20180807Blackfoot Telephone Form 481 - Redacted.pdf

U,uq-T-l8-o,
State of Montana CERTIFICATION BY ELIGIBLE TELECOMMUNICATIONS CARRIER
OF COMPLIANCE WITH SERVICE QUALITY AND CUSTOMER
PROTECTION, ABILITY TO REMAIN FUNCTIONAL IN EMERGENCIES,
AND USE OF FEDERAL HIGH-COST SUPPORT.
County of Missoula
AFFIDAVIT OF BUSINESS OR CORPORATE OFFICER
The ldaho Public Utilities Commission Order No. 29841 requires that Eligible Telecommunications
Carriers (ETC) certify that it is compliant with applicable service quality standards and consumer
protection rules; and ETCs must demonstrate the ability to remain functional in emergencies. ln
addition, the Commission must file an annual certification with the USAC and the FCC that all federal
high-cost support provided to ETCs within the State of ldaho will be used only for the provision,
maintenance, and upgrading of facilities and seryices for which the support is intended. Accordingly,
the undersigned states and verifies under oath the following:
1. I am an officer of Blackfoot Telephone Cooperative, lnc., an eligible telecommunications carrier for
receiving federal universal service support under section 214(e) of the Telecommunications Act of
1996 in the state of ldaho.
2.1am familiar with the Company's dayto-day operations in the state of ldaho and with the State's
service quality standards and consumer protection rules as set forth in Commission Order No. 29841
3. Blackfoot Telephone Cooperative, lnc. is complying with applicable service quality standards and
consumer protection rules of the Federal Communications Commission and the ldaho Public Utilities
Commission.
4. I certify to the Commission that the Company is able to remain functional in emergencies as set
forth in Commission Order No. 29841 and in 47 C.F.R. S 54.201(aX2).
5. ! also certify that allfederal universal service support funds received by Blackfoot Telephone
Cooperative, /nc. during the current calendar year will be used in a manner consistent with section
25a@); that is, for the provision, maintenance, and upgrading of facilities and services for which the
support is intended. The company will continue to comply for the period of January 1,2019, through
December 31,2019, to be eligible for federal universal service fund support.
6. This verification and affidavit is provided to be the ldaho Public Utilities Commission to enable the
IPUC to certify to the FCC that federal universal service support received by the eligible carriers in the
state will be used in a manner consistent with Section 25 @) of the Telecommunications Act.
ler, Chief Financial Officer
Date
SUBSCRIBED AND SWORN to before me thi ay of L
MICHETIE I.EE OWENS
I,IOTARY PUBUC br the
State ol Montana
Residing at Hamifion, MT
My Commission Expires
September@, 2021.
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<010> Study Area Code l a::):
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<030> Contact Nanle: person USAC should contact
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<035> Contact felephone Number:
Number ol the person identitaed in date lioe <030>
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Form Type 5{ .311 aad 5l . {22
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Form 481 - Carrler Annual Reportlng oM8 Cosnd l.lo. ,061!.0986/OMB {ontlel rlo. X06&0019
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<4OO> yoice cornplaints (zero or Breater) for voice telephony service in the prio.
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any facilities you own, operate, lease, or otherwise utilire.
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Select from the drop down menu or check the boxes below to note compliance with 54.313(f)11). Privately held carriers n)ust ensure compliance with the
financial reporting requirements set forih in 47 CFR 54.31310{2}. I further ce.tity that tlre intormetion reported on this form and in rhe documents
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(3009t
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Progress Reporl oo 5 Year Plan
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Commu.rty Anchor Inst,tutrons {47 CFR 0
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Electroni€ copy of their annuol RUS report,
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Borrowe.s)
Document{sl wrth Salance Sheet, locome Statement
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ll lhe rerponge is yes on line 3014, attach your
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boxes below to confirm ygur submission on line
3025 purruant to 5 54.313{l)(2), con!.ins
Either a copy of (heir audited financial statemenU or
(2) a financial report in a Iorm€t comparable to RUS
Operaring Report for Tele.ommunications Bo.rowers
Dacumen({s) for Balance 5heet, lncornc Statemeot
and Sratement o{ Cash Flows
Managemenl letter and/or audit opinion issued bt/
the ,ndependent c€rti[ied publi( accountant thal
performed the company't financial audit.
