Common-Council-Meeting-Agenda-Packet-9-1-2026.pdf

The YouTube channel "City of Franklin WI" will be live streaming the Common Council meeting so that the public will be able to view and listen to the meeting. https://www .youtube.com/c/CityofFranklinWIGov CITY OF FRANKLIN COMMON COUNCIL MEETING** FRANKLIN CITY HALL - COMMON COUNCIL CHAMBERS 9229 WEST LOOMIS ROAD, FRANKLIN, WISCONSIN AGENDA* TUESDAY, SEPTEMBER 1, 2026 AT 6:30 P.M. A. Call to Order and Roll Call. B. 1. 2. A Proclamation in Recognition of Rawson Pub's 40 Years in Business. Citizen Comment Period. C. Approval of Minutes: Regular Common Council Meeting of August 18, 2026. D. Hearings. E. Organizational Business. F. Letters and Petitions. G. Reports and Recommendations: 1. Consent Agenda: (a) A Resolution authorizing Franklin Director of Health and Human Services to accept and execute the Grant Agreement modification for the 2026 DPH LPHD Consolidated Contract. (b) A Resolution authorizing Franklin Director of Health and Human Services to accept and execute the Grant Agreement for the Tuberculosis (TB) Dispensary Program. (c) Population Estimate as of January 1, 2026. (d) A Resolution authorizing the installation of a retaining wall within the 20' Public Drainage Easement upon Lot 2 of Whispering Woods Subdivision (6860 W. Wild Flower Court) (TKN 837-0213-000) (Derek & Nellie Foster, Applicant). (e) A Resolution authorizing the installation of a fence within the 20' Sanitary Sewer Easement upon Lot 16 of Cape Crossing Subdivision (9378 S. Parkside Lane) (TKN 890-1016-000) (Lukas Buttke, Applicant). (f) Request Council Approval to accept a $300.00 public donation from the Franklin Lioness Foundation and apply this to the Automated External Defibrillators (AED's) in the City of Franklin Parks Program. 2. Direction on W. Puetz Road Pathway Project. 3. A Resolution authorizing certain officials to execute a Development Agreement for public infrastructure improvements with Advenir Azora Development, LLC [or an Common Council Meeting Agenda September 1, 2026 Page2 affiliate thereof, Franklin SFR owner, LLC] - Leo Cottages 7705 S. 31st Street (TKN786-9988-000,) 7631 S 31st Street (TKN 786-9987-000,) and 7721 S. 31st Street (TKN 786-9992-000) Franklin, Wisconsin. 4. Engineering Department update for 2026. 5. A Resolution imposing conditions and restrictions for the approval of a Conditional Use for a car wash business use upon properties located at approximately 6311 S. 27th Street (Justin Barnes, Club Car Wash Operating, LLC, applicant) (College Avenue Associates, LLC, Property Owner). 6. A Resolution imposing conditions and restrictions for the approval of a Conditional Use for a self-service storage facility use upon property located at 5160 W. Ryan Road (TKN 882-9002-000), (5100, LLC, Property Owner and Applicant). 7. A Resolution Authorizing Certain Officials to Execute an Assignment, Subordination and Standstill Agreement of the Tax Incremental District No. 10 Development Agreement, between the City of Franklin, LxL Pg Apartments, LLC (Borrower) and CIBC Bank USA (Agent), for the redevelopment project named Poth's General (Project), and to effect such developments, including the terms and provisions of said development agreements. 8. Civic Celebrations Commission financial operations, budget accountability, and internal controls. 9. January-March, 2026 Quarterly Financial Report. 10. A Resolution designating signatures for checks and orders pursuant to Section 66.0607 Wisconsin State Statutes. 11. An Ordinance to amend Ordinance 2025-2712, an Ordinance adopting the 2026 Annual Budget for the General Fund to provide $19,500 of contingency appropriations for professional services necessary to claim the Federal Solar Investment Tax Credits. 12. A Resolution to authorize certain officials to execute an additional statement of work with CliftonLarsonAllen LLP for professional services related to the preparation and filing of the City's Federal Solar Investment Tax Credit Return and related forms. 13. VH PVR, LLC v. City of Franklin, Milwaukee County Circuit Court, Case No. 26- CV-7463. The Common Council may enter closed session pursuant to Wis. Stat. § 19.85(l)(g), to confer with legal counsel for the Common Council who is rendering advice concerning strategy to be adopted by the body with respect to the subject litigation, and to reenter open session at the same place thereafter to act on such matters discussed therein as it deems appropriate. 14. A Resolution to award the Pleasant View Reserve repairs project to Payne and Dolan, Inc. in the amount of $464,154.20. 15. Cell Towers Communications Facilities Providers Lease Agreements with the City of Franklin and the Franklin Water Utility. The Common Council may enter closed session pursuant to Wis. Stat. § 19.85(l )(e), for market competition and bargaining reasons, to deliberate and consider terms relating to the Cell Towers Communications Facilities Providers Lease Agreements with the City of Franklin and the Franklin Water Utility, the investing of public funds and governmental actions in relation thereto, including the terms and provisions thereof, and to reenter open session at the same place thereafter to act on such matters discussed therein as it deems appropriate. Common Council Meeting Agenda September 1, 2026 Page 3 16. Agreement between the City of Franklin and JPM Acoustics Noise Vibration and potential amendment to agreement between the City of Franklin and JPM Acoustics Noise Vibration, for Sound Monitoring, Noise Mitigation, and Compliance Services at the Tax Incremental District No. 5 Ballpark Commons Area. The Comm on Council may enter closed session pursuant to Wis. Stat. § 19.85(1)(e), for market competition and bargaining reasons, to deliberate and consider terms relating to the agreement between the City of Franklin and JPM Acoustics Noise Vibration and a potential amendment thereto, the investing of public funds and governmental actions in relation thereto, including the terms and provisions thereof, and to reenter open session at the same place thereafter to act on such matters discussed therein as it deems appropriate. H. Licenses and Permits: License Committee Meeting of September 1, 2026. I. Bills. Request for Approval of Vouchers and Payroll. J. Adjournment. **Notice is given that a majority of the Civic Celebration Commission may attend this meeting to gather information about an agenda item over which the Civic Celebration Commission has decision­ making responsibility. This may constitute a meeting of the Civic Celebration Commission, per State ex rel. Badke v. Greendale Village Board, even though the Civic Celebration Comm ission will not take formal action at this meeting. *SupportingdocumentationanddetailsoftheseagendaitemsareavailableatCityHallduring normalbusinesshours. [Note: Upon reasonable notice, efforts will be made to accommodate the needs of disabled individuals through appropriate aids and services. For additional information, contact the City Clerk's office at (414) 425-7500.] REMINDERS: September 3 Plan Comm ission September 7 City Hall Closed-Labor Day September 15 Common Council September 17 Plan Commission October 6 Common Council October 8 Plan Commission October 20 Common Council 6:00 p.m . 6:30 p.m. 6:00 p.m . 6:30 p.m . 6:00 p.m . 6:30 p.m . BLANKPAGE E i t of1franklin tolanation APROCLAMATIONINRECOGNITIONOFRAWSONPUB FORITS40YEARSINBUSINESS WHEREAS, the character and community life of the City of Franklin, Wisconsin are greatly enriched by the longevity and welcoming service of its local business owners; and WHEREAS, Rawson Pub, located at 5621 W. Rawson Avenue in the City of Franklin, was established in 1986, creating a welcoming neighborhood gathering place that has brought residents together for four continuous decades; and WHEREAS, for 40 years, Rawson Pub has served as a familiar social hub for generations of area citizens, hosting high school class reunions and summer recreational sports leagues; and WHEREAS, Rawson Pub has consistently demonstrated a commitment to giving back through its community-focused event, the Patriots MC Annual Bike Blessing, which directs l 00 percent of proceeds to first responders; and WHEREAS, on this milestone 40" anniversary, the City of Franklin recognizes the entrepreneurial spirit, civic engagement, and classic hospitality that Rawson Pub and its staff continue to bring to our city. NOW, THEREFORE, BE IT PROCLAIMED, that I, John R. Nelson, Mayor of the City of Franklin, Wisconsin, on behalf of all of the Citizens of Franklin, do hereby congratulate the owners, staff, and patrons of Rawson Pub on their historic milestone; and thank this business establishment and neighborhood landmark for 40 years of hospitality, good cheer, and community spirit. Presented to the City of Franklin Common Council this l st day of September, 2026. BLANKPAGE ROLL CALL A. CITIZEN COMMENT B. MINUTES C. l. AUGUST 4, 2026 MINUTES C.2. AUGUST 6, 2026 MAYORA L E. APPOINTMENTS CITY OF FRANKLIN COMMON COUNCIL MEETING AUGUST 18, 2026 MINUTES The regular meeting of the Franklin Common Council was held on August 18, 2026, and was called to order at 6:30 p.m . by Mayor John R. Nelson in the Franklin City Hall Council Chambers, 9229 W. Loomis Road, Franklin, Wisconsin. On roll call, the following were present: Alderman Johnson, Alderwoman Eichmann, Alderman Hasan, Alderwoman Kresovic, Alderman Salous, and Alderwoman Kenney. Also in attendance were Director of Administration Kelly Hersh, City Attorney Jesse A. Wesolowski, City Attorney Christina Lucchesi and City Clerk Shirley Roberts. Citizen comment period was opened at 6:31 p.m . and was closed at 6:43 p.m . Alderman Hasan moved to approve the minutes of the Common Council meeting of August 4, 2026, as presented. Seconded by Alderwoman Eichmann. All voted Aye; motion carried. Alderwoman Kenney moved to approve the minutes of the Special Common Council meeting of August 6, 2026, as presented. Seconded by Alderman Hasan. All voted Aye; motion carried. Alderman Salous moved to confirm the following Mayoral Appointments: 1. Jeff Steinbach, 8109 S. 47 St., Ald. Dist. 5 - Comm unity Development Authority, 4 year term expiring 08/30/30. 2. Michelle Streed, 10528 W. Cortez Circle, Unit 22, Ald. Dist. 6 - Community Development Authority, 4 year unexpired term expiring 08/30/28. Seconded by Alderman Hasan. On roll call, all voted Aye. Motion carried. CONSENT AGENDA G.1. RES. NO. 2026-8513 G.l. (a) FUN FLICKS CONTRACT RES. NO. 2026-8514 G.1.(b) OPIOID RESPONSE GRA NT AGREEMENT Alderwoman Eichmann moved to approve the following consent agenda items: Approve Resolution No. 2026-8513, A RESOLUTION AUTHORIZING FRANKLIN DIRECTOR OF HEALTH AND HUMAN SERVICES, TO SIGN THE 2026 FUN FLICKS OUTDOOR MOVIES CITY OF FRANKLIN HEALTH DEPARTMENT CONTRA CT; and Approve Resolution No. 2026-8514, A RESOLUTION AUTHORIZING FRANKLIN DIRECTOR OF HEALTH AND HUMAN SERVICES TO ACCEPT AND EXECUTE THE GRANT AGREEMENT AMENDMENT BETWEEN COMMUNITY ADVOCATES AND CITY OF FRANKLIN FOR ALLIANCE WI YOUTH STATE OPIOID RESPONSE (SOR4) PREVENTION. Common Council Meeting August 18, 2026 Page 2 S. 51ST ST DESIGN G.2. Approval for all the above consent agenda items was seconded by Alderwoman Kresovic. All voted Aye; motion carried. Alderwoman Kresovic left the meeting at 7:12 p.m. Alderwoman Kresovic returned to the meeting at 7:14 p.m. Alderman Hasan moved to approve to continue design with option C. Seconded by Alderwoman Kresovic. On roll call, Alderwoman Kenney, Alderman Salous and Alderwoman Eichmann voted No; Alderwoman Kresovic, Alderman Hasan and Alderman Johnson voted Aye. Mayor Nelson broke the tie with voting No. Alderwoman Kenney moved to approve to continue design with option B. Seconded by Alderwoman Eichmann. On roll call vote, Alderman Johnson, Alderwoman Eichmann, Alderwoman Kresovic and Alderwoman Kenney voted Aye; Alderman Hasan and Alderman Salous voted No; motion carried. Alderman Hasan moved to adopt Resolution No. 2026-8515 , A RESOLUTION TO ACCEPT A WATERMAIN AND SANITARY SEWER EASEMENT FROM ADVENIR AZORA DEVELOPMENT, LLC AT LEO COTTAGES 7705 S. 31%T STEET (TKN 786-9988-000), 7631 S. 31ST STREET (TKN 786­ 9987-000), AND 7721 S. 31ST STREET (TKN 786-9992-000) FRANKLIN, WI, subject to changes to the Resolution approved by the City Engineer, Director of Administration and the City Attorney. Seconded by Alderwoman Kenney. All voted Aye; motion carried. Alderman Hasan moved to adopt Resolution No. 2026-8516, A RESOLUTION TO AUTHORIZE ACCEPTANCE OF STORM WATER FACILITIES MAINTENANCE AGREEMENT AND STORM WATER ACCESS EASEMENT FROM ADVENIR AZORA DEVELOPMENT, LLC AT LEO COTTAGES 7705 S. 31ST STREET (TKN 786-9988-000), 7631 S. 31ST STREET (TKN 786-9987-000), AND 7721 S. 31ST STREET (TKN 786-9992-000) FRANKLIN, WI, subject to changes to the Resolution approved by the City Engineer, Director of Administration and the City Attorney. Seconded by Alderman Salous. All voted Aye; motion carried. Alderwoman Kenney moved to put over to the September 1, 2026 Common Council meeting. Seconded by Alderman Hasan. All voted Aye; motion carried. Alderman Hasan moved to adopt Resolution No. 2026-8517, A RESOLUTION AUTHORIZING CERTAIN OFFICIALS TO ACCEPT A REVISED CONSERVATION EASEMENT FOR RES. NO. 2026-8515 G.3. WATERMAIN EASEMENT AND SEWER FOR LEO COTTAGES RES. NO. 2026-8516 G.4. STORM WATER FACILITIES AGREEMENT FOR LEO COTTAGES DEVELOPMENT G.5. AGREEMENT WITH ADVENIR AZORA - LEO COTTAGES RES. NO. 2026-8517 G.6. CONSERVATION EASEMENT FOR Common Council Meeting August 18, 2026 Page 3 PROPERTIES ON S. 31ST ST RES. NO. 2026-8518 RENAME ERNIE LAKE PARK ORD. NO. 2026-2747 SCHLUETER PKWY PARKING CLOSED SESSION PLEASANT VIEW RESERVE CLAIMS PLEASANT VIEW REPAIRS PROJECT CLOSED SESSION G.7. G.8. G.9. G.10. G.11. 7705 S. 31ST STREET, (TKN 786-9988-000), 7631 S. 31ST STREET, (TKN 786-9987-000), AND 7721 S. 31ST STREET (TKN 786-9992-000), (ADVENIR AZORA DEVELOPMENT, APPLICANT) (MATTEO AND GERMANO NORANTE, OWNER, 7705 S. 31ST STREET) (BC MANAGEMENT, OWNER, 7631 S. 31° STREET) (ESTATE OF GERALD F ZAWADZKI, OWNER, 7721 S. 31ST STREET). Seconded by Alderman Johnson. All voted Aye; motion carried. Alderwoman Eichmann moved to adopt Resolution No. 2026-8518, A RESOLUTION TO RENAME ERNIE LAKE PARK TO 'TONY MEGNA PARK, HOME OF LAKE ERNIE,' LOCATED AT 8000 S. CHAPEL HILL DR. (TKN 800-9972-005, 800-9982-010, 795-9999-005 AND 800-0102-000) (CITY OF FRANKLIN, PROPERTY OWNER). Seconded by Alderman Johnson. All voted Aye; motion carried. Alderman Hasan moved to adopt Ordinance No. 2026-2747, AN ORDINANCE TO MODIFY THE MUNICIPAL CODE SECTION 245-5 D.