OMB 3060-0806 Approval by OMB FCC Form 471 December 2018 Description of Services Ordered and Certification Form 471
FCC Form 471 Application Information Nickname 21DCSD 471-C1 Application Number 211006136 Funding Year 2021 Category of Service Category 1
Billed Entity Contact Information DOUGLAS COUNTY SCHOOL DISTRICT R E 1 MARY JO SAGNELLA 620 WILCOX ST CASTLE ROCK CO 80104 - 1739 203-445-9577 303-387-0100 [email protected] [email protected]
Billed Entity Number 142133 FCC Registration Number 0012216396 Applicant Type School District
Consulting Firms Name Consultant City State Zip Phone Email Registration Code Number Number E-RATE ONLINE LLC 16048791 Orange CT 6477 203-445-9577 [email protected] om
Entity Information
School District Entity - Details BEN Name Urban/ State State NCES School District How does Total Endowment Rural LEA ID School Code Attributes the district Student ID report its Count for student count Category for Category Two Budget Two budget? 142133 DOUGLAS COUNTY Urban Public Sch A number for 64674 None SCHOOL DISTRICT R E 1 ool District each school in the district
Related Entity Information
Related Child School Entity - Details
Page 1 BEN Name Urban/ State State NCES Alternative School Attributes Total Endowment Rural LEA ID School ID Code Discount Students for C2 Budget 93388 BUFFALO RIDGE ELE Urban None Public School 442 None MENTARY 93390 ACADEMY CHARTER Urban None Public School 745 None SCHOOL 93392 CASTLE ROCK MIDDL Urban None Public School 842 None E SCHOOL 93393 CASTLE ROCK ELEME Urban None Public School 421 None NTARY SCHOOL 93394 SOUTH RIDGE ELEME Urban None Public School 595 None NTARY SCHOOL 93396 DC OAKES ACADEMY- Rural None Public School 158 None CASTLE ROCK 93397 ROCK RIDGE ELEMEN Urban None Public School 534 None TARY SCHOOL 93398 DOUGLAS COUNTY HI Urban None Public School 1808 None GH SCHOOL 93451 CHERRY VALLEY ELE Rural None Public School 35 None M SCHOOL 93452 FRANKTOWN ELEMEN Rural None Public School 364 None TARY SCHOOL 93456 LARKSPUR ELEMENT Rural None Public School 237 None ARY SCHOOL 93496 ACRES GREEN ELEM Urban None Public School 493 None ENTARY SCHOOL 93497 EAGLE RIDGE ELEME Urban None Public School 627 None NTARY SCHOOL 93499 DCS MONTESSORI CH Urban None Public School 556 None ARTER SCHOOL 93500 ROXBOROUGH ELEM Rural None Public School 375 None ENTARY SCHOOL 93502 PLATTE RIVER ACADE Urban None Public School 565 None MY CHARTER 93505 SAND CREEK ELEMEN Urban None Public School 454 None TARY SCHOOL 93506 NORTHRIDGE ELEME Urban None Public School 632 None NTARY SCHOOL 93507 BEAR CANYON ELEM Urban None Public School 492 None ENTARY SCHOOL 93508 HIGHLANDS RANCH H Urban None Public School 1680 None IGH SCHOOL 93509 CRESTHILL MIDDLE S Urban None Public School 776 None CHOOL 93510 COUGAR RUN ELEME Urban None Public School 441 None NTARY SCHOOL 93511 FOX CREEK ELEMENT Urban None Public School 528 None ARY SCHOOL 93512 RANCH VIEW MIDDLE Urban None Public School 795 None SCHOOL 93513 THUNDERRIDGE HIGH Urban None Public School 2042 None SCHOOL 93514 SUMMIT VIEW ELEME Urban None Public School 523 None NTARY SCHOOL 93515 COYOTE CREEK ELE Urban None Public School 408 None MENTARY SCHOOL 93516 TRAIL BLAZER ELEME Urban None Public School 413 None NTARY SCHOOL Page 2 BEN Name Urban/ State State NCES Alternative School Attributes Total Endowment Rural LEA ID School ID Code Discount Students for C2 Budget 93544 CHAPARRAL HIGH SC Urban None Public School 2193 None HOOL 93546 SIERRA MIDDLE SCH Urban None Public School 875 None OOL 93548 PINE GROVE ELEMEN Urban None Public School 587 None TARY SCHOOL 93549 PONDEROSA HIGH SC Urban None Public School 1440 None HOOL 93550 MOUNTAIN VIEW ELE Urban None Public School 314 None MENTARY SCH 93551 NORTHEAST ELEMEN Rural None Public School 288 None TARY SCHOOL 93553 CHEROKEE TRAIL ELE Urban None Public School 564 None MENTARY SCH 93554 SEDALIA ELEMENTAR Rural None Public School 254 None Y SCHOOL 93558 PIONEER ELEMENTAR Urban None Public School 483 None Y SCHOOL 93561 PINE LANE PRIMARY Urban None Public School 756 None SCHOOL 212931 WILDCAT MOUNTAIN Urban None Public School 525 None ELEMENTARY SCHOO L 230731 ARROWWOOD ELEME Urban None Public School 383 None NTARY SCHOOL 230733 MEADOW VIEW ELEM Urban None Public School 457 None ENTARY SCHOOL 230734 SAGEWOOD MIDDLE Rural None Public School 884 None SCHOOL 230737 RENAISSANCE EXPED Urban None Public School 395 None ITONARY LEARNING O UTWARD BOUND SCH OOL 230740 SADDLE RANCH ELEM Urban None Public School 434 None ENTARY SCHOOL 234642 TIMBER TRAIL ELEME Urban None Public School 357 None NTARY 234643 LEGACY POINT ELEM Urban None Public School 358 None ENTARY 234644 FLAGSTONE ELEMEN Urban None Public School 489 None TARY 234704 MOUNTAIN RIDGE MID Urban None Public School 1088 None DLE SCHOOL 234705 ROCKY HEIGHTS MID Urban None Public School 1346 None DLE SCHOOL 234707 ROCK CANYON HIGH Urban None Public School 2310 None SCHOOL 234801 ELDORADO ELEMENT Urban None Public School 451 None ARY SCHOOL 234803 FRONTIER VALLEY EL Urban None Public School 488 None EMENTARY 234805 IRON HORSE ELEMEN Urban None Public School 460 None TARY 234806 PRAIRIE CROSSING E Urban None Public School 701 None LEMENTARY SCHOOL
