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<br /> <br /> <br />Name of Administrative Authority <br />Administrative Authority’s Form Identifier <br />Contact Person Telephone Number <br />Block 2: Certifications and Signature (Continued) <br />6. I certify that as of the date of the start of discounted services: <br />a the recipient(s) of service under my administrative authority and represented in the Funding Request Number(s) <br />for which you have requested or received Funding Commitments has (have) complied with the requirements of <br />the Children’s Internet Protection Act, as codified at 47 U.S.C. § 254(h) and (l). <br />b pursuant to the Children’s Internet Protection Act, as codified at 47 U.S.C. § 254(h) and (l), the recipient(s) of <br />service under my administrative authority and represented in the Funding Request Number(s) for which you <br />have requested or received Funding Commitments: <br />(FOR SCHOOLS and FOR LIBRARIES IN THE FIRST FUNDING YEAR FOR PURPOSES OF CIPA) is <br />(are) undertaking such actions, including any necessary procurement procedures, to comply with the <br />requirements of CIPA for the next funding year, but has (have) not completed all requirements of CIPA for <br />this funding year. <br /> <br />(FOR FUNDING YEAR 2003 ONLY: FOR LIBRARIES IN THE SECOND OR THIRD FUNDING YEAR FOR <br />PURPOSES OF CIPA) is (are) in compliance with the requirements of CIPA under 47 U.S.C. § 254(l) and <br />undertaking such actions, including any necessary procurement procedures, to comply with the <br />requirements of CIPA under 47 U.S.C. § 254(h) for the next funding year. <br />c the Children’s Internet Protection Act, as codified at 47 U.S.C. § 254(h) and (l), does not apply because the <br />recipient(s) of service under my administrative authority and represented in the Funding Request Number(s) for <br />which you have requested or received Funding Commitments is (are) receiving discount services only for <br />telecommunications services. <br />CIPA Waiver. Check the box below if you are requesting a waiver of CIPA requirements for the Second Funding Year <br />after the recipients of service under your administrative authority have applied for discounts: <br />d I am providing notification that, as of the date of the start of discounted services, I am unable to make the <br />certifications required by the Children’s Internet Protection Act, as codified at 47 U.S.C. § 254(h) and (l), <br />because my state or local procurement rules or regulations or competitive bidding requirements prevent the <br />making of the certification(s) otherwise required. I certify that the recipient(s) of service under my administrative <br />authority and represented in the Funding Request Number(s) for which you have requested or received Funding <br />Commitments will be brought into compliance with the CIPA requirements before the start of the Third Funding <br />Year in which they apply for discounts. <br /> <br />(CIPA WAIVER FOR LIBRARIES FOR FUNDING YEAR 2004. Check the box above if you are requesting this waiver <br />of CIPA requirements for Funding Year 2004 for the library(ies) under your administrative authority that has (have) <br />applied for discounts for Funding Year 2004. By checking this box, you are certifying that the library(ies) represented <br />in the Funding Request Number(s) on this FCC Form 479 will be brought into compliance with the CIPA requirements <br />before the start of the Funding Year 2005.) <br /> The certification language above is not intended to fully set forth or explain all the requirements of the statute. <br />7. Signature of authorized person 8. Date <br />9. Printed name of authorized person <br />10. Title or position of authorized person <br />11. Telephone number of authorized person <br />Page 22 of 29