20220714Fremont Telecom Form 481.pdf

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Page 1
<O1O> StudvAreaCode ,r73333
<015> StudvArea Name Frenont T.lecon - RoR
<O2O> Prosram Year 2023
<030> contactName: PersonUSACshouldcontact
with questions about thls data ulchella tuere
<035> Contact Telephone Numberi 406s41s131 ext.
Number ot the pe6on identitied in data line <030>
<039> Contact Email Address:
Email of the oerson identllied in data line <030>morena@blackfoot., con
FormType s4.3L3 ar\d s4.422
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a73!33
<O2D Pro8r.mY!.r 2023
<O:t(> Conkllanc-PaMnusAcCroddfficl,!8.rdin8thirdru E&11.M!
<):i$ Cont.ct Emrll Md6 - Emll Add6 oI E s idrntlflcd ln dfr lln. <m> rcEr.bl.dor, @
<21D For thc prlor obndfi ycar, rcc thcra any Eportrble wie $ru'm outrSrs?
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<01(> StudyArea Code
<)15> StudyArea Name
<020> Protram Year
<)3D Cont ct Neme - Pcrson USAC ahould contact regardlnt this data E&uG tu.
<)35>Contact Tellphone l{umber - Number of percon ldentlfied ln data lln€
<03(>
<039>Contact Emall Address - Emall Addr6s of person ldentiffed ln dat line
<03(>
<zlo0>
<410>
<420>
Select from the drop{own list to indicetc hor you would like to report
volce compl.lnts (zrro or greatarl for voice telephony srrvice ln th! prlor
calGndar year for cach servlce arca ln whlch you arc deslgnatcd an ETC for
any facilities you own, operatc, h$e, or othetwls! utilize.
Complalnts per ilno customeB for fixed voice
Complaints per 1q)0 customcts ior moblle voice
P$s
?aa.tl
OlSt ShrdyhihD.
do c.oEtil'PEils^cJtajdffid..ilill*d- EdLM
#! addrJ.furrsb.e*JmMrit*ha ao5tali13l 6.
@ CoriH Efrll lddE - Ei.[ H6 ol !.H ld.iti.d h Ab rm 4(> !M1.46!.q
€t$ C.r$lyMDlLM wltt! Blh.bL nlnlnm 6lc. d&d.d.
P.r'i
Pfr S
d16 tudrrhcode
<r!it Strdy^Erilrm
d20>tnorm Yd
<0:I> Cort 6ta.m-PmusActhdHomr'rrdlrtl*dn 8&u. m.
dils> cddTd6trd r{urltts- tt{mt{ of Dffi ldatfrrd ln dra llm<r3(b'o'xltttl G
<0:l$ coitEtEmdlAddm
<606 C.rofyffipn n@ rtll.dlrf .b$tytotncdoi ho.r|acy.tturtlffi taa
<51(D @h! dcnatfor R dfoi.lttyln Emr.3Eysltudloos a7z222ti5l0.tBE
Prr 5
P.fa 5
<01O, StudyAG. Code a13!33
O15> StudYAEilare
<)Zb ProcnmY6r 2423
<030> Contact l{.m - Plmtr USAC sh@H @ntad remrdim thE d.ta
<035> CodactTlbpheel{umb.r-tumberofE|gldomifhdlnddaltre<o:x> .065.1513r d!.
<r3> Contact Emll AddE$ - Emll MdEs of Emn H.rtif.d ln d.t llh. <r3o>
<8(> R.Dodimc.rrbr E@t &l.il 6.
<8lD HoHim CommnY BtC Eo1&gr, trc.
tudhda^m.v tIffi 6. B B1.ckt6t tuioti@.
4r)>
Nfim.r ltac
ttached workr
Dollt aurlna.a
^3cmlpfiyor
lrud D?rtn tlolr
Pag.6
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<,1(> StudyArc.cod.a?l!33
<015> StudyAm t{ec l@l Llacr rcR
<gr0t 2027
<t36 Cooffittm-Pgsus C.Idld@nmt{..dlntthirdbb xt&rlt Mr
<035> cont*tTclehd.Iumbq-t{mbGofpcrsnl&ntm.dlnd.bllm<0:l(b '065'M31 dt-
<r:l9r Conm Emil Addr6- Eroil ld&6 otp.m H.otii.d ln de lln dr3lb
<90o, Dors thc filir8 .ntity offcr trlb.l land 3.rvlc.s? (Y/Nl
<910> Tribal L.nd(s) on whlch ETc s.rvcs
<92D Trlbal Govcrnmcnt Engatrm.nt Obllgttlon
It your smp.ny sm5 Trib.l bnds, plc.{ $let (Y.tilo, NA) for .[h th6. bq.3
to @nfrm th. !t t6 dG$rlb.d on th. rttrch.d PDf, on llm 920,
drmnrtntls c@dlnrtlon wlth th. Tdbrl torrnmnt puEunt to
5 54.313(rX5) lnclud6;
<921>Neods arsos$mnt and deployrnom pbnnhg wlth a fucr,3 on Ttlbal
communlty andror lnsdtjtons,
Feaslblllty 8nd su3t lnabillty plrnnlng;
Martatlnt xrvles ln a cultunlly snsltlvc m.nncr
compll.ne wlth Rl3hts ot w.y processcs
compllancc wlth l"rnd Us! prrmlttlry roqulrcmcnts
comdhnce wttt F.cllldcs Sltll[ rules
Compllancc s,lth EnviEnmcntal Rcviaw plocasscs
compllancc wlth Cultunl PE3arvatlon rcvlcw procG3s.s
compll.ncc dth fdbal 8u3in.$.nd Lj€.mlng rcqulrom.nts.