lf the response is oo on line 3018, plcase checl rhe
boxes below to confirm your 5ubmiiiign on lrn€
3025 pursu3rt to 5 54.313(fX2), contrrns:
Copy o, their financial statemeot whrch hn5 been
rubject to.eview by 3n rndependent certified publrc
accountant; or 2) a financial report rn a fo.mal
comgarable to RUs Operating Report for
Teleao6muorcatrcns Sorrow€rs
UnCerlvinS anfornlaticn iubjected to a feview bV an
independent certitied public accountant
loformation
lt: A.:i.h i.? l'-m:tr::y -r:i::or:j
N.me of Attached Document Lishf,g Required'"l?['ffi o c
(Yes,/Nol O O
ri .. .:)_., !rr:
l?ji;i in: ]r:iiri !i. ri,......: ! t:
r!?.1 i'!,ir lr)itij ilar:.r: i I s. ir !n
N.me cf Attached Document Ustihg Required
lnformation
{Yes/No)oo
(302 2)
{302 3)
(3 024 )Underlyrng infoamatron 5!bjecred to an otficer
certiiicat on.
( 302 s)Document(si with Balnn.e She€t, lncome Statement
and Statement cf C.sh Flows
E
tln
tJ02b) Attach the workshee! lrsirng requrreo rnicrrrtatron Naoe oi Atlacred tocumenr ustrag Hequireo
lnformrtioa
tS5) Rd. Or n.!u'n &dsAJdhbnrl Mmdl.lbft
D.i. a.lldbn tor6
fCC rdm 411
OMD Cootiol to. ,o5O-O9S/oMB bnt.ol No. lo@.0E19
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<0 10>Studv drea Code
<015>5tudy Area f,lame
<020>Yea r
<0 l9>Contict !morl
contnct
of person
4005 Rural Broadbard Experime.t
Authonaed Rural Broadband a.xpeilffent 1RB[) recipient5 murt addaesr ihe
[5t oI ncwlv 5erved commuoity anaho, rnstrtutions
Publlc lnterest Obllgataons - tCC 1rl-98 (parag.aphs 26"29,78)
pleaie address line 4OOl regarding compliance with the
response to Line 4001.
4001. Recrp,ent certrfles that rt rr offering broadband meeting
whrch they wete relected, including broadband speed,
compar.ble oifeilngs rn urban area5.
Comnrunity Anchor lnstitution. - fCC 14-98 (paragraph 79)
4003a. RBt partrcipants must provide the number, names,
whrch they newly deployed broadband 5e.vice rn the
(yes - aftach new communrty dnchorr, no - no new
for public intere5t obligatrons ond provide a
obligations. All R8E pnrticrpatrls nrust provide a
public interest obligations consistent with the category for
and rate5 that are reaJonably coryrparable lo rates iqr
of community anchor institutions to
year. On this line, please rerpond
indicate whether this list wrll be provided,
Nanre of rlttached Document hsting Required lnfo.matton
lf yes to 4003A, please provide a response for 40038.
4003b. Provide the number, narne5 aod iddresses
of community ancho( rnjtitutions to which the
recapient newly began providing access to
btoadband servrce an the preceding calendar year.
<010>StudV Area Code
<o 1.5 >Study Area Name
<020>Program Year
<03D ContactName-PersonUSACshouldcontactregardingthisdata .',..:.. :.-
<039> Contact Email Address - Emarl Address of petron identilied in d?ta line <030>
5005 Alalka Plan
(5010) Do you participate in the Alaska plan?
(501 1)
PleaJe indicate whether any terrestrial backhaul or other ratellite backhaul became
comnlercially available in th€ previous calendar year in areas previously gerved
exclusively by performance.limitirrg srtellite backhaul.
