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T: 888-964-2227
D: 989-753-2424
F: 989-753-2655
E: micta@mictatech.org
4805 Towne Centre
Suite 100
Saginaw, MI 48604

P2 - 470 TIS22010

 

FCC Form

Approval by OMB
3060-0806

Priority 2 #638840000811798

 


Estimated Average Burden Hours Per Response: 4.0 hours

This form is designed to help you describe the eligible telecommunications-related services you seek so that this data can be posted on the Fund Administrator website and interested service providers can identify you as a potential customer and compete to serve you.
Please read instructions before beginning this application. (To be completed by entity that will negotiate with providers.)
Block 1: Applicant Address and Identifications
Form 470 Application Number:   638840000811798
Applicant's Form Identifier:   MiCTATIS22010
Application Status:   CERTIFIED
Posting Date:   01/14/2010
Allowable Contract Date:   02/11/2010
Certification Received Date:   01/14/2010

1. Name of Applicant:
 MICTA
2. Funding Year:
 07/01/2010 - 06/30/2011
3. Your Entity Number
     16024867
4a. Applicant's Street Address, P.O.Box, or Route Number
515 NORTH WASHINGTON AVE SUITE 405
 
City
SAGINAW
State
MI
Zip Code
48607
b. Telephone number
(888)  964- 2227
c. Fax number  
(989)  753- 2655  
5. Type Of Applicant
  Individual School    (individual public or non-public school)
  School District   (LEA;public or non-public[e.g., diocesan] local district representing multiple schools)
  Library    (including library system, library outlet/branch or library consortium as defined under LSTA)
  Consortium   (intermediate service agencies, states, state networks, special consortia of schools and/or libraries)
6a. Contact Person's Name: Gary Green
First, if the Contact Person's Street Address is the same as in Item 4 above, check this box. If not, please complete the entries for the Street Address below.
6b.   Street Address, P.O.Box, or Route Number
  P.O. Box 303
          City
       Walloon Lake
State
MI
Zip Code
49796
Check the box next to your preferred mode of contact and provide your contact information. One box MUST be checked and an entry provided.
  6c. Telephone Number   (231)  881- 6612
  6d. Fax Number          (231)  535- 2993
  6e. E-mail Address gary.green@mictatech.org