Page 3 BEN Name Urban/ State State NCES Alternative School Attributes Total Endowment Rural LEA ID School ID Code Discount Students for C2 Budget 234809 CHALLENGE TO EXCE Urban None Public School 521 None LLENCE CHARTER SC HOOL 234868 HERITAGE ELEMENTA Urban None Public School 439 None RY 234869 MOUNTAIN VISTA HIG Rural None Public School 2381 None H SCHOOL 16024043SOARING HAWK ELEM Urban None Public School 577 None ENTARY 16030794REDSTONE ELEMENT Urban None Public School 488 None ARY 16030795COPPER MESA ELEM Urban None Public School 428 None ENTARY 16036530CASTLE VIEW HIGH S Urban None Public School 2183 None CHOOL 16036560AMERICAN ACADEMY Urban None Public School 2535 None CHARTER SCHOOL 16048334STONE MOUNTAIN EL Urban None Public School 672 None EMENTARY 16048337MAMMOTH HEIGHTS E Urban None Public School 668 None LEMENTARY 16048338LONE TREE MAGNET Urban None Public School 421 None SCHOOL 16048340ROXBOROUGH INTER Rural None Public School 392 None MEDIATE 16048342GOLD RUSH ELEMEN Urban None Public School 699 None TARY 16048345LEGEND HIGH SCHOO Urban None Public School 2215 None L 16048346MESA MIDDLE SCHOO Rural None Public School 865 None L 16053064CIMARRON MIDDLE S Urban None Public School 1293 None CHOOL 16053068EARLY CHILDHOOD C Urban None Public School 93 None ENTER 16053506CLEAR SKY ELEMENT Urban None Public School 744 None ARY 16059637SAGE CANYON ELEM Urban None Public School 789 None ENTARY 16065804STEM ACADEMY Urban None Public School 1875 None 16070239BEN FRANKLIN ACAD Urban None Public School 930 None EMY 16059960CANTRIL SCHOOL Urban None Public School 25 None 17011700RENAISSANCE SECO Urban None Public School 327 None NDARY SCHOOL 17013034Aspen View Academy Urban None Public School 904 None 17013035Cloverleaf Enrichment S Rural None Public School 301 None chool 17013036eDCSD Urban None Public School 35 None 17013038Highlands Ranch HS Pr Urban None Pre-K; Public School 22 None e-K 17013039Parker Core Knowledge Urban None Public School 702 None 17013040Parker Performing Arts Urban None Public School 735 None School
Page 4 BEN Name Urban/ State State NCES Alternative School Attributes Total Endowment Rural LEA ID School ID Code Discount Students for C2 Budget 17013041Rock Canyon HS Pre-K Urban None Pre-K; Public School 0 None 17013042World Compass Acade Rural None Public School 619 None my 16077396HOPE ONLINE LEARN Urban None Public School 489 None ING ACADEMY ELEME NTARY 16085457GLOBAL VILLAGE ACA Rural None Public School 389 None DEMY - DOUGLAS CO UNTY 16077394HOPE ONLINE LEARNI Urban None Charter School; 846 None NG ACADEMY MIDDLE Public School 16051286NORTH STAR ACADE Urban None Public School 667 None MY 17021449Ascent Classical Acade Urban None Charter School; 544 None my of Douglas County Public School
Related Child School Entity - Discount Rate Calculation Details BEN Name Urban/ Number of Students CEP CEP Base Rural Students Count Based Percentage Year on Estimate 93388 BUFFALO RIDGE ELEMENTARY Urban 442 N/A 93390 ACADEMY CHARTER SCHOOL Urban 745 N/A 93392 CASTLE ROCK MIDDLE SCHOOL Urban 842 N/A 93393 CASTLE ROCK ELEMENTARY SCHOOL Urban 421 N/A 93394 SOUTH RIDGE ELEMENTARY SCHOOL Urban 595 N/A 93396 DC OAKES ACADEMY-CASTLE ROCK Rural 158 N/A 93397 ROCK RIDGE ELEMENTARY SCHOOL Urban 534 N/A 93398 DOUGLAS COUNTY HIGH SCHOOL Urban 1808 N/A 93451 CHERRY VALLEY ELEM SCHOOL Rural 35 N/A 93452 FRANKTOWN ELEMENTARY SCHOOL Rural 364 N/A 93456 LARKSPUR ELEMENTARY SCHOOL Rural 237 N/A 93496 ACRES GREEN ELEMENTARY SCHOOL Urban 493 N/A 93497 EAGLE RIDGE ELEMENTARY SCHOOL Urban 627 N/A 93499 DCS MONTESSORI CHARTER SCHOOL Urban 556 N/A 93500 ROXBOROUGH ELEMENTARY SCHOOL Rural 375 N/A 93502 PLATTE RIVER ACADEMY CHARTER Urban 565 N/A 93505 SAND CREEK ELEMENTARY SCHOOL Urban 454 N/A 93506 NORTHRIDGE ELEMENTARY SCHOOL Urban 632 N/A 93507 BEAR CANYON ELEMENTARY SCHOOL Urban 492 N/A 93508 HIGHLANDS RANCH HIGH SCHOOL Urban 1680 N/A 93509 CRESTHILL MIDDLE SCHOOL Urban 776 N/A 93510 COUGAR RUN ELEMENTARY SCHOOL Urban 441 N/A 93511 FOX CREEK ELEMENTARY SCHOOL Urban 528 N/A 93512 RANCH VIEW MIDDLE SCHOOL Urban 795 N/A 93513 THUNDERRIDGE HIGH SCHOOL Urban 2042 N/A 93514 SUMMIT VIEW ELEMENTARY SCHOOL Urban 523 N/A 93515 COYOTE CREEK ELEMENTARY SCHOOL Urban 408 N/A
Page 5 BEN Name Urban/ Number of Students CEP CEP Base Rural Students Count Based Percentage Year on Estimate 93516 TRAIL BLAZER ELEMENTARY SCHOOL Urban 413 N/A 93544 CHAPARRAL HIGH SCHOOL Urban 2193 N/A 93546 SIERRA MIDDLE SCHOOL Urban 875 N/A 93548 PINE GROVE ELEMENTARY SCHOOL Urban 587 N/A 93549 PONDEROSA HIGH SCHOOL Urban 1440 N/A 93550 MOUNTAIN VIEW ELEMENTARY SCH Urban 314 N/A 93551 NORTHEAST ELEMENTARY SCHOOL Rural 288 N/A 93553 CHEROKEE TRAIL ELEMENTARY SCH Urban 564 N/A 93554 SEDALIA ELEMENTARY SCHOOL Rural 254 N/A 93558 PIONEER ELEMENTARY SCHOOL Urban 483 N/A 93561 PINE LANE PRIMARY SCHOOL Urban 756 N/A 212931 WILDCAT MOUNTAIN ELEMENTARY SCHOOL Urban 525 N/A 230731 ARROWWOOD ELEMENTARY SCHOOL Urban 383 N/A 230733 MEADOW VIEW ELEMENTARY SCHOOL Urban 457 N/A 230734 SAGEWOOD MIDDLE SCHOOL Rural 884 N/A 230737 RENAISSANCE EXPEDITONARY LEARNING OUTW Urban 395 N/A ARD BOUND SCHOOL 230740 SADDLE RANCH ELEMENTARY SCHOOL Urban 434 N/A 234642 TIMBER