20220623Blackfoot Telephone CAF ICC Data.pdf

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Certilicstion of Officer
to Authorize an Agent to f ile Data on Behalf of Reporting Carrior ,.I
I certi$ that (Name of Agent) John Staurulakis.Inc. (JSD is authorized to submit information
reported on behalfofthe reporting carrier. I also certify that I am an oflicer ofthe 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 Blackfoot Telephone Cooperative, Inc.
Signature of Authorized Officer Sa4/r/7/u4//Q/"Date
6/1412022
Printed name of Authorized Officer {*"yMueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized Officer. ( 406 ) 541-5000
Study Area Code of Reporting Carrier 482235 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. $$ 502, 503(b), or fine or imprisonment under Title l8 of the United States Code, l8 U.S.C. $ 1001.
Certification of Officer as to the Accuracy of the CAF ICC Data Reported
I certify 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 Blackfoot Telephone Cooperative, Inc.
Signature of Authorized Officer Sair,/-V/u4112L Date
611412022
Printed name of Authorized Officer uStacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer.(406) s4r-s000
Study Area Code of Reporting Carrier 4t2235 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 of the United States Code, l8 U.S.C. $ l00l.
Certification of OIIicer for Rate.of-Return Carrier Eligibility for CAF/ICC Recovery
I certi$ 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 Recovety $51.917(d) and
Access Recovery Charge $51.917(e) and is eligibte to receive the CAF ICC support requested pursuant
to $s1.917(f).
Name of Reporting Carrier Blackfoot Telephone Cooperative, Inc.
Signature of Authorized Officer Sa447ilue02/"Date
6/1412022
Printed name of Authorized Officer U
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 482235 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 of the United States Code, l8 U.S.C. $ 1001.
Certilication of Oflicer for Rate'of-Return Carrier Not Seeking Duplicative Recovery
I certify that I am an officer of the reporting carrier and thaf to the best of my knowledge, the
reporting carrier is not seeking duplicative recoverT in the state jurisdiction for any Eligible Recovery
subject to the recovery mechanism as per $51.917(dXvii).
Name of Reporting Carrier Blackfoot Telephone Cooperative, Inc.
Signature of Authorized Officer SAu4rhluzZzL Date
6/14/2022
Printed name of Authorized Officer U
Stacey Mueller
Title or position of Authorized Officer Chief Financial Officer
Telephone number or Authorized
Officer.(406) s4l-s000
Study Area Code ofReporting Carrier 482235 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. $$ 502, 503(b), or fine or imprisonment under Title l8 of the United States Code, l8 U.S.C. $ 1001.
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State of Montana 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.
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. 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. Blackfoot Telephone Cooperative, lnc. 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. S 5a.202(aX2).
5. I also certify that allfederal universal service support funds received by Blackfoot Telephone
Cooperative, lnc. 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 forfederal universalservice
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
June 21 .2022
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SUBSCRIBED AND SWORN to before me this 2 of June,,y,