mediator in any litigation, including administrative proceedings before the
FCC. This provision is intended to protect the confidentiality of TA mediations and to promote
open and candid communications with TA Mediators.
You are encouraged to obtain the advice of counsel before executing this form.
1. Name of Licensee — Please provide the name of your organization as it appears on the
FCC License(s) for which you request TA mediation.
2. Licensee Call Sign(s) — Please list all of the 800 MHz or 1.9 GHz call signs for which you
request TA mediation. Attach a separate sheet if necessary.
3. Contact information — Please provide complete contact information for the individual who
signed this waiver.
4. Submit a completed copy of the Waiver of Privilege and Confidentiality Form in one of
the following ways:
Via email (PDF): TAMediationassd.com
The TA reminds licensees that representations made to the TA are herd to the same requirement of truth end candor as representations made to the FCC.
website www.800TA.org I e-mail cotnrnents@800TA.org I phone 888.800.8220 I fax 888.701.4380
Transition
Administrator
The Official Reconfiguration Manager
Via U.S. mail:
FCC 800 MHz Band Reconfiguration
ADR Waiver of Privilege and Confidentiality Form
Form #: TA — 7.1
Page 3 of 3
TA Mediation
c/o Squire, Sanders & Dempsey L.L.P.
1201 Pennsylvania Avenue, N.W.
P.O. Box 407
Washington, D.C. 20044-0407
The TA reminds licensees that representations made to the TA are held to the same requirement of truth and candor as representations made to the FCC,
website www.800TA,org I e-mail comrnents0800TA,arg phone 888.800,8220 I fax 888.701.4380