Instructions:Copyandpastethetextbelowontoconsortiummember’sletterhead.Replaceallredand/orbracketedtextwiththeappropriateinformation.
North Country Library System
22072 County Route 190
Watertown, NY 13601
Re:LetterofAgencyForFundingYear2016–2018
ThisistoconfirmourparticipationintheNorth Country Library System E-rateConsortiumfortheprocurementofInternet Access and/or Telecommunications, and Internal Connections.IherebyauthorizeNorth Country Library System tosubmitFCCForm470,FCCForm471,andotherE-rateformstotheSchoolsandLibrariesDivisionoftheUniversalServiceAdministrativeCompanyonbehalfofthe[InsertEntityName].
Iunderstandthat,insubmittingtheseformsonourbehalf,I ammakingcertificationsfor[InsertEntityName].BysigningthisLetterofAgency,Imakethefollowingcertifications:
Icertifythatour libraryiseligibleforassistancefromaStateLibraryAdministrativeAgencyundertheLibraryServicesandTechnologyActof1996,Pub.L.No.104-208,§211etseq.,110Stat.3009(1996)thatdoesnotoperateasa for-profitbusinessandwhosebudget is completely separatefromanyschool(including,butnotlimitedtoelementary,secondaryschools,colleges,oruniversities).
a)Icertifythatourlibraryhassecuredaccess,separatelyorthroughthisprogram,toalloftheresources,includingcomputers,training,software,internalconnections,maintenance,andelectricalcapacity,necessarytousetheservicespurchasedeffectively.Irecognizethatsomeoftheaforementionedresourcesarenoteligibleforsupport.Icertifythattotheextentthatthebilledentityispassingthroughthenon-discountedchargesfortheservicesrequestedunderthisLetterofAgency,thattheentitiesIrepresenthavesecuredaccesstoalloftheresourcestopaythenon-discountedchargesforeligibleservicesfromfundstowhichaccesshasbeensecuredinthecurrentfundingyear.
b)Icertifythattheservicestheschool,library,ordistrictpurchasesatdiscountsprovidedby47U.S.C.§254willbeusedsolelyforeducationalpurposesandwillnotbesold,resold,ortransferredinconsiderationformoneyoranyotherthingofvalue,exceptaspermittedbytherulesoftheFederalCommunicationsCommission(CommissionorFCC)at47C.F.R.§54.500(etseq.).
d) IcertifythatourlibraryhascompliedwithallprogramrulesandIacknowledgethatfailuretodosomayresultindenialofdiscountfundingand/orcancellationoffundingcommitments.Iacknowledgethatfailuretocomplywithprogramrulescouldresultincivilorcriminalprosecutionbytheappropriatelawenforcementauthorities.
e)Iacknowledgethatthediscountlevelusedforsharedservicesisconditional,forfutureyears,uponensuringthatthemostdisadvantagedschoolsandlibrariesthataretreatedassharingintheservice,receiveanappropriateshareofbenefitsfromthoseservices.
f)IcertifythatIwillretainrequireddocumentsforaperiodofatleasttenyearsafterthelastdayofservicedelivered.IcertifythatIwillretainalldocumentsnecessarytodemonstratecompliancewiththestatuteandCommissionrulesregardingtheapplicationfor,receiptof,anddeliveryofservicesreceivingschoolsandlibrariesdiscounts,andthatifaudited,IwillmakesuchrecordsavailabletotheAdministrator.IacknowledgethatImaybeauditedpursuanttoparticipationintheSchoolsandLibraries(E-rate)Program.
g)IcertifythatIamauthorizedtoprocureand/orordertelecommunicationsandothersupportedservicesfortheeligibleentitycoveredbythisLetterofAgency.IcertifythatIamauthorizedtomakethisrequestonbehalfoftheeligibleentitycoveredbythisLetterofAgency,thatIhaveexaminedthisLetter,thatalloftheinformationonthisLetteristrueandcorrecttothe bestofmyknowledge,thattheentitiesthatwillbereceivingdiscountedservicesunderthisLetterpursuanttothisapplicationhavecompliedwiththeterms,conditionsandpurposesof theprogram,thatnokickbackswerepaidtoanyoneandthatfalsestatementsonthisformcanbepunishedbyfineorforfeitureundertheCommunicationsAct,47U.S.C.§§502,503(b),orfineorimprisonmentunderTitle18oftheUnitedStatesCode,18U.S.C.§1001andcivil violationsoftheFalseClaimsAct.
h)IacknowledgethatFCCrulesprovidethatpersonswhohavebeenconvictedofcriminalviolationsorheldcivillyliableforcertainactsarisingfromtheirparticipationintheSchoolsandLibrariessupportmechanismaresubjecttosuspensionanddebarmentfromtheprogram.Iwillinstitutereasonablemeasurestobeinformed,andwillnotifyUSACshouldIbeinformedorbecomeawarethatIoranyoftheentities,oranypersonassociatedinanywaywithmyentityand/ortheentities,isconvictedofacriminalviolationorheldcivillyliableforactsarisingfromtheirparticipationintheSchoolsandLibrariessupportmechanism.
i)Icertifythat,tothebestofmyknowledge,thenon-discountportionofthecostsforeligibleserviceswillnotbepaidbytheserviceprovider.Iacknowledgethattheprovision,bytheproviderofasupportedservice,offreeservicesorproductsunrelatedtothesupportedserviceorproductconstitutesarebateofsomeorallofthecostofthesupportedservices.
j)IcertifythatIamauthorizedtosignthisLetterofAgencyand,tothebestofmyknowledge,information,andbelief,allinformationprovidedtoNorth Country Library SystemforE-ratesubmissionistrue.
NameofEntity:Signature: Date: (Month,DD,YYYY)Name: Title: