20180807Freemont Telcom Form 481- Redacted.pdf

State of Montana
County of lvlissoula
SUBSCRIBED AND SWORN to before me thi of
MICHELI.E LEEOWENS
NOTARY PUBLIC forthe
State ol Montana
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(;"un-T-itui
CERTIF!CATION BY ELIGIBLE TELECOMMUNICATIONS CARRIER
OF COMPLIANCE WITH SERVICE QUALITY AND CUSTOMER
PROTECTION, ABILITY TO REMAIN FUNCTIONAL IN EIVIERGENCIES,
AND USE OF FEDERAL HIGH-COST SUPPORT.
Jor{
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. In
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 services for which the support is intended. Accordingly,
the undersigned states and verifies under oath the following:
1. I am an officer of Fremont Telcom Co., an eligible telecommunications canier for receiving federal
universal service support under section 21a@) of the Telecommunications Act of 1996 in the state of
ldaho.
2.1 am familiar with the Company's day-to-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. Fremont Telcom Co. 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(a)(2).
5. I also certify that all federal universal service support funds received by Fremont Telcom Co. during
the current calendar year will be used in a manner consistent with section 254(e); 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 25a@\ of the Telecommunications Act.
eller, Chief Financial Officer
')
Date
Du-tt firy
at Hamillon, MT
Erplres
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Select fronr the drop down meou or check the boxes below to note compliance with 5a.313(f)(f). Privately held carriers must ensure compliance with the
financial reportint requirements set forth in 47 CFR 54.313{f)(2). I further certify that the informatioo reported on this form and in the documents
attached below is accurate.
(3009)
(.1010A)
(30108)
(301 2 A)
(30128)
(301 3)
(301 4)
Progress Report on 5 Year Plan
Ca.rier certifies to 54 311(ll{1}{iii)
Name of Attached Document Li5trng Required
Name of Attached Do@ment Li!(ing Sequired
(Yes/No)
Ii)!, itiriih a(iririi,:,rri.rii!
(J02u) Arracir tne worisireet iistrnB requrreo rniorrnatron
Certificatron of Public lnterest Obfigatron5 {47 CFR 5
54.r13(fX1Xi))
Please Provide Attachme.t
Communitv Anchor lnsrirurions {47 CFR I
s4 3t3lt)(l){iiu
Pleasc Provide Attachmenl
l! your company a Prvately Held ROR Ca.ner (47 CFR
$ 54.311(f)(2))
li yes, does your company file the RUS annull reporl
Plea5e check the5e boxes to confirm that lhe
attached POF, on line 10.17, containt the required
ioformation pu.suant to $ 54-313(f)(2) compliance
€lectronic copy of their annual RUS .eporls
(cperatrng Repoat for Telecommun(atrons
Borrorvers )
Document(s) lvith galance Sheet, lncome Sta(emenr
end statement of cash Flows
lf rhe respoose is ves on line 3014, attach your
company's RUS annual report and all required
documenlalion
lf the response i5 no on line 301.1, is vour company
.!dited?
lf the response is ye5 on line 3018, please check the
boxes below to confirm your submission on line
3026 pu.su.nt to 0 54.113(f)12), contains:
Either r copy of thcir auditcd finaoc,al 5tatement; gt
(2) a frnancial repo.t rn a format.omparable to RUS
Operating Repoat for Telecommunrcations Borrowers
Document(J) to, Ealance 5heet, lncome statement
ahC Statement of Ca!h Flows
Management letter aod/or audit opr^ion issucd by
the ndependent certrfied p!blic accountrnt that
perlormed the company's fioanciel audit.
li the response is no on line 3018, please check the
boxes below to confirm you. tubmi5sion on Iine
3026 pursu.nt to I 54.313(f)(2), conta'ns:
Copy ol their tinancial statement which has beeo
subrect to .eview by an independent certified public
accouotant; or 2) a financial .eport in a format
comoarable to RUS Operating Repott for
Teleaommunications Eorrowe15
Underlying intormitaon subiccted to a review by an
indepeodent certified public accountant
Doc!ment{s) with Balance Sheel, lncome Statem€nt
nnd Statement ol Cash tlows
lnlormation
)s I-. Ie! as'i,rr):r1.'., Lr(l:o:s
lnformation
(Yes/No)ocoo
(30rs)
{ 3016)
(3017)
{3018}
(3019)
{3020)
(302 1 |
Name of Altached Document Lrst ng Required
lnformation
lYes/No)oo
(302 2 )
(302 3)
(302 4)Underlying information sublected to an offi.e.
aertilicatron.