(4) DESIGNATING NO PARKING ON THE WEST SIDE OF SCHLUETER PKWY FROM W. DREXEL AVENUE TO S. LEGEND DRIVE. Seconded by Alderwoman Eichmann. All voted Aye; motion carried. Alderwoman Eichmann moved to enter closed session at 7:34 p.m. pursuant to Wis. Stat. $19.85(1)g ), to confer with legal counsel for the Common Council who is rendering advice concerning strategy to be adopted by the body with respect to the subject claims and litigation in which it is likely to become involved, and to reenter open session at the same place thereafter to act on such matters discussed therein as it deems appropriate. Seconded by Alderman Hasan. On roll call, all voted Aye. Motion carried. Mayor Nelson called a recess at 7:35 p.m. Mayor Nelson reconvened at 7:40 p.m. Upon reentering open session at 8:34 p.m. Alderwoman Kenney moved to proceed as discussed in closed session. Seconded by Alderman Salous. All voted Aye; motion carried. Alderman Hasan moved to put over to the September 1, 2026 Common Council meeting. Seconded by Alderwoman Eichmann. All voted Aye; motion carried. Alderman Hasan moved to enter closed session at 8:36 p.m. pursuant to Wis. Stat. §19.85(1)(e), for market competition and Com mon Council Meeting August 18, 2026 Page 4 CELL TOWERS LEASE AGREEMENT MISCELLANEOUS LICENSES VOUCHERS AND PAYROLL ADJOURNMENT H. I. J. bargaining reasons, to deliberate and consider terms relating to the Cell Towers Communication Facilities Providers Lease Agreements with the City of Franklin and the Franklin Water Utility, the investing of public funds and governmental actions in relation thereto, including the terms and provisions thereof, and to reenter open session at the same place thereafter to act on such matters discussed therein as it deems appropriate. Seconded by Alderwoman Eichm ann. On roll call, all voted Aye. Motion carried. Upon reentering open session at 8:43 p.m. Alderman Hasan moved to proceed as discussed in closed session. Seconded by Alderwoman Kresovic. All voted Aye; motion carried. Alderwoman Eichmann moved to approve the following licenses of the License Committee Meeting of August 18, 2026. Grant New Class B Combination Entertainment & Amusement 2026-2027 License to Mulligan's Irish Pub & Grill LLC, DBA Mulligan 's Irish Pub & Grill, Brian Francis, Agent, 8933 S 27 St; Grant Extraordinary Entertainment & Special Event License to Rawson Pub LLC - 40" Bar Anniversary 2026, Person in Charge: Steve Schweitzer, Location: 5621 W Rawson Ave, Date: 9/12/26; Grant New 2026-2027 Operator License pending correction of application to Alan Fay; Grant New 2026-2027 Operator License to Chloe Veenstra; Grant Temporary Class "B" Beer License to Franklin Lions Club: St. Martin's Labor Day Fair, Person in Charge: Jeffrey Terp, Location: 11241 W St Martins Rd, Dates of Event: 9/6/26 and 9/7/26; Seconded by Alderwoman Kenney. All voted Aye; motion carried. Alderwoman Kresovic moved to approve City vouchers with an ending date of August 13, 2026 in the amount of $1,070,759.20, and payroll dated August 7, 2026 in the amount of $472,936.68 and payments of the various payroll deductions in the amount of $269,771.85 plus City matching payments, and estimated payroll dated August 21, 2026 in the amount of $502,000 and payments of the various payroll deductions in the amount of $578,000, plus City matching payments. Seconded by Alderwoman Kenney. On roll call, all voted Aye. Motion carried. Alderwoman Kenney moved to adjourn the meeting of the Comm on Council at 8:46 p.m. Seconded by Alderwoman Kresovic. All voted Aye; motion carried. APPROVAL Reportsand Recommendations REQUESTFOR COUNCILACTION ARESOLUTION AUTHORIZINGFRANKLIN DIRECTOR OFHEALTHANDHUMAN SERVICESTOACCEPTAND EXECUTETHE GRANTAGREEMENTMODIFICATIONFOR THE2026DPHLPHD CONSOLIDATED CONTRACT MEETINGDATE 09/01/2026 ITEMNUMBER Background:The Wisconsin Department of Health Services Division of Public Health awards grants in a variety of programs to local public health depart ments. The Franklin Health Department (FHD) has again been awarded grant funding for the continuation of the following grants: • BIOT FOCUS A PLANN ING: $40,322.00 • BIOT PREPARE- CRI: $15,558.00 These grants assist the FHD in offering additional programming and services to residents based upon analysis and assessment of community needs in addition to the services required of the department by the State and Municipal codes. The focus of the grants are to enhance Wisconsin's and Franklin's ability to rapidly mobilize, surge, and respond to public health emergencies identified by the Centers for Disease Control and Prevention (CDC). Recommendation:The Director of Health and Human Services recommends approval to accept and authorization to execute and deliver the Division of Public Health Consolidated Contract Grants for 2026 awarded to the Franklin Health Department. FiscalNote:Without the additional grant funds above, many of the programs and services Franklin residents have become accustomed to would be reduced or become unavailable due to a loss of funds. The consolidated contract has been sent to the City attorney for review and approval of signature pending Council approval. COUNCILACTION REQUESTED A Motion to adopt Resolution No. 2026- " A RESOLUTION AUTHORIZING FRANKLIN DIRECTOR OF HEALTH AND HUMAN SERVICES TO ACCEPT AND EXECUTE GRANT AGREEMENT MODIFICATION FOR THE 2026 DPH LPHD CONSOLIDATED CONTRACT. Health Department: EH STATE OF WISCONSIN CITY OF FRANKLIN RESOLUTION NO. 2026­ MILWAUKEE COUNTY Draf 09/01/2026 A RE SOLUTION AUTHORIZING FRANKLIN DIRE CTOR OF HEALTH AND HUMAN SERVICES TO ACCEPT AND EXECUTE THE GRANT AGREEMENT MODIFICATION FOR THE 2026 DPH LPHD CONSOLIDATED CONTRACT WHEREAS, The City of Franklin Health Department (FHD) focuses efforts on the ability to rapidly mobilize, surge, and respond to public health emergencies; and WHERE AS, the Wisconsin Department of Health Services Division of Public Health has awarded the Franklin Health Department grant awards to support the delivery of such services in 2026. NOW, THEREFORE , BE IT RESOLVED, by the Mayor and Comm on Council of the City of Franklin, Wisconsin, that the Grant Modification to the 2026 DPH LPHD Consolidated Contract, in the form and content as annexed hereto, be and the same is hereby approved. BE IT FURTHER RESOLVED, that the Franklin Director of Health and Human Services is hereby authorized to accept, execute and deliver such agreement. Introduced at a regular meeting of the Common Council of the City of Franklin this day of , 2026. Passed and adopted at a regular meeting of the Common Council of the City of Franklin this day of 2026. APPROVED: John R. Nelson, Mayor ATTEST: Shirley J. Roberts, City Clerk AYES NOES ABSENT DocusgnEnvelopeID.920FE000-30D0-8540-804C-5F768C937CA8 WisconsinDepartmentofHealthServices ContractCentralizationLegalReview Agreement Number: 435100-G26-DPHCC26-26M3 Bureau of Procurement and Contracting (BPC) Review: OTi s agreement requires StandardOLC review. OTi s agreement uses a BPC template with Office of Legal Counsel (OLC) approved language and requires SimpleOLC review. QT is agreement uses a BPC template with Office of Legal Counsel (OLC) approved language and does notrequire AdditionalOLC review. OT s agreement uses intergovernmental cooperative purchasing. Description; NIA Office of Legal Counsel (OLC) Review and Approval: [l This agreement has been reviewed for form and app roved by the Wisconsin Department of Health Services Office of Legal Counsel. Name: Title: Date Signed Revision: 02/2112025 (previous versions obsolete) DocusgnEnvelopeID:920FE000-30D0-8540-80A4C-5F768C937CA8 GRANTAGREEMENTMODIFICATION betweenthe STATEOFWISCONSINDEPARTMENTOFHEALTHSERVICES And FranklinHD for 2026DPHLPHDConsolidatedContract OHS Grant Agreement No.: 435100-G26-DPHCC26-26 M3 Agreement Amount: $55,880 Agreement Term Period: 10/1/2025 to 9/30/2027 GEARS Pre-Packet No: 5322 Grantee Grant Administrator: Ellen Henry Grantee Address: 9229 W LOOMJS RD, FRA NKL IN , WI, 531329728 Grantee Email: ehenry@franklinwi.gov Modification Description: We are adding funding for the Public Health Emergency Preparedness (PHEP) Program (Profiles 155015 and 155190). Please see attached scope of work. Final reports are due 45 days from the end of the designated contract period for any included profiles. This is a Modification of an existing Agreement, as specified above. This Modification of Agreement encompasses both Amendments and Addendums to an existing Grant Agreement. This Modification is entered into by and between the State of Wisconsin Depart ment of Health Services (OHS) and the Grantee listed above. With the exception of the terms being modified by this Grant Agreement Modification, ALL OTHER TERMS AND CONDITIONS OF THE EXISTING AGREEMENT, INCLUDING FUNDING, REMAIN IN FULL FORCE AND EFFECT. This Modification, including any and all attachments herein and the existing agreement, collectively, are the complete agreement of the parties and supersede any prior agreements or representations. OHS and the Grantee acknowledge that they have read the Modification and understand and agree to be bound by the terms and conditions of the existing agreement as modified by this action. This Modification becomes null 'and void if the time between the earlier dated signature and the later dated signature exceeds sixty (60) days, unless waived by OHS. OHS Division: Division of Public Health OHS Grant Administrator: Anna Benton DH S Email: DHSGACMail@ dhs.w isconsin.gov StateofWisconsin DepartmentofHealthServices Authonzed Representative Name Title Signature Date Grantee Entity Name Author1zed Representative Name Ellen Henry Title Interim Health Officer Signature Date Page 1 of 4 Template Revision: 03/02/2026 (previous templates no longer usable) DocusignEnvelope ID'920FE000-30D0-8540-804C-5F768C937CA8 CIVILRIGHTSCOMPLIANCEATTACHMENT TheWisconsinDepartmentofHealthServicesandGranteeagreetothebelowchangetotheagreement. Thebelowenumeratedagreementrevisionisherebyincorporatedbyreferenceintotheagreementandis enforceableasifrestatedthereininitsentirety. Section10oftheAgreement(CIVILRIGHTSCOMPLIANCE")isherebyamendedbyinsertingthe following: In accordance with the provisions of Section 1557 of the Patient Protection and Affordable Care Act of 2010 (42 U.S.C. § 18116), Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 701 et seq.), the Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.), and regulations implementing these Acts, found at 45 C.F.R. Parts 80, 84, and 91 and 92, the Grantee shall not exclude, deny benefits to, or otherwise discriminate against any person on the basis of sex, race, color, national origin, disability, or age in admission to, participation in, in aid of, or in receipt of services and benefits under any of its programs and activities, and in staff and employee assignments to patients, whether carried out by the Grantee directly or through a Sub-contractor or any other entity with which the Grantee arranges to carry out its programs and activities. In accordance with the provisions of Section 11 of the Food and Nutrition Act of 2008 (7 U.S.C. § 2020), the Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 701 et seq.), the Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq.), and Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq.), and the regulations implementing these Acts, found at 7 C.F.R. Parts 15, 15a, and 15b, and Part 16, 28 C.F.R. Part 35, and 45 C.F.R. Part 91, the Grantee shall not discriminate based on race, color, national origin, sex, religious creed, disability, age, or political beliefs or engage in reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by the United States Department of Agriculture. HIGH-RISKITREVIEW Pursuant to Wis. Stat. 16.973(13), Contractor is required to submit, via the contracting agency, to the Department of Administration for approval any order or amendment that would change the scope of the contract and have the effect of increasing the contract price. The Department of Administration shall be authorized to review the original contract and the order or amendment to determine whether the work proposed in the order or amendment is within the scope of the original contract and whether the work proposed in the order or amendment is necessary. The Department of Administration may assist the contracting agency in negotiations regarding any change to the original contract price. Page 2 of 4 Template Revision: 03/02/2026 (previous templates no longer usable) DocusignEnvelopeID:920FE000-30D0-8540-80AC-5F768C937CA8 GEARSPAYMENTINFORMATION DHS GEARS STAFF INTERNAL USE ONLYGEARSPAYMENTINFORMATION The information below is used by the DHS Bureau of Fiscal Services, GEARS Unit, to facilitate the processing and recording of payments made under this Agreement. GEARS Contract year: 2027 Agency # : Agency Agency GEARS Contract GEARS Contract Program Total Contract: Name: Type: Start Date End Date 472787 FranklinHD 60 711/2026 6/30/2027 $55,880 Profile ProfileCurrent ProfileChange ProfileTotalProfileName ProfileNote FundingControlsID# Amount Amount Amount 155015 BIOT FOCUS - $40,322 $40,322 NIA A PLANNING 155190 BIOT - $15,558 $15,558 NIA PREPARE - CRI $55,880 Page 3 of 4 Template Revision: 03/02/2026 (previous templates no longer usable) Docusign EnvelopeID'920FE000-30D0-8540-80A4C-5F768C937CA8 GEARSFEDERALAWARDINFORMATION DHSProfileNumber 155015 155190 FAIN NU90TU000048 NU90TU000048 FederalAwardDate 7/9/2026 7/9/2026 Sub-awardperiodof 7/1/2026 7/1/2026PerformanceStartDate Sub-awardperiodof 6/30/2027 6/30/2027PerformanceEndDate AmountofFederalFunds $40,322 $15,558obligatedinthesubaward TotalAmountofFederal $40,322 $15,558Fundsobligated FederalAwardProject To enhanceWisconsin'sabilityto rapidly ToenhanceWisconsin'sabilityto rapidly mobilize, surge, and respond to publichealth mobilize, surge, and respondto publicDescription emergenciesidentified by CDC. healthemergenciesidentified by CDC. FederalAwardingAgency DHHS-Centersfor Disease Control and DHHS-Centersfor DiseaseControl and Name(Department) Prevention Prevention DHSAwardingOfficial DebraK.Standridge DebraK.StandridgeName DHSAwardingOfficial 608-266-9622 608-266-9622ContactInformation AssistanceListingsNumber 93.069 93.069 AssistanceListingsName Public Health Emergency Preparedness Public Health Emergency Preparedness Totalmadeavailableunder eachFederalawardatthe $11,771,867 $11,771,867 timeofdisbursement R&D? No No Indirect Cost Rate 6.7% 6.7% Page 4 of 4 Template Revision: 03/02/2026 (previous templates no longer usable) Docusign Envelope JD·920FE000-30D0-8540-80AC-5F768C937CA8 Ag wI sCONSIN DEPARTMENT %a erEA T sERv c s WisconsinDepartmentofHealthServices DivisionofPublicHealth for PublicHealthEmergencyPreparedness(PHEP)Program t'"'l•~ Q ,.,.ll',, 4"'""" ' ""'-' ;;;.;. :z'l!N "- "'~ ~:J\"1,!"-,~ U -u;,\,hiOi;Wa = il' ,:;.,= '"'~ ~,,; :;,;;& ~l \).:~'>Ji/;;;;.\'S/:I,.== J!I.J, e.~ ~ ,.,,.,¼1~ ~ \,H\h ¾ ~ :ik~ \l ,. ~ ~ """'"' ~:;;;.,"%_,isJf;;;,,,c~;.¾ '-" i'''' "" "~ ~ ,-,,~~i<)l;,t;~ ,.,;,;a;sl ,I SCOPE OF WORK (GRANT VIA GEARS) ? ,hi«ieeiiitr,iii e re-egemere . znee. erere msmse e s ergeseggame mere3mp/moper%2er.grpe e. mseme ns9egerm9me9g ee 9gm.. g22299me 0geog sa gerwerowore eA/gee , g eeg M A. OVERVIEW Public Health Emergency Preparedness Program: (PHEP) Program Period of Performance: July 1, 2026 to June 30, 2027 GEARS Contract Year: 2027 Profile(s): 155015 B. BA CKGR OUND AND/ OR CONTEXT The mission of the Wisconsin Depart ment of Health Services is to protect and promote the health and safety of the people of Wisconsin. The Public Health Emergency Preparedness (PHEP) Program aims to strengthen the capacity and capability of the public health system to prepare for, respond to, and recover from public health threats and emergencies. The intent of this funding is to create and maintain an excellent system of public health preparedness at the state and local levels with the continued purpose of strengthening and enhancing the capabilities of state and public health systems to mitigate the loss of life and reduce the threats to community health and safety utilizing the Centers for Disease Control and Prevention's (CDC) Response Readiness Framework and the Public Health Emergency Preparedness and Response Capabilities. C. COMMUNICATION S It is the responsibility of the Grantee to provide this Scope of Work document to appropriate agency staff responsible for programmatic and financial reporting requirements. The expectation is a minimum of annualcommunications between DHS and the Grantee. DHS DocusignEnvelopeID:920FE000-30D0-8540-804C-5F768C937CA8 SA9 w1sCONSINDEPARTMENT %a EAITs ERvcEs reserves the right to request more frequent communications as deemed necessary. Communications may include but are not limited to: Email providing or requesting infonnation. Programmatic or contractual meetings. - Reporting including status updates and the submission of GEARS expense reports. D. POINTS OF CONTACT The Grantee is responsible for notifying DHS at DHSPHEP@dhs.wisconsin.gov if there are any changes in contact information within ten (10) business days. I. TABLE 1: DPH CONTACT AND ROLE FullName,EmailandPhoneNumber Role Jaime Niedermeier, Program Contact jaime.niedermeier@dhs.wisconsin.gov Ramona Baldoni-Lake, Contract Manager Ramona.baldonilake@dhs.wisconsin.gov Jessica Kessler, Fiscal Contact Jessica.kessler@dhs.wisconsin.gov DHSPHEP@dhs.wisconsin.gov Other (specify): Program Inquiries E. GEAR S EXPENSE REPORT(S) AND PAYMENT SCHEDULE The funds will be reimbursed through the Grant Enrollment, Application and Reporting System (GEARS). GEARS expenses must be submitted as actual monthly expenses (either paid or incurred) and these expenses must align with the approved budget and terms and conditions of this Agreement/Contract. GEARSExpenseReport(s)andPaymentSchedule: Grantee must report costs incurred on the GEARS Expenditure Report Form (f-00642) and submit the GEARS Expenditure Report by the 15thof the month via email to the GEARS Unit (dhs600RCars@dhs.wisconsin.gov). The GEARS Unit is responsible for issuing payment. The DHS program staff are responsible for ensuring claimed expenses are allowable and agree with approved budgets and scopes of work. Final GEARS Expense Reports are due by 8/15/2027,which is 45daysfrom the end of the contract period. Failure to follow the GEARS Expense Report(s) and Payment Schedule could result in a dispute(s) whereby OHS can delay or deny payment(s). Reference the GEARS Payment Processing Schedule 2 DocusignEnvelopeID:920FE000-30D0-8540-804C-5F768C937CA8 A9 WISCONSINDEPARTMENT Va9 orrAa r sERvcs and further guidance on How to Submit GEARS Expenditure Reports. Direct any questions related to the technical aspects of expenditure report processing, monthly payment reports, and reimbursements can email DHSDESBFSGEARS@dhs.wisconsin.gov. Direct all other questions regarding expense reports to the OHS program area (DHSPHEP@dhs.wisconsin.gov). F. 1. REP OR TING REQU IR EMENT S FINANCIAL REPORTING Mid-year and final grant expenditures must be reported to OHS through the DPH Application and Reporting Tool (DART). A report of mid-year expenditures (July I-December 31, 2026) is due January15,2027,and a report of final expenditures (through June 30, 2027) is due August15, 2027.Please see the Local Preparedness Budget Management page on the PCA Portal for more details and a link to the PHEP Fiscal Report (to be posted by September 30, 2026). Additional financial reporting must be provided by the Grantee upon request by OHS. This may include (but not limited to) expenses associated with salaries, supplies, travel, contractual, or other (including copies of receipts documenting the purchase of specific items and timesheets for salaries). 