TRAIL ELEMENTARY Urban 357 N/A 234643 LEGACY POINT ELEMENTARY Urban 358 N/A 234644 FLAGSTONE ELEMENTARY Urban 489 N/A 234704 MOUNTAIN RIDGE MIDDLE SCHOOL Urban 1088 N/A 234705 ROCKY HEIGHTS MIDDLE SCHOOL Urban 1346 N/A 234707 ROCK CANYON HIGH SCHOOL Urban 2310 N/A 234801 ELDORADO ELEMENTARY SCHOOL Urban 451 N/A 234803 FRONTIER VALLEY ELEMENTARY Urban 488 N/A 234805 IRON HORSE ELEMENTARY Urban 460 N/A 234806 PRAIRIE CROSSING ELEMENTARY SCHOOL Urban 701 N/A 234809 CHALLENGE TO EXCELLENCE CHARTER SCHOOL Urban 521 N/A 234868 HERITAGE ELEMENTARY Urban 439 N/A 234869 MOUNTAIN VISTA HIGH SCHOOL Rural 2381 N/A 16024043 SOARING HAWK ELEMENTARY Urban 577 N/A 16030794 REDSTONE ELEMENTARY Urban 488 N/A 16030795 COPPER MESA ELEMENTARY Urban 428 N/A 16036530 CASTLE VIEW HIGH SCHOOL Urban 2183 N/A 16036560 AMERICAN ACADEMY CHARTER SCHOOL Urban 2535 N/A 16048334 STONE MOUNTAIN ELEMENTARY Urban 672 N/A 16048337 MAMMOTH HEIGHTS ELEMENTARY Urban 668 N/A 16048338 LONE TREE MAGNET SCHOOL Urban 421 N/A 16048340 ROXBOROUGH INTERMEDIATE Rural 392 N/A 16048342 GOLD RUSH ELEMENTARY Urban 699 N/A 16048345 LEGEND HIGH SCHOOL Urban 2215 N/A 16048346 MESA MIDDLE SCHOOL Rural 865 N/A 16053064 CIMARRON MIDDLE SCHOOL Urban 1293 N/A 16053068 EARLY CHILDHOOD CENTER Urban 93 N/A
Page 6 BEN Name Urban/ Number of Students CEP CEP Base Rural Students Count Based Percentage Year on Estimate 16053506 CLEAR SKY ELEMENTARY Urban 744 N/A 16059637 SAGE CANYON ELEMENTARY Urban 789 N/A 16065804 STEM ACADEMY Urban 1875 N/A 16070239 BEN FRANKLIN ACADEMY Urban 930 N/A 16059960 CANTRIL SCHOOL Urban 25 N/A 17011700 RENAISSANCE SECONDARY SCHOOL Urban 327 N/A 17013034 Aspen View Academy Urban 904 N/A 17013035 Cloverleaf Enrichment School Rural 301 N/A 17013036 eDCSD Urban 35 N/A 17013038 Highlands Ranch HS Pre-K Urban 22 N/A 17013039 Parker Core Knowledge Urban 702 N/A 17013040 Parker Performing Arts School Urban 735 N/A 17013041 Rock Canyon HS Pre-K Urban 0 N/A 17013042 World Compass Academy Rural 619 N/A 16077396 HOPE ONLINE LEARNING ACADEMY ELEMENTAR Urban 489 N/A Y 16085457 GLOBAL VILLAGE ACADEMY - DOUGLAS COUNTY Rural 389 N/A 16077394 HOPE ONLINE LEARNING ACADEMY MIDDLE Urban 846 N/A 16051286 NORTH STAR ACADEMY Urban 667 N/A 17021449 Ascent Classical Academy of Douglas County Urban 544 N/A
Related Child School Annexes School BEN School Name Annex Name 93561 PINE LANE PRIMARY SCHOOL Pine Line Intermediate 16036560 AMERICAN ACADEMY CHARTER SCHOOL American Academy Parker 16036560 AMERICAN ACADEMY CHARTER SCHOOL American Academy Lincoln Meadows
Related School District NIFs School School District Name NIF BEN NIF Name District BEN 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16053054 WILCOX ADMINISTRATION 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16053055 SERVICE CENTER 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16053058 OPERATIONS EAST 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16053059 TRANSPORTATION NORTH 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16053060 SHEA STADIUM 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16053062 STADIUM #3 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16053070 INSTRUCTIONAL SUPPORT SERVICES HOPE 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16053092 SUPPORT SERVICES WEST 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16053066 EARLY CHILDHOOD CENTER NORTH 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 16070238 DC LIFE CENTER 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 17006200 Data Center 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 17008536 Sports Authority Stadium 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 17024931 Stone Canyon
Page 7 School School District Name NIF BEN NIF Name District BEN 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 17024932 East Transportation Terminal 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 17024933 West Transportation Terminal 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 17024934 Echo Park 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 17024935 Teddy Lane 142133 DOUGLAS COUNTY SCHOOL DISTRICT R E 1 17025876 PLUM CREEK ACADEMY
Discount Rate School District School District School District School District Category One Category Two Enrollment NSLP Count NSLP Percentage Urban/Rural Status Discount Rate Discount Rate 64674 7472 12.0% Urban 40% 40%
Page 8 Funding Request for FRN #2199006318 Funding Request Nickname: 21DCSD-IA
Service Type: Data Transmission and/or Internet Access
What is the FRN number from the previous 2099031826 year ?
Agreement Information - Contract Contract Number Account Number
Establishing FCC Form 470 190005671 Service Provider CenturyLink Qwest Corporation (SPN: 143005231) Was an FCC Form 470 posted Yes for the product and/or services Based on State Master No you are requesting? Contract?
Award Date February 26, 2019 Based on a multiple award No schedule? How many bids were received 4 Includes Voluntary Extensions? No for this contract?
What is the service start date? July 01, 2021 Remaining Voluntary Extensions
Total Remaining Contract Length
What is the date your contract June 30, 2022 expires for the current term of the contract?
