FCC Form 471



Approval by OMB
3060-0806

Schools and Libraries Universal Service
Description of Services Ordered and Certification Form 471

Estimated Average Burden Hours per Response: 4 hours
This form is designed to help schools and libraries to list the eligible services they have ordered and estimate the annual
charges for them so that the Fund Administrator can set aside sufficient support to reimburse providers for services.
Please read instructions before beginning this application. (You can also file online at www.usac.org/sl.)
The instructions include information on the deadlines for filing this application.
Applicant’s Form Identifier (Create an identifier for your own reference)

MNT
Form 471 Application #:

991804
(To be assigned by administrator)
 Block 1: Billed Entity Address and Identifications
      1   Name of Billed Entity
       HIRA EDUCATIONAL SERVICES OF NORTH AMERICA

      2   Funding Year   2014

      3a Entity Number 16063855

      3b FCC Registration Number 0020717328

      4a Street Address, P.O. Box, or Route Number
      621 OLD HARMONY RD
      

      City NEWARK  State DE  Zip Code 19711-

      4b Telephone Number (201)  984-9115 

      4c Fax Number           (866)   611-3986

      5a Type of Application (check only one)
       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)
       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

      5b Recipient(s) of Services:
             Private        Public        Charter
             Tribal        Head Start        State Agency
Entity Number: 16063855 Applicant's Form Identifier: MNT
Contact Person: Asif Kunwar Contact Phone Number: (201) 984-9115
 Block 1: Billed Entity Address and Identifications (continued)
      6a Contact Person's Name
             Asif Kunwar

If the Contact Person’s Street Address is the same as Item 4 above, check here. If not, complete Item 6b.

      6b Street Address, P.O. Box, or Route Number
      NOTE: USAC will use this address to mail correspondence about this form.
      621 OLD HARMONY RD
      
      City  NEWARK    State  DE   Zip Code  19711-

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  (201)  984 - 9115  
       6d Fax Number            (866)  611 - 3986
       6e E-Mail Address       erate@hiraguidance.org
      Re-enter E-mail Address   erate@hiraguidance.org


      6f Holiday/vacation/summer contact information: please include name of alternate contact (if applicable) and alternate phone, fax or E-mail address
      

If a consultant is assisting you with your application process, please complete Item 6g below:

      6g Consultant Name   
      Name of Consultant’s Employer 
      Consultant’s Street Address   
                                                            