2. PROGRAMMATI C REPORTING Anannualcontractdeliverablereportingsurveyis required on or before the agreement period ends. Grantees are required to quantitatively and qualitatively document program deliverables and provide a written statement through the reports. Grantee will be provided report forms and deadlines from the DHS program area via the PCA Port al. Direct all questions regarding reports to the DHS program area (DHSPHEP@dhs.wisconsin.gov). Failure to meet a reporting requirement(s) can result in a dispute(s) for noncompliance, default, and/or breach of the agreement terms and conditions. G. UN ALLOWABLE COSTS GeneralRestrictions • Recipients may not use funds for research. • Recipients may not use funds for clinical care except as allowed by law. • Recipients may use funds only for reasonable program purposes including personnel, travel, supplies, and services. • Generally, recipients may not use funds to purchase furniture or equipment. Any such proposed spendingmust be clearly identified in the budget. 3 DocusgnEnvelopeID:920FE0O0-30D0-8540-80A4C-5F768C937CA8 [A w sCONSIN DEPARTMENT %a" rAL r sERv cEs • Reimbursement of pre-award costs generally is not allowed, unless the CDC provides written approval to the recipient. • Other than for normal and recognized executive-legislative relationships, no funds may be used for: o Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body. o Using the salary or expenses of any grant or contract recipient, or agent acting for such recipient, for any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body. • See additional requirement (AR) 12 for detailed guidance on this prohibition and additional guidance on lobbying for CDC recipients. • The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an award to another party or provider who is ineligible. • In accordance with the United States Protecting Life in Global Health Assistance policy, all non­ governmental organization (NGO) applicants acknowledge that foreign NGOs that receive funds provided through this award, either as a prime recipient or subrecipient, are strictly prohibited, regardless of the source of funds, from performing abortions as a method of family planning or engaging in any activity that promotes abortion as a method of family planning, or to provide financial support to any other foreign non-governmental organization that conducts such activities. See AR 35 for applicability. • Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. • Payment or reimbursement of backfilling costs for staff is not allowed. • None of the funds awarded to these programs may be used to pay the salary of an individual at a rate in excess of executive level II or $228,000 per year. • Funds may not be used to purchase or support (feed) animals for labs, including mice. • Funds may not be used to purchase a house or other living quarters for those under quarantine. Rental may be allowed with approval from CDC Office of Grants Services. • Funds may not be used to purchase gift cards. Supplanting Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. Federal law prohibits recipients of federal funds from replacing state, local, or agency funds with federal funds. For example, funds may not be used to cover positions and other expenditures already fundedby other sources. PersonnelCosts Recipients may (with prior approval) use funds for overtime for individuals directly associated (listed 4 Docusign Envelope ID:920FE000-30D0-8540-80AC-5F768C937CA8 A wI sCONSIN DEPARTMENT %a orEA rn sERv cEs in personnel costs) with the award with prior approval from CDC Office of Grants Services. Travel Travel or conferences not specific to public health emergency preparedness are not allowed. All travel costs must be reimbursed following State of Wisconsin travel guidelines. Lobbying Other than for normal and recognized executive-legislative relationships, PHEP funds may not be used for: • Publicity or propaganda purposes, for the preparation, distribution, or use of any material designed tosupport or defeat the enactment of legislation before any legislative body. • The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body. See AR 12 for detailed guidance on this prohibition and additional guidance on lobbying for CDC recipients. ConstructionandMajorRenovations Recipients may not use funds for construction or major renovations. Generally, recipients may not use funds to purchase furniture or equipment. Any such proposed spendingmust be clearly justified in the budget. PassengerRoadVehicles • Funds cannot be used to purchase over-the-road passenger vehicles. • Funds cannot be used to purchase vehicles to be used as means of transportation for carrying people or goods, such as passenger cars or trucks, and electrical or gas-driven motorized carts. • Recipients can (with prior approval) use funds to lease vehicles to be used as means of transportation for carrying people or goods, for example, passenger cars or trucks and electrical or gas-driven motorized carts during times of need. • Additionally, PHEP grant funds can (with prior approval) be used to make transportation agreements with commercial carriers for movement of materials, supplies, and equipment. There should be a written process for initiating transportation agreements (such as contracts, memoranda of understanding, formal written agreements, and/or other letters of agreement). Transportation agreements should include, at a minimum: o Type of vendor o Number and type of vehicles, including vehicle load capacity and configuration o Number and type of drivers, including certification of drivers o Number and type of support personnel o Vendor's response time 5 Docusign Envelope ID:920FE000-30D0-8540-80AC-5F768C937CA8 'A wIsCONSINDEPARTMENT %aerHEA TH sERv1cEs o Vendor's ability to maintain cold chain, if necessary to the incident o This relationship may be demonstrated by a signed transportation agreement or documentation of transportation planning meeting with the designated vendor. All documentation should be available to the CDC project officer for review if requested. TransportationofMedicalMaterial • Funds can (with prior approval) be used to procure leased or rental vehicles for movement of materials, supplies, and equipment. • Recipients can (with prior approval) use funds to purchase material-handling equipment (MHE) such asindustrial or warehouse-use trucks to move materials, such as forklifts, lift trucks, turret trucks, etc. Vehicles must be of a type not licensed to travel on public roads. • Recipients may purchase basic (non-motorized) trailers with prior approval from CDC Office of Grants Services. ProcurementofFoodandClothing • Funds may not be used to purchase clothing such as jeans, cargo pants, polo shirts, jumpsuits, sweatshirts, or T-shirts. • Purchase of vests (or similar items) that may be used multiple times by numerous individuals and to beworn during exercises or responses may be allowed. • Generally, funds may not be used to purchase food. However, under limited circumstances and with prior approval from OPEHC, funds may be allowed for the purchase of food following current state and federal government guidelines. Note:In the event prior approval has been obtained to purchase food, recipients are required to maintain an agenda and a meal sign-in sheet at the local level for auditing purposes. See 45 CFR 75.432 for additional information. Vaccines • PHEP recipients can, with prior CDC approval, use funds to purchase caches of antibiotics for use by public health responders and their households to ensure the health and safety of the public health workforceduring an emergency response, or an exercise to test response plans. Funds may not be used to supplant other funding intended to achieve this objective. • PHEP recipients can, with prior CDC approval, use funds to purchase caches of vaccines for public health responders and their households to ensure the health and safety of the public health workforce. • PHEP recipients can, with prior CDC approval, use funds to purchase caches of vaccines for select critical workforce groups to ensure their health and safety during an exercise testing response plans. o Recipients must document in their submitted exercise plans the use of vaccines for select critical workforce personnel before CDC will approve the vaccine purchase. 6 Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 09 WISCONSINDEPARTMENT %a rArrs ERvc s • Recipients may not use PHEP funds to supplant other funding intended to achieve these objectives. • Recipients of PHEP-funded vaccines (within the context of the exercise) may include: o Persons who meet the criteria in the CDC Advisory Committee on Immunization Practices (CDC/ACIP) recommendations for who should receive vaccine; and o Persons who are not eligible to receive the vaccine through other entitlement programs such as Medicare, Medicaid, or the Vaccines for Children (VFC) program. ■ VFC-eligible children or Medicare beneficiaries may participate in the exercise; however, they should be vaccinated with vaccine purchased from the appropriate funding source. • PHEP funds may not be used to purchase vaccines for seasonal influenza mass vaccination clinics orother routine vaccinations covered by Advisory Committee on Immunization Practices (ACIP) schedules. • PHEP funds may not be used to purchase influenza vaccines for the general public. Recipients may not use funds for clinical care except as allowed by law. Per the PHEP Notice of Funding Opportunity, clinical care is defined as "directly managing the medical care and treatment of individual patients." PHEP-funded staff may administer medical countermeasures (MCMs), such as antibiotics or vaccines, as a public health intervention in the context of an emergency response or an exercise to test response plans. CDC does not consider this clinical care since it is not specific to an emergency response or an exercise to test response plans. LaboratorySupplies Instruments, reagents, and supplies for the following are not generally purchased with PHEP funding: • Instruments, reagents, and supplies for testing seasonal influenza; • Instruments, reagents, and supplies for testing rabies; • Instruments, reagents, and supplies for routine food testing (surveillance); • Instruments, reagents, and supplies for testing vaccine preventable diseases (such as measles or mumps); • Instruments, reagents, and supplies for routine testing of vector-borne illnesses (both clinical and vector surveillance); • Routine drug screening of laboratory staff; and • Influenza vaccines (for the general public). AdvertisingandPublicRelations,Supplies,Meetings,PromotionalItemsandMemorabilia See: Federal Regulation Codes under section 200.421: PART 200- Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards a) The term "advertising costs" means the costs of advertising media and corollary administrative costs. Advertising media includes magazines, newspapers, radio and television, direct mail, exhibits, electronic or computer transmittals, and the like. b) The only allowable advertising costs are those which are solely for: 7 Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 9 WISCONSIN DEPARTMENT %aorAr r sER1 cEs (i) The recruitment of personnel required by the non-federal entity for performance of a federal award (See also §200.463 Recruiting costs). (ii) The procurement of goods and services for the performance of a federal award. (iii) The disposal of scrap or surplus materials acquired in the performance of a federal award except when non-federal entities are reimbursed for disposal costs at a predetermined amount. (iv) Program outreach and other specific purposes necessary to meet the requirements of the federal award. c) The term "public relations" includes community relations and means those activities dedicated to maintaining the image of the non-federal entity or maintaining or promoting understanding and favorable relations with the community or public at large or any segment of the public. d) The only allowable public relations costs are: (i) Costs specifically required by the federal award. (ii) Costs of communicating with the public and press pertaining to specific activities or accomplishments which result from performance of the federal award (these costs are considered necessary as part of the outreach effort for the federal award). (iii) Costs of conducting general liaison efforts with news media and government public relations officers, to the extent that such activities are limited to communication and liaison necessary to keep the public informed on matters of public concern, such as notices of funding opportunities, financial matters, etc. e) Unallowable advertising and public relations costs include the following: (i) All advertising and public relations costs other than as specified in paragraphs (b) and (d) of this section. (ii) Costs of meetings, conventions, convocations, or other events related to other activities of theentity (see also §200.432 Conferences), including: 1) Costs of displays, demonstrations, and exhibits. 2) Costs of meeting rooms, hospitality suites, and other special facilities used in conjunction with shows and other special events. 