{ves/No}
lf the filing carrier identified in its approved perfonlance rt relies on
15012) salellite backhaul for a certain poriton of the populatlon irl a rea,
any terrestrial backhaul or other satellite backhaul avd in the
prevroius {alendar year in areas that were previoiutly backhaul
whether (Y€s/No)
<5013>
D.tcription Ol B.(kh.ul I.<hnolort N.wlv S!rvcd Loc.lioni or Popularron0,,. o7ln",,0."*0"
OMB co,rtrol No. 3060.0986/OMg conl.ol No. 1060.0819Oata Colle(lloo Form
(Yes/No)
Pige I 7
<010> Study Arei Ccde i 3;: t,t
<015) Study Are. Narne 3JJ\i'I4T TJ:3',tl
<C20> Program Yeaa 2 rl :.9
<C30> Contact Namc - Perton USAC 5hould contlct reg.rding thiJ datn !i!a:1el ln i3ei5
<C35> Conlact Tele,lhone Number - Numbe. of person idenliried rn data line <030> '1 )r'5{ il i il exi
<039> Contact Eflarl Addrerr .EmJil Addres5 91 pe(lon rdentrfied n data liile <030>
TO BE COMPTETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FITIN6 ANNUAL REPORTING ON ITS OWN BEHALF:
Certification of Officer as to the Accuracy of the Data Reported for the Annual Reporting for CAF or Ll Recipients
I certify that I .m an ofticer of the reporting carler; my responsibilities include ensuring lhe ac(ura(y of the annual reportint reqoirements for unive.sal service support
recipients; ind, to the best of my knowledBe, the information repo.ted on this torm and io any attachments li ac(urate.
Nameof RepcrtineC6lr;u. ts-ACiFoo'l'l:i' - 3:'l
sr{narureoiAuthori2edcfficeri'ilii!i1:f i::i)it Detc O'tllJt'2Ar1
Prrnted name o, Authorrzed Officer: lrr'i ilililsoa
fitleo.oo5itionof AuthoriledOfficer: ir:1 3eterd! C:)Lrsel
lelephone number of Authorired Officer: i055l:5556 e):;
study Area code of Reportrnt Carrier: { '2215 Filing Due Date ior rhislo(fr' o t i L3/ 2'\a
under Title 18 of rhe Unjted Srares Codr, 18 U.5.C. 5 l00l
Page 1 7
Prge 1"8
<010> Study Area Code .t i::2 3 l;
<015> Study Area Name 3:ACXiOO',f t!'_ J't',\
<O?0> Prcgraft Year ,n1,
<030> Contact Nadre . Parlon USAC rhoulci co.tact retardinB thi5 data tri3hella Cwea$
<o35> contactrelephoneNlmber-Numbeaotper5onrdentifiedindataline<0lo> il61{l5tlt exi
<039> Contaat !6arl Addrels - €mail Addrerr ol identified rn data line <O3O> r)we:r r,bla.ri::c:...n
TO 8E COMPTMED 8Y THT REPORTING CARRIER, IF AN AGENT 15 FILING ANNUAI REPORTS ON THE CARRIER'S HALF:
IO BE COMPTETED BY THE AUTHORIZED AGENT:
Certirication of Officer to Authorize an Atent to File Annual Reports for CAF or Ll leiipien$ on Behalf ol Reporting Carri€r
cortify that (Name of Agent) is euthorized ro
cortlfy that I am .n ofticer of tho ,epo,tin9 carier; my responsibilitios includo eosu.iog the accuracy ol
and, to the best of my knowlodge, thg .eporls and data provided to tho authoriaed agent is accurate-
ths infoamalion reponed on behalf of tho rgporting carrier. I
data reporting.equi.emonts providod to lhe authorized
Date
Study Aree Code of Reporting Carrier:I
under Iitlc 18 ot the
per$nj wrllrully maling fal* Jtrtaheoti od !hra ronn can be txrn[hed by {ine or ,l 'n" i"-**.";;;;;l;;; o, , s c oq snr, rorto,, or r,ne o, mp,,sonmenr
f iode.18USC !l0ol
rte fr thrs form:
-^l'Certification o, Agent Authorized to File I Repons for CAt or Ll Recipients on gehalf of Reporting Carrier
the data rcportod herein bar€d on data provided by the reporting ca.rie.; and, t6 the be!l of my lnowledte, the info.mation reponed herein is ac.urate.
