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 Internet - Segra Application Number 201034846 Funding Year 2020 Category of Service Category 1

Billed Entity Contact Information CHESTERFIELD COUNTY PUBLIC SCHOOLS Brian D Jones 9900 KRAUSE ROAD CHESTERFIELD VA 23832 804-639-8930 804-639-8931 [email protected] [email protected]

Billed Entity Number 126544 FCC Registration Number 0011810835 Applicant Type School District

[email protected] Holiday/Summer Contact Information

Entity Information

School District Entity - Details BEN Name Urban/ State State NCES School District Endowment Rural LEA ID School Code Attributes ID 126544 CHESTERFIELD COUNTY PUBLIC Urban Public School District None SCHOOLS

Related Entity Information

Related Child School Entity - Details BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 25001 ALBERTA SMITH Urban 021 0620 51 - None Pre-K; Public School None ELEMENTARY SCH 00840- 462 25002 BAILEY BRIDGE MIDDLE Urban 021 0631 51 - None Public School None SCHOOL 00840- 53 25003 MANCHESTER HIGH Urban 021 0632 51 - None Public School None SCHOOL 00840- 338 25004 CLOVER HILL HIGH Urban 021 0740 51 - None Public School None SCHOOL 00840- 324 25005 CLOVER HILL Urban 021 0150 51 - 00840- None Pre-K; Public School None ELEMENTARY SCHOOL 2055