&
<922>
<923>
<924>
<925>
<925>
<927>
<928>
<929>
Solod
YBdNos
Nol Appllabl.
I
Ped.eT
<)10>Aroa Codc a?331!
lMt tll.cc - rcR
<l2O> PruEm Y.ar
<030> Contact N.mc - PGBon USAC should contact rrt'rdlng thls deta B&u. ore'
<035> ContactTclaphoncNumbcr-NumbcrofpcBonldcntlficdlndattllne<030> .06s.r5131 ct.
{3D Contact EmailAddrc$ - Emall Addr$3 of pcrson ldcntm.d ln d.t lin. <03O> rbu61.c}rd.6
<ld)o>Volca scillces ratc companblllty cartlflmtlon Yes
472222l.dLoLo.Edf
<101(>Attach dctallad drscriptlon for voic. $wicrs ntc
compa..blllty complisne
l{ama of Att chcd Dtrumnt
<1020>Bredberd omprnbllity ccrtnBtbn
YeE - Prlclng ig no more Ehan the rcst receat rppllcable b€nctmrk .mouced bythe tllreline C@petltlon Bureau
<103(>Attach d.tallcd dc$rlptlon for brcsdbend
comparabllity @mpliem.
,[?2222ldr030 .Pau
Namc of Attachcd Documnt
Pag.8
Page 9
<010> Study Area Codc a?3333
<015> StudyAr.. Namc
<020> Program Ycer ao2i
<035> Contact Tclcphonc ilumber - Number of person identified in data linc <03D r0ss.15131 .*r.
<039> Contact Em.il Addrgs - Emlil Addrrss of prrson idrilmed in data linc <r3D EEE6bckt6r.cfi
<1100> C.rtify wh.thc. tcrcst ial backhaul options cxist {Y/N)
<1130> Ploase s€lect lha approp.late rrsporr3o (Y$, No, Not Appllcable) b confm ths
irpoding canl€r ofieB bmadbgnd s€rvica of at l6ast 1 Mbpo dilnsbBam ard 250 tbps
uFbBam within the supportod arsa pur8uant b S 54.313(g).
<1140>Alilka Plan nt -of-retum c.rtifiation (y.3, no, or not tpplicabLl ot
compllanc! wlth approvcd pcrfomance plan.
P!g! 9
Pag. 10
Area Codc
Area t{!mr
{?t333
Ycer
Contrct Namc - Plrson USAC contact
<039> Contact pcrsorl
<030> 4o6q1s1i1 d
<030>
<1210> Tcrms & Conditions of Voicc T.lephony Lifcllnc Plans
<1220>HTTP
'Plo$ chek th4 bor.r bclqf, to trfim thrt thr .ttrch.d dfiumfft(s), on lln. 121q
or tha rcb3h. llsd, on lln. 1220, mt lns th. EqulEd lnlbmtt n puE6nt to
! 54.422(aX2) .nnBl Eportint ior EIG E€Mu lfl{nEm suppoG orlctr must
unully nport:
<1221> lnformation dcscriblng th. terms and @ndltlons of eny voket lGphony scwic plans ofhrcd to lifcline sub3crlb.6,
<122D D€talls on thc numbcr of minutcs prwidcd.s p3rt ofthr plan,
<1223> Additionel charycs for toll callt .nd Etes for..ch such plan.
E
EA
E
PaE.10
P.fc u
473!3!
<0t5>
2023
Select tfte approprLtc r€sponses below (Yes, No, Not Appllcablel to notc compllance as a reclplent offtozen Hlth Gost support, Hlgh Co6t support
to offset access chatge roduc'Uone, and Connect Amerlca Phase ll support as set forth ln 47 cFR 54.313(c),(d),(e). The lniormatlon reported on thls
form and ln the documents attachcd belw ls accuratc.
<2015> 2016 and future Frozen Support Certification 47 CFR 0 54.313(cX4)
Prlce Cap Grrler Crnnect Amerlca lCC Support {47 CFR 5 54.313(d}}
<2016> certificatlon support used to build broadband
Connect America Phasc lt Reportlng{47 CfR I54.3$(q}
<2A17 A> Connect America Fund Phase ll reclpient?
<2OL7C> Total amount of Phase ll support, ff any, the prlce cap carrler used for
capital expenditur€s in 2021.
<2018>Attach the number, names, and addresses of community anchor
lnstitutions to which the carrier newly began providing access to
broadband service in the preceding calendar year - 54.313(e)(1)(il)(A)
Conncct Amerlca Phasc ll - FCC Form 470 PostlnF
<2019> Forthe fillng due July l following full lmplem€ntation of this requirement,
answer yes, no, or not applicable to this certification request
Name ofAttached Document Listing
Required lnformation
Pr3c 11
P.8c 12
<01D StudyArea Code 473333
<r15> StudyArea Name Fremont Telecom RoR
<r2D ProgramYear 2023
<)30> Contact Name - Person USAC should contact re8ardinS thls data Michelle owens
<035> Contact Telephone Number - Number of pcrson idsntified in date line <80>4065415131 ext.
<039> Contact EmailAddr$s - EmallAddress of person identified in data line <o3D mOwenS@blaCkf OOt . COm
(3007)Does this filing retain a Cost Consultant and/or Firm, or other Third Party to prepare financial and
operations data disclosures submitted to the National Exchange Carrier Association (NECA), USAq
or the Administrator?
l{emc of CoBultrnt Itlamc of Consultant Flrm^hlrd Party
P.t 12
Prea
<)10> StudyArcacod.47?11?