3) Salaries and wages of employees engaged in setting up and displaying exhibits, making demonstrations, and providing briefings. (iii) Costs of promotional items and memorabilia, including models, gifts, and souvenirs. (iv) Costs of advertising and public relations designed solely to promote the non-federal entity. Direct all questions regarding eligible expenses to the DHS program area (DHSPHEP@dhs.wisconsin.gov). H. BUDGET MANAGEMENT Cost deviation or change from approved budget categories more than 25%,or the addition of a new line item, will require submission of a new budget and will require revised budget approval 8 DocusignEnvelopeID:920FE000-30D0-8540-80AC-5F7680937CA8 PA wI SCONSIN DEPARTMENT %a"rrAr s Ev cEs from DHS prior to incurring costs. The DHS may proactively recommend a revision should spenddown tracking suggest the need to redistribute remaining funds. Grantee must receive prior approval from the DHS Contract Administrator for any equipment purchases using state or federal funds that exceed $10,000 per Uniform Guidance (2 CFR 200.439). Direct all questions regarding budget management or equipment purchases to the DHS program area (DHSPHEP@dhs.wisconsin.gov). I. DPH APPLICATI ON AND REPORTING TOOL (DART) DHS is implementing a new system, the Division of Public Health Application and Reporting Tool (DART) during this period of performance. Upon implementation, if applicable, the Grantee agrees to participate in system transition activities, including signing up for a MyWisconsin ID, requesting access to the DART system, and participation in training activities. The Grantee may be required to submit reports or forms, enter data, and/or provide supporting documentation through the new system. The Grantee agrees to participate in revised submission procedures and other activities through the DART system upon notification. K. ADDITI ONAL INFORMATION AND/OR REQUIREMENTS Deadlines/ImportantDates • January 15, 2027 - Mid-year fiscal report for PHEP BP3 expenses due • May 15, 2027 - Deadline to submit requests for budget revision for PHEP BP3 • August 15, 2027 - Deadline to submit final GEARS Expense Reports for PHEP BP3 • August 15, 2027- Final fiscal report for PHEP BP3 expenses due L. PR OJECT DELIVERABLES The Wisconsin Department of Health Services (DHS) has established objectives and deliverables for completion by local and Tribal public health agencies (LTPHA's) during the budget period from July 1, 2024, to June 30, 2029, with a goal of ensuring Wisconsin local and Tribal public health agencies are response ready. These contract deliverables are described in Addendum A. 9 Docusign EnvelopeID:920FE000-30D0-8540-80A4C-5F768C937CA8 Local and Tribal PublicHealth Emergency PreparednessContract Objectives Centersfor Disease Control and Prevention (CDC)Cooperative Agreement #CDC-RFA-TU24-0137 Budget Period:July 1, 2026 - June 30, 2027 *Note:This document includesallcontract deliverablesforafive-yearcooperativeagreementperiod (7/1/2024- 6/30/2029).Some deliverablesarerequired annually, while othershave the expecteddue dateforeachbudget period.Nochangeshave beenmade tothe contract deliverablesforBudget Period 3. Pleasesend anyquestions regarding Contract Objectives tothe OHSPHEPprogram at DHSPHEP@dhs.wisconsin.gov. The Wisconsin Department of HealthServices{OHS) hasestablishedthefollowingobjectivesand deliverablesforcompletion by local andTribal publichealth agencies(LTPHA's)duringthe budget period from July 1, 2024,toJune30, 2029,with agoalof ensuringWisconsin local andTribal publichealth agenciesare response ready. Theseobjectivesarebased on CDC's2024 ReadinessResponseFrameworkand aresupported bythe Public Health EmergencyPreparednessand ResponseCapabilities,whichCDCreleased in2018and updated in 2019.In addition,theseobjectivesarewritten,toalignwithCDC'sPublicHealth Emergency PreparednessPHEPCooperativeAgreement. Duringthisbudget period, OHSanticipatesthat LTPHAswill continueto use a"wholecommunity" approachasdefined by FEMA.A"wholecommunity" approach isthe ideathat preparednessisashared responsibility that must includethefull rangeof preparednessstakeholders, includingnot just government, but also individualsandfamilies(includingthosewith accessandfunctional needs), businesses, community organizations, schools, nonprofits, mediaoutlets, and more. Planningfor awholecommunityshould addresshealthequity issuesby consideringindividualswith accessand functional needs. PerCDC'sAccessand Functional NeedsToolkit (March2021),Theterm "accessand functional needs" refersto individualswithand without disabilities,who mayneed additional assistancebecause of any condition (temporaryor permanent)that may limit their abilityto act in anemergency.Individualswith accessandfunctional needsdo not requireany kindof diagnosisor specificevaluation. Populationswith accessandfunctional needsmay include but arenot limitedto: • Childrenand youth • Individualswith chronicdiseasesor underlyingconditions • Individualswithcognitive impairment • Individualswith developmentaldisabilities • Individualswith hearingimpairment • Individualsexperiencing homelessnessor housing instability • Individualswith language barriersand/or limited English proficiency • Marginalized populationsexperiencingsocial, political, or economicexclusions,suchaspeople living in poverty,peopleexperiencing racism,or peoplewho areundocumented • Older population • Individualswith limitedaccesstotransportation • Individualswith limitedaccesstothe internet or Wi-Fi 1]P ag e DocusignEnvelopeID:920FE000-30D0-8540-804C-5F768C937CA8 • Underservedcommunities,suchasruralor uninsured/underinsured communities • Individualswithvisual impairment • Peoplewho arepregnant Using PHEPFundsfor Response PHEPcooperativeagreement funding isintended primarilytosupport preparednessactivitiesthat help ensurestateand local publichealth departmentsareresponse ready.PHEPfundsmay,onalimited, case-by-case basis, beusedtosupport responseactivitiestotheextent theyareusedfortheir primary purposes:tostrengthen publichealth preparednessand enhancethe capabilitiesof state, local, and Tribal governmentsto respondto public healththreats. LTPHAsmust receive priorapprovalfrom the Wisconsin PHEPprogram for any proposed responseactivities. Joint PHEP/HPP/Emergency Management Activities Objectivesthat alignwith program requirementsasset forth bytheCDCPHEPprogram andtheAssistant Secretaryfor Preparednessand Response (ASPR)Hospital PreparednessProgram (HPP)areindicated asa '(Joint PHEP/HPPActivity)'.TheWisconsin PHEPprogram recommendsthat LTPHAscoordinatewiththeir regional HealthcareEmergency ReadinessCoalition (HERC)and emergency management partnerson theseactivities. Required Reporting Annualyear-end reportingonall contract deliverablesisdueJune30 " eachyear of the5-year cooperativeagreement. Required reportingwill beaccessedviathe Partner Communicationsand Alerting (PCA)Portalonceavailable.Additional information about year-end reportingwill be communicatedto localandTribal preparednessstaff throughout the budget periodsviaemail communicationsand PHEPQ&A(QuestionsandAnswers)webinars. Local andTribal preparednessstaff shouldsignupto receivePublic Health EmergencyPreparednessemailcommunicationsifthey havenot already. Budget Management All LTPHAswill submit aproposed budget to DHSusingthe PHEPand CRIBudget Template.All LTPHAs will report mid-year andfinal expendituresbythe deadlinesbelow.Budgetsand fiscal reportswillbe submitted viathe DPHApplicationand ReportingTool (DART),withspecificinstructionspostedonthe PCAPortal Local Budget Management page.Torequest accesstothe PCAPortal, pleasecontact DHSPCAPortal@dhs.wisconsin.gov. Deliverable Number Due Date Objective Deliverable 1 ByJune30,eachyearof the 5­ Submit the PHEPproposed budget year cooperativeagreement Deliverable 2 ByJanuary 15, eachyearof Submit mid-year PHEPexpenditures the 5-year cooperative agreement (beginningin BP3) 2] Page DocusgnEnvelope ID:920FE000-30D0-8540-80A4C-5F768C937CA8 ByAugust 15, eachyear ofthe Submit final PHEPexpenditures 5-yearcooperativeagreement Strategy1--All-h azardactivities strategy 1 encompassesthefollowing Response ReadinessFrameworkprogram priorities. • Developarisk-based approachto all-hazardsplanningto advance risk-based planning;address evolvingthreats; and support medical countermeasuredistribution, dispensing,and administration and medicalmateriel management. • Modernize data collectionand systemsto improvesituational awarenessand information sharingwithhealthcaresystemsand other partners. • Integrate healthequity practicestoenhancepreparedness, response, and recoverysupport for populationsexperiencing healthdisparities. Risk-BasedApproachtoAll Hazard Planning(AHA) Public Health Response Readiness Framework- Priority 1. Prioritize arisk-based approach (AHA-A) • Capability 1:CommunityPreparedness • Capability3: EmergencyOperationsCoordination • Capability 13: Public HealthSurveillanceand Epidemiological Investigation Whensubmittingthe riskassessment (RA)or HazardVulnerabilityAssessment (HVA), identifythetop fiverisksbased on public healthconsequencesand report thefollowingRiskAssessment DataElements (RADE): • Participantsinvolved intheassessment, • Identified risks, • Arankingof thetopfiverisks(new), • Publichealthconsequencesof the risksdescribingthevulnerabilitiesassociatedwith prioritized risks(new), • Resourcesusedto conduct the riskassessments,suchasCDC'sSocialVulnerability Index,CDC PLACES,or HHSemPOWERdata(new), and • Identified expertiseto provide consultation duringapublichealth emergency associatedwith prioritized risks(new). Deliverable Number Due Date Objective Deliverable3 January31, 2025 Conduct ariskassessment (RA)or Hazard VulnerabilityAssessment (HVA)and identify thetopfiverisksbased on publichealth consequences. If your most recent RA 3[ Page Docusign Envelope ID:920FE000-30D0-8540-80AC-5F768C937CA8 occurred in Budget Periods2,3,4, or5 of the previousNOFO performance period, submit that RA alongwiththe riskassessment data elements(RADE) based on elements addressed at that time. Onceinthe5-year Completeandsubmit anew RA/HVAonce performanceperiod duringthefive-year performance period on the PCAPortal and includeRADE Ensure baseline competency and integration with preparedness requirements- Priority 1. Prioritize arisk-based approach (AHA-G) It isrecommended by CDCthat PublicHealth preparednessand recoverystaff shouldstrivetocomplete the courseworkbelow basedontheir preparednessand response rolesand positions. • Publichealthpreparednessand recoverystaff,includingexercise planningstaff: o Independent Study (IS)100:Introductiontothe Incident Command System o IS200: BasicIncident CommandSystemfor Initial Response(ICS200) o IS700:An Introductiontothe National Incident Management System (NIMS) o ICS706: NIMSIntrastateMutualAid o IS800: National Response Framework,An Introduction o IS-2900.A: National Disaster Recovery Framework(NDRF)Overview o IS-120:an Introductionto Exercise o HomelandSecurity Exercise and Evaluation Program o Emergency Management AssistanceCompact (EMAC)Pre-Event Preparationfor Resource Providers • Health Department supervisory positions: o ICS200:BasicICSfor Initial Response o Independent Study (IS)-2200: BasicEmergencyOperationsCenter Functions • Staff withdesignated response roles: o ICS300:IntermediateICSfor ExpandingIncidents(In Person) o EMACJust-in-TimeTrainingfor Deploying Personnel o Crisisand Emergency RiskCommunication (RISKCOMMUNICATIONPLAN) • Seniorstaff whosupport the management of large/complex responses(incidentsacrossmultiple locationsor over alargearea): o O ICS400:Advanced ICS(In Person) Deliverable Number Due Date Objective Deliverable4 New staff: At aminimum public healthstaff should have Withinthefirst yearof hire successfully completed: IS-100, IS-200, IS-700, IS-800 Current staff: Ensurecurrent staff areproficient withthe Maintain duringthe5-year most recent FEMAcourseversionavailable performanceperiod for IS-100, IS-200, IS-700, IS-800 4] Page Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 Data Modernization {OM} Public Health Response Readiness Framework- Priority 6. Modernizedatacollection and systems (DM-A), (DM-B) • Capability3: EmergencyOperationsCoordination • Capability 13: Public HealthSurveillanceand Epidemiological Investigation Incorporatedatasystemsand datasourcefunctionality and infrastructurein publichealthemergency response plansandtestingof thefunctionalityof thosesystems. Deliverable Number Due Date Objective Deliverable5 June 30, 2026 Identifythe resourcesand infrastructure necessaryfor datasystemsandsourcesto meetjurisdictional needsduringan emergency responseand include in emergencyplans Deliverable6 June30, 2027 Prioritize improvingdatasystemsand data sourcesthat arethe most essentialfor effective response. Health Equity (HE) Public Health Response Readiness Framework- Priority 8. Incorporate health equity practices (HE-A) • Capability 1:Community Preparedness • Capability2:Community Recovery • Capability4: Emergency Public InformationandWarning • Capability7: MassCare Ensureriskassessmentsinclude relevant input from partnerstoensurethey reflect healthequity. Consider disproportionally impacted populationsorcommunity'sprojectedto beadversely impacted by the publichealthconsequenceof risks. Include populationswith limited English proficiencyand consider how social determinantsof health may affect healthoutcomesduringan emergency. Deliverable Number Due Date Objective Deliverable7 Overthe5-year performance Identify impacted communitiesand period implement actionsto understand how public healthemergency response plansand exercisescan be developedor updatedto addressunique preparedness, response, and recovery needsof thecommunities 5[ Page Docusign Envelope ID' 920FE0O0-30D0-8540-80AC-5F768C937CA8 Strategy2- WholeCommunityReadiness Strategy2encompassesthefollowingResponse ReadinessFrameworkprogram priorities: • Enhance partnershipswithfederal and non-governmental organizationstoeffectivelysupport community preparednessefforts • Strengthen riskcommunication activitiesto improveproficiency indisseminatingcritical public health informationandwarningsand addressmisinformation or disinformation • Prioritize community recoveryeffortstosupport healthdepartment reconstitutionand incorporate lessonslearnedfrom public healthemergency responses • Integrate healthequity practicesto enhance preparedness, response, and recoverysupport for communitiesexperiencingdifferencesin healthstatusdueto structural barriers Partnerships(PAR) PublicHealthResponseReadinessFramework- Priority2. Enhance Partnerships(PAR-A) • Capability 2:Community Recovery • Capability6:InformationSharing Includecritical responseand recovery partnersin required plansand exercises. Deliverable Number Due Date Objective Deliverable8 Overthe 5-year performance Continually assessyour abilitytoaddressthe period unique needsor community members throughout exercises Maintain response affiliationswith private industrypartnersincluding, but not limited to, largeemployers, pharmacies, academia, and others Maintain involvement in regional HERC ByJune30" eachyear of the Ensurethat yourorganization hasat least 5-year performance period threestaff with profilesand emergencycall rankingonthe PCA Portal and review accuracy It isstronglyencouragedtoincludeyourlocal healthofficerorTribalhealthdirectorasone of these contacts. Annually duringthe 5-year At minimum one representativefromyour performanceperiod organizationwill haveattendedorwatched the recordingof all coordinationcallswith VoluntaryOrganizationsActiveinDisaster (VOAD) partnersthat occurredduringthe budget period Annually duringthe5-year MaintainjurisdictionalWisconsin Emergency performanceperiod AssistanceVolunteer Registry(WEAVR) administrator contact information 6[ Page DocusignEnvelopeID:920FE000-30D0-8540-80AC-5F768C937CA8 Risk Communications (RSK) Public Health Response Readiness Framework- Priority 7. Strengthen risk communications activities(RSK-A) • Capability 1Community Preparedness • Capability2Community Recovery • Capability8MedicalCountermeasureDispensingandAdministration • Capability9Medical Materiel Management and Distribution Timelycommunicationof situational awarenessand risk information. DeliverableNumber DueDate Objective Deliverable9 Overthe5-year performance Incorporatelessonslearnedfrom exercises period and responsesinto riskcommunicationsand informationdissemination plans. Incorporatestrategiesto monitorand combat misinformation and disinformation into risk communication and information dissemination plans. Deliverable 10 Review Annually Maintainthecapacityand capabilityto manage, distribute, dispense,and administer medical countermeasuresaccordingtothe AdministrationforStrategicPreparedness and Response/ StrategicNationalStockpile requirementsand guidelines.Updatemass dispensingand massvaccinationclinicsitesin the POD DVCManagement Tool onthePCA Portal. Onceannually overthe5­ Annually conduct at least onealertingdrill (or year performanceperiod utilizeWEAVRduringareal-worldevent)to alert registervolunteers Exercise Objective: All LTPHAswill participatein at least one Homeland Security Exerciseand Evaluation Program (HSEEP) consistent exercise in each budget periodthroughout BP1-5. Useof Incident CommandSystem (ICS)to managearealevent may beused in lieu of an exerciseaslongasan HSEEPconsistent AfterAction Report (AAR)/lmprovement Plan (IP)iscompleted.Not e: This AAR/ IP may f ocus on any one or multiple of the 15 public health emergency preparedness and response capabiliti es. LTPHAs can participate with their regional HERC in the development of an AAR. a.All LTPHAsthat receivestate-suppliedvaccineto conduct aschool-located massvaccination exerciseduringany budget period in BP1-5 must completean HSEEPconsistent AAR/IPof the exerciseusingthe Immunization Program Functional ExerciseAAR/IPtemplate.ThisAAR/IPwill satisfydeliverable 11. 