Document Name Document Description
19DCSD Century Link Internet.pdf
Pricing Confidentiality Is there a statute, rule, or other restriction which prohibits No publication of the specific pricing information for this contract?
8 Gb Internet Access Narrative
Page 9 Line Item # 2199006318.001
Product and Service Details Internet access service that includes a connection from any applicant site directly to the Internet Service Purpose Provider
Function Fiber
Type of Connection Ethernet Bandwidth Speed Upload Speed 8.0 Gbps Download Speed 8.0 Gbps
Connection Information Does this include firewall services? No Is this a connection between eligible schools, No libraries and NIFs (i.e., a connection that provides a “Wide area network”)?
Is this a direct connection to a single school, Yes library or a NIF for Internet access?
Cost Calculation for FRN Line Item # 2199006318.001
Monthly Cost One-Time Cost Monthly Recurring Unit Cost $4,240.00 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 = $4,240.00 One-time Quantity x 0 Costs Monthly Quantity x 1 Total Eligible One-time Costs = $0.00 Total Monthly Eligible Recurring = $4,240.00 Costs Summary Months of Service x 12 Total Eligible Recurring Costs $50,880.00 Total Eligible Recurring Costs = $50,880.00 Total Eligible One-time Costs + $0.00 Pre-Discount Extended Eligible = $50,880.00 Line Item Cost
Page 10 Recipients of Services BEN Name 93388 BUFFALO RIDGE ELEMENTARY 93390 ACADEMY CHARTER SCHOOL 93392 CASTLE ROCK MIDDLE SCHOOL 93393 CASTLE ROCK ELEMENTARY SCHOOL 93394 SOUTH RIDGE ELEMENTARY SCHOOL 93396 DC OAKES ACADEMY-CASTLE ROCK 93397 ROCK RIDGE ELEMENTARY SCHOOL 93398 DOUGLAS COUNTY HIGH SCHOOL 93451 CHERRY VALLEY ELEM SCHOOL 93452 FRANKTOWN ELEMENTARY SCHOOL 93456 LARKSPUR ELEMENTARY SCHOOL 93496 ACRES GREEN ELEMENTARY SCHOOL 93497 EAGLE RIDGE ELEMENTARY SCHOOL 93499 DCS MONTESSORI CHARTER SCHOOL 93500 ROXBOROUGH ELEMENTARY SCHOOL 93502 PLATTE RIVER ACADEMY CHARTER 93505 SAND CREEK ELEMENTARY SCHOOL 93506 NORTHRIDGE ELEMENTARY SCHOOL 93507 BEAR CANYON ELEMENTARY SCHOOL 93508 HIGHLANDS RANCH HIGH SCHOOL 93509 CRESTHILL MIDDLE SCHOOL 93510 COUGAR RUN ELEMENTARY SCHOOL 93511 FOX CREEK ELEMENTARY SCHOOL 93512 RANCH VIEW MIDDLE SCHOOL 93513 THUNDERRIDGE HIGH SCHOOL 93514 SUMMIT VIEW ELEMENTARY SCHOOL 93515 COYOTE CREEK ELEMENTARY SCHOOL 93516 TRAIL BLAZER ELEMENTARY SCHOOL 93544 CHAPARRAL HIGH SCHOOL 93546 SIERRA MIDDLE SCHOOL 93548 PINE GROVE ELEMENTARY SCHOOL 93549 PONDEROSA HIGH SCHOOL 93550 MOUNTAIN VIEW ELEMENTARY SCH 93551 NORTHEAST ELEMENTARY SCHOOL 93553 CHEROKEE TRAIL ELEMENTARY SCH 93554 SEDALIA ELEMENTARY SCHOOL 93558 PIONEER ELEMENTARY SCHOOL 93561 PINE LANE PRIMARY SCHOOL 212931 WILDCAT MOUNTAIN ELEMENTARY SCHOOL 230731 ARROWWOOD ELEMENTARY SCHOOL 230733 MEADOW VIEW ELEMENTARY SCHOOL 230734 SAGEWOOD MIDDLE SCHOOL 230737 RENAISSANCE EXPEDITONARY LEARNING OUTWARD BOUND SCHOOL 230740 SADDLE RANCH ELEMENTARY SCHOOL
Page 11 BEN Name 234642 TIMBER TRAIL ELEMENTARY 234643 LEGACY POINT ELEMENTARY 234644 FLAGSTONE ELEMENTARY 234704 MOUNTAIN RIDGE MIDDLE SCHOOL 234705 ROCKY HEIGHTS MIDDLE SCHOOL 234707 ROCK CANYON HIGH SCHOOL 234801 ELDORADO ELEMENTARY SCHOOL 234803 FRONTIER VALLEY ELEMENTARY 234805 IRON HORSE ELEMENTARY 234806 PRAIRIE CROSSING ELEMENTARY SCHOOL 234809 CHALLENGE TO EXCELLENCE CHARTER SCHOOL 234868 HERITAGE ELEMENTARY 234869 MOUNTAIN VISTA HIGH SCHOOL 16024043 SOARING HAWK ELEMENTARY 16030794 REDSTONE ELEMENTARY 16030795 COPPER MESA ELEMENTARY 16036530 CASTLE VIEW HIGH SCHOOL 16036560 AMERICAN ACADEMY CHARTER SCHOOL 16048334 STONE MOUNTAIN ELEMENTARY 16048337 MAMMOTH HEIGHTS ELEMENTARY 16048338 LONE TREE MAGNET SCHOOL 16048340 ROXBOROUGH INTERMEDIATE 16048342 GOLD RUSH ELEMENTARY 16048345 LEGEND HIGH SCHOOL 16048346 MESA MIDDLE SCHOOL 16051286 NORTH STAR ACADEMY 16053064 CIMARRON MIDDLE SCHOOL 16053068 EARLY CHILDHOOD CENTER 16053506 CLEAR SKY ELEMENTARY 16059637 SAGE CANYON ELEMENTARY 16065804 STEM ACADEMY 16070239 BEN FRANKLIN ACADEMY 16077394 HOPE ONLINE LEARNING ACADEMY MIDDLE 16077396 HOPE ONLINE LEARNING ACADEMY ELEMENTARY 16053054 WILCOX ADMINISTRATION 16053055 SERVICE CENTER 16053058 OPERATIONS EAST 16053059 TRANSPORTATION NORTH 16053060 SHEA STADIUM 16053062 STADIUM #3 16053070 INSTRUCTIONAL SUPPORT SERVICES HOPE 16053092 SUPPORT SERVICES WEST 16059960 CANTRIL SCHOOL 16053066 EARLY CHILDHOOD CENTER NORTH 16070238 DC LIFE CENTER 16085457 GLOBAL VILLAGE ACADEMY - DOUGLAS COUNTY
Page 12 BEN Name 17006200 Data Center 17008536 Sports Authority Stadium 17011700 RENAISSANCE SECONDARY SCHOOL 17013034 Aspen View Academy 17013035 Cloverleaf Enrichment School 17013036 eDCSD 17013038 Highlands Ranch HS Pre-K 17013039 Parker Core Knowledge 17013040 Parker Performing Arts School 17013041 Rock Canyon HS Pre-K 17013042 World Compass Academy 17021449 Ascent Classical Academy of Douglas County 17024931 Stone Canyon 17024932 East Transportation Terminal 17024933 West Transportation Terminal 17024934 Echo Park 17024935 Teddy Lane 17025876 PLUM CREEK ACADEMY