Name of Repo.tr.g Carrier:
Name of Authorizei Agent Firm:
SBn.lure ofAuthori2ed Agent or Employee ot Agent:Date
Name ql Authoriaed Agent Employee:
or po5rtion cfAuthorized Aqent or Emplovee ol Ae-.nt
Telephone number of Authorited Ageot or Emplayee of Agent:
ttuo'At"tcoo",,!lLtfttflS!'!t'"1,, ,,,,,, ,,,,,,,,,, t'ltn3ou"?"t"t!!ln'tt1t-' , , ,, , ,, ,
l8 of the Un(ed SrareJ Code, ta U.S.C I lmt
fCC form 481
OMB Control No,,060{8t9
!am. da Arilh6.ir.d Arp^t'
\ame of Reoortine Carrier:
;i!nature of Authonred offi.!r:\\\
ieleohone number of Authorii.d Of[rcer:
Page 16
Functionality in Emergency Situations
Program Year 2019 - 2018 Submission o1'2017
JB Ray
Network I nfrastructu re l\,4anager
Blackfoot
This document provides a high level description of the measures in place to provide
functionality in Emergency situations in lhe 482235, 483308 and 472222 study areas.
Central Offices in all 3 study areas (with the limited exceptions of the Drummond
Albefion) are equipped with backup generators in the event of commercial AC power
failures, Fuel supplies for these generators are adequate for 24-36 hours of operation
and back up batteries located in each central office provide an additional 6-8 hours of
backup power. ln the event of a power outage affecting the Drummond or Alberton
central offices, Blackfoot will deploy a portable generator to the site after 4 to 5 hours of
no power.
All remote subscriber carrier locations are equipped with backup batteries that are
capable of providing 6-10 hours of DC power in the event of a commercial AC power
fallure. We also maintain a pool of portable generators that are used to recharge these
batteries if the AC power is not restored prior to the batteries being fully discharged.
Where practical, fiber optic cable routes that provide connectivity to a remote central
office back to the host central office have diverse routes to insure uninterrupted
operation in the event of a cable cut or failure. lf diverse routes are not practical the
remote central office is equipped with a "stand alone" function that insures uninterrupted
local operation within the remoter central office service area.
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Tribal Engagement
Program Year 2019 - 2018 Submission of 2017
Judy Geer, Sales Manager
Dusty St John, Account Executive
Blackfoot Telephone Cooperative, lnc.
Blackfoot Telephone Cooperative, lnc. ("BTC") provides a broad range of services to the
Confederated Salish Kootenai Tribe ("CSKT") on the Flathead lndian Reservation in
northwestern lvlontana. ln fact, CSKT is one of BTC's largest customers. Judy Geer is
the Sales Manager and past Account Executive for CSKT. Dusty St John is the new
Account Executive and handles all of CSKT's accounts for BTC.
Over the past year, BTC worked with CSKT on a number of pro.jectsiinitiatives and we
look fonruard to continuing our partnership and expanding our services for CSKT. The
following is a timeline of events with summaries of our activities:
ln April 2017, Blackfoot delivered the CSKT's Capital Credit Checks for patronage
distributed to the CSKT as a member of Blackfoot Telephone Cooperative, lnc.
May 2017, Blackfoot invited CSKT to the cooperative's annual meeting. Blackfoot
worked with CSKT's lT Program lVlanager and sent Blackfoot proposal for l Gbps/1Gbps
dedicated internet access along with Blackfoot's Regional Fiber Network Map.
August 2017, Blackfoot worked with CSKT's lT Program Manager to see if they would
like to move fonruard with the 1 Gbps/1 Gbps dedicated internet solution.
November 2017, Blackfoot worked with CSKT's lT Program Manager to let her know
that Blackfoot is thankful for its partnership with CSKT in the spirit of the Thanksgiving
season.