7[ Page Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 For LTPHAsthat receive state-supplied vaccinetoconduct aschool-located massvaccinationexercise duringany budget period in BP1-5: Deliverable 11: ByApril30, post HSEEPconsistent AAR/IPtothe PCA PortalAfterAction Reportspage. LTPHAsthat participatedwiththeir regional HERCinthedevelopment of anAAR/IPshouldensurethat that their agency islisted asaparticipatingorganization inthe document andthat eitherthe regional HERCCoordinatoror arepresentativefrom one LTPHA inthe region haspostedtheAAR/IPtotheAfterAction Reportspage. For LTPHAssubmittingotherAARs: Deliverable 11: ByJune30,post HSEEPconsistent AAR/IPtothe PCA PortalAfterAction Reportspage. LTPHAsthat participatedwiththeir regional HERCinthedevelopment of anAAR/IPshouldensurethat that their agency islisted asaparticipatingorganizationinthe document andthat eitherthe regional HERCCoordinatoror arepresentativefrom one LTPHA inthe region haspostedtheAAR/IPtotheAfterAction Reportspage. Deliverable Number Due Date Objective Deliverable 11 Onceannually overthe5-year Homeland Security Exerciseand Evaluation performance period Program (HSEEP)compliant exercise Reporting requirement: Deliverable Number Due Date Objective Deliverable 12 ByApril 30 (if school-based Exercise afteraction reportsand vaccinationexercise)or by improvement plans(AAR/IP) uploadedto June30 (all other exercises) PCA Portal eachyear of the 5-year performanceperiod Risk Communications {RSK) Public Health Response Readiness Framework- Priority 7. Strengthen risk communicationsactivities(RSK-B) • Capability4: Emergency Public Information&Warning • Capability6: InformationSharing Identifyand implement communicationsurveillance, media relations, and digitalcommunication strategiesinexercises. Deliverable Number Due Date Objective Deliverable 13 Eachbudget periodoverthe Exercise riskcommunication plansand 5-year performanceperiod principlesto ensureriskcommunicationand staff activitiessimulateactionsthat will be taken duringan emergency. 8] Page Docusign EnvelopeID:920FE000-30D0-8540-80A4C-5F768C937CA8 Risk Communications (RSK) Public Health Response Readiness Framework- Priority 7. Strengthen risk communications activities(RSK-C) • Capability4:EmergencyPublic Information&Warning • Capability6: InformationSharing Identifyand implement specificcrisisand emergency riskcommunicationactivitiesthat meet thediverse needsof communitiesof focus DeliverableNumber DueDate Objective Deliverable 14 Review each budget period Use lessonslearnedfrom, mpox,and other and updateasneeded recent responsesor exercisesto identifyand addressgapsin riskcommunicationactivities that support communitiesof focus. Collaboratewith partnersthat represent prioritized populationsto developculturally, linguistically,and accessibleappropriaterisk messagesfor populationswithaccessneeds, functional needs, and healthdisparities. Recovery (REC) Public Health Response Readiness Framework- Priority 10. Prioritize community recovery efforts (REC-A) • Capability1:CommunityPreparedness • Capability2:Community Recovery Incorporate recoveryoperationsinto public health preparednessplans DeliverableNumber DueDate Objective Deliverable 15 ByJune30" eachyear of the Identifycommunity partnerswho aidin 5-year performance period recoveryand engageindiscussions regardingtheir potential rolesandtheir resources. 0 Identify rolesand responsibilitiesforstaff designatedtosupport recoveryoperations. Deliverable 16 ByJune30 eachyear of the Establish methodsfordetermining 5-year performance period community recoveryprioritiesand communicatingthestatusof recovery operationswith relevant partners, interested groups, andthe public. 9[ Page DocusgnEnvelopeID:920FE000-30D0-8540-80AC-5F768C937CA8 Health Equity (HE) PublicHealthResponseReadinessFramework- Priority8.Incorporatehealthequity practices(HE-B) • Capability 1:Community Preparedness Engage partnersto incorporatehealthequity principlesinto preparednessplansand exercises Deliverable Number Due Date Objective Deliverable 17 Review eachbudget period Engagecommunity or nontraditional and updateasneeded partners,suchasfaith-basedorganizations and privateindustry eachyeartosupport communitiesof focusidentified inthe RADE health equitysection. Strategy 3- lmproveCa pac..., strategy3encompassesthefollowing Response ReadinessFrameworkprogram priorities: • Build workforce capacityto meet jurisdictional surge management needsand support staff recruitment, retention, resilience, and mental health Workforce (WKF) PublicHealthResponseReadinessFramework Priority5. Buildworkforcecapacity (WKF-B) • Capability 1CommunityPreparedness • Capability14 ResponderSafetyand Health • Capability7:MassCare Provideguidance,direction, andtrainingto maintain aready responderworkforceacrosstheentire healthdepartment Deliverable Number Due Date Objective Deliverable 18 Review each budget period Include health department preparedness and updateasneeded staff and surgestaff outsidethe preparednessprogram whofill key incident command rolesin preparednesstrainingand periodic exercises. Primaryresponsestaff must participate in exercisesonarotational basisasdetermined bythe health department. 10] Page Docusign Envelope ID:920FE000-30D0-8540-80AC-5F768C937CA8 PHEP5-year Grant DeliverableOverview Deliverable Due Date Objective Number Deliverable 1 ByJune30,eachyear of the Submit the proposed budget 5-yearcooperative agreement Deliverable 2 ByJanuary 15,eachyear of Submit mid-year expenditures the5-year cooperative agreement (beginningin BP3) ByAugust 15, eachyearof Submit final expenditures the5-year cooperative agreement Deliverable3 January31, 2025 Conduct ariskassessment (RA)or Hazard VulnerabilityAssessment (HVA)and identifythe topfiverisksbasedon publichealth consequences. If your most recent RAoccurred in Budget Periods2,3,4, or 5 of the previous NOFO performance period, submit that RAalong withthe risk assessment data elements(RADE) based onelementsaddressed at that time. Onceinthe 5-year Completeand submit anew RA/HVAonceduring performance period thefive-year performanceperiodonthe PCA Portal and include RADE Deliverable4 New staff: At aminimum public healthstaff should have Withinthefirst year of hire successfully completed: IS-100,IS-200, IS-700, IS-800 Current staff: Ensurecurrent staff are proficient withthe most Maintain duringthe5-year recent FEMA courseversionavailablefor IS-100, performanceperiod IS-200, 1 -700, IS-800 Deliverable5 June30,2026 Identifythe resourcesand infrastructure necessaryfor datasystemsand sourcesto meet jurisdictional needsduringan emergency responseand include inemergency plans Deliverable 6 June30, 2027 Prioritizeimprovingdatasystemsand data sourcesthat arethe most essentialforeffective response. Deliverable7 Overthe5-year performance Identifyimpacted communitiesand implement period actionsto understand how publichealth emergency response plansandexercisescanbe developedor updatedtoaddressunique *Benchmark preparedness, response,and recoveryneedsof Activity the communities 11] Page DocusignEnvelopeID' 920FE000-30D0-8540-80AC-5F768C937CA8 Deliverable8 Overthe5-year performance Continually assessyour abilitytoaddressthe period unique needsor community members throughout exercises Maintain responseaffiliationswithprivate industry partnersincluding, but not limitedto, largeemployers, pharmacies,academia,and *Benchmark others Activity Maintain involvement in regional HERC ByJune30 eachyear of the Ensurethat your organization hasat least three 5-year performance period staff with profilesand emergencycall rankingon the PCAPortaland review accuracy Itisstronglyencouraged toincludeyourlocal healthofficerorTribalhealthdirectorasone of these contacts. Annually duringthe 5-year At minimum one representativefromyour performance period organizationwill haveattended orwatchedthe recordingof all coordinationcallswithVoluntary OrganizationsActivein Disaster (VOAD)partners that occurredduringthe budget period Annuallyduringthe 5-year MaintainjurisdictionalWisconsin Emergency performance period AssistanceVolunteer Registry(WEAVR) administrator contact information Deliverable9 Overthe5-year performance Incorporatelessonslearnedfrom exercisesand period responsesinto riskcommunicationsand informationdissemination plans. Incorporatestrategiesto monitor andcombat misinformation and disinformation into risk communication and information dissemination plans. Deliverable 10 Review Annually Maintainthecapacityand capabilityto manage, distribute,dispense, and administer medical countermeasuresaccordingtotheAdministration for StrategicPreparednessand Response/ StrategicNationalStockpile requirementsand guidelines. Updatemassdispensingand mass vaccinationclinicsitesinthe POD DVC Management Toolonthe PCAPortal. Onceannually overthe5­ Annually conduct at least onealertingdrill (or year performanceperiod utilizeWEAVRduringareal-world event)to alert registervolunteers Deliverable 11 Onceannually overthe 5­ Homeland Security Exerciseand Evaluation year performanceperiod Program (HSEEP)compliant exercise Deliverable 12 ByApril 30 (if school-based Exerciseafteractionreportsand improvement vaccination exercise)or by plans(AAR/IP)uploaded to PCAPortal June 30 (allotherexercises) eachyear of the5-year performance period 12[ Page DocusignEnvelopeID:920FE000-30D0-8540-80A4C-5F768C937CA8 Deliverable 13 Eachbudget period overthe Exercise RISKCOMMUNICATIONPLANplansand 5-year performance period principlesto ensureriskcommunicationandstaff activitiessimulate actionsthat will betaken B enchmark duringan emergency. Activity Deliverable 14 Review eachbudget period Use lessonslearnedfrom COVID-19, mpox,and and updateasneeded other recent responsesto identifyand address gapsinRISKCOMMUNICATIONPLANactivities that support communitiesof focus. Collaboratewith partnersthat represent prioritized populationsto developculturally, linguistically,and accessibleappropriate risk messagesfor populationswithaccessneeds, functional needs, and healthdisparities. Deliverable 15 ByJune30 eachyearof the Identifycommunity partnerswho aid in recovery 5-year performance period and engage in discussionsregardingtheir potential rolesandtheir resources. 0 Identifyrolesand responsibilitiesforstaff designatedtosupport recoveryoperations. Deliverable 16 ByJune30" eachyear of the Establish methodsfordeterminingcommunity 5-year performance period recovery prioritiesand communicatingthestatus of recoveryoperationswith relevant partners, interested groups, andthe public. Deliverable 17 Review eachbudget period Engagecommunityor nontraditional partners, and updateasneeded suchasfaith-based organizationsand private industryeachyeartosupport communitiesof focusidentified inthe RADEhealthequity section. Deliverable 18 Review each budget period Include health department preparednessstaff and updateasneeded and surgestaff outsidethe preparednessprogram who fill key incident command rolesin preparednesstrainingand periodicexercises. Primaryresponsestaff must participate in exercisesonarotational basisasdetermined by the healthdepartment. 13[ Page Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 WisconsinCitiesReadinessInitiative{CRI) Contract Objectives PublicHealthEmergencyPreparednessCooperativeAgreement Budget Period3:July1, 2026--June 30, 2027 *Note: This document includes all contract deliverables f or afi ve-year cooperati ve agreement period (7/ 1/2024- 6/30/2029). Some deliverables are required annually, while ot hers have the expected due datef or each budget period. Please send any questi ons regarding Cont ract Obj ecti ves to the OHS PHEP program at DHSPHEP@dhs.wisconsin.gov. CRI Resources PHEPNOFOCRISupplemental Guidance PHEPNOFOExerciseFrameworkSupplemental Guidance Strategiesand Deliverables Thefollowingdeliverablespertainonlytothefollowinglocal health departments: Human Services Individual ReportingJurisdictions City of Milwaukee HealthDepartment NorthShoreHealth Department PierceCounty PublicHealth Department St.Croix County Health&HumanServices Washington Ozaukee Public Health Department WaukeshaCounty Department of Health& Greendale HealthDepartment (Zone D) HalesCornersHealth Department (Zone D) Cudahy Health Department (Zone E) Oak CreekHealthDepartment (Zone E) South Milwaukee/St. FrancisHealth Department (Zone E) Southwest Suburban Health Department (ZoneC) • Franklin Health Department (Zone D) Milwaukee CountyZones WauwatosaHealth Department (ZoneC) Strategies The proposedstrategiesfor PHEPRecipientsand eachCRIZone andjurisdiction indicatethat all 62PHEP Recipientsand local planningjurisdictionsin 72CRI metropolitanstatistical areas(MSAs) must ensure operational readinessfor at least two ofthejurisdiction'stopthreatsincluded intheir riskassessment (RA). 1. Ensurereadinessfor alarge-scale event that requiresmedical countermeasures(MCMs) Distribution/Dispensing/Administration (D/D/A) a. Could include anthraxorother emerginginfectiousdisease (EID)scenario response or similarthreat that requiresrapid D/D/AOFMCMs. b. Should bearesponsewherepublichealth islikelyto play alead role. 2. Ensurereadinessfor aprioritythreat selectedfrom thejurisdiction'sRA included intheCDC's PublicHealth Response ReadinessFramework.(Figure1) Docusign Envelope ID:920FE000-30D0-8540-80AC-5F768C937CA8 a. Could includeenvironmental hazards/climatechange,domesticterrorism,orother responsesthat arenot EID-related. b. May bearesponsewherepublic health islikelyto playasupport role. Public Health Response ReadinessFramework2024-2029PHEPProgram Priorities Figure 1 1 Develop threat-specific approach toaugmentall-hazards planning, address evolving threats, and support medical countermeasure logistics 2 Enhance partnerships (federal and nongovernmental organ!zatlons)to effectively supportcommunity preparednessefforts 3 Expand local support tolmproveJUrlsdictional readlnesstoeffectively manage publlc health emergencies 4 Improve administrative and budget preparedness systems to ensure timely access to resources for supporting jurisdictional responses 5 BuildWorkforce capacity to meet jurisdictional surge managementneedsand support staffrecruitment, r_etentfon, resilience, and mental health 25 The Wisconsin Department of HealthServices(OHS) hasestablishedthefollowingstrategiesand deliverablesforcompletion byCRls, inadditiontotheir LTPHAcontract deliverables,duringthe budget periodfrom July 1, 2026,toJune30,2027. Thesestrategiesarebasedon CDC'sReadinessResponse Framework,Public Health Emergency Preparednessand ResponseCapabilities, and the PHEPNoticeof FundingOpportunity (NOFO)and include referencestotheseguidancedocumentswhereapplicable. Deliverables Deliverable1: All LTPHAswillsubmit aproposed budget to OHSusingthe PHEPand CRI Budget Template.All LTPHAs will report mid-year andfinalexpendituresbythe deadlinesbelow.Budgetsandfiscal reportswill be submittedviathe DPHApplication and ReportingTool (DART),withspecific instructionsposted onthe PCA Portal Local Budget Management page.Torequest accesstothe PCAPortal, pleasecontact DHSPCAPortal@dhs.wisconsin.gov. Deliverable Number Due Date Deliverable Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 Deliverable 1 ByJune30,eachyearof the 5­ Submit theCRIproposedbudget year cooperativeagreement ByJanuary 15,eachyearof Submit mid-yearCRIexpenditures the5-year cooperative agreement (beginningin BP3) ByAugust 15, eachyearofthe Submit final CRIexpenditures 5-year cooperative agreement Deliverable2: Objective: All local healthdepartment staff responsiblefor CRIdeliverableswill maintainawarenessof CRI planning and readinessstrategies. EachCRIwill maintainasystemfortrackinginventoryof suppliesand Medical Counter Measures{IMATS, Excelspreadsheet,orothersystem).Appropriate healthdepartment staff responsiblefor inventory management will maintain knowledgeof thetrackingsystem, includingtrainingand exercisingas neededto ensure responsereadiness. Deliverable Number Due Date Deliverable Deliverable 2 Ongoingasnew staff join Subscribeto receiveWIOHSPublic Health Emergency Preparedness Planning and Response emailcommunications. ByJune 30,eachyear of the Maintain inventorytrackingsystem 5yearcooperativeagreement If using IMATS(not required), assureprimary and backup staff haveaccesstoCDC SecureAccessManagement Services(SAMS) Please contact David Clerkin at David.clerkin@dhs.wisconsin.gov f or SAM S access Deliverable3: Strategy 1- All-hazardactivities Strategy 1encompassesthefollowingResponse ReadinessFrameworkprogram priorities. Develop arisk-based approachto all-hazardsplanningto advancerisk-based planning; address evolvingthreats; and support medical countermeasuredistribution,dispensing,and administrationand medical materiel management. Modernize data collection and systemsto improvesituational awarenessand information sharingwith healthcaresystemsand other partners. Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 Integrate healthequity practicestoenhancepreparedness, response,and recoverysupport for populationsexperiencing health disparities. Risk-BasedApproachtoAll Hazard Planning (AHA) Public Health Response ReadinessFramework--Priority 1.Prioritizearisk-basedapproach(AHA-A) Capability 1:CommunityPreparedness Capability 3: EmergencyOperationsCoordination Capability 13: PublicHealthSurveillanceand Epidemiological Investigation By December3, 2024,and again byJune 3,eachfollowingyear of the 5-year cooperativeagreement, eachCRIZoneandjurisdictionwillsubmit an action planto DHSPHEP@dhs.wisconsin.gov. a. Action plansmayfocusonactivitiesdesignedto addressprioritized planningandoperational gapsidentified acrossanyof thefifteen CDCPublicHealth EmergencyPreparednessand ResponseCapabilities. b. EachCRIZone andjurisdiction may identifyplanningand operationalgapsviavariousactivities, includingbut not limitedtoareasof improvement identified in ajurisdiction'smost recent review document,exercises, real incidents, needsassessments, and more. c. EachCRIZone andjurisdiction may usethe MCM Action Plantemplatelocatedonthe PCA Portal CRIpageorthey may createtheir own. Quarterly Updates- All EachCRIZone andjurisdictionwill submit quarterly reportsupdatingOPEHCon activitiesidentified ontheir action plans. Deliverable Number Due Date Deliverable Deliverable3 December 1,2026 Provide DHSwith acopyofyour CRIZone andjurisdiction BP2(2025-2026)action plan June 3" eachyear of the 5­ Eachyear provide DHSwithan updatedcopy year cooperativeagreement of your CRIZone orjurisdictional action plan startingJune3, 2025 Budget Periods2-5 Submit an updated copyof yourCRIZoneor December jurisdictional action planto June DHSPHEP@dhs.wisconsin.gov Budget Period3(2026-2027) Provide quarterly updatesonaction plan Quarterly dates: activitiesviaCRI UpdateCalls September 17, 2026 December 17, 2026 March 18, 2027 June 17, 2027 Docusign Envelope ID:920FE000-30D0-8540-80AC-5F768C937CA8 Budget Periods4-5 Quarterly dates: (TBD) September December March June Deliverable4: FutureBPs: Providequarterly updateson actionplan activitiesviaCRIUpdateCalls EachCRIZoneandjurisdictionwill haveat least one representativefromtheir zoneorjurisdiction participate inscheduledquarterlyconferencecallswithDHSstaff.These conferencecallswill providean opportunityfor eachCRIZone andjurisdictiontoaddressanychallengesor barrierstocompleting action plans. Deliverable Number Due Date Deliverable Deliverable4 Ongoing- quarterly in EachCRIZone andjurisdictionwill haveat September least onerepresentativefromtheir zone or December jurisdiction participateinscheduled March quarterly conferencecallswith DHSstaff. June Deliverable5: Capability 8: Medical CountermeasuresDispensingand Administration MCM Response Requirementsfor CRls: Inclusion of lessonslearnedfrom COVID-19 responseand other eventsthat required D/D/Aor MCMs. Operational readinessfor D/D/Aof oral drugs,vaccines, and IV medications. Capabilityfor rapid distributionof MCMsto largeportionof the populationwithinthe MSA, including rural areas. Capabilityto request,accept, process,warehouse,safelystore, and distribute/transport deliveriesof cachesfromthe SNS, includingdisposal and decommissioningof MCMs. Partnershipswith pharmacies, FQHCs, CBOs, healthcaresector,coalitions, and other jurisdictional partnerswithcapacityfor D/D/A. Performanceof supportingcapabilitiesrequiredtosuccessfully execute large-scale MCM response including but not limitedto incident management, emergency riskcommunication, laboratory response, andvolunteer management. ByJune30,eachyear of the5-year cooperativeagreement, all CRlswill updatetheir dispensing/vaccinationclinic(DVC)and pointsof dispensing(POD)sitesinthe PODList Management Toolonthe PCAPortal. Docusgn Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 Deliverable Number Due Date Deliverable Deliverable 5 June 30,eachyearof the 5­ EachCRIZone andjurisdictionwill update year cooperativeagreement theirdispensing/vaccinationclinic(DVC)and pointsof dispensing(POD)sitesinthe POD List Management Toolonthe PCAPortal, and updatethe "Dateof Annual Review" Deliverables6+7: ExerciseObjectives: The CRIexerciseschedulewill follow the 2024-2029 PHEPExercise Framework.(Figure2, Figure3) EachCRIwill be requiredtocomplete Homeland Security Exerciseand EvaluationProgram (HSEEP) compliant chemical, radiological/nuclear,and administrativediscussion-based exercisesonceeach during BP1-5. HSEEPcompliant biologicaldiscussion andfunctional exercisesrequiringMedical Countermeasure dispensationwill also be required duringthefive-year budget period.The biologicaldiscussion exercise should becompleted by allCRlsbyJune30,2025.TheStateof Wisconsinwill leadonorganizingand executingthe biologicalfunctional exercisewithinthe period. Finally,an HSEEPcompliant naturaldisasterfocusedseriesof exercises(discussion, drill,functional, and full-scale)will be completed during BP1-5.TheStateof Wisconsin (OPEHC)willserveas/producethe following: Exercise Director Responsibleforthestrategicoversight and direction onthe HSEEPCycleforan individual exercise. Exercise PlanningTeam Lead Responsibleforthe management of the exercise planningteam and coordinateswiththe Exercise Director andsenior leaders. Exercise EvaluationGuide Responsibleforthe development of the Exercise EvaluationGuides(EEGs) usedfortheexercise. CRI ExerciseWorkgroup {CRIEW) membersserve as: Design and Development (PlanningTeam) Responsiblefor compilingand developingall exercise background andfacilitationor control, providingtechnical orfunctional expertisefor scenario development,developingthesimulation construct asapplicable,and workingwiththeevaluationand resource/support functionsto ensureall exercise designand development needsaremet. Dependingon how thegroupdecidesto deliver,they may serve(or locate)thefacilitatorand recruit evaluatorsto utilizethe EEGsin evaluatingtheTTX. BP3 Update: Followingfloodingin BP2,Southeast (SE)regionCRlsweregrantedanexercise accommodation byCDCtousethisresponseasthefull-scaleexercisefortheseries, and pivot toa correctiveactionseries. Rolesand planningwill remainasdescribed aboveforthisseries. Northwest (NW) regionCRlswere not impacted bythefloodingand havepivotedto aradiological/nuclearfocused exerciseseries. BothOPEHCand theexercise planningteam will remainavailableto NW CRlstoassist in their planningand executionof thisexerciseseries. Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 Deliverable Number Due Date Deliverable Deliverable6 June30,2025 Completed BP1:HomelandSecurity Exercise and Evaluation Program (HSEEP)compliant medicalcountermeasureD/D/Adiscussion exercisethat willleadto afunctional exercise (BIO 100discussion-basedexercise) By December31, 2029 BP3-5Completethefollowingexercises: . Chemicaldiscussion-based . Radiological/Nucleardiscussion­ based . Administrativepreparedness discussion-based . Biological MCM functionalexercise . Natural Disaster (SECRls)or radiological/nuclear (NW CRls} discussion-based, drill,functional, and full-scale Optional:Criticalcontactsdrill Deliverable7 Within 60 daysof exercise Exerciseafter action reportsand completion improvement plans(AARs)should be uploadedtothe PCAPortalwithin 60daysof completingthe exercise Thefollowinggraphicsummarizesthe 2024-2028 PHEPExerciseframework. TypesofDisc ussion·BasedExercises{DBE) (iow to mod eratecomplexity} TypesofOperations-BasedExcerises(0BE) (moderate tohighcomplexity) Ca selectAo.togtcatinadent0, Cher at # den t, }ecdiotgcau/tuce ar te star aua # l aster ts jartapstometoo mafological'Nuclear incident cherialtnident Drill Full-Scale ► GameTabletop 100 WorkshopSeminar lliologicalTl>tk ► 100 Capstone Track p Figure2 Docus1gn Envelope ID·920FE000-30D0-8540-80AC-5F768C937CA8 PlannerIcons Operations-based exercise Discussion-based exercise & Administrative 9 preparedness eChemical Naturaldisaster A Radiological/ f8J nuclear GtRural,frontier, andtribal Budget Period i fu!HI @ @) @ @ ua!❖I IRHI au!B ale ¢ ¥ 4 Discussion-Based Exercises± » a $ t Figure3:Wisconsin ExerciseTimeline 8 Deliverable8 (MSABorderCountiesOnly) Cross-BorderCollaboration: CRIcountiesborderingMSAsin Minnesotaand assigned CRIstatusaccordingly should maintain communicationwithCRI leadsinthosestatesasneededtoensuremutual understandingand cross­ border preparedness.Theyshouldfurther collaborateand participate intrainingopportunitieswhere possible. DeliverableNumber DueDate Deliverable Deliverable8 Ongoing Maintain communicationwithCRIleadsin (MSABorder neighboringstates; collaborateand CountiesOnly) participate intrainingopportunitieswhere possible. PHEP5-yearCRIGrant DeliverableOverview DeliverableNumber DueDate Deliverable Deliverable 1 ByJune30,eachyearof the 5­ Submit the CRI proposed budget year cooperativeagreement ByJanuary 15, eachyear of the Submit mid-year CRIexpenditures 5-year cooperativeagreement (beginningin BP3) Docusgn Envelope ID:920FE000-30D0-8540-80AC-5F768C937CA8 ByAugust 15,eachyearof the Submit final CRIexpenditures 5-yearcooperativeagreement Deliverable 2 Ongoingasnew staff join Subscribeto receiveWIOHSPublic Health Emergency Preparedness Planning and Response emailcommunications. June30, eachyear of the5year Maintain inventorytrackingsystem cooperativeagreement Deliverable3 December 1, 2026 Provide OHSwith acopyof yourCRIZone andjurisdiction BP2 (2024-2025)action plan June3" eachyear of the 5year Eachyear provide OHSwithan updated copy cooperativeagreement of your CRIZone orjurisdictionalaction plan startingJune3,2025 Budget Periods3-5 Submit an updated copyof yourCRIZone or December jurisdictional action planto June DHSPHEP@dhs.wisconsin.gov Budget Period 3(2026-2027) Provide quarterly updatesonaction plan Quarterly dates: activitiesviaCRI UpdateCalls September 17,2026 December 17, 2026 March18, 2027 June 17, 2027 Budget Periods4-5 FutureBPs: Providequarterly updateson Quarterly dates: (TBD} action planactivitiesviaCRIUpdateCalls September December March June Deliverable4 Ongoing- quarterly in AllCRlswill haveat least one representative September from their zoneorjurisdiction participate in December scheduled quarterlyconferencecallswith March OHSstaff. June Deliverable 5 June30,eachyear of the5­ EachCRIZone andjurisdictionwill update year cooperativeagreement their dispensing/vaccinationclinic(DVC)and pointsof dispensing(POD)sitesinthe POD List Management Toolonthe PCAPortal Deliverable 6 June30, 2025 Completed BPl : Homeland Security Exercise and Evaluation Program (HSEEP)compliant medical countermeasureD/D/Adiscussion exercisethat will leadto afunctional exercise (BIO 100discussion-basedexercise) DocusignEnvelopeID:920FE000-30D0-8540-804C-5F7680937CA8 By December31, 2029 BP2-5Completethefollowingexercises: . Chemical discussion-based . Radiological/Nucleardiscussion- based . Administrativepreparedness discussion-based . Biological MCM functionalexercise . Natural Disaster (SECRls}or radiological/nuclear (NW CRls} discussion-based, drill,functional, andfull-scale . Optional:Criticalcontactsdrill Deliverable7 Within 60daysof exercise Exercise afteraction reportsand completion improvement plans(AARs)should be uploadedtothe PCAPortalwithin 60 daysof completingthe exercise Deliverable8 Ongoing Maintain communicationwithCRI leadsin (MSA Border neighboringstates; collaborateand CountiesOnly) participateintrainingopportunitieswhere possible. DocusignEnvelopeID:920FE000-30D0-8540-80AC-5F768C9370A48 SA w1sCONSINDEPARTMENT , " rHEAurs v cEs WisconsinDepartmentofHealthServices DivisionofPublicHealth for PublicHealthEmergencyPreparedness(PHEP)Program CitiesReadinessInitiative(CRI) A. OVERVIEW Public Health Emergency Preparedness Program: (PHEP) Cities Readiness Initiative (CRI) Period of Performance: July 1, 2026 to June 30, 2027 GEARS Contract Year: 2027 Profile(s): 155190 B. BACKGROUND AND/ OR CONTEXT The mission of the Wisconsin Department of Health Services is to protect and promote the health and safety of the people of Wisconsin. The Public Health Emergency Preparedness (PREP) Program aims to strengthen the capacity and capability of the public health system to prepare for, respond to, and recover from public health threats and emergencies. The intent of this funding is to create and maintain an excellent system of public health preparedness at the state and local levels with the continued purpose of strengthening and enhancing the capabilities of state and public health systems to mitigate the loss of life and reduce the threats to community health and safety utilizing the Centers for Disease Control and Prevention's (CDC) Response Readiness Framework and the Public Health Emergency Preparedness and Response Capabilities. C. COMMUNICATION S It is the responsibility of the Grantee to provide this Scope of Work document to appropriate agency staff responsible for programmatic and financial reporting requirements. Docusgn Envelope ID:920FE000-30D0-8540-80AC-5F768C937CA8 749 wISCONSINDEPARTMENT %arA r sRvacts The expectation is a minimum of annualcommunications between DHS and the Grantee. DHS reserves the right to request more frequent communications as deemed necessary. Communications may include but are not limited to: Email providing or requesting information. - Programmatic or contractual meetings. - Reporting including status updates and the submission of GEARS expense reports. D. POINTS OF CONTACT The Grantee is responsible for notifying DHS at DHSPHEP@dhs.wisconsin.gov if there are any changes in contact information within ten (10) business days. 1. TABLE 1: DPH CONTACT AND ROLE FullName,EmailandPhoneNumber Role David Clerkin, Program Contact David.clerkin@dhs.wisconsin.gov Ramona Baldoni-Lake, Contract Manager Ramona.baldonilake@dhs.wisconsin.gov Jessica Kessler, Fiscal Contact Jessica.kessler@dhs.wisconsin.gov DHSPHEP@dhs.wisconsin.gov Other (specify): Program Inquiries E. GEARS EXPEN SE REPOR T(S) AND PA YMENT SCHEDULE The funds will be reimbursed through the Grant Enrollment, Application and Reporting System (GEARS). GEARS expenses must be submitted as actual monthly expenses (either paid or incurred) and these expenses must align with the approved budget and terms and conditions of this Agreement/Contract. GEARSExpenseReport(s)andPaymentSchedule: Grantee must report costs incurred on the GEARS Expenditure Report Form (f-00642) and submit the GEARS Expenditure Report by the 15thof the month via email to the GEARS Unit (dhs600RCars@dhs.wisconsin.gov). The GEARS Unit is responsible for issuing payment. The DHS program staff are responsible for ensuring claimed expenses are allowable and agree with approved budgets and scopes of work. Final GEARS Expense Reports are due by 8/15/2027,which is 45daysfrom the end of the contract period. Failure to follow the GEARS Expense Report(s) and Payment Schedule could result in a dispute(s) 2 DocusignEnvelopeID:920FE000-30D0-8540-80A4C-5F768C937CA8 79 WISCONSINDEPARTMENT %a"H EATHspRvacrs whereby DHS can delay or deny payment(s). Reference the GEARS Payment Processing Schedule and further guidance on How to Submit GEARS Expenditure Reports. Direct any questions related to the technical aspects of expenditure report processing, monthly payment reports, and reimbursements can email DHSDESBFSGEARS@dhs.wisconsin.gov. Direct all other questions regarding expense reports to the OHS program area (DHSPHEP@dhs.wisconsin.gov). F. REPORTING REQU IREMENTS 1. FINANCIAL REPORTING Mid-year and final grant expenditures must be reported to OHS through the DPH Application and Reporting Tool (DART). A report of mid-year expenditures (July I-December 31, 2026) is due January15,2027,and a report of final expenditures (through June 30, 2027) is due August15, 2027.Please see the Local Preparedness Budget Management page on the PCA Portal for more details and a link to the PREP Fiscal Report (to be posted by September 30, 2026). Additional financial reporting must be provided by the Grantee upon request by OHS. This may include (but not limited to) expenses associated with salaries, supplies, travel, contractual, or other (including copies of receipts documenting the purchase of specific items and timesheets for salaries). 