20190614Cambridge Telephone CAF ICC.pdf

TO EE COMPLETED BY THE REPORTING CARRIER,
--T- 11- o I
Gertiflcation of Offlcer as to the.Accuracy of the CAF lCC Data Reported
I cenlfy that I am an ofllcor ot tha reporling sarrl6r; my rssponslbllitles includ€ en6uring tte sccuracy ofth6 aclual data roportod; and, to lho bost of my
knowl€dge, tho informatlon roportod on thls form ls accurale,
Namsof Rooorun, c",r1", Cambridge,Telephone Co., lnc.
5t2812019
Kristie Kanady
Manager
reledprp number ot Authodz€d ofrlcer: d,2,09)?,5-7- !:31,1 ed.
Study Area Codc ol RsDorllno Carier 472215 liltffili##r'#"*irsrorrhrstorm lo"n,r,o,"
Per3ons wllllully maklog fals6 stalem€nts on thls form cafl be punlshed by fhs or lorfellure und€r the Communicsllons Act of 1934, 47 U.S.C. SS 502, 5030), or flne or
lmprlsonment under Tltle 18 ol lh6 Unlled Slatos Code, 18 U.S.C. S 1001.
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Carrier Cert
TO BE COMPLETED BY AN OFFICER OF THE REPORTING CARRIER
Certificatlon of Offlcer for Rate-of-Return Carrler Not Seeking Dupllcative Recovery
I cettlfy that I am an offlcer of the reporting carrler and that, to the best of my knowledg€, thls reportlng carrler is not seeklnB du pl lcatlv€ recovery in
the state lurisdktion fo, any EllSible Recovery subiect to the recovery mechanlsm as per 51,917(d)(vil),
{ar}6of Reporilmc",r1", Cambfidge Telephone Co,, lng.
of st28t2019
Kristie Kanady
Billing Manager
tetephons numberof authorized oftico.: (20P) 2-57-3?M
Study Area Code of Reoortlno CanlBr 472215 l,:..:':,,,lrlrrng oue Dare Iorthts fom
l.:lli,".-l, l.irlrmnvoolwwt 06 /17 /2019
Persons wlllfully mlklno falso st tements on this ftrm Gan be punished by line or forlGitulc undcr the Communlcations AGt ot '19341 47 U,S,C. SS 502,
503(bl, or fine or lmprlsonmont under Tills 18 of the Unllsd Statas Code, 18 U"s,C, S 1001,
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TO BE COMPLETED BYAN OFFICER OF THE REPORTING CARRIER
Certificatlon of officer for Rate-of-Return Carrier Eligibility for CAF/ICC Recovery
lcertirythatlamanofflcorofthoroportlnScatrl€randthat,tothabestolmyknowledge, thereportingcar.leronthlsfo;mcertlfletthatlthas
complled wlth Ellglble Recovory !51.917(d) and Acce!t R€covery charSe 551.917(e) .nd ls eligible to receivs th€ cAF lcc support requost€d pursuant
to 051.917{0.
Name ot ReDs.no cu,r", Cambridge Telephone Co., lpc.
Dats 512812019
Kanady
Billing Manager
rsteDhone numbaror authorlz€d officor: (20q) 257-33.X*
Sludy fuea Code of Raportlns Carder l+tzzts |;ffiln,x.:m1erorth,s,o'm 05 / t7 /2Or9
Porsons wlllfully making false statements on lhls form can bo punlshed by
503(b)t or llna or lmprlsonment under Tltle 18
tlno or forfelture undsrlhc Communic.tlons Aot ot ,|934, .17 U.S.C. SS 602,
of the Unlted States Code, '18 U.S.C. S 1001.
TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING DATA ON THE CARRIER'S BEHALF:
Certlficatlon of Offlce, to Authorlze an Agent to Flle Data Reported on Bohalf of Reportlng Carrlor
lcedlly that (Namr ol ASent) [,1,999 Ad4$.-tte ts {uthodzed to submlt ths lnformallon Eporled oo behalt of lho rspo]tlng c.rlal lalso oedlly thal I am an
omcel ot tho ropoillng card.r; my rosponrlbllltlc8 lnclude cnerlng the occuncy of the dat. provldod to Urs Authorlzod Agonl; rnd, lo the best ot my knoalcdge,
IhB actuel dsla provldod to lhe Authodzod Agont lre rcourate.
rrir r d m6rmrdvrrc aa* MoSS Adams LLP
rrrr d needongr u'60 Cambrldge Flephono Co., lnc. ,
m 512812019
.dld Kristie Kanady
tdtdosnnd rnt adq m@snqydc p6569 (2081257:3314-o*- ' ^ ^ ^
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