Page 13 Line Item # 2199006318.002
Product and Service Details Internet access service that includes a connection from any applicant site directly to the Internet Service Purpose Provider
Function Miscellaneous
Type of Connection Taxes and USF Fees
Cost Calculation for FRN Line Item # 2199006318.002
Monthly Cost One-Time Cost Monthly Recurring Unit Cost $241.25 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 = $241.25 One-time Quantity x 0 Costs Monthly Quantity x 1 Total Eligible One-time Costs = $0.00 Total Monthly Eligible Recurring = $241.25 Costs Summary Months of Service x 12 Total Eligible Recurring Costs $2,895.00 Total Eligible Recurring Costs = $2,895.00 Total Eligible One-time Costs + $0.00 Pre-Discount Extended Eligible = $2,895.00 Line Item Cost
Page 14 Recipients of Services BEN Name 93388 BUFFALO RIDGE ELEMENTARY 93390 ACADEMY CHARTER SCHOOL 93392 CASTLE ROCK MIDDLE SCHOOL 93393 CASTLE ROCK ELEMENTARY SCHOOL 93394 SOUTH RIDGE ELEMENTARY SCHOOL 93396 DC OAKES ACADEMY-CASTLE ROCK 93397 ROCK RIDGE ELEMENTARY SCHOOL 93398 DOUGLAS COUNTY HIGH SCHOOL 93451 CHERRY VALLEY ELEM SCHOOL 93452 FRANKTOWN ELEMENTARY SCHOOL 93456 LARKSPUR ELEMENTARY SCHOOL 93496 ACRES GREEN ELEMENTARY SCHOOL 93497 EAGLE RIDGE ELEMENTARY SCHOOL 93499 DCS MONTESSORI CHARTER SCHOOL 93500 ROXBOROUGH ELEMENTARY SCHOOL 93502 PLATTE RIVER ACADEMY CHARTER 93505 SAND CREEK ELEMENTARY SCHOOL 93506 NORTHRIDGE ELEMENTARY SCHOOL 93507 BEAR CANYON ELEMENTARY SCHOOL 93508 HIGHLANDS RANCH HIGH SCHOOL 93509 CRESTHILL MIDDLE SCHOOL 93510 COUGAR RUN ELEMENTARY SCHOOL 93511 FOX CREEK ELEMENTARY SCHOOL 93512 RANCH VIEW MIDDLE SCHOOL 93513 THUNDERRIDGE HIGH SCHOOL 93514 SUMMIT VIEW ELEMENTARY SCHOOL 93515 COYOTE CREEK ELEMENTARY SCHOOL 93516 TRAIL BLAZER ELEMENTARY SCHOOL 93544 CHAPARRAL HIGH SCHOOL 93546 SIERRA MIDDLE SCHOOL 93548 PINE GROVE ELEMENTARY SCHOOL 93549 PONDEROSA HIGH SCHOOL 93550 MOUNTAIN VIEW ELEMENTARY SCH 93551 NORTHEAST ELEMENTARY SCHOOL 93553 CHEROKEE TRAIL ELEMENTARY SCH 93554 SEDALIA ELEMENTARY SCHOOL 93558 PIONEER ELEMENTARY SCHOOL 93561 PINE LANE PRIMARY SCHOOL 212931 WILDCAT MOUNTAIN ELEMENTARY SCHOOL 230731 ARROWWOOD ELEMENTARY SCHOOL 230733 MEADOW VIEW ELEMENTARY SCHOOL 230734 SAGEWOOD MIDDLE SCHOOL 230737 RENAISSANCE EXPEDITONARY LEARNING OUTWARD BOUND SCHOOL 230740 SADDLE RANCH ELEMENTARY SCHOOL
Page 15 BEN Name 234642 TIMBER TRAIL ELEMENTARY 234643 LEGACY POINT ELEMENTARY 234644 FLAGSTONE ELEMENTARY 234704 MOUNTAIN RIDGE MIDDLE SCHOOL 234705 ROCKY HEIGHTS MIDDLE SCHOOL 234707 ROCK CANYON HIGH SCHOOL 234801 ELDORADO ELEMENTARY SCHOOL 234803 FRONTIER VALLEY ELEMENTARY 234805 IRON HORSE ELEMENTARY 234806 PRAIRIE CROSSING ELEMENTARY SCHOOL 234809 CHALLENGE TO EXCELLENCE CHARTER SCHOOL 234868 HERITAGE ELEMENTARY 234869 MOUNTAIN VISTA HIGH SCHOOL 16024043 SOARING HAWK ELEMENTARY 16030794 REDSTONE ELEMENTARY 16030795 COPPER MESA ELEMENTARY 16036530 CASTLE VIEW HIGH SCHOOL 16036560 AMERICAN ACADEMY CHARTER SCHOOL 16048334 STONE MOUNTAIN ELEMENTARY 16048337 MAMMOTH HEIGHTS ELEMENTARY 16048338 LONE TREE MAGNET SCHOOL 16048340 ROXBOROUGH INTERMEDIATE 16048342 GOLD RUSH ELEMENTARY 16048345 LEGEND HIGH SCHOOL 16048346 MESA MIDDLE SCHOOL 16053064 CIMARRON MIDDLE SCHOOL 16053068 EARLY CHILDHOOD CENTER 16053506 CLEAR SKY ELEMENTARY 16059637 SAGE CANYON ELEMENTARY 16065804 STEM ACADEMY 16070239 BEN FRANKLIN ACADEMY 17006200 Data Center 16053070 INSTRUCTIONAL SUPPORT SERVICES HOPE 16053059 TRANSPORTATION NORTH 16053054 WILCOX ADMINISTRATION 16053092 SUPPORT SERVICES WEST 16053062 STADIUM #3 16053060 SHEA STADIUM 16053055 SERVICE CENTER 16053058 OPERATIONS EAST 16053066 EARLY CHILDHOOD CENTER NORTH 16070238 DC LIFE CENTER 17008536 Sports Authority Stadium 16059960 CANTRIL SCHOOL 17011700 RENAISSANCE SECONDARY SCHOOL 17013034 Aspen View Academy
Page 16 BEN Name 17013035 Cloverleaf Enrichment School 17013036 eDCSD 17013038 Highlands Ranch HS Pre-K 17013039 Parker Core Knowledge 17013040 Parker Performing Arts School 17013041 Rock Canyon HS Pre-K 17013042 World Compass Academy 16077396 HOPE ONLINE LEARNING ACADEMY ELEMENTARY 16085457 GLOBAL VILLAGE ACADEMY - DOUGLAS COUNTY 16077394 HOPE ONLINE LEARNING ACADEMY MIDDLE 16051286 NORTH STAR ACADEMY 17021449 Ascent Classical Academy of Douglas County 17024935 Teddy Lane 17024934 Echo Park 17024932 East Transportation Terminal 17024933 West Transportation Terminal 17024931 Stone Canyon 17025876 PLUM CREEK ACADEMY
Page 17 FRN Calculation for FRN #2199006318
Monthly Charges Total Requested Amount Total Monthly Recurring Charges $4,481.25 Total Eligible Pre-Discount $53,775.00 Total Monthly Ineligible Charges - $0.00 Recurring Charges Total Eligible Pre-Discount One- + $0.00 Total Monthly Eligible Charges = $4,481.25 Time Charges Total Number of Months of x 12 Total Pre-Discount Charges = $53,775.00 Service Discount Rate 40% Total Eligible Pre-Discount = $53,775.00 Recurring Charges Funding Commitment Request = $21,510.00
One-Time Charges Total One-Time Charges $0.00 Total Ineligible One-Time - $0.00 Charges Total Eligible Pre-Discount = $0.00 One-Time Charges
Page 18 Funding Request for FRN #2199006330 Funding Request Nickname: 21DCSD - WAN
Service Type: Data Transmission and/or Internet Access
What is the FRN number from the previous 2099031857 year ?
Agreement Information - Contract Contract Number Account Number
Establishing FCC Form 470 200017970 Service Provider CenturyLink Qwest Corporation (SPN: 143005231) Was an FCC Form 470 posted Yes for the product and/or services Based on State Master No you are requesting? Contract?
Award Date March 09, 2020 Based on a multiple award No schedule? How many bids were received 2 Includes Voluntary Extensions? No for this contract?
What is the service start date? July 01, 2021 Remaining Voluntary Extensions
Total Remaining Contract Length
What is the date your contract June 30, 2024 expires for the current term of the contract?
Pricing Confidentiality Is there a statute, rule, or other restriction which prohibits No publication of the specific pricing information for this contract?
Wide Area Network for District N Narrative
Page 19 Line Item # 2199006330.001
Product and Service Details Data Connection between two or more sites entirely within the applicant’s network Purpose
Function Fiber
Type of Connection Ethernet Bandwidth Speed Upload Speed 1.0 Gbps Download Speed 1.0 Gbps
Connection Information Does this include firewall services? No Is this a connection between eligible schools, Yes libraries and NIFs (i.e., a connection that provides a “Wide area network”)?
Is this a direct connection to a single school, No library or a NIF for Internet access?
Cost Calculation for FRN Line Item # 2199006330.001
Monthly Cost One-Time Cost Monthly Recurring Unit Cost $663.49 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 = $663.49 One-time Quantity x 0 Costs Monthly Quantity x 66 Total Eligible One-time Costs = $0.00 Total Monthly Eligible Recurring = $43,790.34 Costs Summary Months of Service x 12 Total Eligible Recurring Costs $525,484.08 Total Eligible Recurring Costs = $525,484.08 Total Eligible One-time Costs + $0.00 Pre-Discount Extended Eligible = $525,484.08 Line Item Cost
Page 20 Recipients of Services BEN Name 93388 BUFFALO RIDGE ELEMENTARY 93390 ACADEMY CHARTER SCHOOL 93393 CASTLE ROCK ELEMENTARY SCHOOL 93394 SOUTH RIDGE ELEMENTARY SCHOOL 93396 DC OAKES ACADEMY-CASTLE ROCK 93397 ROCK RIDGE ELEMENTARY SCHOOL 93451 CHERRY VALLEY ELEM SCHOOL 93452 FRANKTOWN ELEMENTARY SCHOOL 93456 LARKSPUR ELEMENTARY SCHOOL 93496 ACRES GREEN ELEMENTARY SCHOOL 93497 EAGLE RIDGE ELEMENTARY SCHOOL 93505 SAND CREEK ELEMENTARY SCHOOL 93506 NORTHRIDGE ELEMENTARY SCHOOL 93507 BEAR CANYON ELEMENTARY SCHOOL 93510 COUGAR RUN ELEMENTARY SCHOOL 93511 FOX CREEK ELEMENTARY SCHOOL 93514 SUMMIT VIEW ELEMENTARY SCHOOL 93515 COYOTE CREEK ELEMENTARY SCHOOL 93516 TRAIL BLAZER ELEMENTARY SCHOOL 93548 PINE GROVE ELEMENTARY SCHOOL 93550 MOUNTAIN VIEW ELEMENTARY SCH 93551 NORTHEAST ELEMENTARY SCHOOL 93553 CHEROKEE TRAIL ELEMENTARY SCH 93554 SEDALIA ELEMENTARY SCHOOL 93558 PIONEER ELEMENTARY SCHOOL 93561 PINE LANE PRIMARY SCHOOL 212931 WILDCAT MOUNTAIN ELEMENTARY SCHOOL 230731 ARROWWOOD ELEMENTARY SCHOOL 230733 MEADOW VIEW ELEMENTARY SCHOOL 230740 SADDLE RANCH ELEMENTARY SCHOOL 234642 TIMBER TRAIL ELEMENTARY 234643 LEGACY POINT ELEMENTARY 234644 FLAGSTONE ELEMENTARY 234801 ELDORADO ELEMENTARY SCHOOL 234803 FRONTIER VALLEY ELEMENTARY 234805 IRON HORSE ELEMENTARY 234806 PRAIRIE CROSSING ELEMENTARY SCHOOL 234809 CHALLENGE TO EXCELLENCE CHARTER SCHOOL 234868 HERITAGE ELEMENTARY 16024043 SOARING HAWK ELEMENTARY 16030794 REDSTONE ELEMENTARY 16030795 COPPER MESA ELEMENTARY 16036560 AMERICAN ACADEMY CHARTER SCHOOL 16048334 STONE MOUNTAIN ELEMENTARY
Page 21 BEN Name 16048337 MAMMOTH HEIGHTS ELEMENTARY 16048338 LONE TREE MAGNET SCHOOL 16048342 GOLD RUSH ELEMENTARY 16051286 NORTH STAR ACADEMY 16053068 EARLY CHILDHOOD CENTER 16053506 CLEAR SKY ELEMENTARY 16059637 SAGE CANYON ELEMENTARY 16053054 WILCOX ADMINISTRATION 16053058 OPERATIONS EAST 16053059 TRANSPORTATION NORTH 16053092 SUPPORT SERVICES WEST 16059960 CANTRIL SCHOOL 17011700 RENAISSANCE SECONDARY SCHOOL 17024931 Stone Canyon 17024932 East Transportation Terminal 17024933 West Transportation Terminal 17024934 Echo Park 17024935 Teddy Lane 17025876 PLUM CREEK ACADEMY
Page 22 Line Item # 2199006330.002
Product and Service Details Data Connection between two or more sites entirely within the applicant’s network Purpose
Function Fiber
Type of Connection Ethernet Bandwidth Speed Upload Speed 10.0 Gbps Download Speed 10.0 Gbps
Connection Information Does this include firewall services? No Is this a connection between eligible schools, Yes libraries and NIFs (i.e., a connection that provides a “Wide area network”)?
