20220714Blackfooot Telephone Form 481.pdf

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Page 1
<010> StudvAreacode 442235
<O1S> StudvArea Name AI.ACXFOOT TEL - BTC
<020> ProsramYear 2021
<030> ContactName: PersonUSACshouldcontact
with questions about this data Mlchelle OueB
<035> Contact Telephone Number:
Number ol the oerson identitied in data line <O3O>
4065415131 qt
<039> Contact Email Address:
Emall of the person identitied in data line <030>rcreBoblackfoot . con
Form Type 5,1.313 and 54-422
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<01O) Study A.e. d!a92235
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<020> PaognhYaal 2023
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<O!Xb C.ntid Em.ll Add6 - Emll addr6 of D.m ldatlfu ln d.tl llrc <03O D@61.*tot . cc
<210> Forthe prbr ohndrr ycar, reB thGrc rny roportable rcicG $ruk outaSes?
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<010> StudyArea Code tl22ta
<015> StudyArea Name
<02(> ProgamYear
<03(> Contact Namc - Perlon USAC should contact rc8.rdintthls data u&u. tu
<)35>Contact
<,:t(>
Numbcr - Number of perrcn ldentlffed in data line
<039>Contact Emall Addre$ - Email Addrcss of person identifl€d in data line
<03(>
<4(Xl>
<410>
<420>
Sclect ftom the dropdown llst to lndlcate how you would llke to report
voice complalnB (zcao or gGatrrl br \rolc! telcphony srlice in the p,lor
calendar year for each service arca in which you arc deslgnated an ETc for
any facllitics you own, opcratc, lcaic, or odlerwlic utillzc.
Compl.lnts pcr 1000 customers for fixed Yoice
complaints pcr ilno customcrs for moblh voicr
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Page 5
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<)15> StudyAENarc
<02(> ProgEmYqr
<0:!0> Cont ct N.rc - Plmn USAC rhouH @ntact rHrrdinrthb d.tr
Orsi> qntadTdephdsilumber-ilumberotpemldemilt dlnd.t llnc<):r(,> .055.15M d.
<,39, Contacl EmallAddrc$ - EmllAddB of p"pn kl€ntm.d h drta llre <r3D Mhckr@r. cd
<81D Rcmrtlm Ca.rhr Bla4t@t trl.pbno cq.rrtlE. Iuc.
<81D HoHlmComo.ny et rmucSl.
<812> Orntlm CommnY
dt3>
Arihtct Doltl lldrEA3Coif{lrff lrrtd Da*mdoislc
a^hai{ w.lrk!
P.8! 6
P.g! 7
d[lb SodyAi..Cod.taa2zs
<r19> studyApt{.m EffiE
d6
dl6 Cotux|m-N.rffts C
<r35> ConHTchDh@l{unbs-tlumbsof ffi lffiiltdlndtullm<03&'
4$hE FEll ^&.n- Eilllrfuolffin ihnrltuln de lln d!16
<9oO> Oors thc flllng.ntlty ofhrtrlbal land scrulces? (Y/Nl
<910> Trlbal [.nd{sl on whlch ETc s.ruca
<92o, Trlb.l Gdrcmmant Entalamant obllaation
lf you mp.ny $ilG Trlbd bnds, ph!$ elcct (Ycr,No, t{A} ior ch tho bilcs
to oifirm th. strurs d.srfb.d on th. .ttrchGd POF, on llm 920,
d.mnltntG ordlnrtion wtth th. Tribal Sdammnt puEu.nt to
5 54.313(.XSl lnclud.s:
<921> Noads assorsmont and deployment plsnning whh a foqls on Trlbal
cornmunily ancfior hsb'h.{ions.
<92> F..slblllty.nd sustalnabllltyplannln$
€23> Maitctinl t.rvlc.3 ln a culturally scmltivr mnnrr;
<92rD compllancc wlth Blthts ofwry proc!3Es
<925> compllancr wlth lrnd Us! permhdng Equhlmnts
€25> @mpliancc with F.cllltlcs Sitlng tul.s
<927> Compllanca wlth Envlronmcntal Raylcw pm.ss3
€28> compliancc Mth Cultunl PEsan atlon rcvlcw procassas
<929> Compllancc wlth Trlbal Busina$ and Lienslnt nqulrGmants.
l{.m of Attrctcd Dodm.nt
Sdocl
Y6qNoor
Not AlDlloabL
L.I La
L.
i.a
Peg.7
P8ic 8
<010>Arcr Codr {42r35
<015>Araa Nama M@m@ BE
<O3O> Contact Narrc - PcBon USAC should @ntact rrtardlnt thls dats
<035> ContactTalcphoncNumbar-Numbarof peFonldentifisdlndltallnr<030> .065.1s1!1 *.
<039> Cont dEmallAddru$-En.llAddrcsof p.6onidcntlflcdind.talin.<030> rcrt!6h*r@r.6
<1(D0>Voie saNicls Btr comp.Ebllity ertmetbn Yea
48223smt1010.pdf
<1010>Attach dctaiLd d.scription forvoicc s!ruh.s Et!
compaEbility complianc!