<015> StudyArea Nsme Fremonts Telecom - RoR
<020> ProgEmYcar 2023
<030> contad Namc - Pcrcn UsAc shouH @nt ct Egardln8 this dat Michelle owens
<035> ContectTelephoncNumber-Numbcrofpersonid€ntifi€dlndat linc<030> 4065415131 ext.
<o3r> contact EmatlAddre$ - EmatlAddrrss of peren tdcnfifled tn data ltm <o3o> mowens@blackf oot ' com
Select from the drop down menu or check the boxes below to note compliance with 54.313(fX1). Privately held carriers must ensure compliance with the
financial reporting requirements set forth in 47 cFR 54.313(0(2). I further certii, that the information reported on this form and in the documents
attached below is accurate.
(3009)
(3010A)
(30108)
(3012A)
(30128)
(30131
(3014)
(301s)
(3015)
(3017)
(3018)
(301s)
(3020)
(30211
(3022)
(30231
(3024)
(302s)
(30251
Progress Report on 5 Year Plan
carri"r clrtifi.s to 54.313(fX1)(iii)
Ccrtification of Public lntercst Obligations {47 CFR 0
s.313(fl(1xi))
Pleas Pdidc Attachment
RrtG-of-nltum Communlty A|chot tnstltutlon3
lndiete if thr carricr ncwly dcploycd brcadband
sryicc to @mmunity anchor institution(s) in th.
prcvious elcndarycar.
Plca* Provlde Attachment
Using link, downloadtemplat and listthe numbcr,
namc and addrcss foreach community enchor
institution. Attach the documcnt which contains th.
community anchor institution d.tails as rcquircd by
47 C.F.R. g 54.313(fXlxiil
ls your company a Privat ly Held ROR carrier {47
cFR 5 s4.313(fX2))
lf ycs, dcs your @mpany fib thr RUS annual rcport
Please chsk thls box6 to confim thet the
attachcd PDF, on linc 3012 contains thc rcquirrd
information pursuant to I 54.313(fX2) ompliane
roquirrs:
Ehctronic copy ofthrir annual RUS reports
(Operating RGport for Td@mmuni€tions
BorcrcE)
Dcument(s) with Balancc Shet lncorc Statcmlnt
and Statcmcnt of cash Flows
lf the rcspons it yes on linc 3014 sttech your
@mpany's RUS annual report and all rcquircd
dftumentation
lf the response is no on linr 3014 is yourcompany
auditcd?
lf th! rcsponsc is yes on lin! 3018, pleasc chrck thc
boxas bclow to confim your 3ubmission on linc
3026 pursuant to g 54.313(0(2), ontains:
Eithcr a copy of th.ir auditrd financial statrmcnt; or
(2) a financi.l rcport in a fom.t comparabl. to RUS
OpcntinS Report for Trl@mmunietions BonorcE
Document(s) for Balanc! Shcat, lncomc statcmcnt
and Statcmcnt of c.sh Flm
Managemlnt lltter and/or audit oplnion issued by
thc indeprnd.nt certified public accountant that
pcrform.d thc company's financial audit.
lfthe rcspon* is no on |in.3018, plca* chcck thc
boxes b€low to confirm your submision on linc
3026 puBuant to g 54.313(0(2), contains:
copy ofth.ir financial statcm.nt which has bccn
subject to revilw by an indcpcndent certificd public
accountant; or 2) a financial r"port in a format
@mparabh to RUS Operating RaFort for
T!lammmunietions BorweB
Undcrlying information subjrctrd to a rcview by an
independ.nt ccrtifi .d public accountant
Undcrlying infomation subjccted to an offier
crrtifi€tion.
Document(s) with Balane shat, lncome Statrm.nt
and statcment of Cash Flows
Attach th" workshet listing rcquirGd information
IeE - Atlach Celtlficatlon
Namc of Attached Documrnt Listing Requirod
lnformation
Yea - Atlach Neu Comunlty kcholE
Nam. ol Attach.d Documcnt Usting
Rcquirod lnformation
(Ycs/No)
(Yes/No)
Namr of Atteched Document Listing Requircd
lnfomtion
Nam ofAttachld Documlnt Listing Rcquired
lnformation
a72lzz1o3olzDcoturEy hcDo! IDEtltutlon.xl!n
.F!
oooo
(Ycs/No) O O
P.gc 13
Page 14
Hr0.hl D.n sumnrl
(3027) Rennm
(ilo28l Op€rutlnt &p.ns3
(30291 Net lncore
(30301 Tdcphom Phnt ln Scrvle(IPIS)
(3031) Totrl Asts
(30!2)Tot l Drbt
(30331 Tot l Equlty
(:lo3{) Divld.nds
5993339
5004178
690339
23/,92207
20865562
6636122
14?294r']0
0
P.fr 14
P{E 15
<010>studyArca code
<r15>
<o20>
Area Nam!
Program
tur tu1*n - ld
<)30>Contact Namc - Person USAC should cont cl data ddl1. h.
<039>Contact Email Address - Email Addr$s of pcrson ldGntift ad ln data line <030> @,.dr.*.@r..*
tO05 nur.l Iro.dband Etgcrlmcnt
Authorized Rur.l Broadb.nd Erpcrimcnt (RBEI recipi.nB mrat addrgs thc Gertificatlon for public interest
obli3.tions and provide a list of nrwly scrvcd community anchot institutions.
hblk lntert6t obllrdc- FoC ft}98 (p.rtr.pb 2G29 78)
Plcass address Une rtool re3ardlng compliahce with the commisslon's publlc lntcrcst obligations, All RBE
particlpants must provide a rccponse to Llne 4{D1.