      City        State        Zip Code   
      Consultant’s Telephone Number     Ext.   
      Consultant’s Fax Number                
      Consultant’s E-mail Address   
      Re-enter E-mail Address          
      Consultant Registration Number   
  Blocks 2 and 3 [Reserved]
Entity Number: 16063855 Applicant's Form Identifier: MNT
Contact Person: Asif Kunwar Contact Phone Number: (201) 984-9115
Block 4: Discount Calculation Worksheet Worksheet - 1732445
Page 1 of 1
The Block 4 worksheet is used to calculate your discount for services. You will complete one or more worksheets depending on the type of application you are filing. If you file more than one worksheet, please number the completed worksheets to assure that they are all processed correctly. Please refer to the instructions for information specific to the Type of Application you indicated in Block 1, Item 5.
Check here if this worksheet contains all eligible entities in the school district or library system.
9a List entities and calculate discount(s):
(For Administrator’s Use)
School District or Library System Name: School District or Library System Entity Number:
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Name of Eligible Entity Entity Number AND NCES Code (for Schools) or FSCS Code (for Libraries) Urban or Rural U or R Total Number of Students Number of Students Eligible for NSLP Percent of Students Eligible for NSLP (Col. 5 / Col. 4) Disc. from Disc. Matrix New Cons tructi on Admin Entity or NIF Alt Disc Mech Weighted Product for Calculating Shared Discount (Col. 4 x Col. 7) Insert appropriate codes(s): P= pre-K, H = Head Start, A = Adult Education, J = Juvenile Justicem E = ESA, D = Dormatory Entity Number of School District in which Library Outlet/Branch is Located Discount of Member Entity Shared Discount
ALL ENTITIES   SCHOOLS AND LIBRARIES Schools with shared services Schools Library Outlet/Branch Consortia  
BETHEL CHILD CARE CENTER 16046518
U 3030 100.000% 90 N NN 2700 P   90
TARBIYAH INC. 16073404
U 120110 91.667% 90 N NN 10800 P   90
HOGAR INFANTI CHILD DEVELOPMENT CENTER 16051787
U 105105 100.000% 90 N NN 9450 P   90
DAR AL-HIKMAH ELEMENTARY SCHOOL 208847
U 280214 76.429% 90 N NN 25200 P   90
AL-GHAZALY ELEMENTARY SCHOOL 208838
U 190150 78.947% 90 N NN 17100 P   90
A WHOLE NEW KIDS WORLD 16046517
U 7570 93.333% 90 N NN 6750 P   90
LITTLE ONES SCHOOL HOUSE INC. 16046443
U 3025 83.333% 90 N NN 2700 P   90
RISING STAR ACADEMY 16057953
U 200160 80.000% 90 N NN 18000 P   90
AL MANARA ACADEMY 16073458
U 6851 75.000% 90 N NN 6120 P   90
AL-GHAZALY HIGH SCHOOL 7845
U 250190 76.000% 90 N NN 22500 P   90
9b Shared Services
SCHOOL DISTRICTS: (Including groups of schools within school districts.) Calculate the totals of Columns 4 and 11. Divide the total of Column 11 by the total of Column 4. Enter the result in Column 15.                        
LIBRARY SYSTEMS: Calculate the total of Column 7. Divide this total by the number of outlets/branches. Enter the result in Column 15.                        
CONSORTIA: Calculate the total of Column 14. Divide this total by the number of member entities. Enter the result in Column 15.                     900 90%
Entity Number: 16063855 Applicant's Form Identifier: MNT
Contact Person: Asif Kunwar Contact Phone Number: (201) 984-9115
Block 5: Discount Funding Request(s)
Instructions: Use one Block 5 page for EACH service (Funding Request Number) for which you are requesting discounts. Make as many copies of this page as needed, and number the completed pages to assure that they are all processed correctly.
     Block 5,  page  1  of 1

     FRN 2706953
                     (to be assigned by administrator)
   10       If this is a duplicate Funding Request (e.g., of an FRN that is not yet approved, under appeal,
                  etc.), check this box and enter the original FRN in the space provided:                                                 
11 Category of Service ( only ONE category should be checked)

   PRIORITY 1
 Telecommunications Service
   PRIORITY 2
 Internal Connections Other than Basic Maintenance
 Internet Access  Basic Maintenance of Internal Connections
   12     Form 470 Application Number

             894520001226120
   13     SPIN – Service Provider Identification Number

             143028072
   14     Service Provider Name



             Neighborhood Computer Center Corporation Inc.
   15a       Check this box if this Funding Request is for non-contracted tariffed or month-to-month services.
   15b     Contract Number

             16063855
   15c       Check this box if this Funding Request is covered under a master contract (a contract negotiated by a third party, the terms and conditions of which are then made available to an eligible entity that purchases directly from the service provider).
   15d       Check this box if this Funding Request is a continuation of an FRN from a previous funding year based on a multi-year contract. If so, provide that FRN here:     
   16a     Billing Account Number (e.g., billed telephone number)

            
   16b      Check this box if there are multiple Billing Account Numbers and attach a complete list of those numbers to this page.
   17     Allowable Vendor Selection/Contract Date (mm/dd/yyyy)
            (based on Form 470 filing)

                          03/20/2014
   18     Contract Award Date (mm/dd/yyyy)
                          03/26/2014
   19     Service Start Date (mm/dd/yyyy)
                          07/01/2014
   20a    Service End Date (mm/dd/yyyy)
                         
            Contract Expiration Date
   20b
    (mm/dd/yyyy)
                          06/30/2020
         23     Calculations
Recurring Charges
  A. Monthly charges (total amount per month for service)


             $40,000.00
  B. How much of the amount in A is ineligible?