Is this a direct connection to a single school, No library or a NIF for Internet access?
Cost Calculation for FRN Line Item # 2199006330.002
Monthly Cost One-Time Cost Monthly Recurring Unit Cost $973.49 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 = $973.49 One-time Quantity x 0 Costs Monthly Quantity x 18 Total Eligible One-time Costs = $0.00 Total Monthly Eligible Recurring = $17,522.82 Costs Summary Months of Service x 12 Total Eligible Recurring Costs $210,273.84 Total Eligible Recurring Costs = $210,273.84 Total Eligible One-time Costs + $0.00 Pre-Discount Extended Eligible = $210,273.84 Line Item Cost
Page 23 Recipients of Services BEN Name 93392 CASTLE ROCK MIDDLE SCHOOL 93398 DOUGLAS COUNTY HIGH SCHOOL 93508 HIGHLANDS RANCH HIGH SCHOOL 93509 CRESTHILL MIDDLE SCHOOL 93512 RANCH VIEW MIDDLE SCHOOL 93513 THUNDERRIDGE HIGH SCHOOL 93544 CHAPARRAL HIGH SCHOOL 93546 SIERRA MIDDLE SCHOOL 93549 PONDEROSA HIGH SCHOOL 230734 SAGEWOOD MIDDLE SCHOOL 234704 MOUNTAIN RIDGE MIDDLE SCHOOL 234705 ROCKY HEIGHTS MIDDLE SCHOOL 234707 ROCK CANYON HIGH SCHOOL 234869 MOUNTAIN VISTA HIGH SCHOOL 16036530 CASTLE VIEW HIGH SCHOOL 16048345 LEGEND HIGH SCHOOL 16048346 MESA MIDDLE SCHOOL 16053064 CIMARRON MIDDLE SCHOOL
Page 24 Line Item # 2199006330.003
Product and Service Details Data Connection between two or more sites entirely within the applicant’s network Purpose
Function Fiber
Type of Connection Ethernet Bandwidth Speed Upload Speed 1.0 Gbps Download Speed 1.0 Gbps
Connection Information Does this include firewall services? No Is this a connection between eligible schools, Yes libraries and NIFs (i.e., a connection that provides a “Wide area network”)?
Is this a direct connection to a single school, No library or a NIF for Internet access?
Cost Calculation for FRN Line Item # 2199006330.003
Monthly Cost One-Time Cost Monthly Recurring Unit Cost $1,113.49 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 = $1,113.49 One-time Quantity x 0 Costs Monthly Quantity x 2 Total Eligible One-time Costs = $0.00 Total Monthly Eligible Recurring = $2,226.98 Costs Summary Months of Service x 12 Total Eligible Recurring Costs $26,723.76 Total Eligible Recurring Costs = $26,723.76 Total Eligible One-time Costs + $0.00 Pre-Discount Extended Eligible = $26,723.76 Line Item Cost
Page 25 Recipients of Services BEN Name 93500 ROXBOROUGH ELEMENTARY SCHOOL 16048340 ROXBOROUGH INTERMEDIATE
Page 26 Line Item # 2199006330.004
Product and Service Details Data Connection between two or more sites entirely within the applicant’s network Purpose
Function Fiber
Type of Connection Ethernet Bandwidth Speed Upload Speed 10.0 Gbps Download Speed 10.0 Gbps
Connection Information Does this include firewall services? No Is this a connection between eligible schools, Yes libraries and NIFs (i.e., a connection that provides a “Wide area network”)?
Is this a direct connection to a single school, No library or a NIF for Internet access?
Cost Calculation for FRN Line Item # 2199006330.004
Monthly Cost One-Time Cost Monthly Recurring Unit Cost $1,900.00 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 = $1,900.00 One-time Quantity x 0 Costs Monthly Quantity x 1 Total Eligible One-time Costs = $0.00 Total Monthly Eligible Recurring = $1,900.00 Costs Summary Months of Service x 12 Total Eligible Recurring Costs $22,800.00 Total Eligible Recurring Costs = $22,800.00 Total Eligible One-time Costs + $0.00 Pre-Discount Extended Eligible = $22,800.00 Line Item Cost
Page 27 Recipients of Services BEN Name 17006200 Data Center
Page 28 FRN Calculation for FRN #2199006330
Monthly Charges Total Requested Amount Total Monthly Recurring Charges $65,440.14 Total Eligible Pre-Discount $785,281.68 Total Monthly Ineligible Charges - $0.00 Recurring Charges Total Eligible Pre-Discount One- + $0.00 Total Monthly Eligible Charges = $65,440.14 Time Charges Total Number of Months of x 12 Total Pre-Discount Charges = $785,281.68 Service Discount Rate 40% Total Eligible Pre-Discount = $785,281.68 Recurring Charges Funding Commitment Request = $314,112.67
One-Time Charges Total One-Time Charges $0.00 Total Ineligible One-Time - $0.00 Charges Total Eligible Pre-Discount = $0.00 One-Time Charges
Page 29 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). 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 $839,056.68 471 Total funding commitment request amount on this FCC Form 471 $335,622.67 Total applicant non-discount share of the eligible amount $503,434.01 Total budgeted amount allocated to resources not eligible for E-rate $100,000.00 support Total amount necessary for the applicant to pay the non-discount $603,434.01 share of eligible and any ineligible amounts Are you receiving any of the funds directly from a service provider No listed on any of the FCC Forms 471 filed by this Billed Entity for this funding year? Has a service provider listed on any of the FCC Forms 471 filed by No this Billed Entity for this funding year assited you in locating funds needed to pay your non-discounted share?
