20190619Fremont Telcom CAF ICC.pdf

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Certification of Officcr
to r\uthorize an Agcnt to Filc f)atn on Behalf of Reporting Ca
I ccrtify that (Narne of Agent) John Staurulal<is. Inc. (JSI) is authorizecl to submit information
reported on bchalf of the reporting carrier. I also certify that I am an officcr of thc reporting carrier;
my responsibilitics include ensuring the accuracl'of the datn provitled to the r\uthorized Agent; and,
to the best of my knorvledge, the acturtl elata provicled to the Authorized Agent are accurate.
?019 JUH l9 PH 3, SS
rrier; i.1-:g pUBLIC
!'i lLl Ti i li COMMtSSIOh
Jolrn Staurulakis, Inc. (JSl)Narnc of Authorized Agent
Name of' Reporting Carrier Frernont J'clcolrr Co.
Signatr"rre oI Authorized Otficer lDate, rI glzzlq
Printed rrarne of Authorized offrceLZsracey Mueller
'Iitle or position of Authorized Officer Chiel'Financial Officer
't'elephone number or Authorized Otticer. ( 406 ) 541-5424
Study Area Code of Reporting Carier 472222
or USAC
internal
473333
Filing Due Date for this form
(mn/ddiyyyy)ailfin0t9
Persons lvillfully nraking lalse statements on this lbrm can be punished by fine or tbrfeitule under the Con'ununications Act
of 1934,47 U.S.C. Ns\ 502, 503(b), or fine or imprisomnent under Title l8 of the United States Codc, 18 U.S.C. .s 1001.
Ccrtification of Officer as to the r\ccuracl,of thc CAF ICC Data Reportcd
I ccrtil"v that I anr irn olllcer of the reporting carrier; my responsibilities inclucle ensuring the
accuracv of thc actunl data reportccl; antl, to thc bcst of my knowlcdgc, the information rcported on
this forrn is accurate.
Name ol' Iteporting Carrier l'remont Telcom Co.
S ignature ol Authorized OI'frcer Datg5 th
P rirrtecl rrarne o l' Authorized Ottl cer {242!5;;;;;rr"r'
'l'itle or position of .,\uthorized OIficer Chie f lrinanciaI OtJicer
Telephone number or Authorized
Otficer.
( 406 ) s4t-s424
Study Area Code ol Ileporting Carrier 472222
or US..\C
internal
473333
Filing Due Date for this fumr
(mmlddiyyyy)06117 t2019
Persons willfutly rnaking lhlse statements on tl'ris fomr can be punished by fine or forf'eiture under the Cornmunications Act
of 193.1.47 U.S.C. s\$ 502, 503(b), or fine or imprisonrnent under-fitle l8 of the United States Code. 1,9 U.S.C. $ 1001.
I
I
Ce rtification of Ofticer for llntc-of-Return Caruicr Iiligibilitr, Ibr CAF/lCC llccovery
I certifl,that I nm an officcr of the reporfing carrier anrl that, to the best of nty linorvleclge, the
reporting ctrrier on this form certifics thnt it has complied rvith liligible Rccoverr,$51.917(d) and
.,\ccess llecoverl'Charge $51.917(e) and is eligible to receive the C,,\!- ICC support requested pursuant
to $51.eI7(0.
Name ol' Iteporting Carrier Fremont'I'elcom Co
Signature of Authorized Otficer h
Date r tslzal I
P rinte<i nanrc o I A u thorized oti{t y'rStacey M uel I er
'f itle or position of Authorized Ollicer Chief Financial Otlicer
Telephone number or Authorized
Oltlcer.
(406) s4t-s424
Snrdy Area Code of Reporting Carrier 11))))
or USAC
internal
473333
Filing Due Date for this fornr
(mnlddiyyyy)06117t201e
Persons rvillfully nraking false statements on this fcrrm can be punished by fine or forfeiture under the Conrrnunications Act
ol1934.47 U.S.C. s\$ 502,503(b), orfine orimprisonment underTitle I8 oltheUnited StatesCode, l8 U.S.C. $ I001.
Certilication of Ofliccr lbr llate-ol'-lteturn Carrier Not Sccliing Duplicative ltccovcry
I ccrtil.r, that I anl an otllcer of the reporting carrier and thlt, to thc bcst of my knorvletlge, thc
rcporting carrier is not seeking duplicative rccover)' in the state juriscliction for nn1' Iiligible Recovcrv
subjcct to thc recoycrl'mcchanism as per $51.917(d)(vii).
Nanre of Reporting Carrier Fremont'Ielcom Co.
Signature of Authorized Oflrcer ra Date t ,Slzzlrt
Irrintetl nanre of A uthorizecl Offi ce rL4rur;ey M r:el I er
Title or position of Authorized Oft'icer Chief Financial Offlcer
Telephone nurnber or Authorized
OlTicer.
(406 ) 54t-s424
Study Area Code of Reporting Canier Iriling Due f)ate tbr this fbrm
(mrniddlyyyy)06n7/2019
Persons rvillfirlly making false staterrrents on this tbnl can be punished by fine clr lbrfeiture under the Con:munications Act
of 1934.47 U.S.C. S$ 502.503(b), or fine or irnprisonnrent underTitle l8 of the United States Code, l8 U.S.C. $ 1001.
4.17)))
or USAC
internal
473333
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
Blackfoot Telephone Cooperative Fremont Telecom Co.
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 0 17,640 369,972 0 1,908 3,972 4,752 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
1,404 4,212 0 0 0 0 411,477 371,067 8,624 34,949 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
(1,432)(1,731)0 0 0 28,383 28,383 0 383,095 0 2,769
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
6,692 8,175 0 417,119 383,953 20,309 33,202 0 (10,778)(9,567)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
0 26,199 26,199 0 390,920 0 2,639 6,094 9,156 25,305
State of Montana CERTIFICATION BY ELIGIBLE TELECOMMUNICATIONS CARRIERSS 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 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 carrier for receiving federal
universal service support under section 21a(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. 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(aX2).
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 1,2020, 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.
Chief Financial Officer
Date
SUBSCRIBED AND SWORN to before me this day of Jot4
)
)
)
(-
MICHELTE LEE OWENS
T.IOTARY PUBUC |ortho
State ol Montana
Residing at Hamilton, MT
Gommission Etpinas
2021.
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