(102 5)
r\ame oi A!!acne,j uocument LlstrnB hequrreo
lnlorhation
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<0 15>Study Area Name
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Conl.ct Nam. - Person UsAC slrould contact thrt
Co^tact
Contact Imar] Addres5 " emarl Address of perron ilentified rn data line 40)0>
4005 Rural Broadband Experinrent
Authonzed Rural Eroadband Experiment {RB[).eopients nlust nddre5t the ce^ification tor public
lrrt of newly served cgmmunrty an(hor !nstitutions.
obligaten5 and p.ovid€ a
Putllic loterest Obllgations - FCC 14-98 (paragraphs 26-29, 78i
Plea5e addres: Lif,e 4001 regarding compliance with the Commrssion'5 public interett
respon5e to Line 4001.
All RBE partrcrpantr must orovide a
4001. Reciprent cert(ie! that rt is offering broadband,neeting obligatioos consistent with the cate8ory for
whrch thcy were selected, inaluding broadband tpeed,
(onrparable offerrngs in u.ban area5,
rater that are.ea5qoably comparalrle to rates for
Comorunity Ao(hor lnstitution5 - FCC 14-98 {paragraph 79)
4003a. RBE participants must provide the number, naile3, aod of community anchor instrtutrons fo
which they newly deploved broadband seeice in the year. On thir line, please respond
(yes - attach new communrty anchors, no - no new indacate whether thir list will be provided.
4003b. Provide the number, names and addre5ses Name of Attached Document Llsting Required lnformation
of communlty anchor institution! to which the
recipient newly began provrdang access to
broadband service in tlre preceding calendar
OMo Contro, No.306G0986/OMg Control No.
lf yes to 4003A, please provide a response for 40038. I
<0 10>Studv Aren Code
<c15>Studv Area Name
1910. -- ""-"-l'lcl1r_Iet_<)30> conta(t Namc . peron uslc sircure;;"t.t;;;ns fii;;i. -'- ,; ,
-
-
.9.r. :,_<039> Contact [mail Addres! - fmail Address of person identified in data line <030>
5005 Alaska Plan
(5010) Do you participate in the Alaska plan?(Yes/No)
Please indicate w,rether any terrestrial backhaul or other satellite backhaul{5011} contrnercially available in the previous calendar y€ar in ar€as previouslv sefved lYes/No)
exclusively by perfo[rar]ce-iiiliting satellite backhaul.
lf the filing carrier identified in its approved perfomance plans *at it
{5012) satellite backhaul for a certain poriton of the population in its rervice
exclusively on
indicate whether (Yes/No)
any terrestrial backhaul or other satellite backhaul became available in the
previoius calerdar year in areas that were by satellite backhaul
<5013>
O.rciptbn Ol g.clb.ul Tr(hnqbgy il.kly S.rv.d 14.lioa! or Popul.taonD.r. 8..lh.ul Av.il.Dl.
(5005) r,Ur5la Plan Parti(ipant, Addltionll DOru6ettation
oata colleation form
tCC forn 481
OMg Control No. 1060{986/0MB Control No. 3060{rg19
lulv r0la
P.Be I 7
.:010> 5tudy Area Code
<015> Study Arei Name !':eko). I'4)ecortr lis
<020> Progrnm Year 2019
<030> Conta(t Name - ?erson USAC rhould contact regi.dang this data slcrel Ie cwe:r3
<0:l5t Conla(tlelephoneNumber'Numberoipertcn'dcntliiedindataline<030> liiri${}51}1 4x!
<039> Co^t3ct Email Add.ess - Emarl Address of person identilied in data line <030> {cEers,rhLa.'k!<)r: . cirri
TO BE COMPIETED BY THE REPORTING CARRIER, IF THE REPORIIN6 CARRIER 15 FILING ANNUAL REPORTING ON ITS OWN BEHALF:
Certification of Officer as to the Accuracy of the Data Reported for the Annual Reporting for CAf or Ll Recipients
certity that I am .n otti(er of the repo.tint caraier; my responsibalities i.clude en5uring the accuracy of the anrual repo,ting requirements for universal service suppotl
"ecipieots; .nd, to the best of my knowledge, the into.mallon reported on this [o.m and in any attachments is accurate.
\ame of Reportlng Carrier: F'-'$J:lir l''1econ 13:1
Srghature ol Authorired Cfficet: f:::l'i l!'IlD or:ir:Oate otlL'i2xla
Prnled name of aurhorized oafiaer: ia::rr *_ei:s3r
Title o. positron of Authoriaed officer: v? Geaeral ccuso' I
Ieleohone numberof Authorizedcfticeri {065{r5556 ex!
StudvAreaCodeofReoortrnsCerner: lrll:l Filins Due Date ior this ford 0l"l;;2'18
undnr Titlc 18 oa the United Sr.tet Code, 18 U-s,C. I 1001.
Page I l
lat. :.3
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<010> Stvdy Area Code I i t.: J:;
<015> StudY Area N.m€C:c(oii Tel4car :lJl
<020> Protaam Year .t-1:i
<030> Contad Name . pe6on USAC should contact .ega,din8 this data
<035> ContactTelephon.Number.Numbe.otpersonident;fiedirdatalin.<030> nl6tn:5Il: +x:
<039> coDta(t Email Address - Email Address of perron deotified rn.la!a lire <030> n:xe:rs rirli;k:]:,: . .):r
10 BE COMPTETED BY THE RTPORTING CARRIER, IF AN AGENT 15 FILING ANNUAL REPORIS ON THE CARRIER's BEHATF:
TO BE COMPLETTD BY THE AUTHORIZED AGENT:
Certification of Officer to .Aulhorize an Agent to tile Annual Reports for C,qF or ,l'{ecipients on Behalf of Reporting Carrier
certily that I am .n officer ot th€ reporting carrie,; my respoosibilities include ensuring the accuracy of
and, to lho best of my k.owlodgo, the roports and dat, provided to ths authorized ag6nt is
cr.tify that {Namo o,is aulhorired to lho inlormation reported oo b6hall o, the repoding ca.rier. I
annual dala reporting requirements provided to the authorized
0ate
d lor this formr
Pa.&ns *illfully malin3 falre {alcnrenti on thi, forfi ain be fnirhed by
under td€ l8
cy'nder rhe Comrnurrrations Act o, 1934, 4i U.5-C- li 502, S03{b). or lme or rdpnronment
y't.ter Cde, 18 U S C. ! I00l
*f o^^*,Certifi(ation of Agent Authorized Reports for CAF or Ll Recipients on Behalf of R€porting Carrier
l, as atent for the r€portiog car.ier, certify thrt I afi authori:ed to
the data reported herein based on data provided by the reponilg
iubmit
carder;
the annlal rcporti for universal reruice s{pport reclpients on behalf of the reporting carrieri I have provided
and, to the best ol my lnowledge, the informatlon .eponed herein Is aacurate.
Name of Reportrog Caarie.
Name of Althorized AEent Firmi
Signature of Authorired Agent or Emplovee cf Agent:Date:
Name of Autho.ired Agent Eoployee:
Iitle or position of Authorized Asent or Emolovee of AEent I
felephone number of Authoized Atent or Emoloyee of lgeg{'
itudv Aaea Code oa Reporting Carrier:Filirg Due Dat€ for this fo.m
le.rcns w'f{utty -af ing fofr. ,,o"*n,, on ,f,o for2{I canbepunirhedbyfineorforfe*u(eundertheCo'nmun(ation5ActolI93,{,47U5.C09502.503ibl,ortineo.rmp.rsonmentrode.Trtle
18 of the Unitcd Sratet Codr, l8 U 5.i. t l0ol.
P3ge 16
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iien:turp of Aurhorirpd Cffi.pr'
fitle or positron cf Authonzed Officer:
leleohon. numbar of Autlbnzed Oflicar:
I
Functionality in Emergency Situations
Program Year 2019 - 2018 Submission ol 2017
JB Ray
Network lnfrastructure Manager
Blackfoot
This document provides a high level description of the measures in place to provide
functionality in Emergency situations in the 482235, 483308 and 472222 study areas.
Central Offices in all 3 study areas (with the limited exceptions of the Drummond
Alberton) 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 Alberlon
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
failure. 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
Iocal operation within the remoter central office service area.
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Voice Services Rate Comparability
Program Year 2019 - 2018 Submission of 2A17
lVichelle Owens
Regulatory Specia list/Paralegal
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
$4s.38.
Data Services Rate Comparability
Program Year 2419 - 2018 Submission of 2017
It/ichelle Owens
Reg ulatory 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 - 2A18 Submission of 2017
lMichelle Owens
Regulatory Specialist/Paralegal
Blackfoot
For the Program year 2019, 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 eligibility has been determined.
