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					ITS H.323 Site Certification Form                                                                                                                                                     Site and Contact Information                                  3/29/2012




        ITS H.323 Site Certification Form V2.0                                                                    Certification Date:

        Site and Contact Information
        Customer and Site Information                                                     Room Facilitator (point of contact)
        Site ID:                                                                          Name:                                                                                   2
        Site Name:                                                                        Job Title:
        Address:                                                                          Department:
        City:                                                                             Phone:
        County:                                                                           Fax:
        State:                                                                            Email Address:
        Zip Code:
        Phone Number:                                                                     Technical (point of contact)
                                                                                          Name:                                                                                   3
        Billing Information                                                               Job Title:
        Federal ID Number:                                                                Department:
        ITS Department Code:                                                          1   Phone:
        ITS Circuit/Customer Tele. Number:                                                Fax:
        Off-net Guest:                                                                    Email Address:
        Bill To:
        Job Title:                                                                        Site Scheduling (point of contact)
         Billing Address:                                                                 Name:                                                                                   4
        Billing Phone:                                                                    Job Title:
        Billing Fax:                                                                      Department:
        Email Address:                                                                    Phone:
                                                                                          Fax:
        Product Codes                              For ITS Use Only                       Email Address:
        Product Code1:
        Product Code2:
        Product Code3:
        Product Code4:

        Client Responsibilities
        Please complete all areas highlighted in                      Instructions:       1. If you current have a circuit provided by IT S enter the circuit number, otherwise
        yellow                                                                            enter your primary billing telephone number. Enter all informationpertaining to
                                                                                          2. Enter the person responsible for the video conferencing room.
                                                                                          3. Enter a technical point of contact such as your network administrator or
                                                                                          4. Enter the desinated person that will be able to schedule conferences.




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ITS H.323 Site Certification Form   Site and Contact Information                                  3/29/2012




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ITS H.323 Site Certification Form   Site and Contact Information                                  3/29/2012




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ITS H.323 Site Certification Form   Site and Contact Information                                  3/29/2012




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ITS H.323 Site Certification Form                                                                                        H.323 Endpoint Information                                  3/29/2012




        ITS H.323 Site Certification Form V2.0                                                                  0

        H.323 Endpoint Information
        Video Equipment Details                                      Endpoint Connectivity Information
        Make:                                                        Hub Type:                                       4
        Model:                                                       Switch Type:
        Software Version:                                            Port Speed:
        Multipoint Capable:                                          Duplex Setting:
        ISDN Capable:                                                Connectivity                                    5
        NCIH H.320 Capable:                                          Bandwidth:
        IP Capable:
        System Name:
        Admin Password:                                          1   E.164 Assignment
        Serial Number:                                               E.164 Assigned:
                                                                     Assigned on (Date):
        IP Details                                                   Assigned By:
        Loopback:                                                2   Codec End-Point Name:
        Public IP Address:
        Private NAT IP Address:
        Subnet Mask:
        Default Gateway:

        Site Firewall Details                                    3
        Make:
        Model:
        Operating System Version:
        Firewall Supports H.323:
        Site will Tunnel using Fixed Ports:


                                                 Instructions:       1. Enter the system configured name such
                                                                     as "Johnston CC". Also enter any password
                                                                     that may have been programed into the
                                                                     system to secure it. Enter the serial number
                                                                     of the unit.
                                                                     2. Enter the public IP address of the system.
                                                                     Your network administrator should have this
                                                                     3. If your video unit is behind a network
                                                                     firewall enter this information. Your network
                                                                     administrator should have this information.
                                                                     4. Enter as much information as possible
                                                                     about any hubs or switches that your video
                                                                     unit is connected to.
                                                                     5. Enter the service provider of your video
                                                                     connectivity an example would be "T ime
                                                                     Warner/Road Runner. Enter the bandwidth




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ITS H.323 Site Certification Form   H.323 Endpoint Information                                  3/29/2012