I certify an FCC Form 470 was posted and that any related RFP was made available for at least 28 days before considering all bids received and selecting a service provider. I certify that all bids submitted were carefully considered and the most cost-effective service offering was selected, with price being the primary factor considered, and is the most cost-effective means of meeting educational needs and technology goals. I certify that the entity responsible for selecting the service provider(s) has reviewed all applicable FCC, state, and local procurement/competitive bidding requirements and that the entity or entities listed on this application have complied with them. I certify that the services the applicant purchases at discounts provided by 47 U.S.C. § 254 will be used primarily for educational purposes, see 47 C.F.R. § 54.500 and will not be sold, resold or transferred in consideration for money or any other thing of value, except as permitted by the Commission’s rules at 47 C.F.R. § 54.513. Additionally, I certify that the entity or entities listed on this application have not received anything of value or a promise of anything of value, as prohibited by the Commission’s rules at 47 C.F.R. § 54.503(d), other than services and equipment sought by means of this form, from the service provider, or any representative or agent thereof or any consultant in connection with this request for services. I certify that I and the entity(ies) I represent have complied with all program rules and I acknowledge that failure to do so may result in denial of discount funding and/or cancellation of funding commitments. There are signed contracts or other legally binding agreements covering all of the services listed on this FCC Form 471 except for those services provided under non-contracted tariffed or month-to-month arrangements. I acknowledge that failure to comply with program rules could result in civil or criminal prosecution by the appropriate law enforcement authorities. I acknowledge that the discount level used for shared services is conditional, for future years, upon ensuring that the most disadvantaged schools and libraries that are treated as sharing in the service, receive an appropriate share of benefits from those services. I certify that I will retain required documents for a period of at least 10 years (or whatever retention period is required by the rules in effect at the time of this certification) after the later of the last day of the applicable funding year or the service delivery deadline for the associated funding request. I acknowledge that I may be audited pursuant to participation in the schools and libraries program. I certify that I will retain all documents necessary to demonstrate compliance with the statute and Commission rules regarding the application for, receipt of, and delivery of services receiving schools and libraries discounts, and that if audited, I will make such records available to USAC. I certify that I am authorized to order telecommunications and other supported services for the eligible entity(ies) listed on this application. I certify that I am authorized to submit this request on behalf of the eligible entity(ies) listed on this application, that I have examined this request, that all of the information on this form is true and correct to the best of my knowledge, that the entities that are receiving discounts pursuant to this application have complied with the terms, conditions and purposes of the program, that no kickbacks were paid to anyone and that false statements on this form can be punished by fine or forfeiture under the Communications Act, 47 U.S.C. §§ 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. § 1001 and civil violations of the False Claims Act. I acknowledge that FCC rules provide that persons who have been convicted of criminal violations or held civilly liable for certain acts arising from their participation in the schools and libraries support mechanism are subject to suspension and debarment from the program. I will institute reasonable measures to be informed, and will notify USAC should I be informed or become aware that I or any of the entities listed on this application, or any person associated in any way with my entity and/or the entities listed on this application, is convicted of a criminal violation or held civilly liable for acts arising from their participation in the schools and libraries support mechanism. I certify that if any of the Funding Requests on this FCC Form 471 are for discounts for products or services that contain both eligible and ineligible components, that I have allocated the eligible and ineligible components as required by the Commission's rules at 47 C.F.R. § 54.504. Notice
Page 30 Section 54.504 of the Federal Communications Commission's rules requires all schools and libraries ordering services that are eligible for and seeking universal service discounts to submit an application for such discounts by filing this Services Ordered and Certification Form (FCC Form 471) with the Universal Service Administrator. 47 C.F.R. § 54.504. The collection of information stems from the Commission's authority under Section 254 of the Communications Act of 1934, as amended. 47 U.S.C. § 254. The data in the report will be used to ensure that schools and libraries comply with the application requirements for universal service discounts contained in 47 C.F.R. § 54.504. Schools and libraries must file this form themselves or as part of a consortium. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The FCC is authorized under the Communications Act of 1934, as amended, to collect the information we request in this form. We will use the information you provide to determine whether approving your application for universal service discounts is in the public interest. If we believe there may be a violation or a potential violation of any applicable statute, regulation, rule or order, your application may be referred to the Federal, state, or local agency responsible for investigating, prosecuting, enforcing, or implementing the statute, rule, regulation or order. In certain cases, the information in your application for universal service discounts may be disclosed to the Department of Justice or a court or adjudicative body when (a) the FCC; or (b) any employee of the FCC; or (c) the United States Government is a party of a proceeding before the body or has an interest in the proceeding. In addition, consistent with the Communications Act of 1934, FCC regulations and orders, the Freedom of Information Act, 5 U.S.C. § 552, or other applicable law, information provided in or submitted with this form or in response to subsequent inquiries may be disclosed to the public. If you owe a past due debt to the Federal government, the information you provide may also be disclosed to the Department of the Treasury Financial Management Service, other Federal agencies and/or your employer to offset your salary, IRS tax refund or other payments to collect that debt. The FCC may also provide the information to these agencies through the matching of computer records when authorized. If you do not provide the information we request on the form, the FCC or the Universal Service Administrator may delay processing of your application for universal service discounts or may return your application without action. The foregoing Notice is required by the Paperwork Reduction Act of 1995, Pub. L. No. 104-13, 44 U.S.C. § 3501, et seq. Public reporting burden for this collection of information is estimated to average 4.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing, and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the reporting burden to the Federal Communications Commission, Performance Evaluation and Records Management, Washington, DC 20554. We also will accept your comments via the email if you send them to [email protected]. DO NOT SEND COMPLETED WORKSHEETS TO THESE ADDRESSES. Authorized Person Title: Consultant Name: MARY JO SAGNELLA
Phone: 203-445-9577 Email: [email protected]
Address: 200 Boston Post Road E-Rate Online Employer: E-RATE ONLINE LLC LLC Orange CT 06477
08-Feb-2021 15:39:31 EST Certified Timestamp
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