NamG of Att.chld D@umrnt
<102(>Bmdbsnd comp.r!blllty eft metbn
yea - Prlcitrg i6 no nore tshan the noBt recent appllcable bcnchnark amouced bythe Wircline CorlEtitioD Bureau
<1030>Attach dctalbd dcacrlptlon for bro.dbend
comp.rability @mpliane
4822358t1030 . pdf
N.me of Att chcd Documnt
Pagc 8
Pag! 9
<)10>Are Codc
Arer il.mr ffid@ - Bt
<020>Yaar
contact
<035> contactTebphon! Numb.r- Numbrrof prrson in <03O> 106$1513r dr
O39> Contact Emall Addr.$- Ernall Addr.ss otpcrson idcntmcd in d.te linc <030>
<1100> Ccrtify whrther tcrr.strial backhaul options Gxist (Y/t{}
.1130, flffi sslsc{ ths approprlab t€spom. (Yes, No, Nd APdlcabl€) b cdrflm the
rBportng cafibr oferr bDadband sarvlca of at loast 1 Mbpo doyyttstsam end 250 kbps
upst€8m within tho 3uppodod arBa Puraranr b s 54.313(9).
<1140>Alaskr Plan r.t!-of{Gtum c.ftmBtbn (ycs, no, or not.pplieblclof
compllancr wlth approv:d pcrformanca plan.
fet
Psae 9
Prge 10
<o10>Arca Code
<015>Area N8mc
aa22!5
<o20>Ya!r
<030> Cont ct NamG - Pcmn USAC 6ntact
<O35> Cont ct
<O3$ Contrct
d.tr
in drtr lina <O3O> ro6s.r5r!1 d.
<O30> *currck!@r.6prlson
<1210> Terms & @nditions of Volcr Tlhphony Lifclinc Plens
<1220>HTTP
'P1..$ chack th6a boxlc b!|ry to conffrm thrt th! .ttlchcd d@umrnt(s), on llnr 1210,
or tho mbslta llstld, o lina 1220, st lN th! EquiEd lnfomtbn puEEnt to
I54.422(rX2) rnnu.l cportlnS for ETC! mlvlnS lqfl-lncomr 5uppoG enl!6 must
.nnu.lly Egort:
<1221> lnfotm.tion dsriblrt thc tcms .nd @nditions of any voicet hphony scruic! plans offrrod to Lifelinc aubscribds,
<122D halls on thc numbcr of minutls puided as part of thc phn,
<122D Additional chrrycs for toll calls, and ntcs for each such plan.
E
E
Pat! 10
P.te U
<)1(> StudyAroCodc le22tr5
<rl5> studyAtrail.mc EMm E - BE
2024<02E Prolnm Y!.r
<oab @iradilam.-P.tsus^CC|{[e-mail] xl&rltM
<03$ Coilad Eh.ll AddB - EmilAd
Solect ilr€ approprlaE responsc below (Ycs, t{o, t{ot Appllcablel to noG compllane as a reclplcnt offtoren Hlgh Cost suppoQ Hlgh Gost support
to offset access charge reducfom, and Csnnect Anerlca Phase !l support as set forth ln 47 CFR 54.313(c),(dl,(e). The lnformatlon reported on thls
form and ln tfie documcnB ettaded below ls accurate.
<2015> 2015 and future Frozen Support Certification 47 CFR 0 54.313(cx4l
Prlce Cap Gnler C.onncct Amerlca ICC Support {47 CFR g 54.313(d)}
<2016> Certlfication support used to bulld broadband
Connect Amerlca Phasc tl Reportlng {47 CFR ! 54.313(q}
<2017b Connect America Fund Phase ll reciplent?
<2OL7C> Total amount of Phase ll support, if any, the price cap carrier used for
capital expenditures ln 2021.
<2018>Name of Attached Dodment Listing
Required lnformation
Conncct Amcdca Phase l! - FCC Form 470 PoednF
<201$ For the filing due July 1 following full lmplementation of this requirement,
answer yes, no, or not applicable to this certification request
P4.11
Attach the number, names, and addresses of communlty anchor
institutions to which the carrier newh began providing access to
broadband servlce ln the preceding calendar year - 54.313(e)(lXiiXA)
Pat. 12
<010> Study Area Code 482235
<015> StudyArea Name BI.,ACKFOOT TEI,BTC
<02(> ProgramYear 2023
<):lo> @ntact Name - Pe.son USAC should contact r€gardlng thir data Michelle Owens
<)35> Contact Telephone Numb€r - Number of person identifled ln data line <)30>406541-5131 ext.
<)39> Contact Email Address - EmailAddress of person identified in data line <)3D mowens@blackf OOt . COm
(3007)Does this filing retain a Cost Consultant and/or Firm, or other Third Party to prepare flnancial and
opeEtions data disclosures submitted to the National Exchange Canier Association (NECA), USAq
or the Administrator?
NamG of Consultant Namc of Consultant Flrmfhlrd Party
P.8. t:l
P{! 13
<010> StudyArca codc ,.arraR
<)1$ StudyArcr Nam.
<O2o> Pro8nm Ycar 2021
<)3o> cont d Nrrc - P!rcn USAC should @ntast EgardloS thls drta Michelle Owena
<035> contctTdcphorcl{umbcr-Numbrrofpcrcnidrntifhdind.tallm<030> 4065415131 exE.
<039> contrct Email Addrc$ - Em.ll Addrcss of peren ldcntifhd ln data llrc <030>mowens@blackfoot. com
Select from the drop down menu or check the boxer below to note compliance wlth 54.313(fX1). Privately held carriers must ensure compliance with the
financial reporting requircments set forth in 47 CFR 54.313(0(21. I further certify that the information reported on this form and in the documents
attached below is accur.te.
