[Attachment F] SMC Order Form
Tennessee Educational Broadband Consortium
Multiple Award Schedule
State Master Contract Order Form
This agreement ("Agreement") is entered into between Hickman County School District ("Customer")
and Zayo Education ("Service Provider"), for E-Rate Category 1 or Category 2 purchases. For good and
valuable consideration, including the mutual promises contained herein, Customer orders from the
Service Provider the services identified below and/or in Attachment A to this Agreement ("Service").
Customer and Service Provider agree that the Service shall be provided pursuant to the rates, charges,
terms and conditions set forth in SWC 400 Zayo Broadband Services ("Master Contract").
Service Ordered by Customer:
IDENTIFY REQUESTED SERVICE(S) HEREIN AND/OR IN ATTACHMENT A
The selected Service period is (July 1, 2026 - June 30, 2031 unless otherwise agreed upon in writing, the
Service period shall commence upon service installation.
Requested Service Commencement Date(s): July 1, 2026
If this Agreement is cancelled or terminated prior to Service Installation, cancellation charges will apply
as set forth in the Master Contract (if applicable).
Customer may seek Universal Service Fund funding pursuant to the rules and regulations associated
with the E-Rate program.
Customer further warrants and represents that Customer is authorized to enter into this Agreement and
to order Service pursuant to the Master Contract. There are no other terms and conditions allowed
pursuant to this agreement other than those present in the underlying State Master Contract. Customer
further warrants and represents that this Agreement complies with all applicable procurement laws
and/or requirements.
This Agreement is effective when executed by Customer. Submission of a quote at the request of the
Customer constitutes the Service Provider's intent to proceed upon acceptance of the Customer. This
Agreement is subject to and controlled by the provisions of the State Master Contract, including any
amendments as may be made from time to time.
Customer Name:
Accepted by [VENDOR NAME]:
Print Name: Belinda Anderson
Print Name:
By: Belmader
By:
Title: Interim Director of Schools
Title:
Date:
MAR 2 0 2026
Date:
ATTACHMENT A
Updated: 12/15/2025
*This is not a contract. The SMC Order Form is to memorialize that a mini-bid was conducted to select a service provider from the
multiple award State Master Contracts - Tennessee Education Broadband Consortium (TEBC) for specific products/services. No
additional terms and conditions can be added to this document, per the TEBC Master Contracts.
[Attachment F] SMC Order Form
Quantity
Name of Product or Service
Hickman
HICKM
E-Rate
[Attachment A] TEBC Mini-Bid
County
AN
Funding
Service/Equipment List
School
COUNT
Year
District
Y
2026
BIDDER
Compa
Zayo Education,
INFORMATIO
ny
LLC
N: (to be
Name:
completed
Compa
143030857
by vendor)
ny SPIN
(498
ID):
Contac
Ali Johnson
t
Name:
Contac
ali.johnson@zayo.c
t E-
om
mail:
Contac
(781) 556-1365
t
Phone:
To Be Completed by Applicant
To Be Completed by Vendor
School/Buildi
TEBC
Bundled
Speed/
Quan
MRC
NRC
Ineligi
Ineli
Annual
ng Name
Produc
or
Capacit
tity
(per
(inst
ble
gible
Cost
(Tip > incl. all
t
Standalo
y
circui
allati
Servic
Cost
(incl.
service
Catego
ne?
(Tip >
t)
on,
es
S
12-
locations)
ry
incl. all
mak
(descr
month
speed
e-
iption)
S
increme
read
MRC+
nts for
y
NRC+i
which
cost
neligib
you
s,
le
want
etc.)
costs)
pricing)
Hickman
C1
Bundled
7 Gbps
1
$4,60
$
N/A
$
$55,20
County
Broadb
/ 10
0 /
-
-
0 /
District
and
Gbps
$5,12
$61,50
Office
5
0
(IA+FW)
Hickman
C1
Bundled
7 Gbps
1
$4,60
$
N/A
$
$55,20
County
Broadb
/ 10
0 /
-
-
0 /
District
and
Gbps
$5,12
$61,50
5
0
Updated: 12/15/2025
*This is not a contract. The SMC Order Form is to memorialize that a mini-bid was conducted to select a service provider from the
multiple award State Master Contracts - Tennessee Education Broadband Consortium (TEBC) for specific products/services. No
additional terms and conditions can be added to this document, per the TEBC Master Contracts.
[Attachment F] SMC Order Form
Office
(IA+FW)
Centerville
C1
Bundled
10 Gbps
1
$550
$
N/A
$
$6,600
Elementary
Broadb
-
-
School
and
Centerville
C1
Bundled
10 Gbps
1
$550
$
N/A
$
$6,600
Intermediate
Broadb
-
-
School
and
Hickman
C1
Bundled
10 Gbps
1
$550
$
N/A
$
$6,600
County
Broadb
-
-
Middle
and
School
Hickman
C1
Bundled
10 Gbps
1
$550
$
N/A
$
$6,600
County High
Broadb
-
-
School
and
East
C1
Bundled
10 Gbps
1
$1,35
$
N/A
$
$16,20
Hickman
Broadb
0
-
-
0
Elementary
and
School
East
C1
Bundled
10 Gbps
1
$550
$
N/A
$
$6,600
Hickman
Broadb
-
-
Intermediate
and
School
East
C1
Bundled
10 Gbps
1
$550
$
N/A
$
$6,600
Hickman
Broadb
-
-
Middle
and
School
East
C1
Bundled
10 Gbps
1
$1,35
$
N/A
$
$16,20
Hickman
Broadb
0
-
-
0
High School
and
Hickman
C1
Bundled
10 Gbps
1
$1,25
$
N/A
$
$15,00
County
Broadb
0
-
-
0
District
and
Office
Updated: 12/15/2025
*This is not a contract. The SMC Order Form is to memorialize that a mini-bid was conducted to select a service provider from the
multiple award State Master Contracts - Tennessee Education Broadband Consortium (TEBC) for specific products/services. No
additional terms and conditions can be added to this document, per the TEBC Master Contracts.