4001. Recipicnt clrtitlcs that it ls ofrerinS broadb.nd mecting th! rcguisit. public intcrcst oblEations consist.nt
with th. catc8ory for udrich thry w.rc schctc4 lncludinS bmdband spccd, latency, usag! capacity, .nd r.t.3 that
are rcasonably comparrblG to aat s fot comparablc offarirus in urban arras.
RBt Commuolty Ardlor ltrsilullons
</rc03a> lndic.t? if thc carricr n.wly drployed broadband slrvic. to @mmunity .nchor imtitution{sl In thr
prcvious calcndar ycar
<4003b Plcsic Providc Attachm.nt Ushr3 link,
download template and list tfi! numb.r, name
and address for sach communw anchor
institution. Attach thc documcnt which cont ins
th! communtty .nchor indrhrtion details es
requircd by FCC 1rt-98 (paragmph 79)
Nam! ofAtt chcd Document listirE Rcquired lnformation
P{! 15
P.tc 16
<010>Area Code 473333
<015>Area Nama<020> ProSram Yrar 2o2t<O3O> Cont"a fame - Pe
<039>Contact Email Address - Email Addrss of perrn identified in data line <O30> **d1rd@r . .-
5{,O5 Alaska Plan
(s011)
(s012)
Please indicate whether any tenestrial backhaul or other satellite backhaul became
commercially available in the previous calendar year in areas previously served
exclusively by performance-limiting satellite backhaul.
lfthe filing carrier identified in its approved perfomance plans that it relies exclusively on
satellite backhaul for a certain poriton ofthe population in its service 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.
(Yes/No)
(Yes/No)
<5013>
h*r+rlcn Ol E.cth.ul lGhFlofy
Alaska Plan Mobile CarrierJ Reasonably Comparablc Rat€ Demonstratlon
(s014a)Answer yes or no if mobile carriers receiving support from the Alaska Plan can demonstrate
compliance at the end ofthe filre-year milestone (2022) by showing that your required stand-
alone voice plan, and one service plan that offers broadband data services, ifyou offer such
plans, are:
. Substantially similar to a service plan offered by at least one mobile wireless service
provider in the cellular market area (CMAI for Anchorage, Alaska, and
. Offered for the same or a lower rate than the matchint plan in the CMA for Anchorage.
Alask Phn Moblle CarierC Reasonably Companble Rate t emonstretlon Attadrment
(5014b) lf Yes' is selected for 5014a, attach a document demonstrating compliance with the Fyear
milestone. f 'No' is selected for 5014a, attach an explanation of non-compliance.
(Yes/No)
Namc of Attached
Docurcnt Listint
Rcquircd lnformation
Ps 16
Code
<015>Arra Nam!
dl?ll> Prurrh Y.tt 202!
<):f(> Contac ltame - Pe .
<039> ContactEm.ilAddrgs-EmallAddressofprBonidcntif,.dlnd.talin!<)30> -*dl.cE@r..*
<6010> Enter thc total amount of Phase ll Auction Suppo( if any, the carrier
used for capital exPenditures.
Phile ll Auctlon and ilew Yor& Funds Ccrtirk tbn
<6011>Certify (either yes or no) regarding whether the recipient has arailable
funds for all project costs that will exceed the amount of support that will
be recelved for the next calendar year. This certificetion must be provided
starting the ftrst July 1st after receiving support until the recipient's
penultimate year of support.
(ves/No)
Phase ll Auctlon Community Anchor lnnhutlons
<6012a> lndicete ifthe carrier newly deployed broadband service to community
anchor institution(s) in the previous calendar year,
Pf! 17
156126; Please Provide Attachment Usint link, download template and list the
numbcr, name and address for each communlty anchor lnstitution.
Attach the document which contains tha community anchor
lnstitution details as required by FCC 14-98 (paragraph 79).
Phas. lt Aucdon FCC Form 470 Posti!f,s
<6013> For the filing due July l following full implementetion of this
requirement answer yes, no, or not applicable to this crrtification request.
<5014>
Phase ll Auctbn Port-fhal Deployment Mia.ston Performance Certmctuon
Starting the firstJuly lst after meeting the final scrvice milestone, certify
(yes, nq or not applicable) that the Phase ll-frinded netwo* that the Phase ll
auction recipient operated in the prior yea. meets the relevant performance
requirements in 0 54.309.
N8m. of Attached
Docum.nt l"isting Requircd
lnfomation
P.tE17
PII lt
<010>
<02(>
<039>
Ar.a Code
Area Name
Year
contact
Contact <030>
person
<7010> Phase ll Auction recipient performance requirements certification (Yes/Nol
Pt! ll
PI. rlt
<01(>
<020>
<035>
Code
Area Nama
Yeer
Contact
Contact
contact
- Email Address of person
<030>
<8010>Unlendo a Puerto Rlco St ge 2 Fired - C.pltll Er(D.rdhurcs
Ent r the tot l amount of Unilndo a Pulrto Rico StaSe 2 fixcd suppoG if any, thc
6ricr uscd for 6pital cxpcndituros.
<8011>Unlendo a Puerto Rlco State 2 Flxed - Avelbbh Funds Certific.tlon
C.rtify (€ithcr ycs or no) rogarding whcthcr thc Eipicnt has availablc funds for all prcjcct
@sts that willrxccld thc.mount of support th.t will br rcaiEd forthe ncn cal.ndar
yrar. This enification must b€ prwid.d starting thc first luly lst aftcr rcciving support
until the rcipilnt'i p.nuhim.tc year of support.