(300e)
(3010A)
(30108)
(3012A)
(30128)
(3013)
(3014)
(301s)
(3016)
(3017)
(3018)
(301e)
(3o2ol
(30211
(30221
(30231
(3024)
(302s)
(3025)
Progress Report on 5 Ycer Plan
carrilr ccrtifi cs to 54.313(0(rxiiil
Ccrtification of Public lnt.rcst Oblltations {47 cFR g
s4.313(fxlxil)
Pl.8$ Prorrida Attachrcnt
Rrtc-or{.$m Communlty Andot hntudons
lndicrtr if thc carricr newly dcploycd broadbrnd
$rvicc to ommunlty anchor institution(sl in thr
praviou3 olcndarycar.
Plcas Provida Attechmcnt
UsinS linlf downlo.d template and list th! numbcr,
namc and addrcs for .ach @mmunity anchor
institution. Attrch thc documcnt which contiins th.
communlty andior institution dctails as ruquircd by
47 cF.R. I s43r3(f)(rxrD
ls your comp.ny a Prlvltcly Hlld RoR c.ni.r {47
cfR 0 s4.313(0(2))
lf ycs, des your company fil. th. RUS ennusl Eport
Plaas€ ch6k thsa boxc3 to confim that thc
attachcd PDF, on linc 3012 @ntiins thc rcquircd
informetion pursuant to 5 54.313(fI2l @mpli.nc.
cquires:
Electronic copy of th"ir annurl RUs rcports
(OpcEting R.port for Talacommunications
BoffowcE)
Documnt(s) with B.lencr shrct, lncom. Statrm.nt
and statemcnt of cesh Flovrs
lfth. rospons! is ycs on linc 3014 sttach your
6mpany's RUs annual rcport rnd all rcquired
documrntation
lfthc rusponsc is no on llne 3014 isyour company
audltcd?
lf th. rrspons is yrs on line 3018, dc!$ chcck thc
boxcs bclow to confirm your submission m linr
3026 pursent to 0 54.3r3ffX2), contains:
Either a copy of th.ir auditrd flnancltl 3t!tem.nt; or
(2) a finsnci.l rcport in . format comp.Ebl.to RUS
OpGEtinS Rcport for Trbcommunietions BomB
Document(sl for Babne Shet, lncomc Statam.nt
and Statrmrnt of cash Flils
Man8gement l.ttcr and/or rudit opinim isu.d by
th. indlpcnd.nt crtiflcd publlc accountant that
pcrformcd th. coflipany's financial audit.
f thc rcsponsc is rc on linc 3018, plcas dtrck thc
boxrs bclow to confinn yoursubml3sion on linr
3025 pursuant to 0 54.313(0(21, @ntains:
@py of thcir flmncisl st tcmcnt whlch has b.cn
subjcct to rcvi.w by 8n ind.plndrnt ccrtified public
sccountant; or 2l a financial rcport in a format
@mparable to RUS Oplrating Report ror
Tcb@mmunications Bonoslrs
Undcrlying inlomation subjrctrd to a rcvicw by an
indcpcndrnt ccrtif ird public.ccountsnt
Undcrlying infomrtion subjr€ted to an ofticcr
anificatlon.
Documnt(s) with Bslane Shlct, lncomc Statcment
and Statcmrnt of Qsh Flffi
Att ch thc wo*shr.t listing rcquircd infomation
Ye. - AtEa.h Certlflcallon
Namr of Attachad Documnt Listing RcquiEd
lnformation
182235mt3010.Pd!
Yea - Atlacb Xer Coffilty hchols
Nam. of Attachcd Documcnt Usting
Rcquircd lnfom.tion
0es/rbl
(Y.rNol
Namc of Attached Docum.nt UstinS Required
lnformation
(Ycs/tlo)oo
]gf2J5[EaOlZDCOruEy ECOO! tnaElEUEaOn.Xla6
l82235tut3026Audlt.dFllmcl.I!, IEt
oooo
Nam ofAttachcd Doclmcnt ListiB R.quircd
lnfomation
P{r t3
P.8r 14
Flo.nd.l Dd.s{mmry
(:to27,R.wnE
(30281 OpcEting Expcnss
(3029) Nrtlmmc
(3030!Tclcplpm Plant ln SGMefPls)
(inSUTot lAsts
(30321r;l olbt
(30331 Tot l Equlty
(30341 Dividcnds
30513851
22274007
13738858
1551438174
148U8752
31479950
1 16868802
1537876
P.gc 14
P{t E
<010>studv Area Code
<015>
<020>
Area Name
Program
<030>Contact Name - Person USAC should contact this data
<039>ContactEmailMdrcss-EmailMdressofpersonldentm.dindatalinr<0:D> -."dud6r.s
4(xE Rural Bro.db.nd Bpcrlm.nt
Authorhed Rur.l Btoadbsnd Explrimcnt (RBEI rccipients m6t addrs thc certification for public interGst
oblEations .nd providG a lid of ncwly served community anchor institutions.
Plrblk lntercst OblErdons- Fcc 1048 (prr.fr.pb 2F29,781
Plcase address llne rtool r€grrding @mpliancc wlth the Commission's publlc intercst obligations. All RBE
particip.nts must pto\dde a responsc to Unc 4001.
lm1. R.cipicnt c.rtifi.s that it is ofrrring bro.dband meeting thc requisit public intcrcat oblig.tions consistcnt
with th. c.tcgory for whkh thcy werc schctcd, including broadband spc.4 latency, usagr capacity, and rat.s that
8rG reasonably comparable to rates for comparabl! ofrarings in urban arcas.
