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Please complete all yellow sections in the table below. Ram Ware, LLC

Post-secondary educational organization x Online or virtual educational provider

Corporation or industry association

“Educational Entrepreneur” (see RFA page 5 for definition) Other:

x Online Hybrid (online and face-to-face)

Face-to-Face Other:

Elementary/Middle School Credit x High School Credit

Advanced Placement / IB Dual Enrollment

Industry-Based Certification Career and Technical Education Internship / Apprenticeship Other:

Indicate statewide or specific region / parishes / schools

Max students / class Max number of concurrent sessions

Name Rick Mekdessie

Address 7117 Florida Blvd., Suite 304 Baton Rouge, LA 70806 Phone: Land 225-215-0100 Phone: Cell 504-908-7773 Email [email protected] Yes x No No X Yes Allies (list all)

Section 1: Applicant Summary Sheet (1 page)

Name of Course Provider

Organization

Which Best Describes Your Organization? Course Type(s) Focus Area (s) Proposed Geographical Reach Potential Enrollment

Primary Contact Person

Is this the only application your organization will be submitting? Is your organization applying in alliance

with one or more other organizations? (indicate one please)

(indicate all that apply)

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(open-ended response)

Ram Ware is a Louisiana based systems company, founded by Rick Mekdessie, which uses the latest in innovative technologies to provide solutions to state and local government. To date, RAM has been providing innovative and streamlined tax collection solutions to the State of Louisiana and to local governments through its proprietary sales tax software and is now branching into educational services. The technology developed by RAM provided for much easier access and payment of sales taxes by small businesses as well as receipt of the sales taxes by the local government. The

Company’s proprietary Sales Tax Manager solution providing for online calculation and payment of tax was a huge improvement to the previous system from both the standpoint of the taxpayer as well as the taxing body.

Digital technology can also greatly assist state and local governments in the providing of educational services, providing students the same digital access to course work and learning. Digital technology can greatly enhance the education experience for students with graphics and other user-friendly interfaces that students can access as well as simulated test taking for the ACT exam. According to the International Association for K-12 Online Learning (iNACOL

Ezra Hodge, who has a background in both technology and education, recently joined the Company and will assist in its education initiative. Ezra is also a Louisiana native, who left a senior position at Pearson Education in Austin, Texas and is returning home to make a difference. Ezra was

responsible for delivering the largest state-mandated student assessment program in the country and oversaw delivery of state-wide educator technology while at one of the largest education companies in the world. He now wants to bring that experience and know-how to Louisiana with online course development.

Note: if an alliance is applying, the alliance team should only submit one application.

Describe your vision and strategy, indicating how your organization’s vision and strategy logically lead you to apply to provide innovative courses to Louisiana students.

Section 2: Provider Vision, Background and Capabilities (9 pages)

2.1 Provider Vision / Strategy

), “online learning is a powerful innovation that expands education opportunities. iNACOL supports access

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(open-ended response) 2.2 Provider Background: history, leadership, strengths

Describe your organization’s comparative advantages.

As mentioned above, the company is driven by two talented technology entrepreneurs, Rick Mekdessie and Ezra Hodge.

Before starting e-Gov Systems (formerly RAMware, LLC), Rick Mekdessie founded RAM Systems, which provided technical consulting and development services to large IBM

Mainframe clients in the New Orleans area. While consulting with a large drug store chain to

develop an automated sales and use tax solution, Rick discovered a void for businesses that had

to file sales tax returns to multiple local parishes in Louisiana.

In 1997, e-Gov Systems was formed with its flagship sales tax program, Sales Tax Manager®. The software program is used for the preparation and filing of state and local sales and use tax

returns in Louisiana. Sales Tax Manager® continues to be particularly well received by small-to -medium sized businesses, accounting firms, and practitioners that file returns for their clients. As technology evolved and businesses became more comfortable with online transactions, the Company shifted its focus to web-based solutions. e-Gov Systems has grown from originally only offering its desktop sales tax program to now offering a suite of web-based solutions to collect sales taxes, occupational license, property taxes, insurance premium taxes, and fines.

In 2003, the development team began to design and develop a tax portal website,

SalesTaxOnline.com. The online filing and payment website for sales taxes went live in 2004. After being displaced by Hurricane Katrina in 2005, the Company moved to Baton Rouge from its downtown offices in New Orleans. The following year, SalesTaxOnline.com expanded to include online renewal and payment of occupational licenses in addition to sales and use tax

returns.