             $0.00
  C. Eligible monthly pre-discount amount (A minus B)

             $40,000.00
  D. Number of months service provided in funding year

             12
  E. Annual pre-discount amount for eligible recurring charges (C x D)

             $480,000.00
Non-Recurring Charges
  F. Annual non-recurring charges

             $0.00
  G. How much of the amount in F is ineligible?


             $0.00


  H. Annual eligible pre-discount amount for non-recurring charges (F minus G)


             $0.00
Total Charges
  I. Total funding year pre-discount amount (E + H)

             $480,000.00
  J. Discount from Block 4 Worksheet              90.00
  K. Funding Commitment Request (I x J)
             $432,000.00
   21     Description of This Service: NOTE: All Item 21 Attachments must be filed before the close of the filing window.            Attachment
    You MUST attach a description of the service, including a breakdown of components, costs, manufacturer name, make and model number. You
    must include any additional account or telephone numbers if the billed account has multiple numbers. Label the description with an Attachment             MNT
    Number, and note number in space provided.
   22      Entity/Entities Receiving This Service: a. If the service is site-specific (provided to one site
and not shared by others), list the Entity Number of
the entity from Block 4 receiving this service:                
b. If the service is shared by all entities on a Block 4
worksheet, list the worksheet number (e.g., 1):             1732445
Entity Number: 16063855 Applicant's Form Identifier: MNT
Contact Person: Asif Kunwar Contact Phone Number: (201) 984-9115

   Block 5 (Continued):
  24 Description of Broadband and other Connectivity Services Ordered for Schools and Libraries from this
funding request
   
Complete the information below for this funding request only if requesting Telecommunications Services or Internet Access for the
purpose of providing broadband and other types of connectivity to school and/or library facilities.
 

Check this box if this request is for services or equipment that do not provide broadband or connectivity. For instance, check the box if this
funding request is for internal connections, basic maintenance, or requests for services like e-mail or phone service.
 
a

Which technology(ies) and speed(s) are being provided in this Funding Request? Please list the number of lines and average download speed
for the lines included in this funding request. If there are multiple download speeds for the lines within one type of broadband connection, this
form provides two additional lines per broadband connection category. If you need additional space, please makes copies of this page and
number the completed pages to assure that they are all processed correctly. A response to this Item is not a substitute for a complete response
to Item 21 but should be consistent with the description of services in the response to Item 21. Please ask your service provider if you need
assistance.
   
  Type of Connection  Number of lines
   included in this FRN
  Download speed per
   line in Mbps
 
b

If the Internet service is available to students or patrons in more than just a single location or office, please indicate:

1. If the access is provided by wired connections, approximately what percentage of the school classroom or public library rooms
included in the Block 4 worksheet for this FRN will have access to wired drops? ___%

2. If the access is provided by Wi-FI connections, approximately what percentage of the school classroom or public library rooms
included in the Block 4 worksheet for this FRN will have access to a Wi-Fi signal? ___%
 
c

For consortia and statewide applications, do the connections in this FRN include the last mile connection to the school or library? Yes No
If no above, are these connections only for backbone connections? Yes No

Entity Number: 16063855 Applicant's Form Identifier: MNT
Contact Person: Asif Kunwar Contact Phone Number: (201) 984-9115
   

Block 6: Certifications and Signature

   25     I certify that the entities listed in Block 4 of this application are eligible for support because they are: (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. §§
                         7801(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 schools, including, but not
                         limited to, elementary, secondary schools, colleges, or universities.