RBE Commml0 Andor losdUrtont
<4003a> lndic.te ifthe orricr ncwly deploycd brcadband servic. to community anchor institutlon(sl in thc
Prrvious calandar yaer
<4OO3b> Pl?asr Provid! Attachment UsirE llnlf
downlo.d tcmplate and list the number, name
and address for cach community anchot
institution. Attach thc documut whkh contains
th. community .nchor institution details .s
r.quircd by FCC 14-98 (paragraph 79)
Name of Attachrd Document LMIE Rcquired lnformation
Pre 15
Ptc 16
<010>
<020>
Area Code
ProSram Year
<030>Cont ct Namc - Person USAC should contact this data
<035><030>
<039>Contact Emall Address - Email Addrrss of pcmn identified in data line <030> @s!.Gla*!@! . .-
5005 Alaska Plan
(s011)
(s012)
Please indicate whether any terrestrial backhaul or other satellite backhaul became
commercially available in the previous calendar year in areas previously served
exclusively by perrormance.limitinB satellite backhaul.
lfthe filing carrier identified in its approved perfomance plans that it relies exclu3ively on
satellite backhaul for a cenain poriton ofthe population in its sewice area, indicate whether
any terrestrial backhaul or other satellite backhaul became commercially available in the
previoius calendar year in areas that were previoiusly served exclusively by satellite backhaul.
(ves/No)
(ves/No)
,adlysmd lEdil or loEbfbn
(Yes/No)
Namc of Attached
Document Listint
Rrquirud lnformation
<y)13>
D.arlDtbn O, t*Ur.{l ,.dmlofy
Ahska Plan Mobll. CanllrC Reasombly Comparabh Rate DcnroNtratlon
(5014a) Answer yes or no if mobile caniers receiving support from the Alaska Plan can demonstrate
compliance at the end ofthe fine.year milestone (2022) by showing that your required rtand-
alone voice plan, and one service plan that offers broadband data services, ifyou offer such
plans, are:
. Substantially similar to a seMce plan offered by at least one moblle wireless service
provider in the cellular market area (CMA) for Anchorage, Alaska, and
o Offered for the same or a lower rate than the matching plan in the CMA for Anchorage.
Ahrka Plan Mobile Canlert' R€asonably frmpsrablo Rate Demonstratlon Attachment
{5014b) lf Yes' is selected for 5014a, attach a document demonstrating compliance with the s-year
milestone. lf'No' is relected for 5014a, attach an explanation of non-compliance.
PIc 15
Ptc 1,
<o15>
<030>
<039>
Area Code
Area Namc
Contact Name -
Contact
oontact
<030>(030) **r.ua.*
tn
<6010> Ent€r the total amount of Phase ll Auction Support, if any, the carrier
used fo, capital expenditures.
Phare ll Auctbn and ]tlcw York Funds C.rtlftratbn
<6011>Certit (either yes or no) retarding whether the recipient has arailable
funds for all project costs that will exceed the amount of support thet will
be received for the next calendar year, This certification must be provlded
starting the flrstJuly 1st after receiving support until the recipient's
penultimate year of support.
Phese ll Aucdon Communlty Amhor lnstltutlons
<5012a> lndicate lf the carrier ncwly deployed broadband seMce to community
anchor lnstitution(s) in the previous calendar year.
<6012b> Please Proride Attachment Usint link, download template and list the
number, name and address for each community anchor institution.
Attach the document which contains the community anchor
institutlon details as required by FCC 1tt-98 (paragraph 79).
Ph.s€ ll Auctlon FCC fonn tuo Postlqs
<G013> For the flling due July 1 following full implementation of this
requirement answer yes, no, or not applicable to this certification request,
<5014>
Ph.se ll Auctlon P6t-Flnel Deployment Mlhstonc Pedormanc. C.rtlftc.tlon
Startint the first July 1st after meeting the final service milestone, certit
(yes, no, or not applicable) that the Phase ll-funded network that the Phase ll
aucdon recipient operated in the prior year meets the relevarit performance
requirements in 0 54.3ff).
(Yes/No)
Nsme of Attsched
Documcnt Listing Rrquircd
lnformation
P{.1,
PI. I
<)10>StudyArea Code
<015>StudyArua Name
<)!D>
<o39>
contect Name - Pemn USAC mntact
Contact
ldentifiedlndat lin!<O3O>
<7010> Phase ll Auction recipient performance requirements certification (Yes/No)
P.!. ll
PIC 19
<)1(>study Arc. codc
<)15>study Arc. Namc
<020> Prcgram Ycar roz:
<)3O> Contact Namc - Pe .
<)3$ Cortact Email Address - Email Address of pcrson idrntified in data line <030> @Enbr.dler."-
<E010>Unlendo a nErto Rlco Stat 2 Flxed - Gpltal E Qendlturcs
Ent.rth! total amount of Uniendo. Purrto Rico St te 2 fixcd support, if any, the
erricr uEd for capital cxplnditurcs.
<8011>Uniendo a Pucrto Rko sta& 2 Flxed - Ayillabh Funds Certlflcatlon
c.rtify (cith.r yes or no) rqardint whethrrth. rccipient has awihble funds for all prcjcct
costs that will cxcecd the amount of sopport th8t will b! rccaived for thc ncxt elcndar
yrar. This ertifietion must be puidcd strrting thc first JulY lst aftcr raceivint support
until the rcdpiant's prnultimata year of support.
<E012a>Unicndo . Pu.rto nico St $ 2 Fked - Communlty Anchor lnstitutlons
lndicatc if the canicr ncwly dcploycd broadband sryicc to community.nchor iBtitution(sl
ln thr prrvious elcndar ycar.