Additional information to include any applicable terms and conditions can be viewed by
consu m ers at http ://urww. bla ckfoot. com/residenti a l/ .
Broadband Reasonable Request
Program Year 2019 - 2018 Submission ol 2017
Dave lMarlin
Ch ief 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.
MOSSADAMS
Report of Independent Auditors
Board of Trustees
Blackfoot Telephone Cooperative, lnc
Rcport on the .F'inancial Statenrcnt.s
We have audited the accompanying consolidated financial statements of Blackfoot Telephone
Cooperative, lnc. (Cooperative) and its subsidiaries, which comprise the consolidated balance sheets
as of Decemb er 31 ,2017 and 2016, and the related corrsolidated statements of income,
cornprehensive income, members' equity, and cash flows for the years then ended, and the related
notes to the consolidated financial statements.
fu [ a na g e rne nf 's Respons i b i li ty fit r t h e I' inanci crl Sf ei te rnen ts
Management is responsible for the preparation and fair presentation of these consolidated financial
statements in accordance with accounting principles generally accepled in the United States of
America; this includes the design, implementation, and maintenance of internal control relevant to the
preparation and fair presenlation of consolidated financial statements that are free from material
misstatement, whether due to fraud or error,
A uditor,'s Responsibility
Our responsibility is to express an opinion on these consolidated financial statements based on our
audits. We 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
misstaternent.
An audit involves 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, whether due to fraud or error, ln making those risk assessments, the auditor considers
internal control relevant to the entity's preparation and fair presentation of the consolidated financial
statements in order to design audit procedures thal are appropriate for the circumstances, but not for
the purpose of expressing an opinion on the effectiveness of the entity's internal control. Accordingly,
we express no such opinion. An audit also irrcludes evaluating the appropriateness of accounting
policies used and the reasonableness of significant accounting estimates made by nranagement, as
well as evaluating the overall presentation of the consolldated financial statements
We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis
for our audit oplnion.
1
( )p in irrn
ln or-rr opinion, the consoiidated flnarrcial statements referred to above presentfairly, in all malerial
respects, the financial posjtir:rr of Blackfoot Telephone Cooperative, lrrc. and its subsidiaries as of
Decenrber 31, 201 7 and 2016, and the results of their operations ancl their cash flows for the years
then ended in accordance with accountino principles generally accepted in the United States of
America.
t'Ayr) hdnm,r lrl,f
Spokane, Washington
February 28,2018
2
Michelle Owens
From:
Sent:
To:
Subject:
Aaron Neilson
Friday, July 13, 2018 10:23 AM
Michelle Owens
FW: Form 481 Bulk Certification Confirmation
Aaron M. Neilson
Blackfooll Vice Presideni - General Counsel
1221 North Russell Street, [zlissoula. i\,'lT 59808
.106-54 1 - 5556 I a ne i I so n @!lgSLlaQ!_A9m I uir,vr,v b I aqk foot, conr
LEGAL NOTICEI This e-rnail and any attachments may be confidential, subject to attorney-client privilege, and/or protected by the
work-product doctrine. The unauthorized use or disclosure of this e-rnail or any attachment is prohibited. lf you received this e-mail
in error, please notify me and delete the e-mail immediately.
From : Fo rm48 1 @ usac.org Ima ilto : Form48L@ usac.org]
Sent: Friday, July 13,201810:21AM
To: Aaron Neilson <ANeilson@ blackfoot.com>
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 Time: A7/L3/2Ot8 12:21 PM
Filings Certified Byr [e-mail]
Program Year: 2O19
Your certification results are listed belowl
This is a syil*m ginrl aled emJ1i,
Please do nii respond to thi! nlcs:iart
,t) 1997-,101S, {Jrrivr:lrsal Servicq Adminislrdliv* Cr:rnp,:ny, All Riqhts Ri:5;ivr,'s4
tiSAC i 700 l.2lh Slrett i\.lW i Suta 9C0 | Ulashrnqion, DC 20005
il
Study Area Code 494 ID Carrier Name Results
473333 1430025 1 5 Frenront Telecom - RoR Certification Successful
482235 1 430025 3 1 BLACKFOOT TEL - BTC Certification Successfu I
483308 r4300253 I BLACKFOOT TEL. CFT CertiFication Successful
t
Certilication of Offi cer
to Authorize an Agent to l.'ile Data on Behalf of Re;lorting Carrier
I certiti, that (Name of Agent) John Staumlakis. Inc. (JSl) is authorized to subnrit infornrntion
reportctl on behnlfofthc reporting carrier. I also certify that I anr an ofticcr ofthc rcporting carrier;
my responsibilities include cnsuring the accurRcy of the data provided to thc Authorizcd Agent; and,
to the best of nrl' knorvledge, the actual data providctl to thc Authorized Agent are accurate.