Block 2: Summary Description of Needs or Services Requested
7  This Form 470 describes (check all that apply):
a.   Tariffed or month-to-month services to be provided without a written contract. A new Form 470 must be filed for non-contracted tariffed or month-to-month services for each funding year.
b.   Services for which a new written contract is sought for the funding year in Item 2.
  Check if you are seeking  a multi-year contract and/or  a contract featuring voluntary extensions
c.   A multi-year contract signed on or before 7/10/97 but for which no Form 470 has been filed in a previous funding year.
NOTE: Services that are covered by a signed, written contract executed pursuant to posting of a Form 470 in a previous funding year OR a contract signed on/before 7/10/97 and previously reported on a Form 470 as an existing contract do NOT require filing of a new Form 470.
What kinds of service are you seeking: Telecommunications Services, Internet Access, Internal Connections Other than Basic Maintenance, or Basic Maintenance of Internal Connections? Refer to the Eligible Services List at www.sl.universalservice.org for examples. Check the relevant category or categories (8, 9, 10 and/or 11 below), and answer the questions in each category you select.
8   Telecommunications Services
Do you have a Request for Proposal (RFP) that specifies the services you are seeking ? If you check YES, your RFP must be available to all interested bidders for at least 28 days. If you check YES and your RFP is not available to all interested bidders, or if you check NO and you have or intend to have and RFP, you risk denial of your funding requests.
a   YES, I have released or intend to release an RFP for these services. It is available or will become available on the Web at at or via (check one):
          the Contact Person in Item 6 or the contact listed in Item 12.
b   NO , I have not released and do not intend to release an RFP for these services.
Whether you check YES or NO, you must list below the Telecommunications Services you seek. Specify each service or function (e.g., local voice service) and quantity and/or capacity (e.g., 20 existing lines plus 10 new ones). See the Eligible Services List at www.sl.universalservice.org for examples of eligible Telecommunications services. Remember that only eligible telecommunications providers can provide these services under the universal service support mechanism. Attach additional lines if needed.
Check this box if you prefer discounts on your bill. Check this box if you prefer
reimbursement after paying your bill in full.
Check this box if you do not have a preference.
9   Internet Access
Do you have a Request for Proposal (RFP) that specifies the services you are seeking ? If you check YES, your RFP must be available to all interested bidders for at least 28 days. If you check YES and your RFP is not available to all interested bidders, or if you check NO and you have or intend to have and RFP, you risk denial of your funding requests.
a   YES, I have released or intend to release an RFP for these services. It is available or will become available on the Web at or via (check one):
          the Contact Person in Item 6 or the contact listed in Item 12.
b   NO , I have not released and do not intend to release an RFP for these services.
Whether you check YES or NO, you must list below the Internet Access Services you seek. Specify each service or function (e.g., monthly Internet service) and quantity and/or capacity (e.g., for 500 users). See the Eligible Services List at www.sl.universalservice.org for examples of eligible Telecommunications services. Remember that only eligible telecommunications providers can provide these services under the universal service support mechanism. Attach additional lines if needed.
Check this box if you prefer discounts on your bill. Check this box if you prefer
reimbursement after paying your bill in full.
Check this box if you do not have a preference.
10   Internal Connections Other than Basic Maintenance
Do you have a Request for Proposal (RFP) that specifies the services you are seeking ? If you check YES, your RFP must be available to all interested bidders for at least 28 days. If you check YES and your RFP is not available to all interested bidders, or if you check NO and you have or intend to have and RFP, you risk denial of your funding requests.
a   YES, I have released or intend to release an RFP for these services. It is available or will become available on the Web at www.mictatech.org or via (check one):
         the Contact Person in Item 6 or the contact listed in Item 12.
b   NO , I have not released and do not intend to release an RFP for these services.
Whether you check YES or NO, you must list below the Internal Connections Services you seek. Specify each service or function (e.g., a router, hub and cabling) and quantity and/or capacity (e.g., connecting 1 classroom of 30 students). See the Eligible Services List at www.sl.universalservice.org for examples of eligible Telecommunications services. Remember that only eligible telecommunications providers can provide these services under the universal service support mechanism. Attach additional lines if needed.
Check this box if you prefer discounts on your bill. Check this box if you prefer
reimbursement after paying your bill in full.
Check this box if you do not have a preference.
Service or Function: Quantity and/or Capacity:
All Eligible Internal Connections excluding Video Systems and Components 1200
11   Basic Maintenance of Internal Connections
Do you have a Request for Proposal (RFP) that specifies the services you are seeking ? If you check YES, your RFP must be available to all interested bidders for at least 28 days. If you check YES and your RFP is not available to all interested bidders, or if you check NO and you have or intend to have and RFP, you risk denial of your funding requests.
a   YES, I have released or intend to release an RFP for these services. It is available or will become available on the Web at www.mictatech.org or via (check one):
         the Contact Person in Item 6 or the contact listed in Item 12.
b   NO , I have not released and do not intend to release an RFP for these services.
Whether you check YES or NO, you must list below the Basic Maintenance Services you seek. Specify each service or function (e.g.,basic maintenance of routers) and quantity and/or capacity (e.g., for 10 routers). See the Eligible Services List at www.sl.universalservice.org for examples of eligible Telecommunications services. Remember that only eligible telecommunications providers can provide these services under the universal service support mechanism. Attach additional lines if needed.
Check this box if you prefer discounts on your bill. Check this box if you prefer
reimbursement after paying your bill in full.
Check this box if you do not have a preference.
Service or Function: Quantity and/or Capacity:
All Eligible Basic Maintenance (excluding Basic Maintenance for Video Systems) 1200
12 (Optional) Please name the person on your staff or project who can provide additional technical details or answer specific questions from service providers about the services you are seeking. This need not be the contact person listed in Item 6 nor the Authorized Person who signs this form.
Name:
Gary Green
Title:
Consultant
Telephone number
(231) 881 - 6612 
Fax number
(231) 535 - 2993
E-mail Address
gary.green@mictatech.org
13a.    Check this box if there are any restrictions imposed by state or local laws or regulations on how or when service providers may contact you or on other bidding procedures. Please describe below any such restrictions or procedures, and/or a Web address where they are posted and provide a contact name and telephone number.
 
Check this box if no state and local procurement/competitive bidding requirements apply to the procurement of services sought on this Form 470.
13b.  If you have plans to purchase additional services in future years, or expect to seek new contracts for existing services, you may summarize below(including the likely timeframes). If you are requesting services for a funding year for which a Form 470 cannot yet be filed online, include that information here.
The initial term of the resulting contracts will be three (3) years with two (2) one year voluntary extensions. Therefore, the entire term of the contracts awarded under this process may extend through 2016. Also, due to evolving technology and potential price reductions, MiCTA reserves the right to amend the resulting contracts over their term.


 

Block 3: Technology Resources
14.  Basic telephone service only: If your application is for basic telephone service and voice mail only, check this box and skip to Item 16. Basic telephone service is defined as wireline or wireless single line voice service (local, cellular/PCS, and/or long distance) and mandatory fees associated with such service (e.g., federal and state taxes and universal service fees).
 
15.  Although the following services and facilities are ineligible for support, they are usually necessary to make effective use of the eligible services requested in this application. Unless you indicated in Item 14 that your application is ONLY for basic telephone service, you must check at least one box in (a) through (e). You may provide details for purchases being sought.
a. Desktop software: Software required   has been purchased; and/or   is being sought.
b. Electrical systems:   adequate electrical capacity is in place or has already been arranged; and/or   upgrading for additional electrical capacity is being sought.
c. Computers: a sufficient quantity of computers   has been purchased; and/or   is being sought.
d. Computer hardware maintenance: adequate arrangements   have been made; and/or   are being sought.
e. Staff development:   all staff have had an appropriate level of training /additional training has already been scheduled; and/or   training is being sought.
f. Additional details: Use this space to provide additional details to help providers to identify the services you desire.

Block 4: Recipients of Service
16. Eligible Entities That Will Receive Services:

Check the ONE choice (Item 16a, 16b or 16c) that best describes this application and the eligible entities that will receive the services described in this application.You will then list in Item 17 the entity/entities that will pay the bills for these services.
 
  a. Individual school or single-site library.
 
  b. Statewide application for (enter 2-letter state code) representing (check all that apply):
    All public schools/districts in the state:
    All non-public schools in the state:
    All libraries in the state:
 
  If your statewide application includes INELIGIBLE entities, check here.   If checked, complete Item 18.
 
  c. School district, library system, or consortium application to serve multiple eligible entities:
 
 
Number of eligible sites 7263
For these eligible sites, please provide the following
Area Codes
(list each unique area code)
Prefixes associated with each area code
(first 3 digits of phone number)
separate with commas, leave no spaces
201
202
205
207
208
209
210
214
216
217
218
219
224
225
228
229
231
239
240
248
251
252
256
260
262
269
270
276
281
301
302
303
304
305
307
309
310
313
314
317
318
319
320
321
325
330
334
336
352
361
17. Billed Entities
17. Billed Entities: List the entity/entities that will be paying the bills directly to the provider for the services requested in this application. These are known as Billed Entities. At least one line of this item must be completed. If a Billed Entity cited on your Form 471 is not listed below, funding may be denied for the funding requests associated with this Form 470.
Entity Entity Number
MICHIGAN STATE DEPT OF EDUC 131271
18. Ineligible Participating Entities
List the names of any entity/entities here for whom services are requested that are not eligible for the Universal Service Program.
Ineligible Participating Entity Area Code Prefix
MICTA 989
Michigan Dept of Education 517