<8012a>Unierdo a Pu.rto Rico State 2 Fircd - Communlty Anchor lnstltutlons
lndicat! if th" carricr ncwly dcployed broadband scrvlcc to community anchor institution(s)
in th. previous crlcndar ycar.
<8012b>
Plcas Prwide Attachmcnt
Usint link, download tcmplate and list the numbcr, nemc and addrcss for each community
.nchor institution. Attach thc deumcnt which cont ins thc ommunity.nchor iBtitution
d.tails as rcquircd by 47 C.F.R. S 54.313(eX2)(Al, Allowablc Filc Typ$.
Unlendo a Puerto Rlco St te 2 Flxed - tCC Form 470 Postings
<8olb For thr filin8 dua ruly I following full implcmcntrtion of this requircm.nt answlr ycs, no, or
not applieblc to this crtification requast.
<t014>
<8020>
<8030>
N.mc of Att ched
Documant Listing Rrquirod
lnfomation
Unlendo e Puerto Rlco St.te 2 Flxed - Post-Flnal oeployment Mllestom P.rformance Certmc.don
Starting the fiBtJuly 1st.ftcr m.ltinE thc final s.ryicc milcstonc, ccrtify (ycs or nol that the
Unilndo a Puerto Ri@ St.te 2-fund.d netwo* that the StaSe 2 rccipirnt opcmtcd in the prior
ycar mcets th. r.hvant pcrformance requircments in I 54.309.
Unl€ndo a Pu€rto Rlco St tc 2 Flrcd - Support Rclmbursem.nt Crnmcailon
54.313(n): Rlcipicnts of Unicndo a Pucrto Rio Fund St ge 2 fir.d support shall ertifythat
such support ms not uscd for costs that arr (or will br) rcimbumd by othar sources of
support, includinS of fcdcmlor lmlgmrnmrnt aid or insuEncc rcimbursamants; and that
support was not ucld for othlr purposcs, such ar tha retircmrnt of comp.ny dcbrt unrelatcd
to eligible cxpcnditurrs, or othlrcxpcns.s not dlreetly rclated to network r.rtomtion,
hardening, and cxpansion @nsistent with tha fr.mcwork ofthe Uniando a PuGrto Rirc Fund.
Unhndo a ltcrto nlco StatE 2 Fhed - Dls$tcr Preparrdn$s ard Rrspote Docum.ntatlon
54.313(nl: Reipilnts of flxcd *ppon frcm St tc 2 of the Uniendo a Puerto Rico Fund shall
ccrtify that they ha\E @nductcd an annual wiaw of th: documcntation Gqulrad by slction
54.1515(a)-{c, to detcrminc the ncd for and to implcm.nt chang.s or rcvisions to disstcr
prcpaEtion and rrocowry dmumrntation.
<go4o> Unlendo a Pucrto RlcoStage 2 Moblh-Support Relmbu6€mcnt
54.313(n): Rcipirnts of Unilndo e Pu.no Rico Fund St.8c 2 mobilc support shall crtify that
such support ms not used for costs that arr (or wlll bcl rcimbuEd by othcr soures of
suppoG including of fcdaEl or l@lgovamm"nt aid or insuEne rcimbuBemcnts; and that
support ms not usd for othrr purposs, such .s the ctiEment of compsny drbt unrclatrd
to .ligible expcnditurcs, or oth.r Gxprnss not diroctly rchtcd to n.two* rGstontion,
hardening, and cxp.nsion @nsistent with thc frumawork ofthe Unicndo a Pucrto Rico Fund.
<8050>Unlendo a Pu€rto Rlco State 2 Moblh - Dbrster Pr€parcdn€ss rnd Response Documentrtlon
54.313(n): Rlcipients of mobilc support fm St tG 2 of the Unicndo a Purrto Rico Fund shall
ertify that thcy havc cohducted an annual picw of the daumcntation r.quirad by sction
54.1515(al-(cl to d.t.rminc thc nred for and to impbmlnt chant s or rcvisions to disster
prcparation and rccovcry dfiumantation
Unlendo a PErto Rlco Strte 2 Moblle - Moblle Dlsbu6ements Certlflc.tlon
54.313(o): Rrcipicnts of Uni.ndo a Pulrto Rico Fund Stagr 2 mobil. support sh.ll c.rtify that thry arc in
compliane with all r.quiEm.nts for l@lpt of such support to continue rcccivinS St3tc 2 mobllc
disbumments
<8060>
P.tr 19
P{r 20
.nln> Strdv A".. r^d.
<05> StudyArea Name -*". '.r.* - r*
<020> Paogram Ycat 2o2t
<030> Contact Name - Prrson USAC should contact data
<035>Contact
<039>Cont.ct EmailAddress - EmailAddrcss of pcrson identified ln data line <0:t0> -*dr.dd."-
<9010>Connect USvl State 2 Flxed - C.pital Erpenditurrs
Entcr thc total amount of Conncct USVI Fund StaSa 2 fix.d support, if any, the canicr usd
for epital .xpcnditures.
<9011>Connect USVI Stage 2 Flxed -Avellable Fundr Certiflcatlon
Clrtify (.itheryls or no) rcgarding whrther thc rrcipicnt has aEilable funds for all prcjcct
costs that will cxe.d thc amount ofsupport that will be rceivrd forthc ncxt ehndarycar
This certification must ba provided starting the fiBt July 1st aftcr rcceivinS support until the
recipient's penultimat! ycar of support.