<8012b>
<8013>
<8014>
<8020>
<t030>
<8040>
<8050>
Phas Pruidr Attachmrnt
Using link, downlGd trmplatc 8nd list thc number, name and addrcs for each @mmunity
anchor imtitution. Attach the docurcnt s'hich @ntaim the mmunity anchor institution
dctails .s rcquircd by 47 C.F.R. S 54.313(.X21(A). Allowable Fil. Typcs.
Nam!ofAtt ched
Dcument Ljsting Requircd
lnformation
Unlendo . Pucrto Rlco Sta$ 2 Flxad - FCC Form ttTO Posti4s
For thc filint duc.,uly 1 following full implcm.ntation of this r.quir.m.nt answcr ycs, nq or
not appli6bl. to this ertifi€tion r.qucst.
Unlendo . Pu.rto Rko Stale 2 Flxed - Post-Flnrl Dcployment Mll.stonc P3rform.nco Certlfic.tlon
Starti[ the fiBtJuly ld aft.r metinS thc fin.l$ruic. milcstonc, certify (yca or no) that thc
Uniando . Purrto Rico St.tr 2-fundad nrtwork that thc St.tr 2 recipi.nt op.Etrd in thr prior
y.ar mccB thc rclcvrnt p.rfomancc rcquiromcnts in I 54,309.
Unlendo . Pueto nko st & 2 flrcd - suppott Relmbullcmetrt ccrtlftcatlon
S.313(nl: Rcclpicnts of Uniendo a Puerto Ri@ Fund St g" 2 fixed support shall enify that
such support w.s not uscd for costr that are (or will be) rtimburscd by othcr sourccs of
support, including of fedcral or lolgovcmmcnt aid or insurane rcimbumm.nts; and that
support was not usd for othar purposGs, such !s thr retitemrnt of $mpany debt unrclatcd
to eligiblc cxp.ndituros, or othar Gxpcn$s not dircctly rclatcd to nctmrk rostoEtion,
hardcniry, and exprnsion consistcnt with thr fram.work of th. Unirndo a Pu.rto Rico Fund.
Unl€ndo. PuGrto Rlco stata 2 Flred - Dlitst r Pl parldm$ and Rlsponsr Document tion
54.313(n): Rlclpi.nts of fixcd support from St g! 2 of thc Uni.ndo a Puctto Rico Fund shall
ertify that thcy h.va @nductcd an.nnual rcvlcw ofthc documantatlon rrquired by saction
5a.$15(al-(c) to d.tcminc th. nred for and to implem.nt chang.s or rcvislons to disaster
prcpardtlon.nd ncovcry dtrumentation,
Unlendo a Puerto Blco State 2 Moblle - Support Relmburs€metrt
54.313{n}: Rccipicnts of Unirndo , Pucrto Ri@ Fund Stetc 2 mobll. support shall ccnify that
such support wss not usad for @sts that are (or wlll bcl reimbursad by othlr sourcas of
support including of fcdcral or lml governmcnt ald or lnsuranca rcimbursaments; and thet
support wes not usrd for othcr purpo*s, such as thc rrtircmcnt of ompany debt unrclatrd
to lligiblc cxpcndituras, or oth.r axpansas not dircctly rrlatcd to nctwork rcstontion,
hardcnint, and cxpansion @nsistcnt with thc framewort ofth! Uniendo a Puerto Rico Fund.
Unlcndo a Pueno Rko St.te 2 Moblle - Dlsastet Prcpar€dnels and ncaponsa Docilmentatlon
54.313(n): Reipicnts of mobilc support frcm statc 2 ofthe Unicndo e Pucrto Rio Fund shall
c.rtifythat thay h3v. conduct.d an annual rcvicw of thc documcntation rcquired by scction
54.1515(.){cl to drtermine the n.ad for.nd to implemcnt chantls or rcvisions to disst t
prcpamtion and rccov.ry documcntation
Unlcndo a Pucrto Rlco st Se 2 Moblle - Moblh DlsbuEem.nts certlflcatlon
54.313(0): R.cipicnts of Uni.ndo . PErto Ri@ Fund Stetr 2 mobilc support shall ertify thst th.Y are in
complianca with all r.qulromcnts for rcclipt of such support to continue rscciviry Stata 2 mobilc
disbuHments
<8060>
P.gr 19
Pac 20
<010>Study Area Code
<015>Area Name
<030>Contact Name - PeBon USAC ahould contact this data
<039>Contect Email Addrcss - Email Address of pe6on idcftm€d in data line <03D .*.61.d.d.6
<9010>Connect UWI St te 2 Fixed - Capital Expendhures
Entrr the total amount of Conncct USVI Fund Stat 2 fixrd support, if any, thr carier us€d
for capital erprnditures.
<9011>Conn€ct USVI State 2 fixed -Ayailable Funds certlficatlon
Certify (cithrr ycs or no) rcgarding whcthcr thc rccipi.nt has availablc funds for .ll projcct
@sts th.t will cxe.d thc amount ofsupport that will ba rcccived forthc ncrt calcndar year.
This certifietion must bc provided starting thc first July 1st.fter rccriving support until th!
recipirnt's prnultimat! yrar of support.
<go!2a> Connect USnfl Stile 2 Fhed - Communlty Anchor lnsthutlons
lndietr if the erricr ncwly deployed brGdband s.ryie to @mmunity .nchor insthution(sl
in the prcvious Bl.ndarycar.
<9012b>
Phase Provld. Attachmrnt
Using link, download tcmplatc and list thc numbcr, name and addross for each community
anchor institution. Attach th! document which contains the ommunity anchor institution
dctails as requircd by 47 C,F.R. 5 54.313(r)(2XiXA).