2. PROGRAMMATI C REPORTING Anannualcontractdeliverablereportingsurveyis required on or before the agreement period ends. Grantees are required to quantitatively and qualitatively document program deliverables and provide a written statement through the reports. Grantee will be provided report forms and deadlines from the DHS program area via the PCA Portal. Direct all questions regarding reports to the OHS program area (DHSPHEP@dhs.wisconsin.gov). Failure to meet a reporting requirement(s) can result in a dispute(s) for noncompliance, default, and/or breach of the agreement terms and conditions. G. UNALLOWABLE COSTS GeneralRestrictions • Recipients may not use funds for research. • Recipients may not use funds for clinical care except as allowed by law. • Recipients may use funds only for reasonable program purposes including personnel, travel, supplies, and services. • Generally, recipients may not use funds to purchase furniture or equipment. Any such proposed spendingmust be clearly identified in the budget. 3 Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 9 WISCONSINDEPARTMENT a "erA rastRvacEs • Reimbursement of pre-award costs generally is not allowed, unless the CDC provides written approval to the recipient. • Other than for normal and recognized executive-legislative relationships, no funds may be used for: o Publicity or propaganda purposes, including preparing, distributing, or using any material designed to support or defeat the enactment of legislation before any legislative body. o Using the salary or expenses of any grant or contract recipient, or agent acting for such recipient, for any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body. • See additional requirement (AR)12 for detailed guidance on this prohibition and additional guidance on lobbying for CDC recipients. • The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an award to another party or provider who is ineligible. • In accordance with the United States Protecting Life in Global Health Assistance policy, all non­ governmental organization (NGO) applicants acknowledge that foreign NGOs that receive funds provided through this award, either as a prime recipient or subrecipient, are strictly prohibited, regardless of the source of funds, from perfonning abortions as a method of family planning or engaging in any activity that promotes abortion as a method of family planning, or to provide financial support to any other foreign non-governmental organization that conducts such activities. See AR 35 for applicability. • Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. • Payment or reimbursement of backfilling costs for staff is not allowed. • None of the funds awarded to these programs may be used to pay the salary of an individual at a rate in excess of executive level II or $228,000 per year. • Funds may not be used to purchase or support (feed) animals for labs, including mice. • Funds may not be used to purchase a house or other living quarters for those under quarantine. Rental may be allowed with approval from CDC Office of Grants Services. • Funds may not be used to purchase gift cards. Supplanting Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. Federal law prohibits recipients of federal funds from replacing state, local, or agency funds with federal funds. For example, funds may not be used to cover positions and other expenditures already fundedby other sources. PersonnelCosts Recipients may (with prior approval) use funds for overt ime for individuals directly associated (listed 4 DocusignEnvelopeID:920FE000-30D0-8540-80AC-5F768C937CA8 O9 wIsCONSINDEPARTMENT %a9 erA r srRv c s in personnel costs) with the award with prior approval from CDC Office of Grants Services. Travel Travel or conferences not specific to public health emergency preparedness are not allowed. All travel costs must be reimbursed following State of Wisconsin travel guidelines. Lobbying Other than for normal and recognized executive-legislative relationships, PHEP funds may not be used for: • Publicity or propaganda purposes, for the preparation, distribution, or use of any material designed tosupport or defeat the enactment of legislation before any legislative body. • The salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before any legislative body. See AR 12 for detailed guidance on this prohibition and additional guidance on lobbying for CDC recipients. ConstructionandMajorRenovations Recipients may not use funds for construction or major renovations. Generally, recipients may not use funds to purchase furniture or equipment. Any such proposed spendingmust be clearly justified in the budget. PassengerRoadVehicles • Funds cannot be used to purchase over-the-road passenger vehicles. • Funds cannot be used to purchase vehicles to be used as means of transport ation for carrying people or goods, such as passenger cars or trucks, and electrical or gas-driven motorized carts. • Recipients can (with prior approval) use funds to lease vehicles to be used as means of transport ation for carrying people or goods, for example, passenger cars or trucks and electrical or gas-driven motorized carts during times of need. • Additionally, PHEP grant funds can (with prior approval) be used to make transportation agreements with commercial carriers for movement of materials, supplies, and equipment. There should be a written process for initiating transportation agreements (such as contracts, memoranda of understanding, formal written agreements, and/or other letters of agreement). Transportation agreements should include, at a minimum: o Type of vendor o Number and type of vehicles, including vehicle load capacity and configuration o Number and type of drivers, including certification of drivers o Number and type of support personnel o Vendor's response time 5 DocusugnEnvelopeID:920FE000-30D0-8540-80AC-5F768C937CA8 A w1sCONSIN DEPARTMENT %a" rtAr r H sEv1 c s o Vendor's ability to maintain cold chain, if necessary to the incident o This relationship may be demonstrated by a signed transportation agreement or documentation of transportation planning meeting with the designated vendor. All documentation should be available to the CDC project officer for review if requested. TransportationofMedicalMaterial • Funds can (with prior approval) be used to procure leased or rental vehicles for movement of materials, supplies, and equipment. • Recipients can (with prior approval) use funds to purchase material-handling equipment (MHE) such asindustrial or warehouse-use trucks to move materials, such as forklifts, lift trucks, turret trucks, etc. Vehicles must be of a type not licensed to travel on public roads. • Recipients may purchase basic (non-motorized) trailers with prior approval from CDC Office of Grants Services. ProcurementofFoodandClothing • Funds may not be used to purchase clothing such as jeans, cargo pants, polo shirts, jumpsuits, sweatshirts, or T-shirts. • Purchase of vests (or similar items) that may be used multiple times by numerous individuals and to beworn during exercises or responses may be allowed. • Generally, funds may not be used to purchase food. However, under limited circumstances and with prior approval from OPEHC, funds may be allowed for the purchase of food following current state and federal government guidelines. Note:In the event prior approval has been obtained to purchase food, recipients are required to maintain an agenda and a meal sign-in sheet at the local level for auditing purposes. See 45 CPR 75.432 for additional information. Vaccines • PHEP recipients can, with prior CDC approval, use funds to purchase caches of antibiotics for use by public health responders and their households to ensure the health and safety of the public health workforceduring an emergency response, or an exercise to test response plans. Funds may not be used to supplant other funding intended to achieve this objective. • PHEP recipients can, with prior CDC approval, use funds to purchase caches of vaccines for public health responders and their households to ensure the health and safety of the public health workforce. • PHEP recipients can, with prior CDC approval, use funds to purchase caches of vaccines for select critical workforce groups to ensure their health and safety during an exercise testing response plans. o Recipients must document in their submitted exercise plans the use of vaccines for select critical workforce personnel before CDC will approve the vaccine purchase. 6 DocusignEnvelopeID:920FE000-30D0-8540-80AC-5F768C937CA8 9 WISCONSINDEPARTMENT %a"erA rn sER1 cEs • Recipients may not use PHEP funds to supplant other funding intended to achieve these objectives. • Recipients of PHEP-funded vaccines (within the context of the exercise) may include: o Persons who meet the criteria in the CDC Advisory Committee on Immunization Practices (CDC/ACIP) recommendations for who should receive vaccine; and o Persons who are not eligible to receive the vaccine through other entitlement programs such as Medicare, Medicaid, or the Vaccines for Children (VFC) program. ■ VFC-eligible children or Medicare beneficiaries may participate in the exercise; however, they should be vaccinated with vaccine purchased from the appropriate funding source. • PHEP funds may not be used to purchase vaccines for seasonal influenza mass vaccination clinics orother routine vaccinations covered by Advisory Committee on Immunization Practices (ACIP) schedules. • PHEP funds may not be used to purchase influenza vaccines for the general public. Recipients may not use funds for clinical care except as allowed by law. Per the PHEP Notice of Funding Opportunity, clinical care is defined as "directly managing the medical care and treatment of individual patients." PHEP-funded staff may administer medical countermeasures (MCMs), such as antibiotics or vaccines, as a public health intervention in the context of an emergency response or an exercise to test response plans. CDC does not consider this clinical care since it is not specific to an emergency response or an exercise to test response plans. LaboratorySupplies Instruments, reagents, and supplies for the following are not generally purchased with PHEP funding: • Instruments, reagents, and supplies for testing seasonal influenza; • Instruments, reagents, and supplies for testing rabies; • Instruments, reagents, and supplies for routine food testing (surveillance); • Instruments, reagents, and supplies for testing vaccine preventable diseases (such as measles or mumps); • Instruments, reagents, and supplies for routine testing of vector-borne illnesses (both clinical and vector surveillance); • Routine drug screening of laboratory staff; and • Influenza vaccines (for the general public). AdvertisingandPublicRelations,Supplies,Meetings,PromotionalItemsandMemorabilia See: Federal Regulation Codes under section 200.421: PART 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards a) The term "advertising costs" means the costs of advertising media and corollary administrative costs. Advertising media includes magazines, newspapers, radio and television, direct mail, exhibits, electronic or computer transmittals, and the like. b) The only allowable advertising costs are those which are solely for: 7 DocusignEnvelopeID:920FE000-30D0-8540-80AC-5F768C937CA8 (A WISCONSINDEPARTMENT %a9orHEA TH sEv1 c s (i) The recruitment of personnel required by the non-federal entity for performance of a federal award (See also §200.463 Recruiting costs). (ii) The procurement of goods and services for the performance of a federal award. (iii) The disposal of scrap or surplus materials acquired in the performance of a federal award except when non-federal entities are reimbursed for disposal costs at a predetermined amount. (iv) Program outreach and other specific purposes necessary to meet the requirements of the federal award. c) The term "public relations" includes community relations and means those activities dedicated to maintaining the image of the non-federal entity or maintaining or promoting understanding and favorable relations with the community or public at large or any segment of the public. d) The only allowable public relations costs are: (i) Costs specifically required by the federal award. (ii) Costs of communicating with the public and press pertaining to specific activities or accomplishments which result from performance of the federal award (these costs are considered necessary as part of the outreach effort for the federal award). (iii) Costs of conducting general liaison efforts with news media and government public relations officers, to the extent that such activities are limited to communication and liaison necessary to keep the public informed on matters of public concern, such as notices of funding opportunities, financial matters, etc. e) Unallowable advertising and public relations costs include the following: (i) All advertising and public relations costs other than as specified in paragraphs (b) and (d) of this section. (i ) Costs of meetings, conventions, convocations, or other events related to other activities of theentity (see also §200.432 Conferences), including: l) Costs of displays, demonstrations, and exhibits. 2) Costs of meeting rooms, hospitality suites, and other special facilities used in conjunction with shows and other special events. 3) Salaries and wages of employees engaged in setting up and displaying exhibits, making demonstrations, and providing briefings. (iii) Costs of promotional items and memorabilia, including models, gifts, and souvenirs. (iv) Costs of advertising and public relations designed solely to promote the non-federal entity. Direct all questions regarding eligible expenses to the OHS program area (DHSPHEP@dhs.wisconsin.gov). H. BUDGET MANAGEMENT Cost deviation or change from approved budget categories more than 25%,or the addition of a new line item, will require submission of a new budget and will require revised budget approval 8 Docusign Envelope ID: 920FE000-30D0-8540-80AC-5F768C937CA8 9 w1sCONSINDEPARTMENT %, 9 orHEA TH E Rv cEs from DHS prior to incurring costs. The DHS may proactively recommend a revision should spenddown tracking suggest the need to redistribute remaining funds. Grantee must receive prior approval from the DHS Contract Administrator for any equipment purchases using state or federal funds that exceed $10,000 per Uniform Guidance (2 CFR 200.439). Direct all questions regarding budget management or equipment purchases to the DHS program area (DHSPHEP@dhs.wisconsin.gov). I. DPH APPLICATION AND REPOR TING TOOL (DART) DHS is implementing a new system, the Division of Public Health Application and Reporting Tool (DART) during this period of performance. Upon implementation, if applicable, the Grantee agrees to participate in system transition activities, including signing up for a MyWisconsin ID, requesting access to the DART system, and participation in training activities. The Grantee may be required to submit reports or forms, enter data, and/or provide support ing documentation through the new system. The Grantee agrees to participate in revised submission procedures and other activities through the DART system upon notification. K. ADDITIONAL INFOR MATION AN D/OR REQUIREMENTS Deadlines/ImportantDates • January 15, 2027 - Mid-year fiscal report for PHEP BP3 expenses due • May 15, 2027 - Deadline to submit requests for budget revision for PHEP BP3 • August 15, 2027 - Deadline to submit final GEARS Expense Reports for PHEP BP3 • August 15, 2027 - Final fiscal report for PHEP BP3 expenses due L. PR OJECT DELIVERABLES The Wisconsin Department of Health Services (DHS) has established objectives and deliverables for completion by Cities Readiness Initiative (CRI) jurisdictions during the budget period from July 1, 2024, to June 30, 2029, with a goal of ensuring Wisconsin local and Tribal public health agencies are response ready. These contract deliverables are described in Addendum C. 9 DocusgnEnvelopeID'920FE000-30D0-8540-80AC-5F768C937CA8 DEPARTMENT OF HEALTH SERVICES Divisionof EnterpriseSertces F-01788 (03/2022) STATE OFWISCONSIN CERTIFICATION REGARDING DEBARMENT AND SUSPENSION Federal Executive Order(E.O.) 12549"Debarment" requiresthat allcontractors receiving individualawards, using Federalfunds,and allsubrecipientscertifythatthe organizationand itsprincipals arenot debarred, suspended, proposedfordebarment,declared ineligible,orvoluntarily excluded by any Federaldepartment oragencyfromdoing businesswiththe FederalGovernment. By signingthis document you certify that yourorganization and its principals are not debarred. Failuretocomply or attemptsto edit this language may disqualifyyourbid. Information on debarment is available atthefollowingwebsites:www.sam.gov. Your signaturecertifiesthat neitheryounoryourprincipal is presently debarred,suspended, proposedfordebarment, declared ineligible,orvoluntarily excludedfrom participation inthistransaction by any Federaldepartment oragency. SIGNATURE- OfficialAuthorizedto SignApplication For (Name of Vendor) DateSigned Unique Entity Identifier(UEI),if applicable Certificate Of Completion Envelope Id. 920FE000-30D0-8540-80AC-5F768C937CA8 Subject MP - Franklin HD -2026 DPH Consolidated Contract-435100-G26-DPH C26-26 M3 Source Envelope· Document Pages. 