Page 1 BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 25006 CRENSHAW Urban 021 0410 51 - 00840- None Pre-K; Public School None ELEMENTARY SCHOOL 2099 25007 SWIFT CREEK Urban 021 0340 51 - 00840- None Pre-K; Public School None ELEMENTARY SCHOOL 1990 25008 SWIFT CREEK MIDDLE Urban 021 0270 51 - 00840- None Public School None SCHOOL 1834 25009 WOOLRIDGE Urban 021 0440 51 - 00840- None Pre-K; Public School None ELEMENTARY SCHOOL 2176 25010 ROBIOUS MIDDLE Urban 021 0760 51 - None Public School None SCHOOL 00840- 347 25011 ROBIOUS ELEMENTARY Urban 021 0730 51 - None Pre-K; Public School None SCHOOL 00840- 346 25012 EVERGREEN Urban 026 0300 51 - 00840- None Pre-K; Public School None ELEMENTARY SCHOOL 2097 25013 JAMES RIVER HIGH Urban 021 0770 51 - None Public School None SCHOOL 00840- 766 25014 BETTIE WEAVER Urban 021 0510 51 - None Pre-K; Public School None ELEMENTARY SCHOOL 00840- 762 25015 MIDLOTHIAN MIDDLE Urban 021 0040 51 - None Public School None SCHOOL 00840- 343 25016 MIDLOTHIAN HIGH Urban 021 0320 51 - 00840- None Public School None SCHOOL 2006 25018 WATKINS ELEMENTARY Urban 021 0650 51 - None Pre-K; Public School None SCHOOL 00840- 335 25030 GRANGE HALL Rural 021 0180 51 - None Pre-K; Public School None ELEMENTARY SCHOOL 00840- 330 25147 CRESTWOOD Urban 021 0560 51 - None Pre-K; Public School None ELEMENTARY SCHOOL 00840- 325 25235 FALLING CREEK MIDDLE Urban 021 0670 51 - Public School None SCHOOL 00840- 329 25236 FALLING CREEK ELEM Urban 021 0670 51 - Head Start; Pre- None SCHOOL 00840- 328 K; Public School 25237 HENING ELEMENTARY Urban 021 0500 51 - None Head Start; Pre- None SCHOOL 00840- 336 K; Public School 25238 MEADOWBROOK HIGH Urban 021 0580 51 - None Public School None SCHOOL 00840- 342 25239 HOPKINS ROAD Urban 021 0060 51 - None Head Start; Pre- None ELEMENTARY SCHOOL 00840- 333 K; Public School 25248 BON AIR ELEMENTARY Urban 021 0020 51 - None Pre-K; Public School None SCHOOL 00840- 318 25249 GREENFIELD Urban 021 0070 51 - None Public School None ELEMENTARY SCHOOL 00840- 33 25250 PROVIDENCE MIDDLE Urban 021 0700 51 - None Public School None SCHOOL 00840- 344 25252 MANCHESTER MIDDLE Urban 021 0600 51 - None Public School None SCHOOL 00840- 338 25253 GORDON ELEMENTARY Urban 021 0290 51 - 00840- None Pre-K; Public School None SCHOOL 1835 25254 MONACAN HIGH Urban 021 0280 51 - 00840- None Public School None SCHOOL 1833 25255 REAMS ROAD Urban 021 0700 51 - None Pre-K; Public School None ELEMENTARY SCHOOL 00840- 345 25256 DAVIS ELEMENTARY Urban 021 0620 51 - None Head Start; Pre- None SCHOOL 00840- 323 K; Public School 25257 PROVIDENCE Urban 021 0380 51 - 00840- None Pre-K; Public School None ELEMENTARY SCHOOL 2056 25258 BENSLEY ELEMENTARY Urban 021 0430 51 - Head Start; Pre- None SCHOOL 00840- 316 K; Public School Page 2 BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 25259 BEULAH ELEMENTARY Urban 021 0130 51 - None Pre-K; Public School None SCHOOL 00840- 317 25261 SALEM CHURCH MIDDLE Urban 021 0722 51 - None Public School None SCHOOL 00840- 349 25262 SALEM CHURCH Urban 021 0720 51 - None Pre-K; Public School None ELEMENTARY SCHOOL 00840- 348 25263 BELLWOOD Urban 021 0660 51 - Head Start; Pre- None ELEMENTARY SCHOOL 00840- 315 K; Public School 25797 MATOACA HIGH Rural 021 0530 51 - None Public School None SCHOOL 00840- 340 25799 ETTRICK ELEMENTARY Urban 021 0350 51 - Head Start; Pre- None SCHOOL 00840- 327 K; Public School 25808 MATOACA MIDDLE Rural 021 0110 51 - None Public School None SCHOOL 00840- 341 25810 MATOACA ELEMENTARY Urban 021 0370 51 - None Pre-K; Public School None SCHOOL 00840- 339 25827 ECOFF ELEMENTARY Urban 021 0480 51 - 00840- None Pre-K; Public School None SCHOOL 2177 25828 CE CURTIS Urban 021 0492 51 - None Pre-K; Public School None ELEMENTARY SCHOOL 00840- 325 25829 THOMAS DALE HIGH Urban 021 0610 51 - None Public School None SCHOOL 00840- 350 25832 CC WELLS ELEMENTARY Urban 021 0050 51 - None Pre-K; Public School None SCHOOL 00840- 319 25833 CARVER MIDDLE Rural 021 0420 51 - None Public School None SCHOOL 00840- 321 25834 HARROWGATE Rural 021 0460 51 - Head Start; Pre- None ELEMENTARY SCHOOL 00840- 332 K; Public School 25836 CHESTERFIELD Urban 021 0089 51 - None Public School None TECHNICAL CENTER AT 00840- 323 COURTHOUSE 25837 BIRD HIGH SCHOOL Urban 021 0010 51 - None Public School None 00840- 337 25838 GATES ELEMENTARY Urban 021 0360 51 - 00840- None Pre-K; Public School None SCHOOL 1989 25839 JACOBS ROAD Urban 021 0400 51 - 00840- None Pre-K; Public School None ELEMENTARY SCHOOL 2098 25841 CHALKLEY Urban 021 0550 51 - Head Start; Pre- None ELEMENTARY SCHOOL 00840- 334 K; Public School 25848 MARGUERITE Urban 021 0780 51 - 00840- None Head Start; Pre- None CHRISTIAN ELEM SCH 1086 K; Public School 25850 ENON ELEMENTARY Urban 021 0390 51 - None New Construction None SCHOOL 00840- 326 School; Public School 215194 SPRING RUN ES Urban 021 0800 51 - 00840- None Pre-K; Public School None 1903 234046 CARVER COLLEGE AND Urban 021 0030 51 - 00840- None Public School None CAREER ACADEMY 1605 16034166 COSBY HIGH SCHOOL Urban 021 0840 51 - 00840- None Public School None 2661 16042050 ELIZABETH SCOTT Urban 021 0850 51 - 00860- None Head Start; Pre- None ELEMENTARY SCHOOL 2779 K; Public School 16042051 WINTERPOCK Rural 021 0860 51 - 00840- None Pre-K; Public School None ELEMENTARY SCHOOL 2780 16046472 TOMAHAWK CREEK Urban 021 0880 51 - 00840- None Public School None MIDDLE SCHOOL 2754 16046473 ELIZABETH DAVIS Urban 021 0870 51 - 00840- None Public School None MIDDLE SCHOOL 2767