NamG of Attachcd
Documcnt Listing Rcquired
lnformatlon
<9013>
@nnect USVI St ge 2 Fhed - FCC Form 47O Postlntr
For thc filing due July 1 following full implemcntation of this rcquircment answer yes, no, or
not applicable to this ccrtification rcqucst.
Conn€ct USVI Stete 2 Flxed - Post-Flnal Deploymant Mil€stone Perfomatrco Gertlflcatlon
Starting thc first July lst 8ft.r metint the final sruice milcstonc, ccrtify (y.s or no) th.t thc
Crnncct USVI Fund Stag. 2-fundcd network that thc Statc 2 rccipicnt opcntrd in thc prior year
m.rts thc r.hvant prrformancc roquircments in 5 54.309.
Conn€ct Usilrl Stage 2 Fix€d - Support Relmburslment Certlftcatlon
54.313(n): Rccipicnts of Conncct USvl Fund St3gc 2 fixrd support shall ertify that such support was
not usd for costs that arc (or will bcl rcimbur*d by othcr sourr$ of support, includiry offcdcral
or loel govcrnment aid or insuEnce rcimbuBcmcnts; .nd thet suppon was not uscd for other
purpos.s, such as the rrtircmcnt of @mpany debt unrelat.d to lligibb expenditurcs, or oth.r
exprn*s not dircdly rclatcd to nctwork r.stoEtion, hardanin& and lrpansion consistcnt with thc
framewor* of the Conncct USVI Fund.
Connect USVI State 2 Fixed - Dlsastcr Pr€paredn€ss and ncsponse Documentation
54.313(nr: Rccipicnt! offixcd support from Stag.2 of thc Conncct UsVl Fund shall ccrtify that th.y
have conductrd an .nnual rcvicw ofthr deumrntation reqlired by sccrion 54.1515(al-(cl to
drtcrminethr ned for.nd to implcmant changcs or ravislons to disastcr preparation and @vcry
documcntation.
Connect Uslrl Fund State 2 Moblle - Support Relmbursement C.rtlflcatlon
94.313(nl: Rftipients of Connect USVI Fund Stage 2 mobile support sh.ll certify that such support
was not uscd forcosts that arc (or will b.) rcimburscd by othcr sources of support, including of
fedcnl or local govcmmlnt aid or insurane rcimbursaments; and that support was not uscd for
othcr plrpoEs, such as thc rctirrmlnt of company dcbt unrclatcd to allgibl. oxplnditurcs, or other
expcnses not directly rclated to n.twork rcstomtion, herdenin& and spansion consistrnt with the
fEmcwork ofthe Conncct UsVl Fund. Recipiants of mobile support from stag. 2 of the conn.ct
USVI Fund shell c.rtify that they havc rcnduct.d an annual rrvicw of the documcntation ruquirad by
section 54.1515(a)-(cl to dctcrminc thc n.ed for and to implemcnt chang.s or rryisions to disstcr
prcparation and recovery documentation.
Connect Usilrl Fund St te 2 Moblle - Dissst€r Pr€parcdness and R6ponse Documanbtlon
54.313(n): R.cipients of mobilc support from stagc 2 ofthc conncct USvl Fund shall ertifythat
thcy havc onductcd an annual ravi.w of thc ddumentation requircd by s.ction 54.1515(e)-(c) to
detrrmin. th. n.rd tor end to impllmrnt changes q rryisions to disast"r praparation tnd respons
documcntation,
Connect USVI Fund Stato 2 Mobila - Moblle Dlsbursements Cenmcadon
54.313(ol: R*ipilnts of Connrct UsVl Fund Stage 2 mobile support shall ertity that th.y ar. in
complianca with all requiremrnts for rcccipt of such support to continuc rccciving staSc 2 mobilc
disbursrments.
<9014>
<9020>
<9030>
<9040>
<9050>
<9060>
Patc 20
P$21
<010>
<020>
<035>
Area Cod€
Area Name
N.mc - Person UsAc should contact
Contact
Contact Email Addr6s - Email Addiess person <o3o> m.-drrcrr-i . .*
this data
<10010>
<10011>
<1oO12a>
<1@12b>
<10013>
<10014>
RooF C.phal Expenditures
Starting the first July 1st attrr r.cciving support until th. July 1st aft.r tha rccipient's
support tem has cnd"d, rccipicnts of Runl Digital Opportunity Fund support must submit
the total amount of support, if any, thc r€cipicnt us.d for €pital .xpcnditures in thc
prcvious calcndar year. This is rcquired by 47 C.F.R. 5
'4.313(.X2Xi)(B).
RDOF Ayailable Funds Certl lcatlon
Plcasc provida a rcspon$ (cithcr ycs or no) to this certitietion requcat for any rcipicnt of
Rur6l Ditital Opportunity Fulld support that thc rccipicnt has ahil.blc funds for all prcjrct
cortg that will excrd the amount of support that will be rccciv.d for th. next calcndar
ycar. This ccrtification must be pdidcd sterting the fiEt July 1st .ftcr rcc.iving support
until the rsipicnt's p€nultimatc ycar of support, as rcquircd by rcquirod by 47 C.F.R. 5
s4.3r3(.1(2Xii).