<9012a> Connest USvl StetE 2 Flx€d - Community Anchor lnstltutlons
lndietc if thr errier newly deploy.d broadband sarvice to community archor institution(s)
in the prcvious elendar ycar,
<9012b>
Phase Provide Attachment
Using link, download tcmplate and list thc numbcr, namc and addrcs for cach @mmunity
anchor institution. Attach th. dcum"nt which contains the @mmunity anchor institution
dctails as rcquir.d W a7 C.F.R. I 5a.313(cX2XiXA).
<9013>
Connect USVI St ge 2 Flxed - FCC Form tuo PostlnF
For the fili4 due July I following full implementation of this r.quirement answ.r yes, no, or
not appli€bh to this c.rtifietion rrquest.
<9014>
Connect USlrl Stage 2 tlxed - Po8t-Flnal Deploymcnt Mll$tone Perform.nce Certmetbn
Starting the irst July 1st aftsr mrting the final seruic! milcstonc, csrtify (yas or no) that thr
Connect USVI Fund Statc 2-funded nctwork that th. Stagc 2 rrcipiant op.ratcd in thc prior ycar
mcrts thr rcbv.nt prrformance requircments in I 54.309.
<9020>
Connect USvl Sta8e 2 Flxed - Support Relmbursement Ccrtlflcatlon
54.313(n): Rccipi.nts of Conncct USVI Fund Stagc 2 fixed support shall ccrtify that such support ms
not usd for osts that are (or will be) rcimbursd by other sures of support, includ!ry of fcdenl
or loel govcrnmant aid or insunne rcimbuEmcnts; and that suppon was not usad for othcr
purposs, such as thc rctlramcnt of company debt unrelatcd to aliSibh expcnditures, or othrr
explnss not diroctly rrl.tld to nctwork rcstoration, herdcnln& and cxpansion consistcnt with the
framework of the Conncst USvl Fund.
<9030>
Connect USVI Stage 2 Flxed - Dlsaster Preparcdness and Respons€ Documentatlon
54.313(n): Rccipients of fired support from Sta8. 2 of the Conn.ct USVI Fund shall crftify that they
hav. conducted an annual review ofthc dcumcntation rcquircd by$ction 54.1515(a)-(cl to
dctcrminr th. nccd for and to implcmcnt chantes or rcvisions to disast r prcparation and raoovery
documentation,
<9040>
€onnect US\rl Fund St te 2 Moblle - Support RelmburscmGm Certlflcatlon
54.313(n): Rlclpients of Connect USVI Fund StaSe 2 mobile support shall certlfy that such support
was not usad for costs that arc {or will ba) rcimbursed by othcr sourcs of support, including of
fcdcnl or lml gwcrnmcnt aid or insurane rcimbuEments; and that support was not used for
othcr purposs, such as thc rctircm.nt of company dcbt unr.latcd to eligibla cxpcnditures, or othcr
spenss not directly rclated to nctwork restoration, hardenin& and sxpansion consistent with the
framcwork ofthc Conncct USVI Fund. Rccipi.nts of mobile support from stag.2 of thc conncct
USVI Fund shall crtify that they havc conducted an annual rcview of the dcumentation rcquircd by
s.ction 54.1515(a)-(c) to dctcminc thc nccd for.nd to implcmant changcs or revisions to disster
prapantion and rcovery documcntation,
<9050>
Connect USVI Fund Stage 2 Mobllc - Dlsaster Prep.redness and Response Documlntatlon
54.313(n): Rccipilnts of mobile support from StaSe 2 of the Connect USVI Fund shall crrtify that
thay have conductad an annual rcvicw of the documentation raquirrd by s.ction 54.1515(a)-(c) to
dctcmine the need for and to implcment changcs or revisions to disster prcpamtion and response
dcumrntation.
Namc of Attachcd
Dcumcnt Listing Rcquir.d
lnfsmation
Connect USvl Fund St & 2 Moblle - Moblle Dlsbursements Certificatlon
54.313(0): Rccipients of Connect USVI Fund Stage 2 mobile support shall ertify that thry ar. in
complianc wlth all rcquir.mcnts for rocript of 3uch suppon to continu. r"cclving Stagc 2 mobile
disbursemlnts.
<9060>
Page 20
P{r 2l
<010>Study &.a code
<015>Araa Name
<03{r>Contact [ame - Prrson USAC contact
<035>Comact
data
<039>Contact EmailAddress - EmailAddress of pemn id.ntmed in data line <03(> "*dl..Esr.ffi
<10010>
<10011>
<10O12a>
<10012b>
<10013>
<lm14>
RDOF Capit.l Expendltures
Startint th. first July lst aftcr racciving support until tha July lst aftcr thc rccipicnt's
suppon tlrm has rnded, r.cipients of Ruml DiSitsl opportunity Fund support must submit
thc total amount of suppon, if any, thc rccipient uscd for epital dp.nditurrs in the
prcvious elendar ycar. This is required by 47 c.F.R. 5 54.313(c)(2Xil(B).
RDOF Avallable Funds Certlflcatlon
Plras provide. rrspons. (cithcryrs or no) to this certifietion rcquest for any r*ipicnt of
Runl Digital Opportunity Fund support thet the r.cipi.nt has anilablc funds for all projlct
costs thet will rxerd the amount of support that will bc l@ivcd for the next elendar
year. Thls certifi€tion must bc providcd starting thc firctJuly lst aft.r rrceiving support
until thc rnipient's pcnultimate ycar of support, 8s r.quirod by requircd by 47 c.F.R. 5
sa.313(cX2Xii).