Page 3 BEN Name Urban/ State State NCES Code Alternative School Attributes Endowment Rural LEA ID School ID Discount 16081142 CHESTERFIELD Urban 021 0089 51 - 00840- None Public School None CAREER & TECHNICAL 2972 EDUCATION CENTER AT HULL 16081145 ACADEMY 360 Urban 021 0930 51 - 00840- None Public School None 2983 17020265 Old Hundred Elementary Rural None New Construction None School School; Public School

Related Child School Entity - Discount Rate Calculation Details BEN Name Urban/ Number of Students CEP Rural Students Count Based Percentage on Estimate 25001 ALBERTA SMITH ELEMENTARY SCH Urban 631 N/A 25002 BAILEY BRIDGE MIDDLE SCHOOL Urban 1570 N/A 25003 MANCHESTER HIGH SCHOOL Urban 2114 N/A 25004 CLOVER HILL HIGH SCHOOL Urban 1752 N/A 25005 CLOVER HILL ELEMENTARY SCHOOL Urban 772 N/A 25006 CRENSHAW ELEMENTARY SCHOOL Urban 659 N/A 25007 SWIFT CREEK ELEMENTARY SCHOOL Urban 677 N/A 25008 SWIFT CREEK MIDDLE SCHOOL Urban 1120 N/A 25009 WOOLRIDGE ELEMENTARY SCHOOL Urban 781 N/A 25010 ROBIOUS MIDDLE SCHOOL Urban 1242 N/A 25011 ROBIOUS ELEMENTARY SCHOOL Urban 744 N/A 25012 EVERGREEN ELEMENTARY SCHOOL Urban 980 N/A 25013 JAMES RIVER HIGH SCHOOL Urban 1909 N/A 25014 BETTIE WEAVER ELEMENTARY SCHOOL Urban 681 N/A 25015 MIDLOTHIAN MIDDLE SCHOOL Urban 1369 N/A 25016 MIDLOTHIAN HIGH SCHOOL Urban 1833 N/A 25018 WATKINS ELEMENTARY SCHOOL Urban 822 N/A 25030 GRANGE HALL ELEMENTARY SCHOOL Rural 867 N/A 25147 CRESTWOOD ELEMENTARY SCHOOL Urban 592 N/A 25235 FALLING CREEK MIDDLE SCHOOL Urban 1478 N/A 49.73% 25236 FALLING CREEK ELEM SCHOOL Urban 763 N/A 53.70% 25237 HENING ELEMENTARY SCHOOL Urban 921 N/A 25238 MEADOWBROOK HIGH SCHOOL Urban 1902 N/A 25239 HOPKINS ROAD ELEMENTARY SCHOOL Urban 735 N/A 25248 BON AIR ELEMENTARY SCHOOL Urban 640 N/A 25249 GREENFIELD ELEMENTARY SCHOOL Urban 640 N/A 25250 PROVIDENCE MIDDLE SCHOOL Urban 1100 N/A 25252 MANCHESTER MIDDLE SCHOOL Urban 1144 N/A 25253 GORDON ELEMENTARY SCHOOL Urban 629 N/A 25254 MONACAN HIGH SCHOOL Urban 1554 N/A 25255 REAMS ROAD ELEMENTARY SCHOOL Urban 495 N/A 25256 DAVIS ELEMENTARY SCHOOL Urban 728 N/A 25257 PROVIDENCE ELEMENTARY SCHOOL Urban 656 N/A 25258 BENSLEY ELEMENTARY SCHOOL Urban 655 N/A 48.90%