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e-As will be more fully explained, the company is completing its first online education product which is an ACT Review, a ½ credit course in Louisiana. The company had worked on a prototype earlier and this experience coupled with a need to improve ACT scores in Louisiana led the Company to offer this project.

(please fill in yellow sections of table below)

Students enter the next, age-appropriate grade on time and on level

Students successfully complete rigorous and advanced high school and post-secondary course work

Students successfully complete industry-based certification courses, programs, internships and/or apprenticeships based on Pathways to Careers

Students graduate on time or early

Students graduate with the skills to enter post-secondary programs and workforce-ready

(please fill in yellow sections of the table below) Gov Systems was awarded a contract with the Louisiana Department of Revenue to develop ParishE-File.com –the first website that offered an online return and remittance system for sales taxes in all Louisiana parishes.

Within a year of being awarded the contract, e-Gov Systems goes live with ParishE-File.com and as a result, Sales Tax Manager clients can e-file returns for all parishes. Parishes also continue to provide their sales and use tax returns to taxpayers on SalesTaxOnline.com. Over 100 cities joined IPTaxOnline.com.

Ezra Hodge also has a long history of educational and technology entrepreneurship. He started his career as an editorwith The Times-Picayune and his interest in technology led to him to start a web design business and to work for several technology companies in the areas of technology strategy and design. Evacuating the area after Hurricane Katrina, he has spent the last six years with Pearson Education in Austin, Texas where he rose to the position of Vice President,

overseeing high value state-level contracts for the state of Texas. While at Pearson, Ezra had extensive experience in online education and wants to use his talents acquired to further the

cause of education in Louisiana.

2.3 Course Choice Goals Addressed

Indicate which Course Choice Goals your proposed course offerings will address (check all that apply).

Use bottom row to include any explanatory text

X

(5)

ACT Review All

1 – maximum number of students the applicant can fit into a single class

2 – maximum number of separate classes applicant can support at the same time Add any open-ended description of your proposed course offerings:

(open-ended response)

(open-ended response)

The curriculum will be targeted to the content of the ACT Exam as stated by the developers of the exam, which is as follows:

Add rows to the table, if required. New as of July 31: applicants intending to offer many course offerings can include an Excel spreadsheet listing their course offerings, using the same column headers as the table below. Spreadsheets of up to two pages will not count against the application’s 40 page limit.

Describe how courses will be delivered to students (online, face-to-face instruction, combination, other)

Describe your proposed curriculum/curricula. Describe each curricular model and focus, listing curriculum sources. Describe how the curriculum is aligned with State Content Standards Initiative, Common Core State Standards, Louisiana’s state-adopted guidelines or industry-based standards, and/or Board of Regents. Describe how your offering will deliver rigorous, engaging and effective instruction for the targeted student population.

Course Title State Course Code Max Enrollment 1 Max Number of Separate Classes 2 Parishes Included

2.5 Format / Technologies Used to Deliver Courses

Section 3: Overview of Proposed Curriculum (12 pages)

3.1 Curriculum Sources

The course will be provided to students online and be interactive, so that students are graded and

assessed online.

English 75 questions 45 minutes Measures standard written English and

rhetorical skills.

Mathematics 60 questions 60 minutes

Measures mathematical skills students have typically acquired in courses taken up to the beginning of grade 12.

Reading 40 questions 35 minutes Measures reading comprehension.

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With respect to the math portion of the test, many of the topics that will be reviewed include those in the Mathematics Common Core Standard published by the Louisiana Department of Education:

The curriculum will be also based upon previous exam questions and sources of information. The Company will be guided by the “National Standards for Quality Online Courses” (Version 2 published October 2011) in the presentation of its online course. The course will provide online learners with multiple ways of engaging with learning experiences that promote their mastery of content and are aligned with state or national content standards.

(open-ended response)

The proposed instructional materials were developed based upon the content of the ACT Examination.

Science 40 questions 35 minutes

Measures the interpretation, analysis, evaluation, reasoning, and problem-solving skills required in the natural sciences. Optional

Writing Test 1 prompt 30 minutes

Measures writing skills emphasized in high school English classes and in entry-level college composition courses.

The high school standards specify the mathematics that all students should study in order to be college and career ready….

The high school standards are listed in conceptual categories: Number and Quantity

Algebra Functions Modeling Geometry

Statistics and Probability.”

3.2 Proposed Instructional Material

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English

Usage/Mechanics Rhetorical Skills

Math:

Pre-algebra

The English test is a 75-question, 45-minute test, covering:

punctuation

grammar and usage sentence structure

strategy organization style

The Math portion consists of pre-algebra, algebra, coordinate geometry, plane geometry and

trigonometry.

: This section governs the numbers and operations that are necessary in order to understand algebra.

A good checklist for pre-algebra content is as follows: Whole numbers Decimals Fractions Integers Square roots Exponents Factors Ratio Proportion Absolute value:

Elementary algebra/intermediate algebra 32%

Will include the evaluation of algebraic expressions through substitution, the use of variables for functional relations and understanding algebraic equations.

Geometry: coordinate geometry: based upon graphing and the relations between equations and

graphs.

(8)

Since the science and reading do not cover direct content, practice questions would be used as testing technique is more valuable than the actual content.

(open-ended response)

Studying each of the particular areas there will be videos, reference materials, flash cards and sample tests. The video will be led by the avatar ACT Whiz Kid.

Triangles

Polygons

Circles

Three-dimensional Trigonometry

The ACTreading test provides 35 m inutes to read for rather lengthy passages and answer 40

questions on the passages. The reading test has two components:the passages and the questions. Each passages followed by 10 questions of varying difficulty making 40 questions on each passage. The passages always consist of prose fiction, social science humanities and natural science. Prose fiction is the only fiction passage on the test the other three are nonfiction. All for a given equal weight in scoring

The science reasoning testsseven science passages; three data representation passages, three

research summaries passage andone conflicting viewpoints passages, which appear in no particular order.

The questions:

-Data representation passages are accompanied by five questions -Research summary passages have six question and

-Conflicting viewpoints has seven questions.

The passage topics include biology or space science chemistry and physics.

Reading Test

Science Reasoning

3.3 Title / Course Sequencing

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(open-ended response) 3.4 Delivery Methods / Differentiating Instruction

Describe the instructional methods used to deliver the course(s) and the ideal learning environment (class size, structure, etc.). Describe how your course is better than current or potential alternatives.

The instructional design of the course is led by the guidelines established by the National Standards of Quality Online Courses (iNACOL version 2)

Instructional Design

(10)

iNACOL Standard Course Attribute Course design reflects a clear

understanding of all students’ needs and incorporates varied ways to learn

and master the curriculum.

The course will have a several instructional and assessment methods, materials and assessments are used throughout the course, which allow students to demonstrate their achievement of the goals and

objectives of the course. The assessment

methods will include sample questions and a

sample test at the end. The course is organized by units

and lessons that fall into a logical sequence. Each unit and lesson includes an overview describing objectives, activities, assignments, assessments, and resources to provide multiple learning opportunities for students to master the content

The ACT review will be organized by units

and lessonsthat fall into a logical sequence and

follow the content of the exam. At the start

of each unit or lesson, an overview is posted describing the objectives to be completed in the learning module. A variety of assignments are provided such as video lectures, flash

cards, sample tests that provide

students with different paths to master the content.

The course instruction includes activities that engage students in

active learning.

The review course will provide multiple

opportunities for students to be actively

engaged in the content

that includes meaningful and authentic learning experiences such as analysis or reactions to videos, concept mapping, review questions and flash cards.

The course providesstudents with multiple learning paths, based on student

needs that engage students in a variety of ways.

Students are given a variety of activities, assignments, assessments and resources to allow them to successfully master the content. If a student is unsuccessful with mastering a

particular concept, the course content provides

the instructor with suggestions they are able to use in order to provide additional remediation activities or alternative assignments. If a student

is not challenged throughout the course, the instructor may adapt the content to add enrichment activities to best meet the student’s talents and skills.

(11)

(open-ended response) assignments and mathematical

requirements are appropriate for the course content and grade-level

expectations

-appropriate readability levels for the grade level

of the student audience and the grade level should be prominently explained within the

course description

The course design provides

opportunities for appropriate instructor-student interaction,

including opportunities for timely and frequent feedback about student

progress.

The course will have a course administrator for feedback to students.

The course design includes explicit communication/activities (both before and during the first week of

the course) that confirms whether

students are engaged and are progressing through the course.

The instructor will follow program guidelines to address non-responsive students.

The administrator will supervise the course

The course provides opportunities for appropriate instructor-student

and student-student interaction to

foster mastery and application of the

material.

The Company is working on student to student

games

Students have access to resources that enrich the course content.

A wide variety of supplemental tools and resources are clearly identified and readily available within the learning management system.