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ITS H.323 Site Certification Form   H.323 Endpoint Information                                  3/29/2012




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ITS H.323 Site Certification Form   H.323 Endpoint Information                                  3/29/2012




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ITS H.323 Site Certification Form                                                                                                  H.323 Certification Data                                  3/29/2012




        ITS H.323 Site Certification Form V2.0                                                           0

        H.323 Endpoint Testing and Certification Data
        Gatekeeper Registration                         Pass/Fail   MCU Connection Testing                        Pass/Fail
        Gatekeeper Registration:                                    Dial-out from MCU to endpoint:
        Registration with 204.211.208.18:                           Dial-in to MCU from endpoint:

        Dial-in/out Testing                             Pass/Fail   MCU Quality Test Results                 30 Minute Conf.Test
        Dial-in using IP Address:                                   Local Sync Loss Count:
        Dial-in using E.164 Address:                                Remote Sync Loss Count:
        Dial-out using IP Address:                                  Local V. Sync Loss Count:
        Dial-out using E.164 Address:                               Remote V. Sync Loss Count:

        Bandwidth Testing (10 Min Each)                 Pass/Fail   Visual Quality Testing                        Pass/Fail
        128 kbps:                                                   RX Motion (Tiling or Blocking):
        384 kbps:                                                   TX Motion (Tiling or Blocking):
        768 kbps:                                                   Audio Quality Testing
                                                                    RX Audio from End-point (Clarity):
                                                                    TX Audio to End-point (Clarity):
                                                                    Volume:
                                                                    Echo:
                                                                    Microphones Connected and Working:


                                                                    Video Algorithym Testing                      Pass/Fail
                                                                    Conference forced to H.261:
                                                                    Conference forced to H.263:
                                                                    Conference forced to H.264:

        Notes/Exceptions:




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ITS H.323 Site Certification Form   H.323 Certification Data                                  3/29/2012




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ITS H.323 Site Certification Form   H.323 Certification Data                                  3/29/2012




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ITS H.323 Site Certification Form   H.323 Certification Data                                  3/29/2012




                                              12               e95ae8cf-73f5-4f14-924d-1be40a2ca36e.xls
ITS H.323 Site Certification Form                                                        H.323 Capabilities                                  3/29/2012




        ITS H.323 Site Certification Form V2.0                                     0

        H.323 Endpoint Capabilities                 ote m
                                                 Rem Com unications Mode (During Test)




                                                 Overall Certification Grade




                                                                                                13            e95ae8cf-73f5-4f14-924d-1be40a2ca36e.xls
ITS H.323 Site Certification Form   H.323 Capabilities                                  3/29/2012




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ITS H.323 Site Certification Form   H.323 Capabilities                                  3/29/2012




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ITS H.323 Site Certification Form   H.323 Capabilities                                  3/29/2012




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0
H.323 Site Certification Summary


Customer and Site Information
Site Name:                                        0
Phone Number:                                     0

Billing Information
Federal ID Number:                                0
ITS Department Code:                              0
ITS Circuit/Customer Tele. Number:                0
Off-net Guest:                                    0
Bill To:                                          0
Job Title:                                        0
 Billing Address:                                 0
Billing Phone:                                    0
Billing Fax:                                      0
Email Address:                                    0

Room Facilitator (point of contact)
Name:                                             0
Job Title:                                        0
Department:                                       0
Phone:                                            0
Fax:                                              0
Email Address:                                    0

Video Equipment Details
                                         Make:    0
                                        Model:    0
                              Software Version:   0

E.164 Assignment
                               E.164 Assigned:    -


IP Details
                           Public IP Address:     0
                     Private NAT IP Address:      0
                               Subnet Mask:       0
                            Default Gateway:      0

Ridgeway Account Information
                           Account Name:          0

Overall Certification Grade                       0


Self Populating Sheet (nothing to complete)

				
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