Page 4 BEN Name Urban/ Number of Students CEP Rural Students Count Based Percentage on Estimate 25259 BEULAH ELEMENTARY SCHOOL Urban 933 N/A 25261 SALEM CHURCH MIDDLE SCHOOL Urban 908 N/A 25262 SALEM CHURCH ELEMENTARY SCHOOL Urban 617 N/A 25263 BELLWOOD ELEMENTARY SCHOOL Urban 562 N/A 55.70% 25797 MATOACA HIGH SCHOOL Rural 1561 N/A 25799 ETTRICK ELEMENTARY SCHOOL Urban 565 N/A 47.40% 25808 MATOACA MIDDLE SCHOOL Rural 998 N/A 25810 MATOACA ELEMENTARY SCHOOL Urban 405 N/A 25827 ECOFF ELEMENTARY SCHOOL Urban 725 N/A 25828 CE CURTIS ELEMENTARY SCHOOL Urban 756 N/A 25829 THOMAS DALE HIGH SCHOOL Urban 2469 N/A 25832 CC WELLS ELEMENTARY SCHOOL Urban 651 N/A 25833 CARVER MIDDLE SCHOOL Rural 1011 N/A 25834 HARROWGATE ELEMENTARY SCHOOL Rural 482 N/A 44.60% 25836 CHESTERFIELD TECHNICAL CENTER AT COURTHOUSE Urban 1095 N/A 25837 BIRD HIGH SCHOOL Urban 1793 N/A 25838 GATES ELEMENTARY SCHOOL Urban 681 N/A 25839 JACOBS ROAD ELEMENTARY SCHOOL Urban 728 N/A 25841 CHALKLEY ELEMENTARY SCHOOL Urban 815 N/A 49.90% 25848 MARGUERITE CHRISTIAN ELEM SCH Urban 770 N/A 25850 ENON ELEMENTARY SCHOOL Urban 809 N/A 215194 SPRING RUN ES Urban 940 N/A 234046 CARVER COLLEGE AND CAREER ACADEMY Urban 284 N/A 16034166 COSBY HIGH SCHOOL Urban 2152 N/A 16042050 ELIZABETH SCOTT ELEMENTARY SCHOOL Urban 787 N/A 16042051 WINTERPOCK ELEMENTARY SCHOOL Rural 1296 N/A 16046472 TOMAHAWK CREEK MIDDLE SCHOOL Urban 1565 N/A 16046473 ELIZABETH DAVIS MIDDLE SCHOOL Urban 1227 N/A 16081142 CHESTERFIELD CAREER & TECHNICAL EDUCATION CENTER A Urban 359 N/A T HULL 16081145 ACADEMY 360 Urban 76 N/A 17020265 Old Hundred Elementary School Rural 815 N/A

Related Child School Annexes School BEN School Name Annex Name 25829 THOMAS DALE HIGH SCHOOL Thomas Dale High School 9th Grade Campus 16081142 CHESTERFIELD CAREER & TECHNICAL EDUCATION ACADEMY 360 CENTER AT HULL

Related School District NIFs School School District Name NIF BEN NIF Name District BEN 126544 CHESTERFIELD COUNTY PUBLIC SCHOOLS 234810 SCHOOL ADMINISTRATIVE BUILDING 126544 CHESTERFIELD COUNTY PUBLIC SCHOOLS 25849 PERRYMONT MIDDLE SCHOOL

Page 5 School School District Name NIF BEN NIF Name District BEN 126544 CHESTERFIELD COUNTY PUBLIC SCHOOLS 16024109 FOOD AND NUTRITION SERVICES 126544 CHESTERFIELD COUNTY PUBLIC SCHOOLS 16024120 FACILITIES AND MAINTENANCE 126544 CHESTERFIELD COUNTY PUBLIC SCHOOLS 16031248 CONSTRUCTION OFFICE 126544 CHESTERFIELD COUNTY PUBLIC SCHOOLS 17017051 Beulah Educational Center

