Western Mental Health Center - Marshall — Rural Health Care posted service request (HCF)

General Information HCP or Consortium: 14702 - Western Mental Health Center - Marshall Application Number: RHC46100022142 FCC Registration Number: 0013810528 Address: 1212 E COLLEGE DR , MARSHALL, MN 56258 Application Nickname: Marshall 26 Funding Year: 2026 Funding Priority: Priority 5 Requested Services Type of Services Description for Other Min Download Speed Max Download Speed Min Upload Speed Max Upload Speed Speed Unit Allow Bids for Similar Services Data 10 10 10 10 Mbps Yes Will the selected service(s) support an off-site data center?: No Will the selected service(s) support an off-site administrative office?: No Dates and Timing What is the HCP's desired service contract length?: Up to 1 Year(s) Will the HCP consider bids with contract extension language?: No Will the HCP consider bids for month-to-month contracts?: No What is the HCP's desired time to publicly post this request for services?: 28 Day(s) What is the HCP's expected bid evaluation period after the public posting?: 14 Day(s) Page1 Bid Evaluation Select the criteria that will be used to evaluate the bids collected. Criteria Description Evaluation Weight (%) Minimum Requirement Price 80 Bandwidth 20 10 mbps - fiber optic lines preferred Does the HCP have any disqualifying factors that will remove bids or bidders from consideration?: No Main Contact Name Organization Title Phone Email Address Angela Jerzak Western Mental Health Center - Marshall IT Departm ent (507) 337-4913 ajerzak@wmhcin c.org 1212 East College Drive , Mar shall, MN 56258 RFP and Summary Is the HCP likely to request more than $100 000 in program support from this request for services?: No Do state, Tribal, or local procurement rules require the HCP to include an RFP with this request for services application?: No Will the HCP be including an RFP with this application?: No Summary of the HCP's requested services. : We are looking for data (internet lines) to create a VPN between our 3 offices sites located with a home base of Marshall linking to Redwood and Granite Falls. Page2 Additional Documentation Document Type Description for Other Document Uploaded On Declaration of Assistance Name Organization Type Title Employer Nature of Relationship Email Telephone Page3 Certifications ✓ I certify under penalty of perjury that I am authorized to submit this request on behalf of the healthcare provider or c onsortium. ✓ I certify under penalty of perjury that I have examined this request and all attachments, and to the best of my knowle dge, information, and belief, all statements contained herein and in any attachments are true. ✓ I certify under penalty of perjury that the applicant seeking supported services has complied with any applicable stat e, Tribal, or local procurement rules. ✓ I certify under penalty of perjury that all requested RHC Program support will be used solely for purposes reasonabl y related to the provision of health care service or instruction that the health care provider is legally authorized to pr ovide under the law of the state in which the services are provided. ✓ I certify under penalty of perjury that the applicant seeking supported services satisfies all of the requirements under section 254 of the Communications Act, 47 U.S.C. § 254, and applicable Commission rules. ✓ I certify under penalty of perjury that the applicant seeking support has reviewed and is compliant with all applicable RHC Program requirements. ✓ I understand that all documentation associated with this request, including a copy of the signed Request for Service s (FCC Form 461), any bids/contracts resulting from the FCC Form 461 posting, scoring sheet, and other informatio n that was used in the decision making process, must be retained for a period of at least five years pursuant to 47 C FR § 54.631, or as otherwise prescribed by the Commission's rules. ✓ I certify under penalty of perjury that the applicant seeking supported services is a nonprofit or public entity that falls within one of the seven categories set forth in the definition of health care provider listed in 47 CFR §54.600 of the Commission's rules. ✓ I certify under penalty of perjury that the applicant seeking supported services is physically located in a rural area a s defined in section 47 CFR § 54.600 of the Commission's rules, or is a member of a consortium which satisfies the majority-rural composition requirements set forth in 47 CFR § 54.607 of the Commission's rules. ✓ I certify under penalty of perjury that the services will not be sold, resold, or transferred in consideration for money o r any other thing of value. Signature Name: Angela Jerzak Email: ajerzak@wmhcinc.org Phone: (507) 337-4913 Employer: Western Mental Health Center, Inc Title: IT Department Employer’s FCC RN: 0013810528 Certifier’s Full Name: Angela Jerzak Digital Signature: Angela Jerzak Date and time: 2/20/2026 2:04 PM EST Page4