20220623Fremont Telcom Form CAF ICC Data.pdf

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Certification of Oflicer
to Authorize an Agent to f ile Data on Behalf of Reporting Carrier
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I certiS that (Name of Agent) John Staurulakis.Inc. (JSD is authorized to submit information
reported on behalf of the reporting carrier. I also certify that I am an oflicer of the reporting carrier;
my responsibilities include ensuring the accuracy of the data provided to the Authorized Agent; and,
to the best of my knowledge, the actual data provided to the Authorized Agent are accurate.
Name of Authorized Agent John Staurulakis, Inc. (JSI)
Name of Reporting Carrier Fremont Telcom Co.
Signature of Authorized Officer Saul-Vluz1/o,L Date
6lt4/2022
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Printed name of Authorized Officer Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized Offrcer. ( 406 ) 541-5000
Study Area Code of Reporting Carrier 472222 Filing Due Date for this tbrm
(mm/dd/yyyy)06/1612022
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act
of 1934,47 U.S.C. $$ 502, 503(b), or fine or imprisonment under Title l8 ofthe United States Code, l8 U.S.C. $ 1001.
Certification of OIIicer as to the Accuracy of the CAF ICC Data Reported
I certiS that I am an officer of the reporting carrier; my responsibilities include ensuring the
accuracy of the actual data reported; and, to the best of my knowledge, the information reported on
this form is accurate.
Name of Reporting Carrier Fremont Telcom Co.
Signature of Authorized Officer SauyTlaollzL Date
611412022
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Printed name of Authorized Officer Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer.(406) s4l-s000
Study Area Code of Reporting Carrier 472222 Filing Due Date for this form
(mm/dd/yyyy)06/1612022
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act
of 1934,47 U.S.C. $$ 502, 503(b), or fine or imprisonment under Title l8 of the United States Code, l8 U.S.C. $ 1001.
Certilication of OIIicer for Rate-of-Return Carrier Eligibility for CAF/ICC Recovery
I certify that I am an ollicer of the reporting carrier and that, to the best of my knowledge, the
reporting carrier on this form certifies that it has complied with Eligible Recovery $51.917(d) and
Access Recovery Charge $51.917(e) and is eligible to receive the CAF ICC support requested pursuant
to $s1.917(f).
Name of Reporting Canier Fremont Telcom Co.
Signature of Authorized Offrcer Saz,1-7ilu2112,L Date
611412022
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Printed name of Authorized Officer Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer.(406) s41-s000
Study Area Code of Reporting Carrier 472222 Filing Due Date for this form
(mm/dd/yyyy)0611612022
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act
of 1934,47 U.S.C. S$ 502, 503(b), or fine or imprisonment under Title l8 ofthe United States Code, l8 U.S.C. $ 1001.
Certification of Officer for Rate-of-Return Carrier Not Seeking Duplicative Recovery
I certiS that I am an officer of the reporting carrier and thaf to the best of my knowledge, the
reporting carrier is not seeking duplicative recovery in the state jurisdiction for any Eligible Recovery
subject to the recovery mechanism as per $51.917(dXviD.
Name of Reporting Carrier X'remont Telcom Co.
Signature of Authorized Officer Sau774/412L Date
6/14/2022
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Printed name of Authorized Officer Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer.(406) s4r-s000
Study Area Code of Reporting Carrier 472222 Filing Due Date for this tbrm
(mm/dd/yyyy)06n6t2022
Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications 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. $ 1001.
State of Montana
County of Missoula
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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.
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. DBA Blackfoot Communications, 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 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. DBA Blackfoot Communications 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. $ 54.202(a)(2).
5. I also certify that allfederal universal service support funds received by Fremont Telcom Co. DBA
Blackfoot Communications 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 1,2023,
through December 31,2023, 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.
ief Financial Officer
June 21 .2022
Date
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SUBSCRIBED AND SWORN to before me this 21 of June,2022