## Table 1

|  | Customer Name: | Accepted by [VENDOR NAME]: |
| --- | --- | --- |
| Print | Name: Belinda Anderson | Print Name: |
| By: | Belmader | By: |
| Title: | Interim Director of Schools | Title: |
| Date: | MAR 2 0 2026 | Date: |

## Table 2

| Hickman County School District | HICKM AN COUNT Y | E-Rate Funding Year 2026 |  |  | [Attachment | A] Service/Equipment | TEBC List | Mini-Bid |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  |  |  |  |  |  |  |  |  |  |
| BIDDER INFORMATIO N: (to be | Compa ny Name: | Zayo Education, LLC |  |  |  |  |  |  |  |
| completed by vendor) | Compa ny SPIN (498 ID): | 143030857 |  |  |  |  |  |  |  |
|  | Contac t Name: | Ali Johnson |  |  |  |  |  |  |  |
|  | Contac t E- mail: | ali.johnson@zayo.c om |  |  |  |  |  |  |  |
|  | Contac t Phone: | (781) 556-1365 |  |  |  |  |  |  |  |
|  |  |  |  |  |  |  |  |  |  |

## Table 3

| To Be Completed | by | Applicant |  |  | To Be | Completed | by Vendor |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| School/Buildi ng Name (Tip > incl. all service locations) | TEBC Produc t Catego ry | Bundled or Standalo ne? | Speed/ Capacit y (Tip > incl. all speed increme nts for which you want pricing) | Quan tity | MRC (per circui t) | NRC (inst allati on, mak e- read y cost s, etc.) | Ineligi ble Servic es (descr iption) | Ineli gible Cost S | Annual Cost (incl. 12- month S MRC+ NRC+i neligib le costs) |
| Hickman County District Office (IA+FW) | C1 Broadb and | Bundled | 7 Gbps / 10 Gbps | 1 | $4,60 0 / $5,12 5 | $ - | N/A | $ - | $55,20 0 / $61,50 0 |
| Hickman County District | C1 Broadb and | Bundled | 7 Gbps / 10 Gbps | 1 | $4,60 0 / $5,12 5 | $ - | N/A | $ - | $55,20 0 / $61,50 0 |

## Table 4

| Office (IA+FW) |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Centerville Elementary School | C1 Broadb and | Bundled | 10 Gbps | 1 | $550 | $ - | N/A | $ - | $6,600 |
| Centerville Intermediate School | C1 Broadb and | Bundled | 10 Gbps | 1 | $550 | $ - | N/A | $ - | $6,600 |
| Hickman County Middle School | C1 Broadb and | Bundled | 10 Gbps | 1 | $550 | $ - | N/A | $ - | $6,600 |
| Hickman County High School | C1 Broadb and | Bundled | 10 Gbps | 1 | $550 | $ - | N/A | $ - | $6,600 |
| East Hickman Elementary School | C1 Broadb and | Bundled | 10 Gbps | 1 | $1,35 0 | $ - | N/A | $ - | $16,20 0 |
| East Hickman Intermediate School | C1 Broadb and | Bundled | 10 Gbps | 1 | $550 | $ - | N/A | $ - | $6,600 |
| East Hickman Middle School | C1 Broadb and | Bundled | 10 Gbps | 1 | $550 | $ - | N/A | $ - | $6,600 |
| East Hickman High School | C1 Broadb and | Bundled | 10 Gbps | 1 | $1,35 0 | $ - | N/A | $ - | $16,20 0 |
| Hickman County District Office | C1 Broadb and | Bundled | 10 Gbps | 1 | $1,25 0 | $ - | N/A | $ - | $15,00 0 |