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 62927 22935 36.0% Urban 60% 60%

Page 6 Funding Request for FRN #2099062378 Funding Request Nickname: Internet - Segra

Service Type: Data Transmission and/or Internet Access

Agreement Information - Contract Contract Number VA-151015-LN Account Number New Service not yet established

User-entered Establishing FCC 325570001348162 Service Provider LUMOS Networks Inc (SPN: Form 470# 143003814)

Was an FCC Form 470 posted Yes Based on State Master Yes for the product and/or services Contract? you are requesting? Based on a multiple award Yes Award Date April 21, 2017 schedule?

How many bids were received 2 Includes Voluntary Extensions? Yes for this contract? Remaining Voluntary 3 What is the service start date? July 01, 2020 Extensions

Total Remaining Contract 36 Length

What is the date your contract June 30, 2021 expires for the current term of the contract?

Document Name Document Description

va-151015-ln.pdf State Master Contract - Lumos minibidInternet response.pdf Mini bid response - Lumos Award Letter to S. Brown 04-24-17.pdf Award evaluation email approval of contract - Lumos.pdf Approval of state contract use and contrac t award date from county purchasing agent

Pricing Confidentiality Is there a statute, rule, or other restriction which prohibits No publication of the specific pricing information for this contract?

Provide 2Gbps internet access and transport for Hull Street Data Center. This circuit is Narrative exclusively used by faculty and staff, with no student access. Pricing was made as a result of a Form 470 posting and Segra provided the lowest quote for 2Gbps service at a monthly cost of $2,850. While another internet provider also has service into this data center, that vendor provides access exclusively to students.

Page 7 Line Item # 2099062378.001

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 2.0 Gbps Download Speed 2.0 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, No library or a NIF for Internet access?

Cost Calculation for FRN Line Item # 2099062378.001

Monthly Cost One-Time Cost Monthly Recurring Unit Cost $2,850.00 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 = $2,850.00 One-time Quantity x 1 Costs Monthly Quantity x 1 Total Eligible One-time Costs = $0.00 Total Monthly Eligible Recurring = $2,850.00 Costs Summary Months of Service x 12 Total Eligible Recurring Costs $34,200.00 Total Eligible Recurring Costs = $34,200.00 Total Eligible One-time Costs + $0.00 Pre-Discount Extended Eligible = $34,200.00 Line Item Cost

Page 8 Recipients of Services BEN Name 25001 ALBERTA SMITH ELEMENTARY SCH 25002 BAILEY BRIDGE MIDDLE SCHOOL 25003 MANCHESTER HIGH SCHOOL 25004 CLOVER HILL HIGH SCHOOL 25005 CLOVER HILL ELEMENTARY SCHOOL 25006 CRENSHAW ELEMENTARY SCHOOL 25007 SWIFT CREEK ELEMENTARY SCHOOL 25008 SWIFT CREEK MIDDLE SCHOOL 25009 WOOLRIDGE ELEMENTARY SCHOOL 25010 ROBIOUS MIDDLE SCHOOL 25011 ROBIOUS ELEMENTARY SCHOOL 25012 EVERGREEN ELEMENTARY SCHOOL 25013 JAMES RIVER HIGH SCHOOL 25014 BETTIE WEAVER ELEMENTARY SCHOOL 25015 MIDLOTHIAN MIDDLE SCHOOL 25016 MIDLOTHIAN HIGH SCHOOL 25018 WATKINS ELEMENTARY SCHOOL 25030 GRANGE HALL ELEMENTARY SCHOOL 25147 CRESTWOOD ELEMENTARY SCHOOL 25235 FALLING CREEK MIDDLE SCHOOL 25236 FALLING CREEK ELEM SCHOOL 25237 HENING ELEMENTARY SCHOOL 25238 MEADOWBROOK HIGH SCHOOL 25239 HOPKINS ROAD ELEMENTARY SCHOOL 25248 BON AIR ELEMENTARY SCHOOL 25249 GREENFIELD ELEMENTARY SCHOOL 25250 PROVIDENCE MIDDLE SCHOOL 25252 MANCHESTER MIDDLE SCHOOL 25253 GORDON ELEMENTARY SCHOOL 25254 MONACAN HIGH SCHOOL 25255 REAMS ROAD ELEMENTARY SCHOOL 25256 DAVIS ELEMENTARY SCHOOL 25257 PROVIDENCE ELEMENTARY SCHOOL 25258 BENSLEY ELEMENTARY SCHOOL 25259 BEULAH ELEMENTARY SCHOOL 25261 SALEM CHURCH MIDDLE SCHOOL 25262 SALEM CHURCH ELEMENTARY SCHOOL 25263 BELLWOOD ELEMENTARY SCHOOL 25797 MATOACA HIGH SCHOOL 25799 ETTRICK ELEMENTARY SCHOOL 25808 MATOACA MIDDLE SCHOOL 25810 MATOACA ELEMENTARY SCHOOL 25827 ECOFF ELEMENTARY SCHOOL 25828 CE CURTIS ELEMENTARY SCHOOL

