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EXHIBIT A <br />ASSET EXCHANGE FORM <br />This Asset Exchange Form shall be processed in accordance with the Asset Exchange Agreement by and <br />between Zayo and City of Tukwila dated . If a License is granted hereunder, the <br />license shall be for the term listed below. <br />ASSET REQUEST (completed by the Licensee): <br />Requesting Party: <br />Date: <br />Contact Person: <br />Phone: <br />EMAIL: <br />AEF Term: <br />AEF Renewal Term: <br />% /,,, <br />Specifications: <br />A Location: <br />Z Location: <br />Number of Conduit: <br />Size of Conduit: <br />Access Points: <br />Specifications (fiber type, <br />requirements, etc.): <br />A Location: <br />Z Location: <br />Fiber Count: <br />Is Fiber within above Conduit?: <br />Splice Points: <br />ASSET REQUEST CONFIRMATION (completed by the Licensee): <br />Date: <br />Signature: <br />ASSET USE AUTHORIZATION LICENSE (completed by the Licensor): <br />Par <br />Date: <br />Contact Person: <br />Phone: EMAIL: <br />❑ License Granted ❑ License Denied (check one) <br />If Granted, Approximate Availability Date: <br />Page 12 of 14 <br />77 <br />