13

i

3.5 Addressing Special Need Students

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6.

The course will do its best to employ as much as practical the Universal Design Principles, set forth by the Center for Universal Design (CUD) at North Carolina State University, to take into account

special need students in the design of its course:

1. . The design accommodates a wide range of individual preferences and

abilities.

2. . The site is easy to understand, regardless of the user's experience, knowledge, language skills, or current concentration level.

3. . The course communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities.

4. . The course design minim izes hazards and the adverse consequences of accidental or unintended actions. The ACT software application will provide guidance when the user makes an inappropriate selection.

5. . The design can be used efficiently, comfortably, and with a minimum of fatigue.

. The course provides for appropriate size and space is provided for approach, reach, manipulation, and use regardless of the user's body size, posture or mobility.

Flexibility in Use

Simple and intuitive

Perceptible information

Tolerance for error

Low physical effort

(13)

(open-ended response)

The ACT Review will be the first course offered by the Company in this curricular area identified in this application.

(open-ended response; nstructor resumes exempt from page limit

Section 4: Instruction Quality (6 pages)

4.1 History / Examples of Instructional Quality

4.2 Instructor Qualifications i )

Describe where and how in the past you’ve provided excellent quality instruction in the curricular areas identified in this application package.

Describe how you will recruit, select and retain your instructors. Describe instructor qualifications and strengths. Describe how your organization will meet all Louisiana teaching credentialing requirements, as outlined in Bulletin 746.

The following is a review of the course based upon the National Standards for Quality Online

Courses by iNACOL.

II

iNACOL Standard Course Attribute

The course accommodates multiple

school calendars; e.g., block, 4X4 and traditional schedules.

The course is created to adjust to multiple school calendars. Assignments and deadlines can easily be adapted and updated depending

on the program offering the course’s schedule.

User Interface

Clear and consistent navigation is present throughout the course.

The course utilizes consistent and predictable navigation methods. Students can move logically and easily between areas of the

course; color, graphics and icons are used to guide the studentthrough the course; and a

consistent look andfeel exist throughout the

course (consistent text, colors, bullets, and

heading styles). Minimal training is required to navigate the course

Rich media are provided in multiple formats for ease of use and access

in order to address diverse student

needs.

Course makes maximum use of the robust capabilities of the online medium and makes these resources available by alternative means

All technology requirements (including hardware, browser, software, etc...) are specified.

All technology requirements (including

hardware,

browser, software, etc.) are identified in the

(14)

Prerequisite skills in the use of technology are identified.

All prerequisite technology skills necessary for

the

specific class are identified in the course

description

or during the registration process and are

shared

with students before they begin the course.

The course uses content-specific tools

and software appropriately.

A variety of software and online tools are used appropriately and as needed within the online

course.

The course is designed to meet internationally recognized interoperability standards.

Interoperability technical standards allow sharing

content among different learning management systems and ensure sharing of questions, assessments and results with others. Copyright and licensing status,

including permission to share where applicable, is clearly stated and easily found.

Course developers or publishers clearly state the copyright and licensing status of all content,

including permission to share where applicable.

Copyright and licensing information should be readily available, understandable and

standardized in terms of use.

Course materials and activities are

designed to provide appropriate

access to all students.

Through the use of web accessibility evaluation

tools, all web pages required for students to engage in online education (e.g., registration, library, course materials, grade retrieval) are validated to conform to accessibility standards.

Data Security

Student information remains confidential, as required by the

Family Educational Rights and Privacy Act (FERPA).

Defined course procedures for reporting grade and student information complies with the Family Educational Rights and Privacy Act

(FERPA)

http://www.ed.gov/policy/gen/guid/fpco/ferpa/ index.html) posted within the course.

National Standards for Quality Online Courses:

(15)

(open-ended response)

iNACOL Standard Course Requirement

The goals and objectives clearly state what the participants will know or be able to do at the end of the course. The goals and objectives are measurable in multiple ways

Within the learning management system, course goals and objectives are present, explicitly stated, and can be easily found by students. The student’s level of mastery is measured against each goal and objective. After reading the list of goals and objectives, students will understand what they will be learning throughout the course.

The course content and assignments are aligned with the state’s content standards, common core curriculum, or other accepted content standards set for Advanced Placement®

courses,

technology, computer science, or other courses whose content is not included in the state standards.