December 2017, Blackfoot sent CSKT holiday greetings and wishes for a happy new
year.
ln early January 2018, Dusty St. John was introduced to CSKT as the new Account
Executive managing the CSKT relationship.
Blackfoot is in compliance with all tribal rights of way processes, land use permitting,
facilities siting rules, environmental review processes, cultural preservation review and
business licensing requirements
Voice Services Rate Comparability
Program Year 2019 - 2A18 Submission o12017
Michelle Owens
Regulatory SpecialisVPa ralegal
Blackfoot
For the Program year 2019, the average urban rate for local service is $25,50, Per FCC
Public Notice DA 17-1093 the reasonable comparability benchmark for voice services is
$45.38. None of the Blackfoot rates are above the reasonable comparable rate of
$45.38.
Data Services Rate Comparability
Program Year 2019 - 2018 Submission of 2017
tVichelle Owens
Regulatory Specialist/Paralegal
Blackfoot
Blackfoot Telephone Cooperative, lnc. (482235,483308 and Fremont Telcom Co. dba
Fremont Communications (472222) have several different voice, broadband and
voice/broadband bundles at different prices. To ensure compliance with the FCC's rate
comparability benchmark for broadband services, Blackfoot offers a distinct set of
broadband service offerings that are priced at rates that are equal to or less than the
FCC's service rate comparability benchmark. These prices are revised annually as the
FCC adjusts the prices, if necessary, to ensure they remain equal to or less than the
rate comparability benchmark.
Lifeline Terms and Conditions
Program Year 2019 - 2018 Submission of 2017
Ivlichelle Owens
Regulatory Specia list/Paralegal
Blackfoot
For the Program year 2A19, Lifeline consumers have the same voice and data options
available to them as non-lifeline consumers. Rates can be reviewed in on Blackfoot's
corporate website. The applicable terms and conditions are the same for any consumer
regardless of low income determination. Local voice services are unlimited as are data
services. Consumers wishing to purchase long distance services have a selection of
service options to ensure the pricing meets their needs. Eligible lifeline consumers
have a lifeline discount added to their account after eliglbility has been determined.
Additional information to include any applicable terms and conditions can be viewed by
con su m ers at http ://www. bla ckfoot. com/residen tial/ .
Broadband Reasonable Request
Program Year 2019 - 2018 Submission of 2017
Dave Martin
Chief Technology Officer
Blackfoot
Blackfoot certifies that it has taken reasonable steps to provide upon reasonable
request broadband service at actual speeds of 4 Mbps downstream/1 Mbps upstream,
with latency suitable for real-time applications, including Voice over lnternet Protocol,
and usage capacity that is reasonably comparable to offerings in urban areas, and that
such requests for such service are met within a reasonable amount of time.
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Report of Indelrendent Auclitors
Board of Trustees
Blackfoot Telephone Cooperative, lnc.
Rcport ou ttre Financial Statenrent.s
We have audited the accompanyirrg consolidated financial statements of Blackfoot Telephone
Cooperative, lnc. (Cooperative) and its subsidiaries, which comprise the consolidated balance sheets
as of Decem b er 31 , 2017 and 201 6, and the related corrsolidated statements of income,
comprehensive income, members' equity, and cash flows for the years then ended, and the related
notes to the consolidated financial statements.
Nlanagentent s Responsibility for the "Iiinancicl Stnferrrents
lvlanagement is responsible for the preparation and fair presentation of these consolidated financial
statements in accordance with accounting principles generally accepted in the United States of
America; this includes the design, implementation, and maintenance of internal control relevant to the
preparation and fair presentation of consolidated llnancial statements that are free from material
misstatement, whether due to fraud or error.
A rrrliror.'s Responsibildty
Our responsibility is to express an opinion on these consolidated financial statements based on our
audits. S/e conducted our audits in accordance with auditing standards generally accepted in the
United States of America. Those standards require that we plan and perform the audit to obtain
reasonable assurance about whether the consolidated financial statements are free from material
misstatement.
