20190619Blackfoot Telephone CAF ICC.pdf

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certification of officer ?BI9 JUll l9 Pll 3:5t
to Authorize an Agent to ['ile Data on Behalf of Reporting Carrier lil,\r,ir pUBLIC
!r il-li:iS C0MMISSIO
I certify' that (Name of Agent) John Staurulakis. Inc. (JSI) is authorizetl to submit information
reported on behalf of the reporting carrier. I also certify that I am an ofticer of the reporting carrierl
my responsibilities include ensuring the accuracy of the data provicled to the Authorized Agent; antl,
to the best of nry knonledge, the actual data provided to thc Authorized Agcnt are accurate.
John Staurulakis, Inc. (JSI)Nante of Authorized Agent
Blackfoot Telephonc Coopcrative, Inc.Nante of Reporting Carier
Stacey Mueller
Date5 LZSignature of Authorized
Printed nanre of
Title or position of Authorized Officer Chief Financial Officer
'Ietephone number or Authorized Officer. ( 406 ) 541 -5424
Study Area Code of'Reporting Carrier Filing Due Date fbr this form
(mm/ddiyyyy)482235 06n7/2019
Persons willfully nraking false statements on this form can be purished by fine or forfeiture under the Communications Act
of 1934,47 U.S.C. $$ 502, 503(b), or fine or inrprisonment under Title l8 of the United States Code, I8 U.S.C. $ 1001.
Certification of Officer as to the Accuracl' of the CAF ICC Data lleported
I ccrtifl,tha( I anr an officcr of thc reporting carrier; my responsibilities includc ensuring the
accur:lcy' of the actual data reported; and, to the best of nry knorvledge, thc information reported on
this form is accuratc.
Blackfoot Telephone Cooperative, Inc.Narne o[' Iteporting Carrier -/,
Signature ol Authorized Otficer l?lol,.
P rinred narne o l' Arrrlr orrrro r roGZst acey Mueller
I
'l"itle or position ol'Authorized Oificer Chie f Financial Officer
Tclephone numbcr or Autltorized
Of-tlcer.
( 406 ) s4t-5424
Study Area Code of Reporting Carrier Filing Due Date fclr this form
(mrldd/yyyy)482235 06117/2a19
Persons rvillfully making false statements on this lorm can be punished by fine or forf'eiture under the Cornmunications Act
of 1934, 47 U.S.C. $$ 502, 503(b), or fine or imprisonment under Title l8 of the United States Code, l8 U.S.C. $ l00l .
I
Ccrtilication of Officcr for Iiatc-of-Return Carricr liligibilitl'for Ci\li/lCC llccor.cn,
I certify that I am an officer of the reporting carrier antl thirt, to the best of my knolvletlge, the
reporting carrier on this form certifies that it has complicrl rvith Iiligible Recovery'$51.917(d) anrl
Access Ilecovery Charge $51.917(e) and is eligible to receive thc C;\F ICC support requested pursuant
to $sl.el7(0.
Name of Reporting Carier Blacklbot'I'elephone Cooperative, Inc.
S ignature of Authorized Date i i5|Lzlg
Printed rranre olAuthorized 6n# Stacey lvlueller
Title or position of Authorized Otlicer Chief Financial Offrcer
'I'elephone nunrber or Authorized
Olllcer.
( 406 ) s4t-5424
Stucly Area Code ol Reporling Carrier 482235 Filing Due Date tbr this fbrm
(mrnldd/yyvy)06fi7120te
Persons willlirlly rnaking fblse statements on this forrn can be punished by fine or forfeiture uncter the Cotnmunications Act
of 1914,47 U.S.C. $$ 502,503(b),or fineorimprisonruentundcrTitle l8 of the United StatesCode, l8 U.S.C. $ 1001.
I
Ccrtification of Officer for llatc-of-Rcturn Carrier Not Seeking Duplicative Recoverl'
I certify' that I am an officer of the reporting carricr anrl that, to the best of my knolvledgc, the
reporting can'ier is not seeking duplicative recover),in the statc jurisdiction lbr any Eligible Recovery
subject to the recovery nrechanism as per $51.917(dXvii).