The content and assignments for the core courses are explicitly and thoroughly aligned to the credit granting state’s academic standards, curriculum frameworks and assessments. Advanced Placement®

courses must be approved

with the College Board and other elective courses should be aligned to other nationally accepted content standards such as computer science, technology courses, etc.

Accessibility

The course content and assignments are of sufficient rigor, depth and breadth to teach the standards being addressed.

The course components (objectives, assessments,

instructional strategies, content, assignments and technology) are sufficiently broad, deep

and rigorous such that successful students will

have the knowledge and skills required by the standards upon completion of the course.

Information literacy and

communication skills are incorporated and taught as an integral part of the curriculum.

Information Literacy, including digital fluency, and communication skills are incorporated as

anintegral part of the curriculum.

4.3 Data Supporting Instructional Effectiveness

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Multiple learning resources and

materials to increase student success

are available to students before the

course begins.

Before the course begins, students are provided

multiple learning resources that prepare them

forthe online course. These could include textbooks, instructional materials links to

browser plugins,and other software, which students must install. Additional materials related to successful strategies for completing

an online course,tutorials, orientations, and a list of prerequisite knowledge and skills are

also provided at thistime.Course

A clear, complete course overview and syllabus are included in the

course.

The syllabus and overview include: course objectives and student learning outcomes; assignments; student expectations; time

requirements; required materials; the grading

policy; teacher-student, teacher-parent contact policies; the intended audience; and the content

scope and sequence.

Course requirements are consistent

with course goals, are representative of the scope of the course and are clearly stated.

The course requirements include: a timeframe for participation, an approximate time required for individual activities, and expectations for communications.

Information is provided to students, parents and mentors on how to communicate with the online

instructor and course provider.

Instructor information is provided to students with contact, availability, and biographical information. Information on how to contact the instructor via phone, email, and/or online messaging tools is provided withinthe contact

information. If regular contact with the instructor is required as part of the course, clear

expectations for meeting this requirement are posted within the course.

The course reflects multi-cultural education, and the content is

accurate, current and free of bias or advertising.

The course creates equal educational

opportunities for students from diverse racial, ethnic, social-class and cultural groups. The content is up to date, accurate and free of

any bias.

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use of copyrighted materials, plagiarism and netiquette (Internet etiquette) regarding lesson

activities, discussions, and e-mail communications are clearly stated.

standards, copyright and academic integrity

expectations is provided.

Privacy policies are clearly stated. A policy statement is posted on the course

provider’s website and/or in the learning management system disclosing the

organization’s

information gathering and dissemination practices.

Online instructor resources and notes are included.

Resources and notes to aid online instructors in teaching and facilitating the course are

included

within the learning management system. Assessment and assignment answers

and explanations are included

Built-in course assessments are provided, and access to answers, explanations, and/or rubrics are included.

(18)

(open-ended response

Increase performance on the ACT exam test readiness and better performance measures for the exam. The students take a practice test in the beginning and then another test at the end of the course.

(open-ended response

iNACOL Standard Course Requirement

Section 5: Accountability (6 pages)

5.1 Specific Course Goals / Metrics )

5.2 Progress Monitoring )

Describe course achievement goals in terms of student performance, including on state-mandated assessments if such assessments are relevant. For career and technical education, describe the specific skills and knowl

Describe progress monitoring systems for student performance based on the goals / metrics described above. Explain how academic progress will be measured for all students (e.g., how often and to whom grade reports will be provided, what interim assessments will be used, etc.). Describe any end-of-course tests or evaluations. Describe how student progress will be reported on a timely and accurate basis.

edge students will gain, why these are important and how they will be measured (including any recognized industry certifications). Identify any other measures or assessments (e.g., ACT, End-of-Course Exams, etc.) and include goals unique to specific populations (e.g., English Language Learners, special needs, gifted, etc.).

Student evaluation strategies are

consistent with course goals and

objectives, are representative of the scope of the course and are clearly

stated.

The strategies used to assess students

throughout the course are consistent with and aligned to what is presented in the course goals and objectives document posted within the

course.

The course structure includes adequate and appropriate methods and procedures to assess students’ mastery of content

Assessment types are matched to the level of knowledge being tested. Both formative assessments (that inform and support learning) and summative assessments (that demonstrate

mastery) are a part of the course structure.

Student-selected assessment options, enabling

learners to demonstrate mastery in different ways, are available.

Ongoing, varied, and frequent assessments are conducted throughout the course to inform

instruction.