An audit in'rolves performing procedures to obtain audit evidence about the amounts and disclosures
in the consolidated financial statements. The procedures selected depend on the auditor's judgment,
including the assessment of the risks of material misstatement of the consolidated financial
statements, whelher due to fraud or error. In making those risk assessments, the auditor considers
internal control relerzantto the entity's preparation and fairpresentation of the consolidated financial
statements in order to design audit procedures that are appropriate for the circumstances, but not for
the purpose of expressing an opinion on the effecti'/eness of the entity's internal control. Accordingly,
we express no such opinion. An audit also includes evaluating the appropriateness of accounting
p<llicies used and the reasonableness of significant accounting estimates made by management, as
well as evaluating the overall presentation of the consolidated financial statements.
We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis
for our audit opinion.
1
Opirrforr
ln or"rr opinion, the consolidated financial statements referred to abo'ye presenl fairly, in all malerial
respects, the financial position of Blackfoot Telephone Cooperative, Inc. and its subsidiaries as of
Decentber 31, 2017 and 2016, and the results ol their operations and their cash flows for the years
then ended in accordance with accounting pdnciples generally accepted in the United States of
America.
$Atr) [rlnn,,l lrl,f
Spokane, Washington
February 28,2018
Z
Michelle Owens
From:
Sent:
To:
Subject:
Aaron Neilson
Friday, July 13, 2018 10:23 AM
Michelle Owens
FW: Forrn 481 Bulk Certification Confirmation
Aaron M. Neilson
Blar:kfo,:t I Vice Presiclent - Generai CoLrnsel
1221 North RussellStreet, lllissoLrla tv-lT 59808
4 06 - 54 1 - 5 5 56 I a n e r l-s r:J @ o I a c kf o o i. c o m I urvrl tr, blp-[J,q p--l.C_Q!]
LEGAL NOTICE: This e-mailarrd any attachments may be confidential, subject to attorney-client privilege, and/or protected by the
work-product doctrine. The urrauthorized use or disclosure of this e-nrail or any attachment is prohibited. lf you received this e-mail
in error, please notify me arrd delete the e-mail immediately.
Frorn: Form48 1@ usac. o rg Ima ilto : Form48 L@ usac.org]
Sent: Friday, July 13, 2018 10:21 AM
To: Aa ron Neilson <[e-mail]>
Subject: Form 481" Bulk Certification Confirmation
Form 481 Bulk Certification Confirmation
3 Study Area Code (SACs) out of 3 selected were certified.
Certification Date and Tlme: 07 /13/ZOLB 12:21 PM
Filings Certified By: [e-mail]
Program Year: 2019
Your certification results are listed below:
Tirrs is i1 syiiem generateii ernari.
Please do nri respond lo this firesseEe
,, lt)97"20 Lll, Uiri.rersri Servit:* Admrnisl;'ati're Conrpany, All P,rghts ReserveC
LiSAC I 70rJ 1Zlh Streel ll$l I Suite 900 | VYashrnglon, DC 20005
J
Study Area Code 498 ID Carrier Name Results
AA)))a 143002515 Fremont Telecom - RoR Certitication Successful
482235 1430025 3 1 BLACKFOOT TEL. BTC Certification Successful
483308 1 430025 3 1 BLACKFOOT TEL - CFT Certifica[ion Successful
I
Certification of Offi cer
to Authorize an Agent to File Dnta on Behalf of lteporting Cnrrier
I certify that (Nanre of Agent) John Staurulakis. lnc. (JSl) is authorized to submit infornration
reported on behalf of the reporting carrier. I also certil.r, that I am an officer of thc reporting carricr;
my responsibilities include ensuring the accuracl, of thc tlata provitlcd to the Authorized Agent; nnd,
to thc bcst of my knowledge, the actual data provided to the Authorized Agent are accurnte.