Page 9 BEN Name 25829 THOMAS DALE HIGH SCHOOL 25832 CC WELLS ELEMENTARY SCHOOL 25833 CARVER MIDDLE SCHOOL 25834 HARROWGATE ELEMENTARY SCHOOL 25836 CHESTERFIELD TECHNICAL CENTER AT COURTHOUSE 25837 BIRD HIGH SCHOOL 25838 GATES ELEMENTARY SCHOOL 25839 JACOBS ROAD ELEMENTARY SCHOOL 25841 CHALKLEY ELEMENTARY SCHOOL 25848 MARGUERITE CHRISTIAN ELEM SCH 25850 ENON ELEMENTARY SCHOOL 215194 SPRING RUN ES 234046 CARVER COLLEGE AND CAREER ACADEMY 16034166 COSBY HIGH SCHOOL 16042050 ELIZABETH SCOTT ELEMENTARY SCHOOL 16042051 WINTERPOCK ELEMENTARY SCHOOL 16046472 TOMAHAWK CREEK MIDDLE SCHOOL 16046473 ELIZABETH DAVIS MIDDLE SCHOOL 16081142 CHESTERFIELD CAREER & TECHNICAL EDUCATION CENTER AT HULL 234810 SCHOOL ADMINISTRATIVE BUILDING 25849 PERRYMONT MIDDLE SCHOOL 16031248 CONSTRUCTION OFFICE 16024120 FACILITIES AND MAINTENANCE 16024109 FOOD AND NUTRITION SERVICES 16081145 ACADEMY 360 17017051 Beulah Educational Center 17020265 Old Hundred Elementary School

Page 10 FRN Calculation for FRN #2099062378

Monthly Charges Total Requested Amount Total Monthly Recurring Charges $2,850.00 Total Eligible Pre-Discount $34,200.00 Total Monthly Ineligible Charges - $0.00 Recurring Charges Total Eligible Pre-Discount One- + $0.00 Total Monthly Eligible Charges = $2,850.00 Time Charges Total Number of Months of x 12 Total Pre-Discount Charges = $34,200.00 Service Discount Rate 60% Total Eligible Pre-Discount = $34,200.00 Recurring Charges Funding Commitment Request = $20,520.00

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 11 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 $34,200.00 471 Total funding commitment request amount on this FCC Form 471 $20,520.00 Total applicant non-discount share of the eligible amount $13,680.00 Total budgeted amount allocated to resources not eligible for E-rate $6,000,000.00 support Total amount necessary for the applicant to pay the non-discount $6,013,680.00 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 12 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: Assistant Director of Technology Name: Brian D Jones

Phone: 804-639-8930 Email: [email protected]

Address: 9900 KRAUSE ROAD CHESTERFIELD Employer: CHESTERFIELD COUNTY PUBLIC VA 23832 SCHOOLS

21-Apr-2020 20:30:34 EDT Certified Timestamp

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