RDOF Community Anchor Instltutions
Recipients of RuEl Ditital Opportunity Fund support must attach a list @ntainint thc
numbcr, namcs, and addrcsscs of community anchor instltutions to whlch th. .ligiblc
trbcommunietions enier newly bcgan prcvidint 8ce$to brGdbend seruice in thr
prcccding elcndar ycar. Thls liling is requlrcd by 47 c.F.R. I 54.313(e)(2|(i)(A).
Pbas. Provid. Attachment
Using link, downled tcmphtr and list thc numbcr, namc and addres for cach @mmunity
anchor institution. Attach thc dcumcnt which conteins the community anchor instltution
dctails as requircd byaT c.F.R. q 5a313(.1(2)(iXA).
llam" of Attachcd
Document Listing
Requircd lnformrtlon
RDOF FCC Form 470 Postln8s
For the flling due July 1st following full implcmcntation of this rcquirement, plca* provide
a rcpon* (cithcr ycs, no,.or not applieblc) to this ccrtiflcation requast. R*ipicnts of RuEl
Digital Opportunity Fund must respond affirmativrly that thry bid on etctory one
t.lEommunietions and lntcrnct .ccc$ sruies in rcspon* to all Fcc Form 47o postin8s
ruking bmdband scruicc that mcts th? connrctivity targets for the schmls and libmries
univcBl sruic. support prcgram for eligiblc schools and librarics (as dc*ribcd in 5
54.501) loatcd within any arca in . census blck whcrc thc orricr is rccciving RuEl Digital
Opportunity Fund, and that such bids wcru at ratcs rcasonabh comprrable to ntcs chargcd
to elitible $h@ls and libnri:s in urban aEas for lnstructionsfor Complcting FCc fum 481
OMB @nt6l No. 306GO986 (High€ost) OMB control No. 3060{819 (Low-lncomc}
Novcmb€r 2020 Pagr 44 companble offerings. Thls filin3 ls rcquircd by47 C.F.R. 5
54.313(cX2XiXC). Ihis ccrtlfication will not bc rcquircd until thr July lst following th. E-
Rste protram year thst this obligstion has been fully implcmcnt.d. Modernizint thc E-Rat.
Prognm for schools and Libhries rt al., wc Dockct. Nos. 13-184, 10-90, 29 Fcc Rcd 15538,
1556G67, pa'a. 7 2 l2o,4l.
RDOF Port-Fln.l DcploynGnt Mlhstonc PGrfom.ncc Ccrtmc.tlon
Sterting the first July 1!t aftlr a Rural Ditit l Opportunity Fund rccipi.nt melts its final
s.ruicc milcstone until thc July lst after thc support reciplcnt's suppoft term has .ndrd,
plcase providc a respons€ (cither y.s, no, or not spplic.bl.l thst the RuEl Digital
Opportunity Fund-fundrd nrtwor* that thc support r.cipl.nt opcEtad in the prior y.ar
meets thc rclcvant pcrfomane rcquirements in 47 c.F.R. s 54.309. This filing is rcquired by
a7 c.F.R. 5 sa.313(eX2Xiill.
Pat. 21
7a9.22
<01D StudyAreaCodc ,r 73333
<015> StudyArea Name FrmonE Tclecom - RoR
<020> Prog6mYcar 2023
<030> Contact Name - Pcrson USAC should contact rcsardinE this d.ta ulchelle oser
<035> ContactTelcphoncNumbcr-Numbcrofpcrsonidcntifiadindatalinr<03D '106s/t1s131 ext
<039> Contact Email Addrcas - Email Addres of person idcntifiad in d8ta lin! <030> rcseuaoblackfoot . cm
TO BE COMPI"ETED BY THE REPORT]NG CARRIER, IF T}lE REPORTING CARRIER IS FITII{G ANNUAL REP,ORTING ON ITS OWN BEHALF:
Cenmcatlon of Offlcer as to the Accuracy of the Data Reported for the Annual Reportlng for CAF or Ll Reclpl€n$
c.rtlfy thrt I am an off,ccr of thc Lpo'tln! c.?tlar my rasponCbllltlcs lndudG Gnsurlnt thr .ccu..c1 of thG .nnu.l rGpordnt rcqulrcmlnB ior unly!i!.| scrylc! 3uppot
adplcnts; md, to thc bcst of my lnowlc{c, 0!c ln ornrrtlon rrpoftGd on thb furm and lr any atodrmcot' lr .6urat!.
{amaof Rrmrtinicarier: Prercnc relec@ - RoR
;isnaturcofAuthorizcdoffier: CBRTTPTED orlnirE Datc 07/L2/2022
,rint.d namr of Authorlzcd offler: stsacey Mueller
ltl! or msitlon of Authorized ffier: Chlef FlImclal Of f Lce!
Icleohonc numbcr of Authorired Offl@r: {065415000 *t
itudv Area code of Remrtini cariar: { 73333 Fllinr Due Dat. forthielorn 07 /29 / 2022
PrmN wlllfully mkinS frlsc st tcrunts on thit fom €n b. punilhrd by fin. or io,ri.lturo und.r thG communletlom Act of 1934, 47 U.S,C, S! 50e 503(bl, or lln! or lmprienmnt
undrr nth 18 otthc Unlt.d StrtE Cod.. 18 U.S.C. 0 1001.