Jolur Staurulakis, Inc. (JSI)Name of Authorized Agent
, Blackfoot Telephone Cooperative, Inc.Name ol l(eporting Carrier
Signature of Authorized o"' tt1(rg
M**|.\ e(Printed narne of Authorized
Title or position of Authorized Otficer Uli{ f tn,nna,Ll lke-z(
dob) 51! 514Y ext -'l'elephone number or Authorized OIIicer
Study Area Code of Reporting Canier Filing Due Date for this form
(mnVdd/yyyy)482235 06/l 8/20 I 8
Pemons willlully making lalse statements on this lbrm can be punished by line or lbrlbiture under the Communications Act
of 1934,47 U.S.C. \\S 502.503(b), or line or imprisonurenl under'l'itle l8 ol the United States Code. l8 U.S.C. $ I001.
o*iufu.
Certilication of Olliccr as to thc Accuracv of thc CAli ICC Data lleported
I certif-v that I ant an officer of the reporting carrier; my responsibilities include ensuring the
accurac)' of tlre actual data reported; and, to thc best of my' knorvledge, the inlbrnration reportctl on
this lbrm is accurate.
Nanre of Repofling Camier ,/- lllackfoot 'l'elephone cooperative, lnc.
Signature ol' Authorized Date b h ltg
prinred nanre of Aurtr orirrdffi " gk^*", [\.l WOt lU(
I'itle or position ol'Authorized Ollicer i c)(
Telephone nunrber or Authorizcd
0l'ficer.U0t ) SLlI 5ya! exr -
Study Area Code of Reporting Carrier Filing Due Date lbr this tbrrn
(mnildd/yyyy)482235 06/18/2018
Persons rvillfully nraking fhlse statcnrents on this fcrrur can be punished by fine <lr fortbiturc under the Communicaliorrs Act
of 1934,47 U.S.C. "sN 502,503(b), or line or imprisonrnenr under'litle l8 ol'the United States Code. l8 U.S.C. N 1001.
Ccrtitication of Ofticcr for llntc-of'-lleturn (larricr liligihilit.r' lbr ('A['/lC() llecoverl'
I certify thnt I am an olficer ofthe reporting cnrricr antl that, to the best of nry' knorvlcdge, thc
reporting carrier on this fornt certifics that it hns conrplied rvith Eligible Recoverl'$51.917(d) and
Access Rccoverl' Charge $51.917(e) and is eligible to receive the CAIr ICC srrpport requestetl pursuant
to $51.917(f).
Illackfoot'I'ele;lhone Cooperativc, lnc.Narue ol- Reporting Can'ier
Dare u/t I tg
l'rinted name ol' Authorized
'fitle or position ol'Authorized C)fIcer
'Ielephone nurnber or Authorized
Officer.Uou) sgl5lzY "xr -*-*
Study Area Code of Reporting Carrier 482235 Filing Due Date lbr this ftrrm
(mnVdd/yyyy)06/r 8/20r 8
Persons u,illfully nraking false statenrents on this tbnn carr be punished by line or forlbiture under the Corunrunications nct
of 1934, 47 U.S.C. \\,s 502, 503(b), or line or imprisonmeut urder Title l8 of the United States Code. l8 U.S.C. ts 1691 .
Signature of Authorized Otlicer q
I
Ccrtification of Ofticer lbr ltate-ol'-lleturn Carricr Not Sccking Duplicative Recoverl'
I certifl, thnt I anr an officer of the reporting carricr and that, to the best of nry knorvledge, the
reporting carrier is not seeking tluplicativc rccovcry in the state jurisdiction for an1' Eligible Rccovery
subject to thc rccovcry mechanism as per $51.917(dXvii).
Signature of Authorized nu" loh lg
Printed nanre of Authorized
Titlc or position of Authorized Ofticer
Telephone number or Authorized
Oflicer.4t1r) 5!1 2!*!".r ----
Study Area Code of Reporting Caricr Filing Due Date tbr this form
(mu/dd/yyyy)482235 06/18/20 1 8
Persons willl'ully ruaking lhlse stateurerrls on this lbrln cau be punished by tine or forfeiture undel the Conrnrunications Act
ol' 1934, 47 U.S.C. Nli 502, 503(b), or fine or imprisoument under Tirle I 8 of tlre United States Code, l8 U.S.C. $ 100 | .