The course provides frequent and ongoing

formative assessments to check for student understanding and to ensure they are prepared

for the next lesson. Initial pre-tests may be provided to assess student readiness Assessment strategies and tools make

the student continuously aware of his/

Feedback tools and procedures are built into the course to allow students to periodically

(19)

(open-ended response)

There will be a robust LMS system for the collection of attendance, lessons and test completion, that will gather and report data at any time. The course administrator will be responsible for

overseeing data collection and dissemination.

her progress in class and mastery of the content.

their academic progress.

Assessment materials provide the

instructor with the flexibility to assess students in a variety of ways.

Multiple versions of tests, test banks and other

resources that support alternative evaluation methods are available

Grading rubrics are provided to the instructor and may be shared with students.

Practice exams throughout course.

The grading policy and practices are easy to understand.

Feedback tools and procedures are built into

the course to allow students to periodically

selfmonitor

their academic progress.

5.3 Assessment / Accountability Systems

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(please fill in yellow sections of the table below)

(open-ended response)

Market based

Course Title Course Title Course Title

Tuition for Eligible Funded

Students1 $300-500

Tuition for Self-Paying Eligible Participating Students

– tuition needs to clearly indicate the price being offered (both a clear indication of the dollar amount offered and the Carnegie unit involved – fractional, single, multiple)

– tuition for self-paying Eligible Participating students needs to include the price being offered (dollar amount, Carnegie unit involved) and payment terms

Pricing Comments (if any):

both

Section 6: Proposed Tuition (2 pages)

6.1 Tuition Price Bid

6.2 Tuition Price Bid Description

Add additional tables, if required. New as of July 31: if you’ve submitted an Excel spreadsheet for many course offerings, you can include your proposed tuitions for each course offering on that spreadsheet. Please clearly label what you’ve done, both in this section of your application and on the spreadsheet.

Payment terms for self-paying students must include: a) timing of payment(s); b) conditions for reduced payments for students who complete the course late, or who do not complete the course

Describe how you arrived at your tuition pricing and if it is market-based. Describe how / if the tuition pricing you’ve proposed will now or eventually lower the market price for the type of instruction you’re proposing.

2

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Does your organization have an electronic accounting system?

Yes No

Does your organization have an assigned person responsible for all accounting / financial issues?

Yes No

Name / E-mail Does your organization have

current financial statements (income statement, balance sheet) available for review?

Yes No

Does your organization have a budget for your proposed course offering(s)?

Yes No

What is the breakeven enrollment for your course(s)? What contingencies has your

organization developed in the event that one or more students enrolled in your course(s) would not complete the course(s) on time, delaying the second LDOE payment for that / those students?

What qualitative commentary would you offer to indicate your organization’s sound financial structure and strength?

(22)

(please fill in yellow sections of the table below)

(please fill in yellow sections of the table below)

(please fill in yellow sections of the table below) Reference Name

(org., individual, title, contact information) Relationship to Proposer Reference Text (

Reference Name (org., individual, title, contact information) Relationship to Proposer Reference Text (

Reference Name (org., individual, title, contact information) Relationship to Proposer Reference Text (

Section 8: References (3 pages)

8.1 Reference 1

8.2 Reference 2

8.3 Reference 3

The LDOE will contact each reference for applicants that are accepted into the Interview stage.

500 word limit, please)

500 word limit, please)

(23)

The State requires that the applicant designate one person to receive all electronic communications. Identify the Contact name and fill in the information below (Print Clearly):

Official Contact Name:______________________________________ A. E-mail Address: _____________________________________________ B. Phone Number with area code: (_____)______________________ C. U.S. Mail Address: ____________________________________________

Applicant certifies that the enclosed application information is true and grants permission to the State to contact the above named person or otherwise verify the information provided.

By its submission of this RFA application package and authorized signature below, Applicant certifies that: (1) The information contained in its response to this RFA is accurate.

(2) Applicant complies with each of the mandatory requirements listed in the RFA and will meet or exceed the requirements specified therein.

(3) Applicant accepts the procedures, evaluation criteria, mandatory terms and conditions, and all other administrative requirements set forth in this RFA.

(4) Applicant’s application package is valid for at least one year from the date of signature below.

Authorized Signature: __________________________________________________ Date: ___________________________________ Typed or Printed Name: ________________________________________________

Title: ___________________________________________________________________________ Company Name: __________________________________________________________________ Address:_________________________________________________________________________ City: ____________________________________ State:_________ Zip: ________________

Section 9: Signature Page

OFFICIAL CONTACT.

CER TIF IC ATION STATEM EN T

References

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