RDOF Communlty Anchor lnstitutions
Rrcipients of Rur.l Ditital Opportunity Fund support must attach e list containing the
numbcr, namcs, and addrcsss of community anchor institutims to which thc Gligiblc
talftommunietions €nicr nrwly bcgan providing a@ss to broadband scruice in the
prcceding €l.ndsrycar. This flllng is rcquircd by 47 C.F.R. S 5a.313(cX2l01(A),
Pleasc Prcvid. Attachment
Uging link, download t"mplatc and list thc numbcr, name and address forcach community
anchor institution. Attech the dGument which contains the communlty anchor institution
dctails as rcqulrcd by a7 C.F.R. I 5a.313(cX2Xil(A).
l,lam. of Attachcd
Document Listing
Rcquired lnformation
RDOF FCC Form rt70 Po.tlus
For the filing due July lst followinS full impl"mcntation of this rcquircmcnt, pl.a* providc
a rrsponsc (cithcryes, no, or not applieble) to this ccrtifietion rcqu.st. Rccipicnts of Rural
Digital Opportunlty Fund must rcspond affirmatively that thcy bid on etctory onc
tclcommunietions and lntcrnet .ccess $ryiccs in rcspon$ to 8ll FcC Form 47o postints
sccklng brodband sedica that m.cts th. connrctivity tarlrts for thc schmls and libraries
univrBl scMcc aupport program for .ligiblc schools and libraries (as describcd in 5
54.501) lo6t d within any arua in a census block whcrc the 6rirr is receivint Ruml Ditital
Opportunity Fund, and that such bids wcrc .t Btas raasonablc compareblc to htca charECd
to cligiblc *hools and librarils in urban srcas for lnstructions for Complrting FCC Form 481
oMB Control No.30600986 (High-Cost) OMB control No.306Go819 (Low{ncomr)
Novcmb€r 2O2o Pstc tl4 compamblc offerings. This filing is rcquircd by47 C.F.R. 5
5a.313(c)(2Xi)(cl. This ertifiotion will not b. rcquirod until thc.luly 1st followint thr E-
Rata program y€ar that this obligation has bcen fully implement.d. Mod.rnizing thc E-Ratc
Program for Schools and Librarlcs ct al., wc Dockrt. Nos. 13-184, 1040, 29 Fcc Rcd 15538,
1s56G6Z para. 72 (2014)'
RDOF Po8t-Flml Dcploymcnt Mll6ton! PGrformtnc! Ccrtlficttlon
Startlng the first July lst eftcr . Rural Ditital Opportunity Fund recipicnt meets its final
scruicc mil.stonc until tha,luly 1st aftcr thc support rcclpicnfs support tcm h.s rndcd,
please proidc a rcspone (elthcr ycs, no, or not applieblc) that the Rural oigital
Opportunity Fund-fund.d nltwo* that tha support rccipilnt opcmtcd in thc prior ycar
merts the rclcvant perfomance rcquircmcnts in 47 C.F.R. S S{.3O9. This filing is rcquircd by
a7 c.F.R. S 54.313(rl(2xiiil.
Pagr 21
PeZcZz
<O10> StudyAr.a Codc 482235
<O1$ StudvArc. llame BIACKFOOT TEI. . BTC
d)2O> Proram Y.rr 202:j
<03o> Contact Nemc - PcEon UsAcshould @nt.ct rcfardinsthis d.t.uLchelle oueDa
<O3S> Contact Tclcphona Numbcr - Numbcr of pcrcn identificd in &ta linc <O3D 't06s{1s131 4t
<O39> Contact Email Addrcs - Email Addrcs of pcrsn idcntified in data line <030>
TO BE COMPI"EIED BY THE REPORNNG CARRIER, IF THE REPORIING CARRIER IS FIUNG AIINUAL REPORTING O'I ITS OWN BEHALF:
Certiflcatlon of Offlcer .s to the Accuracy of the Data Reported for the Annuat Reporting for CAF or Ll Rlciphntr
I cc.Ofy that I .m an ofhccr of thG rGportlry GarrlaD my Esponcblllo6 lnduda cnsudng tha .car.cy of the rnnuel repordnt r.qulrum.nts ior unlyGBd scrylcc support
ndplGntti tnd, to thc bcn ol my lnoudc4f, thc lnformruon ,Gportcd on thts form .nd ln .ny rtt drmGnb b .ccur.tr.
NamcofRrDortinrcasi.r. BlACKFoor TEL - BTc
shnaturrofAuthorizcdofficcr: CBRTTFTED omrm Datc 07/L2/2022
Printad nama of authorizcd offier: stacey uueller
I1tle or Dsition of Authorizld Offier: Chlef FlEnclal Of f icer
Iclcohone numbcr of Authorized Officer: 4055415000 exg
ttudvArea code of R.rcrtim carirr: 48223s Fllinr Du. Date for thislon o7 129/2022
P.mnswllltullymtinifllssbtemntsonthlsiomanbcpunEh.dbyffn.oriorf.ttunund.rthcCommunhltionsActof 1934 47U,S.C.955O2,503(bl,orffnGorimprisnmnt
und.r Tltlc 18 of tha Unltcd Stats Cod!, 18 U,S.C, 5 1mL
PtZc22
Pag.23
<010> Study Ar.. Codc 442235
<015> StudvArc.Nrm BIACKFOOT TE', . BTC
<020> PrcgnmYcar 2023
<030> ContectNlmc-PemnUsAcshouldcontactrciardlngthisd.tr Michelteovcn6
<035> ContactT.lGphoENumbcr-Numb"rotpcrsnidGltlfirdindrt!llru<O3D 4055415131 exs'
<039> Contact Emil Mdrcs - Emil Addrc$ of pcmn idcntifu in dlt lim <O3o> wuoblackf oot . com
TO BE COMPLETED BY]HE REPOTflNG CARRIER, tF Ail AGENT IS FITIilG ANNUAI REPORTS ON THE CARRIERS EEHAIF:
TO BE COMP].ETED BY THE AUTHORIZED AGE'{T!