Nanre ol'Reporting Clarier , lllackfoot Telephone Coo;lcrative, lnc.
Signatule ol' Authorized
Pri nted na nte o I Autltorized O t{*uZZ Stacev }v[ uel I er
"['itle or position olAuthorized Ot'ticer Chiel'Financial Officer
1'elephone nurrrber or Authorized
Officer.
(406) s4L-5424
Study Area Cr:de of Reporting Carrier 482235 Filing Duc Datc [r;r tltis forrn
(mrn,/dd/yyyy)06fi7t2019
Persons rvill{hlly making fulse statenrents on this fbrm can be punished by tine or forfeiture under the Communications Act
of 1934,47 U.S.C. Nrs 502,503(b), or fine or irnprisorrnrent under-l'itle l8 of the United States Code, l8 U.S.C. $ I001.
Date I r5D\\pt
Filing Entity COSA Study Area Name TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2015/2016
Total Eligible
Recovery After
True-Up Including
Otherwise
Unrecoverable
True-Up Revenue
Eligible Recovery
(After True-Up)
Eligible Recovery
(After True-Up)
Eligible Recovery
(After True-Up)
Exogenous Cost
Increments
ILEC Eligible
Recovery
Summary,
C2
BP10 BQ10 BR10
Recovery Summary,
cell BS10-BU10
Eligible Recovery
Summary, cell
BV10
Not a Holding Company Blackfoot Tel - BTC
TY 2015/2016 TY 2015/2016 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018
Total of
Exogenous Cost
True-Ups
Unrecoverable
True-Up
Revenue
Adjustment Maximum ARC
Revenue
Eligible ARC Lines Eligible ARC Lines Eligible ARC Lines Projected CBOL
Lines
ARC Revenue
From CBOL Lines
Revenue From
CBOL Lines
Eligible Recovery
BY10
Eligible Recovery
Summary, cell CG10
Recovery Summary,
cell BF10
Ceiling CAF Calc cell
J10 TY Noted Above
Ceiling CAF Calc cell
K10 TY Noted Above
Ceiling CAF Calc cell
D17 TY Noted Above
Ceiling CAF Calc cell
F17 TY Noted Above
Ceiling CAF Calc cell
H17 TY Noted Above
Rate Comp. CAF
Exchange Level ARC
cell AD21 TY Noted
Rate Comp. CAF
Exchange Level ARC
cell AF21 TY Noted
Summary TY Noted
Above
0 0 (182,390)18,159 158,327 0 2,688 4,908 0 0 0
-2017 are deleted.
TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2018/2019 TY 2018/2019 TY 2018/2019 TY 2018/2019 TY 2018/2019
SLB - Tariff Period
Projected CBOL
Lines
ARC Revenue
From CBOL Lines
From CBOL Lines Tariff Period
Projected CBOL
Lines
Imputed ARC
Revenue From
CBOL Lines
Revenue From
CBOL Lines
Recovery After
True-Up Including
Otherwise
Unrecoverable
True-Up Revenue
Recovery (After
True-Up)
Recovery (After
True-Up)
Eligible Recovery
(After True-Up)
Cost Increments
Rate Comp. CAF
Exchange Level ARC
cell AG21 TY Noted
Rate Comp. CAF
Exchange Level ARC
cell AI21 TY Noted
Summary TY Noted
Above
Rate Comp. CAF
Exchange Level ARC
cell AJ21 TY Noted
Rate Comp. CAF
Exchange Level ARC
cell AL21 TY Noted
Summary TY Noted
Above
Recovery Summary,
cell CJ10
Recovery Summary,
cell CK10 CL10 CM10-CO10
0 0 0 0 0 0 222,462 245,703 74,875 74,126 0
TY 2016/2017 TY 2016/2017 TY 2016/2017 TY 2016/2017 TY 2018/2019 TY 2018/2019 TY 2018/2019 TY 2018/2019 TY 2018/2019 TY 2018/2019 TY 2018/2019
ARC True-Up Imputed ARC
Revenue From
CBOL Lines
2016-2017
Exogenous Cost
True-Ups
Unrecoverable
True-Up Revenue
Adjustment Maximum ARC
Revenue
Revenues
Assessed Per
51.917(e) And
Imputed Per
51.917(f)(2)
ARC Revenue
From Projected
