Description of Services Ordered and Certification Form 471 FCC

OMB 3060-0806 Approval by OMB FCC Form 471 November 2015 Description of Services Ordered and Certification Form 471 FCC Form 471 — Funding Year 2016 Application Number 161031176 Application Information Nickname POTS LD Schools Funding Year 2016 Application Number 161031176 Category of Service Category 1 Billed Entity Contact Information VERNON PARISH SCHOOL BOARD Don S Gallemore 201 BELVIEW RD LEESVILLE LA 71446-2904 337-239-1663 337-239-1663 [email protected] [email protected] Billed Entity Number: 139347 FCC Registration Number: 0011542172 Applicant Type: School District Holiday/Summer Contact Information [email protected] Consulting Firms Name Consultant City State Zip Code Phone Number Email Registration Number School District Name BEN Urban or Rural State LEA ID State School ID NCES Code School District Endowment Attributes VERNON PAR 139347 Rural 058 058 Public Sch None ISH SCHOOL ool Distri ct BOARD Related Child School Entities Name BEN Urban State State NCES Number of Students Alternative CEP School Endow- or Rural LEA ID School ID Code Students based on Discount PercentageAttributes ment estimate EVANS 80938 Rural 058 058003 382 N/A None Public Sch None HIGH ool; Pre-K SCHOOL PITKIN 80961 Rural 058 058010 512 N/A None Public Sch None HIG H ool; Pre- SCHOOL K ; Head Sta rt Page 1 ROSEPINE 80963 Rural 058 058012 516 N/A None Public None H IGH Sch ool SCHOOL ROSEPINE 80964 Rural 058 058016 768 N/A None Public Sch None E ool; Pre- LEMENTARY K ; Head SCHOOL Sta rt ANACOCO 81876 Rural 058 058001 364 N/A None Public None HI GH Sch ool SCHOOL ANACOCO 81877 Rural 058 058018 550 N/A None Public Sch None EL ool; Pre- EMENTARY K ; Head S CHOOL Sta rt HORNBECK 81913 Rural 058 058005 402 N/A None Public Sch None H IGH ool; Pre- SCHOOL K ; Head Sta rt HICKS 81916 Rural 058 058004 352 N/A None Public Sch None HIGH ool; Pre- SCHOOL K ; Head Sta rt VERNON 81917 Rural 058 058014 407 N/A None Public None MID DLE Sch ool SCHOOL EAST 81918 Rural 058 058002 478 N/A None Public Sch None LEESV ool; Pre- ILLE K ; Head ELEM Sta rt SCHOOL LEESVILLE 81919 Rural 058 058006 787 N/A None Public None HIGH Sch ool SCHOO L LEESVILLE 81920 Rural 058 058007 392 N/A None Public None JR HIGH Sch ool SC HOOL WEST 81921 Rural 058 058015 436 N/A None Public None LEESV Sch ool ILLE ELEM SCHOOL PICKERING 81923 Rural 058 058008 898 N/A None Public Sch None ELEMENTARY ool; Pre- SCHOOL K ; Head Sta rt PICKERING 81924 Rural 058 058009 617 N/A None Public None HIGH Sch ool SCHOO L NORTH 81947 Rural 058 058019 639 N/A None Public Sch None POLK ool; Pre- ELEMENTAR K ; Head Y Sta rt SCHOOL Parkway El 81948 Rural 058 058011 456 No None Public Sch None ementary ool; New C S chool onstructio n School SIMPSON 81962 Rural 058 058013 283 N/A None Public None HI GH Sch ool SCHOOL Page 2 Related School District NIFs School District BEN School District Name NIF BEN NIF Name 139347 VERNON PARISH 16022508 VPSB HEADSTART SCHOOL BOARD 139347 VERNON PARISH 16020242 VERNON PARISH SCHOOL BOARD SCHOOL BOARD ADMIN Discount Rate School District School District School District School District Category One Category Two Voice Enrollment NSLP Count NSLP Percentage Urban/Rural Status Discount Rate Discount Rate Discount Rate 9239 5569 61.0% Rural 80% 80% 40% Page 3 Funding Request for FRN #1699064177 Funding Request Nickname: LD ALL SCHOOLS Service Type: Voice What is the FRN number from the previous year ? Agreement Information - Month-to-Month Establishing FCC Form 470 160009786 Account Number 83589969, 85688277, 85688302, 85688305, Was an FCC Form 470 posted for the product and/or services 85688311, 85688315,85688321, 85688326, 85688329, 85688332, you are requesting? No 85688338, 85688340, 85688346, 85688352, 85688359, 85688363, How many bids were received for this contract?0 85688368, 85688376 Service Provider CenturyLink Qwest Communications Company, LLC (SPN: 143001157) Pricing Confidentiality Is there a statute, rule, or other restriction which prohibits No publication of the specific pricing information for this contract? What is the service start date? July 01, 2016 When will the services end? June 30, 2017 Narrative Long distance phone line service for all schools in Vernon parish school system. Line Item # 1699064177.001 Product and Service Details Function Voice Cost Calculation for FRN Line Item # 1699064177.001 Monthly Cost One-Time Cost Monthly Recurring Unit Cost $59.21 One-time Unit Cost $0.00 Monthly Recurring Unit Ineligible - $0.00 One-time Ineligible Unit Costs - $0.00 Costs One-time Eligible Unit Cost = $0.00 Monthly Recurring Unit Eligible = $59.21 One-time Quantity x 0 Costs Monthly Quantity x 155 Total Eligible One-time Costs = $0.00 Total Monthly Eligible Recurring = $9,177.55 Costs Summary Months of Service x 12 Total Eligible Recurring Costs $110,130.60 Total Eligible Recurring Costs = $110,130.60 Total Eligible One-time Costs + $0.00 Pre-Discount Extended Eligible = $110,130.60 Line Item Cost Recipients of Services BEN Name 80938 EVANS HIGH SCHOOL 80961 PITKIN HIGH SCHOOL 80963 ROSEPINE HIGH SCHOOL 80964 ROSEPINE ELEMENTARY SCHOOL 81876 ANACOCO HIGH SCHOOL 81877 ANACOCO ELEMENTARY SCHOOL Page 4 81913 HORNBECK HIGH SCHOOL 81916 HICKS HIGH SCHOOL 81917 VERNON MIDDLE SCHOOL 81918 EAST LEESVILLE ELEM SCHOOL 81919 LEESVILLE HIGH SCHOOL 81920 LEESVILLE JR HIGH SCHOOL 81921 WEST LEESVILLE ELEM SCHOOL 81923 PICKERING ELEMENTARY SCHOOL 81924 PICKERING HIGH SCHOOL 81947 NORTH POLK ELEMENTARY SCHOOL 81948 Parkway Elementary School 81962 SIMPSON HIGH SCHOOL 16020242 VERNON PARISH SCHOOL BOARD ADMIN 16022508 VPSB HEADSTART FRN Calculation for FRN #1699064177 -LD ALL SCHOOLS Monthly Charges Total Requested Amount Total Monthly Recurring Charges $9,177.55 Total Eligible Pre-Discount $110,130.60 Total Monthly Ineligible Charges - $0.00 Recurring Charges Total Eligible Pre-Discount One- + $0.00 Total Monthly Eligible Charges = $9,177.55 Time Charges Total Number of Months of x 12 Total Pre-Discount Charges = $110,130.60 Service Discount Rate 80% Total Eligible Pre-Discount = $110,130.60 Recurring Charges Funding Commitment Request = $44,052.24 One-Time Charges Total One-Time Charges $0.00 Total Ineligible One-Time - $0.00 Charges Total Eligible Pre-Discount One- = $0.00 Time Charges Connectivity Questions District/System-wide Internet Access Questions Does your school district currently aggregate Internet access for the entire district(as opposed to buying Internet access on a building-by-building basis)? Yes Download Speed 2.50 Download Speed Units Gbps Upload Speed 2.50 Upload Speed Units Gbps Per Entity Basis Questions Entity Name VERNON PARISH Entity Number 139347 SCHOOL BOARD Entity Name BEN Download Units Upload Units Connection Wifi Sufficient Barriers to Robust Network EVANS HIGH 80938 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated SCHOOL equipment Page 5 PITKIN HIGH 80961 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated SCHOOL equipment ROSEPINE 80963 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated HIGH equipment SCHOOL ROSEPINE 80964 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated ELEMENTARY equipment SCHOOL ANACOCO 81876 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated HIGH equipment SCHOOL ANACOCO 81877 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated ELEMENTARY equipment SCHOOL HORNBECK 81913 1.00 Gbps 1.00 Gbps Copper Mostly Outdated HIGH equipment SCHOOL HICKS HIGH 81916 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated SCHOOL equipment VERNON 81917 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated MIDDLE equipment SCHOOL EAST 81918 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated LEESVILLE equipment ELEM SCHOOL LEESVILLE 81919 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated HIGH equipment SCHOOL LEESVILLE 81920 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated JR HIGH equipment SCHOOL WEST 81921 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated LEESVILLE equipment ELEM SCHOOL PICKERING 81923 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated ELEMENTARY equipment SCHOOL PICKERING 81924 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated HIGH equipment SCHOOL NORTH POLK 81947 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated ELEMENTARY equipment SCHOOL Parkway 81948 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated Elementary equipment School SIMPSON 81962 1.00 Gbps 1.00 Gbps Fiber Mostly Outdated HIGH equipment SCHOOL Certifications I certify that the entities listed in this application are eligible for support because they are schools under the statutory definitions of elementary and secondary schools found in the No Child Left Behind Act of 2001, 20 U.S.C. §§ 7801(18) and (38), that do not operate as for-profit businesses and do not have endowments exceeding $50 million. I certify that the entity I represent or the entities listed on this application have secured access, separately or through this program, to all of the resources, including computers, training, software, internal connections, maintenance, and electrical capacity, necessary to use the services purchased effectively. I recognize that some of the aforementioned resources are not eligible for support. I certify that the entities I represent or the entities listed on this application have secured access to all of the resources to pay the discounted charges for eligible services from funds to which access has been secured in the current funding year. I certify that the Billed Entity will pay the non-discount portion of the cost of the goods and services to the service provider(s). Page 6 Total Funding Summary Below is a summary of the total line item costs on this FCC Form 471: Summary Total funding year pre-discount eligible amount on this FCC Form $110,130.60 471 Total funding commitment request

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