Nanre of Authorized Agent Jolur Staurulakis, Inc. (JSI)
Name of Reporting Carrier Fremont'l'elcom Co.
S ignature ol' Authorized Ollicer Date
Printed naure of Authorized
Title or position of Authorized Ollicer 0 cL(
Telephone number or Authorized Ollicer,
Study Area Code of Reporting Carrier 472222 Filing Due Date for this fornr
(rnrn/dd/yyyy)06/r8/2018
Persotts rvilltirlly nraking thlse statenrents ort this form can bc' punishcd by line or lbrlbiture urrder tlre Conrrnunications Act
ol' 1934,47 [J.S.C. Nns 502, 503(b), or fioe or imprisonment under'fitle l8 ol'the United States Code, l8 U.S.C. 5s 1991.
L(
Certification of Officer as to the Accuracl' of thc CAF ICC Data Reported
I certify that I anr an officcr of thc reporting carrierl rn1, resportsibilities include ensuring the
accuracy of the actual data reported; and, to thc best of my knon'lcdge, the information reported on
this fornr is accurate.
Name of Reporting Carrier Fremont Tclcom Co.-/)
Signature ol' Authorized Ort"rfl)Datc L 1 l8
Printecl name of Authorized
"l'itle or position of Authorized Oltcer (
Teleplrcne nunrber or Authorized
Otficer.rlbLt 6qI5!?Y "x, ----
\-/v lr' I -
Filing Due Date for this tbnn
(rnnr/dd/yyyy)472222 06/l 81201 8Study Area Code of Rep<lrting Carrier
Persons willfully making f'alse statenrents on this forur can be punishcd by fine or tbrf'eiture under the Communications Act
of 1934,47 U.S.C. $s\ 502,503(b), or fine or imprisonnrent under'I'itle l8 of the United States Code, l8 U.S.C. 51 1991.
J
Ccrtilication of Olficer lbr llate-ot'-l{eturn Cnrrier liligibilitv for C'AI.-/lCC llccoverl'
I certit.1, tlrat I aru an officer of the reporting carrier rnrl that, to thc best of m1' knorvledge, the
reporting carricr on this lbrnr certilics thnt it ltas complied u'ith Eligible llecovery $51.917(d) and
Access Recovery Charge $51.917(c) nnd is eligiblc to rcccive the CAI ICC support rerluested pursuant
to $51.917(t).
Narnc of lleporting Carrier ,a !"^ont'l'elcom Co.
l)ate
Printed naure <lf Authorized O
Title or position of Authorized Olljcer
'l'elephone nunrber or Authorized
Otlicer.dDb6_'!L 2y34 "*r.
Study Area Code of Reporting Canier 472222 Filing Due Date lbr this form
(mm/ddyyyy)06/r8/2018
Persons willfully making lalse statements on this form can be punished by tine or tbrfbiture under the Conrmunications Act
of 1934, 47 U.S.C. .sN 502, 503(b), or t'ine or imprisonment under f itle I8 of the United States Code, l8 U.S.C. rs 1gg 1 .
Signature of Aurhorized om"fu
Ccrtification of Ofliccr tbr llatc-ol'-lleturn Carrier Not Seeking l)uplicative ltecovery,
I certit.r' thnt I anr nn officer of the reporting carrier and that, to the bcst of nry knorvlcdge, the
reporting carrier is not seeking duplicativc rccover)' in the statc jurisdiction for any Eligible Recovcrl'
subjcct to the recoverl, mechanisnr as pcr $51.917(tl)(vii).
Nanre of Reportirrg Carrier i'remont Telcom Co.-G,
Signature of Authorizcd Officer Dale 7 tg
Prinled nante of Authorized t
Title or position of Authorizecl Ofllccr rl I
t
Telephone number or Aulhorized
Officer.Qob 5!1 5{aq".r ____
Sludy Area Code of Reporting Carrier 472222 Filing Due Date for this fonn
(mn/ddlyyyy)06/r8/20r8
Persons willtitlly making talse statements on this fomr cau be punished by line or tbrlbiture under the Communications Act
of 1934, 47 U.S.C. NS 502, 503(b), or line or irnprisonnrent under Title l8 of the United States Code. l8 U.S.C. $ l00l .