CBOL Lines Per
51.917(f)(5) Limit
Imputation For
CBOL Lines
Eligible ARC Lines Eligible ARC Lines
Eligible Recovery
Summary, cell
CP10
Eligible Recovery
Summary, cell
CQ10
Eligible Recovery
Summary, cell CR10-
CT10
Recovery Summary,
cell DB10
Recovery Summary,
cell BZ10
Ceiling CAF Calc cell
I10 TY Noted Above
Ceiling CAF Calc cell
K10 TY Noted Above
Ceiling CAF Calc cell
T10 TY Noted Above
Ceiling CAF Calc cell
U10 TY Noted Above
Ceiling CAF Calc cell
D17 TY Noted Above
Ceiling CAF Calc cell
F17 TY Noted Above
1,290 (261)0 0 (173,271)33,377 33,377 0 189,086 0 3,792
TY 2018/2019 TY 2018/2019 TY 2018/2019 TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2017/2018 TY 2017/2018 TY 2017/2018 TY 2017/2018
Projected MLB
Eligible ARC Lines CBOL Line
Demand
From CBOL Lines Recovery After
Otherwise
Unrecoverable
Eligible
Recovery
(After True-Up)
Eligible
Recovery
(After True-
Up)
Recovery
(After True-
Up)
Exogenous Cost
Increments
Revenue From
Up
True-Ups
Unrecoverable
True-Up
Revenue
Ceiling CAF Calc cell
H17 TY Noted Above
Rate Comp. Exchange
Noted Above
Rate Comp. Exchange
Level ARC cell AH7 TY
Noted Above
Eligible Recovery
Summary, cell
DE10
Summary, cell
DF10
Eligible Recovery
Summary, cell
DG10
Eligible Recovery
CO10
Eligible Recovery
Summary, cell DK10
Eligible Recovery
Summary, cell DL10
Eligible Recovery
Summary, cell
DM10-DO10
Eligible Recovery
Summary, cell
DW10
8,509 12,013 0 253,834 294,681 61,629 70,419 0 (11,266)2,978 0 0
TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2019/2020 TY 2019/2020
Double
Recovery
Adjustment
Maximum
ARC Revenue
Revenues
Assessed Per
Imputed Per
51.917(f)(2)
Expected
Imputed ARC
Projected
CBOL Lines
Per
51.917(f)(4),
After
51.917(f)(5)
Expected CAF
ICC Support
After ARC
CBOL Lines
Eligible ARC Lines Eligible ARC
Lines
Eligible ARC
Lines
Projected
CBOL Line
Demand
From CBOL
Lines
Eligible Recovery
Summary, cell CU10
Calc cell I10 Calc cell K10 Calc cell T10 Calc cell U10 cell D17 Calc cell F17 Calc cell H17 Exchange Level
ARC cell AG12
Exchange Level
ARC cell AH7
(164,607)32,492 32,492 0 221,342 0 3,609 7,739 13,638 1,282
State of Montana CERTIFICATION BY ELIGIBLE TELECOMMUNICATIONS CARRIER
OF COTMPLIANCE WITH SERVICE QUALITY AND CUSTOMER
PROTECTION, ABILITY TO REMAIN FUNCTIONAL IN EIVIERGENCIES
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 services 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 seruice support under section 214(e) 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. 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. I also certify that all federal universal service support funds received by Blackfoot Telephone
Cooperative, lnc, during the current calendar year will be used in a manner consistent with section
25aG); 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 1,2020, through
December 31,2020, 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 254(e) of the Telecommunications Act.
€r,Chief Financial Officer
1
Date
MOHNTE IEEOWE],IS
iIOTARY PUBUChrthe
State of Montana
Besidlng al Hamilton, MT
My Commissbn Expires
September09,20h.
SS
)
)
)
SUBSCRIBED AND SWORN to before me this day of
I