Block 5: Certification and Signature
 
 
19.   I certify that the applicant includes:(Check one or both.)
a.     schools under the statutory definitions of elementary and secondary schools found in the No Child Left Behind Act of 2001, 20 U.S.C.Secs.7081(18) and (38), that do not operate as for-profit businesses, and do not have endowments exceeding $50 million; and/or
b.     libraries or library consortia eligible for assistance from a State library administrative agency under the Library Services and Technology Act of 1996 that do not operate as for-profit businesses and whose budgets are completely separate from any school (including, but not limited to elementary and secondary schools, colleges and universities).
20.   I certify that all of the individual schools, libraries, and library consortia receiving services under this application are covered by technology plans that are written, that cover all 12 months of the funding year, and that have been or will be approved by a state or other authorized body, an SLD-certified technology plan approver, prior to the commencement of service. The plans were written at the following level(s):
a.     individual technology plans for using the services requested in the application, and/or
b.     higher-level technology plans for using the services requested in the application, or
c.     no technology plan needed; application requests basic local, cellular, PCS, and/or long distance telephone service and/or voice mail only
21.   I certify that I will post my Form 470 and (if applicable) make my RFP available for at least 28 days before considering all bids received and selecting a service provider. I certify that all bids submitted will be carefully considered and the bid selected will be for the most cost-effective service or equipment offering, with price being the primary factor, and will be the most cost-effective means of meeting educational needs and technology plan goals. I certify that I will retain required documents for a period of at least five years after the last day of service delivered. I certify that I will retain all documents necessary to demonstrate compliance with the status and Commission rules regarding the application for, receipt of, and delivery of services receiving schools and libraries discounts. I acknowledge that I may be audited pursuant to participation in the schools and libraries program.

22.   I certify that the services the applicant purchases at discounts provided by 47 U.S.C. Sec. 254 will be used solely for educational purposes 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. Sec. 54.500(k). 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, other than the 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.

23.   I acknowledge that support under this support mechanism is conditional upon the school(s) and/or library(ies) I represent securing 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.

24.   I certify that I am authorized to order telecommunications and other supported services for the eligible entity(ies). 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, and to the best of my knowledge, information, and belief, all statements of fact contained herein are true.

25. I certify that I have reviewed all applicable state and local procurement/competitive bidding requirements and that I have complied with them. I acknowledge that persons willfully making false statements on this form can be punished by fine or forfeiture, under the Commissions Act, 47 U.S.C. Secs. 502, 503(b), or fine or imprisonment under Title 18 of the United States Code, 18 U.S.C. Sec. 1001.

26. 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.

27. Signature of authorized person: 
 
28. Date (mm/dd/yyyy):  01/14/2010

29. Printed name of authorized person:  Gary Green
 
30. Title or position of authorized person:  Consultant
 
31a. Address of authorized person:  P.O. Box 303
       City: Walloon Lake  State: MI  Zip: 49796  
 
31b. Telephone number of authorized person:  (231)  881 - 6612  
 
31c. Fax number of authorized person:  (231)  5352993
 
31d. E-mail address number of authorized person:  gary.green@mictatech.org
 
31e. Name of authorized person's employer:  MiCTA


Service provider involvement with preparation or certification of a Form 470 can taint the competitive bidding process and result in the denial of funding requests. For more information, refer to the SLD web site at www.sl.universalservice.org or call the Client Service Bureau at 1-888-203-8100.

NOTICE: 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 file this Description of Services Requested and Certification Form (FCC Form 470) 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 competitive bidding requirement contained in 47 C.F.R. § 54.504. All schools and libraries planning to order services eligible for universal service discounts 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 this application 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 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, information provided in or submitted with this form or in response to subsequent inquiries may also be subject to disclosure consistent with the Communications Act of 1934, FCC regulations, the Freedom of Information Act, 5 U.S.C. § 552, or other applicable law.
 
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 may delay processing of your application 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 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.
 
Please submit this form to:
SLD-Form 470
P.O. Box 7026
Lawrence, Kansas 66044-7026
1-888-203-8100
 
For express delivery services or U.S. Postal Service, Return Receipt Requested, mail this form to:
SLD Forms
ATTN: SLD Form 470
3833 Greenway Drive
Lawrence, Kansas 66046
1-888-203-8100
 
FCC Form 470
November 2004

Instructions to view the MiCTA 470 Certificate on the USAC Website:

 

 

To view MiCTA's 470 Certification on the Universal Service Administrative Company (USAC) website click here

 
     
  Below is what you will have to select/enter to view the MiCTA 470 Certification:  
     
 

Select the Funding Year for which the Form 470 was posted.

Funding Year: 

Click the "Next" button to proceed.

 
     
  Enter the following information to search for posted Forms 470:  
 

Applicant Name: 

 

 

Applicant Type:   Individual School   School District   Library   Consortium

 

 

Application Type:   Tariffed Services   Month-to-month services   New Contracts   Existing Contracts   All

 
     
  Click the "Next" button to view search results  
     
  On the next page select the button next to MiCTA and then select: Review Selected Application