Ccftfkation of Offlcer to Authorhe an Atrnt to Flle Annual Reports for CAF or u Rcclplcnt3 on Beh.l, of Reporting c.nhr
I c.rtly rh.r 0{.m of b &lhodr.d to subNr{t th. lnfom.do nporbd on balrall ol lha iapordng carrLf. I
rgEnt rnd, to tr bct ot my knoo{.dgo,lh. rrporfr atld .bL PIot ld.d to lha autllord lgilt lr Eunb.
il.E. af Adh6.ir.d Ar.ht:
Nam df R.biliE Crri.r:
llrnatur. of Authorhad Oficcr:D.t :
Prlnt d mm of Authori2.d Ofnc.r:
ntla dr eltlm 6f Adlwlr.d Off,dr:
f.bEhoE nuhb.r of Authorl2.d Olfic.r:
itudv Aru C!d. of R.mrtlm Crrricr:Flllm Du Drtc for thls form:
PelMs wlltfuly mklnS f.l* st.t mnts on thl5 fom @n bc FJnbhcd by f,ne orforfeltue undcrth. comrunlc.tbns Act of 19:14, 47 U,s.c a5 502,503(b], or finc or imp.l$nmnt
und.rTtth 18 ofthc Unftcd Sr.tB codc, lt U.S.C. 5 1001.
Crrtfkatlon ot Atent Authodzed to Flh Annurl Reports for CAF or Ll Reclplents on Bchalf of Rcportlng Csnlcr
llGd.t rcponodh.rdnb.rdmd.t!provu.dDylhtruporthSc.nlocrild,tott.hof,nylmou,hqr,tlt.ffirnldorrcDodcdh.rchbtcar.t.
{ama of RamrtE Crrrlcr:
ikn.tur. of Adh6rh.d A!.ht o. Emalo*a of Atcnt:D.t :
{.m of Arrthorh.d Arer* Emolro:
nth or msltlm of Adhorlz.d Ai.nt or Emdffir of Aa.nt
l'alsshom numbcr of Authorizcd Ar.nt or Emploltc of A&nt:
itudv Are C6d. ol R.mdift C.fflcn FlllEDE D.t iorthlsiorm:
Prmns wil],fully mking f.lse st temnts on thls fom en bc punhhrd by llne or torrllturc undcr th! Oommni.stlons Act of 193i1, 47 u.S.C 15 502, S03(bl, or fn. o. lmpil$nmnt
1t of thc Urttcd Ststr. Cod., 18 U.S,C 9 1001.
P.t 23
?ry2r
<01D studyArca Cod.
<)1$ StudyAre. Nem.
<02D PrclramYaa.202)
<l30> Contact l{.m. - Pcren USAC should @nt ct rcSardln! thir data
<035> Cont ct Telcphonc Numb€r - Number of pcrn ldent i.d ln d.ta llrc <r30>
<)3$ contrst Emril Addcrs - Emall Addr6$ ofparen ldentified ln dat' lire <030>er6du&6r..ff
I ertify under pcnaltyof p.rjury that no univer$l scruie support has bcGn or will bc usd to purchasc,
obtain, maintain, improve, modify, orothcruis support any rquipmrnt or sruics produccd or prdidld
by any company desitnatcd bythr Fadlral Communicetions Commission as posing a national $curity
thrcat to the intcgrity of communietions nltworts or thr communications supply chain sinc. thc
cffective drte of tha dasignations.
Pleas Puide Waiwr Ddmcnt Name of Attachcd Documnt UstinS Requircd
Allowablc File Typc (pdf onlyl lnformatlon
I ertifythat no Fcdcral subsidy mad. available through a progr.m admlni3tcrcd byth. commission that
paoidcs funds to b! u*d for th. epital exFndhurcs nesry for th! pBision of advaned
@mmunietions sryiccs has bccn orwill bc u*d to purchasc, rcnt, llasq or oth.ruisc obtein, any
covarrd communications lquipmant ors€rvicc. or maintain any cowrcd communicatioN equipment or
scrvie prcviously purcha*d, rcntcd. leasld, or oth!ruisc obrtaincd, as rcquircd by 47 CF.R. 5 54.10.
YEB
YeB
Pl€s Prryide Waiver Dsument
Allomblc Filc Typc (pdfonly)
Name of Attadred Documrnt tlsting Rcqulrcd
lnformation
PaEe 24
<r10r StudyAE Codc 142235
<015> StudyAcrltam tuw@ B - BE
<r20> ProlnmYlar 2021
<r30> Coftact ilrm - Pllm USAC should @otact mrdlm thb d*a ll&I1. M.
<r35> Cort ctTdcDhqe l{umber - Number of mn ldcntltird ln datr llnG d3O, .055.1sr11 ut.
<)39, Contad EmS Add6 - Emll Addcs of effi idcirtlfiGd ln dat llrc <)3b [e-mail]
<Eil> RlDrdr c.rar ahd6r Elebm cryr.rlE, rEc
P^Hl.da^hEhv troE Appltc$l.
<8ID Opcr.thtcomD.ny Al.dl@t ElqM! CryntiE, bc, DA BbcEoE tulaEl@
413>
ffall.tt t ollt llltraar & Colr.nf a lrrd Htludon
Blackf oot Cormrunications
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acktoot commmlcataong,Inc ^aetola
'rinoa Networke. LLC-
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