   26     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).
a      Total funding year pre-discount amount on this Form 471
       (Add the entries from Items 23I on all Block 5 Discount Funding Requests.)
480000
b      Total funding commitment request amount on this Form 471
       (Add the entries from Items 23K on all Block 5 Discount Funding Requests.)
432000
c      Total applicant non-discount share
       (Subtract Item 26b from Item 26a.)
48000
d      Total budgeted amount allocated to resources not eligible for E-rate support 10000
e      Total amount necessary for the applicant to pay the non-discount share of the
       services requested on this application AND to secure access to the resources
       necessary to make effective use of the discounts. (Add Items 26c and 26d.)
58000
f        Check this box if you are receiving any of the funds in Item 26e directly from a service provider listed on any of the Forms 471 filed by this
             Billed Entity for this funding year, or if a service provider listed on any of the Forms 471 filed by this Billed Entity for this funding year assisted
             you in locating funds in Item 26e.
   27     I certify that, if required by Commission rules, all of the individual schools and libraries receiving services under this form are
                covered by technology plans that do or will cover all 12 months of the funding year, and that have been or will be approved
                by a state or other authorized body or an SLD-certified technology plan approver prior to the commencement of service.

                Or     I certify that no technology plan is required by Commission rules.

   28     I certify that (if applicable) I posted my Form 470 and (if applicable) made any related RFP 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 plan
                goals.

   29     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.

   30     I certify that the services the applicant purchases at discounts provided by 47 U.S.C. § 254 will be used primarily 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. §§
                54.500, 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, 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.

   31     I certify that I and the entity(ies) I represent have complied with all program rules, including recordkeeping requirements, 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 covering all
                of the services listed on this 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.
Entity Number: 16063855 Applicant's Form Identifier: MNT
Contact Person: Asif Kunwar Contact Phone Number: (201) 984-9115

Block 6: Certification and Signature (Continued)

   32     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.

   33     I certify that I will retain required documents for a period of at least five years (or whatever retention period is required by the rules in effect at the
                time of this certification) after the last day of service delivered. 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 the Administrator. I acknowledge that I may be audited pursuant to participation in the schools
                and libraries program.

   34     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.

   35     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.

   36     I certify that if any of the Funding Requests on this 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(g)(1), (2).

   37     I certify that this funding request does not constitute a request for internal connections services, except basic maintenance services, in violation of
                the Commission requirement that eligible entities are not eligible for such support more than twice every five funding years as required by the
                Commission's rules at 47 C.F.R. § 54.506(c).

   38     I certify that the non-discount portion of the costs for eligible services will not be paid by the service provider. The pre-discount costs of eligible
                services featured on this Form 471 are net of any rebates or discounts offered by the service provider. I acknowledge that, for the purpose of this
                rule, the provision, by the provider of a supported service, of free services or products unrelated to the supported service or product constitutes a
                rebate of some or all of the cost of the supported services.

   39       Signature of
              authorized
              person                
   40       Date
                                03/26/2014
   41       Printed name
              of authorized
              person                 Asif Kunwar

   42       Title or position
              of authorized
              person                 Director of Development

                    Check here if the consultant in Item 6g is the Authorized Person.

   43a      Street Address, P.O. Box, or Route Number
                                        621 Old Harmony Rd
                                       
              City                     Newark
              State    DE      Zip Code    19711-
Entity Number: 16063855 Applicant's Form Identifier: MNT
Contact Person: Asif Kunwar Contact Phone Number: (201) 984-9115
   43b     Telephone Number                                                Ext.
              of authorized
              Person                 (201) 984-9115                         

   43c     Fax Number of Authorized Person

                                            (866) 611-3986

   43d     E-mail Address
              of authorized
              Person                                   erate@hiraguidance.org

              Re-enter E-mail Address    erate@hiraguidance.org


   43e     Name of Authorized
              Person’s Employer             Hira Educational Services of North America
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 Services Ordered and Certification Form (FCC Form 471) with the Universal Service Administrator. 47 C.F.R.§ 54.504(c).
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 47C.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, 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 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 471
                                          P.O. Box 7026
                                          Lawrence, Kansas 66044-7026


   For express delivery services or U.S. Postal Service, Return Receipt Requested, mail this form to:
                                          SLD Forms
                                          ATTN: SLD Form 471
                                          3833 Greenway Drive
                                          Lawrence, Kansas 66046
                                          (888) 203-8100
FCC Form 471 - December 2013


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