Pegc22
Pa8. 23
<01D studyArc.Cod.473313
<o't s>Sfirlv Aru Erercn! Telecom - RoR
<02(> Promm Year 2023
<030> Contact N.mr - Par$n
<035> Conttct TGbphore Number - Number of prr$n identtffcd in dlt lirc <o3D 4
Mlchelle Oyen6
<03$ contact EmllAddrcs - EmilAddrc$ of pGmn id.ntifi.d ln dtt! llm <o3o> wrecblackfoots. com
TO BE COMPI"EIED BY THE REPORTIITG CARRIE& IF AI{ AGEI{T IS FIU'{G AT{I{UAI REPORIS OJ{ IHE CARRIERS SEHAI.F:
TO BE COMP1 TED BYIT{E AUTHORIZED AGENT:
Certfkatlon of Offkcr to Authorhc .n &cnt to Fih Annual R.ports for CAF or Ll Reciphntr on Blhalf of Rcporting Clnhr
sdrythrt(NamofArent)lr.ulhod,.dio3ubmltth.lnformtonEport.donb.h!lfoll,r.rupodneG!rlc].l
roa'Ulythetlm*om-oru,.ffiIdqh.n.urlnglh..ccil'tct'ollh..nnu.ld.lr[podnonquhmfibpFr,l.t.dtolh..Uliorts.d
lgmq rd, to [r b..t of niy ltmLdgo th. Epoil. rrd drt pruld.d to th. D0rorL.d .g.nt b mEt ,
{rmaof n.mfriE c.rrLr:
illnrtuh of Afthorlzld offi..r:Det.:
trlntcd mm of Authorl2.d OfflcGr:
fith d Dosltlon of Authorhcd Orffier:
fehohoh. numb.r df Adhorlr.d Offlcan
itudv Ar.. code of R.6rtiE ClrrLr FillE Drc Drtc ior thls iorm:
Pe@n3 willfully mkiri f.l! Catemnt! on this fom 6n bc FJnlshed by llnc or ffiituE underthc Communkatlons Act ot 1934, /t7 U.S.C SS 502, 503(b!, orfln! or imprlsnmnt
undrr Tnh 18 otthc Unltld States Codc, 18 U.S.C. ! 1001.
Ccrtlticatlon of Atcnt Authorlzcd to Flb Annual RGpons tor CAF or Ll Reclphnts on Bahaf of Rcportlng Gnler
n d.t rtportcdh.tlhb.$doodltapovldGdbythrEporthlc.rd.ran4tod[b..totmyfnodc&,ttr.ffin]tport dh.r.hlrramt.
{rma of Rr@rtld Carrl.r:
{!mc of Authorlr.d Ar.nt Flrm:
ilrmturo of Authorlz.d Aent d EmDlov.. of Arent:Datc:
{rme olAdhorlr.d A!.nt EmbloE.:
fhb d Ghbn of Authoi2.d Ar.nt or Emd@! of Arcnt
LlcDhonG numb.r of Authqizld Arcnt or EmdffiG of Arcnt:
Studv Arlr Coda of Rrmrtim C!td.r:Fllinr Drc DatG forthls form:
1t otthc Unlt d St te5 Codq 18 U.S.C. 5 1001.
Pagr 23
PS 24
<01O> StudyAEaco&
<015> Study Area N.me
<020> ProEEm Yrar
<030> @nt d NamG - P.rson USAC shouH cont ct tegardlng this data a&u. tu
a053414M *,<035> ContadT.lophon! Number- Number ofprmn ldcntitled in data llnc <030>
<039> Contact EmallAddesr - Emall Addre$ ofpersn ldentili€d In data lire <030>
I ccrtify under pcnalty of perjury that no universl servic. support has becn or will bc u*d to purchase,
obtain, maintain, improve, modify, or oth.mi$ support any equipmcnt or sruics prcduccd or providcd
by any ompany dcsitnat d by the FedlEl Communietions Commi$ion as posing a national sacurity
threat to thc intcgrity of communications networks orthc communications supply chain sincG the
effrctivr datc of thc dlsitnatlons.
Pleasc P@ido Weiver Deum.nt
Allowablc Filc Type (pdfonlyl
Name of Attachcd Document Ustint Rcquircd
lnformation
I ertify that no Feder.l subsidy made .vailable through a prcgnm administcrcd by thc commlssion that
providrsfunds to be usld for thr cspitsl rxpenditures ncessary forthr prwision ofadvanccd
ommunietions sruiccs has bccn or will be u*d to purchesc, rcnt, lces, or otheruis obtain, 8ny
wcred communicationsrquipmeht or saryie, or maintain any @wred communications equipment or
sruicc prcviously purchsscd, rcntc4 basa4 or othcruisc obtaincd, as rcqulrcd by 47 CF.R. 5 54.10.
Pleas Prcvid! Waiver Dtrumdt Nam of Attachcd Document Listing Rcquired
lnlomationAllowablc Filc Type (pdfonly)
YEE
YGB
Pate 24
<,10> StudyAHcodc a73aa3
<)15> StudyAHiltG irc@rt t l.co
<r2O> Prognm Y€r 3023
<130> Coite.t ilam - Pemn USAC should 6nbd H.rdlM thls dab
<)35> CortactTchphdellumhcr-l{umbGrofp.mHentlfuind.t lirc<}30> .055.151!l qt.
<Xl$ Cortrct Em[ Add6 - lmil AddE$ ot Demn ldrntlfi.d ln d.ta llrc <r3D e@*lrcE@! . m
<t10t Repordm c8dlr !t@l t lcoD &
41D ]loldlm Cqruny m &l&S, e
aDdhr amh..v Freent Alc@ 6. B Bl.cttel CoDIa.!l@,
413>
ffml.trt
Inc.
sAc
48901!Blackfoot Commicat
noa Networka. LLC
sion Net. Inc
oot TeleDhone CooDerative. Inc 443308 Blackfoot Commlcat
a42235 Blackf oot Comunicat
Dofif Ar&16 A3 Csnq ff lnnd DG*mtloo