47 Certificate Pages 5 AutoNav Enabled Envelopeld Stamping Enabled Time Zone (UTC-06.00) CentralTime (US &Canada) d ocusign Status. Sent Envelope Originator Yvette Smith 201 EastWashingtonAvenue Madison,WI 53703 yvettea.smIth@dhswisconsmgov IP Address. 165 225.59 50 Initials 0 Signatures.O Record Tracking Status Onginal 8/26/2026 11:41-01AM Security Appliance Status.Connected Signer Events Ellen Henry EHenry@franklinw gov Interim HealthOfficer Security Level Email,Account Authentication (None) Electronic Record and Signature Disclosure: Accepted 8/26/2026 11:43·06AM ID f6b33ab9-b293-4958-b831-66907e3848df Anna Benton anna benton@dhs.wIsconsIn gov Security Level Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered va Docusign In Person Signer Events Editor Delivery Events Agent Delivery Events Intermediary Delivery Events Certified Delivery Events Carbon Copy Events DHS DPH Contract Routing dhsdphcontractrouting@dhswsconsmn gov Security Level: Email,AccountAuthentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign DPH Contracts DHSDPHContracts@dhswisconsin gov DPH Contracts SharedAccount Wisconsin Department of Health Services Security Level Emal,Account Authentication (None) Electronic Record and Signature Disclosure: Holder:Yvette Smith yvettea smith@dhs.wsconsnn gov Pool·StateLocal Signature Signature Status Status Status Status Status COPIED COPIED Location DocuSign Timestamp Sent. 8/26/2026 11.42·17 AM Viewed·8/26/202611:43'06AM Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp Sent: 8/26/2026 11.42:13 AM Sent 8/26/2026 114 2 13 AM Carbon Copy Events Not Offered via Docusign GEARS Contracts DHSCARSContracts@dhswsconsin gov Wisconsin Department of Health Services Security Level. Email,AccountAuthentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Witness Events Notary Events Envelope Summary Events Envelope Sent Payment Events Status COPIED Signature Signature Status Hashed/Encrypted Status Timestamp Sent 8/26/2026 11 42 16 AM Timestamp Timestamp Timestamps 8/26/2026 11'42:16 AM Timestamps Electronic Record and Signature Disclosure ElectronicRecordandSgnatureDisclosurecreatedon 12/19/2018 8.2451AM Partiesagreedto:EllenHenry ELECTRONICRECORDANDSIGNATUREDISCLOSURE From time to time, Wisconsin Department of Health Services (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to 'I agree to use electronic records and signatures' before clicking 'CONTINUE' within the DocuSign system. Gettingpapercopies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period oft ime (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawingyourconsent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequencesofchangingyourmind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us. Allnoticesanddisclosureswillbesenttoyouelectronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. HowtocontactWisconsinDepartmentofHealthServices: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: DHSContractCentral@dhs.wisconsin.gov ToadviseWisconsinDepartmentofHealthServicesofyournewemailaddress To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at DHSContractCentral@dhs.wisconsin.gov and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. 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By selecting the check-box next to 'I agree to use electronic records and signatures', you confirm that: • You can access and read this Electronic Record and Signature Disclosure; and • You can print on paper this Electronic Record and Signature Disclosure, or save or send this Electronic Record and Disclosure to a location where you can print it, for future reference and access; and • Until or unless you notify Wisconsin Department of Health Services as described above, you consent to receive exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you by Wisconsin Department of Health Services during the course of your relationship with Wisconsin Department of Health Services. APPROVAL Reportsand Recommendations REQUESTFOR COUNCILACTION ARESOLUTIONAUTHORIZINGFRANKLIN DIRECTOR OFHEALTH ANDHUMAN SERVICESTOACCEPTANDEXECUTETHE GRANTAGREEMENTFORTHE TUBERCULOSIS(TB)DISPENSARYPROGRAM MEETINGDATE 09/01/2026 ITEMNUMBER Background:The Wisconsin Department of Health Services (WI DHS) awards grants in a variety of programs to local public health depart ments. The Franklin Health Department (FHD) maintains an active communicable disease control and prevention program to control the incidence and spread of communicable disease in the State of Wisconsin. Wis. Stat. ch. 252 - Communicable Diseases, outlines the statutory requirements regarding communicable disease control, including reportable diseases of urgent public health importance. Tuberculosis (TB) is a Category I disease in the State of Wisconsin. The FHD received an updated grant agreement from the State of Wisconsin for the Tuberculosis (TB) Dispensary Program. The grant agreement is a standard purchase order interagency agreement between the State of Wisconsin and the FHD that provides specifics of how the Wisconsin TB Dispensary program works, who is eligible for coverage, what services and medications are allows, service codes, National Drug Codes (NDC), and Medicaid reimbursement rates as of April 2025. Recommendation:The Director of Health and Human Services recommends approval to accept and authorization to execute and deliver the Grant Agreement for the Tuberculosis (TB) Dispensary Program. FiscalNote:The WI DHS requires an active grant agreement and contract for continued financial support to the FHD through the Tuberculosis (TB) Dispensary Program. The grant agreement has been sent to the City attorney for review and approval of signature pending Council approval. COUNCILACTIONREQUESTED A Motion to adopt Resolution No. 2026- A RESOLUTION AUTHORIZING FRANKLIN DIRECTOR OF HEALTH AND HUMAN SERVICES TO ACCEPT AND EXECUTE GRANT AGREEMENT FOR THE TUBERCULOSIS (TB) DISPENSARY PROGRAM. Health Department: EH STATE OF WISCONSIN CITY OF FRANKLIN RESOLUTION NO. 2026- MILWAUKEE COUN TY Draft 09/01/2026 A RESOLUTION AUTHORJZING FRA NKLIN DIRECTOR OF HEALTH AND HUMAN SERVICES TO ACCEPT AND EXECUTE THE GRANT AGREEMENT FOR THE TUBERCULOSIS (TB) DISPENSARY PROGRAM. WHEREAS, The City of Franklin Health Department (FHD) maintains an active comm unicable disease control and prevention program to control the incidence and spread of comm unicable disease in the State of Wisconsin; and WHEREAS, the Wisconsin Department of Health Services and the FHD shall enter a standard purchase order interagency agreement for the Tuberculosis (TB) Dispensary Program; and NOW, THEREFORE , BE IT RESOLVED, by the Mayor and Common Council of the City of Franklin, Wisconsin, that the Grant Agreement for the Tuberculosis (TB) Dispensary Program, in the form and content as annexed hereto, be and the same is hereby approved. BE IT FURTHER RESOLVED, that the Franklin Director of Health and Human Services is hereby authorized to accept, execute and deliver such agreement. Introduced at a regular meeting of the Common Council of the City of Franklin this day of , 2026. Passed and adopted at a regular meeting of the Common Council of the City of Franklin this day of > 2026. APPROVED: John R. Nelson, Mayor ATTEST: Shirley J. Roberts, City Clerk AYES NOES ABSENT DocusignEnvelopeID:534471C6-8D1F-8C91-8309-82798CE9E0EB WisconsinDepartmentofHealthServices ContractCentralizationLegalReview Agreement Number:435100-G27-TBDISPENSE-25 Bureau of Procurement and Contracting (BPC) Review: OThis agreement requires StandardOLC review. (x)This agreement uses a BPC template with Office of Legal Counsel (OLC) approved language and requires SimpleOLC review. 0 This agreement uses a BPC template with Office of Legal Counsel (OLC) approved language and does notrequire AdditionalOLC review. 0 This agreement uses intergovernmental cooperative purchasing. Description: NIA Office of Legal Counsel (OLC) Review and Approval: [] This agreement has been reviewed for form and approved bythe Wisconsin Department of Health Services Office of Legal Counsel. Date Signed 8/14/2026 ame: man a oss Title:Paralegal ! Signed by d. 5 Revision: 02/21/2025 (previous versions obsolete) DocusignEnvelopeID:53447106-8D1F-8C91-8309-82798CE9E0EB BureauofProcurementandContracting ProcurementAuthorityReview (NotrequiredforCARS/GEARSagreements) Submittingdivision:DPH Divisionsubmitter:Patricia Heger Procurementauthority: D Request for Bid (provide solicitation#): D Request for Proposal (provide solicitation#): [] Request for Services D Waiver (provide waiver#): □ Simplified Bid □lnteragency [] Grant exemption (provide GE#): 31 □Other (describe): Appropriation(ifapplicable):10700 Revision: 8/2/2022 (previous versions obsolete) DocusIgnEnvelopeID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB GRANTAGREEMENT betweenthe StateofWisconsinDepartmentofHealthServices and FranklinHealthDepartment for Tuberculosis(TB)DispensaryProgram OHS Grant Agreement No.: 4351OO-G27-TBDISPENSE-25 Agreement Amount: Sum Sufficient Agreement Term Period: 7/1/2026 to 6/30/2027 DHS Division: Public Health OHS Grant Administrator: Patricia Heger OHS Telephone: 608-266-9692 OHS Email: patricia.heger@dhs.wisconsin.gov Grantee Grant Administrator: Ellen Henry Grantee Email: ehenry@franklinwi.gov Grantee Unique Entity Identifier (UEI) Name: Grantee Unique Entity Identifier (UEI) Number: Grantee Supplier ID:72072 OHS and the Grantee acknowledge that they have read the Agreement and the attached documents, understand them and agree to be bound by their terms and conditions. Further, DHS and the Grantee agree that the Agreement and the exhibits and documents incorporated herein by reference are the complete and exclusive statement of agreement between the parties relating to the subject matter of the Agreement and supersede all proposals, letters of intent or prior agreements, oral or written and all other communications and representations between the parties relating to the subject matter of the Agreement. OHS reserves the rights to reject or cancel Agreements based on documents that have been altered. This Agreement becomes null and void if the time between the earlier dated signature and the later dated signature exceeds sixty (60) days, unless waived by OHS. StateofWisconsin DepartmentofHealthServices Author zed Representative Name Title Signature Date Grantee Entity Name Author1zed Representative Name Ellen Henry Title Interim Health Officer Signature Date Page 1 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB TABLEOFCONTENTS l. DEFINITIONS 3 2. ORDER OF PRECEDENCE 4 3. PARTIES 4 4. PURPOSE AND SCOPE 4 4.1 ListofExhibits 4 5. CONTACT INFORMATION 4 6. PAYMENT FOR GRANT AWARD 5 7. REPORTING 5 8. FEDERAL AND STATE RULES AND REGULATIONS 5 9. AFFIRMATIVE ACTION 6 10. CIVIL RIGHTS COMPLIANCE 6 11. WEB CONTENT ACCESSIBILITY GUIDELINES 6 12. CONFIDENTIAL, PROPRIETARY, AND PERSONALLY IDENTIFIABLE INFORMATION 7 13. SECURITY OF PREMISES, EQUIPMENT, DATA AND PERSONNEL .............................................9 14. HIGH-RISK IT REVIEW 9 15. SUBGRANT or SUBCONTRACT 9 16. GENERAL PROVISIONS 9 17. ACCOUNTING REQUIREMENTS 10 18. CHANGES IN ACCOUNTING PERIOD 1O 19. PROPERTY MANAGEMENT REQUIREMENTS 10 20. AUDITS 10 21. OTHER ASSURANCES 12 22. RECORDS 13 23. CONTRACT REVISIONS AND/OR TERMINATION 13 24. NONCOMPLIANCE AND REMEDIAL MEASURES 14 25. DISPUTE RESOLUTION 14 26. FINAL REPORT DATE 15 27. INDEMNITY 15 28. CONDITIONS OF THE PARTIES' OBLIGATIONS 15 29. GOVERNING LAW 15 30. SEVERABILITY 15 31. ASSIGNMENT 15 32. ANTI-LOBBYING ACT 16 33. DEBARMENT OR SUSPENSION 16 34. DRUG FREE WORKPLACE 16 35. MULTIPLE ORIGINALS 16 36. CAPTIONS 16 37. SPECIAL PROVISIONS, IF APPLICABLE 16 38. NULL AND VOID 17 Page 2 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB 1. DEFINITIONS Words and terms will be defined by their ordinary and usual meanings. Unless negotiated otherwise by the parties, where capitalized, the following words and tenns will be defined by the meanings indicated. The meanings are applicable to the singular, plural, masculine, feminine and neuter of the words and terms. Agency:an office, department, agency, institution of higher education, association, society or other body in State of Wisconsin government created or authorized to be created by the Wisconsin State Constitution or any law, which is entitled to expend monies appropriated by law, including the Legislature and the courts. AssistanceListings:refers to the publicly available listing of Federal assistance programs managed and administered by the General Services Administration, (GSA) at SAM.gov, pursuant to 2 C.F.R. § 200.1. BusinessAssociate:pursuant to 45 C.F.R. § 160.103, a business associate includes: (i) A health information organization, e-prescribing gateway, or other person that provides data transmission services with respect to protected health infonnation to a covered entity and that requires access on a routine basis to such protected health information. (ii) A person that offers a personal health record to one or more individuals on behalf of a covered entity. (iii) A subcontractor that creates, receives, maintains, or transmits protected health inform ation on behalf of the business associate. BusinessDay:any day on which the State of Wisconsin is open for business, generally Monday through Friday unless otherwise specified in this Agreement. ConfidentialInformation:all tangible and intangible infonnation and materials being disclosed in connection with this Agreement, in any fonn or medium without regard to whether the infonn ation is owned by the State of Wisconsin or by a third party, which satisfies at least one (1) of the following criteria: (i)Personally Identifiable Information; (ii) Protected Health Information under HIPAA, 45 C.F.R. § 160.103; (iii) non-public infonn ation related to DHS' employees, customers, technology (including databases, data processing and communications networking systems), schematics, specifications, and all information or materials derived therefrom or based thereon; or (iv) infonnation expressly designated as confidential in writing by DHS. Confidential Information includes all information that is restricted or prohibited from disclosure by state or federal law. Day:calendar day unless otherwise specified in this Agreement. DHS:Depart ment of Health Services. GrantAdministrator:individual(s) responsible for ensuring all steps in the grant administration process are completed, including drafting grant language, negotiating grant terms, and monitoring the granted entity's performance. PersonallyIdentifiableInformation:an individual's last name and the individual's first name or first initial, in combination with and linked to any of the following elements, if that element is not publicly available information and is not encrypted, redacted, or altered in any manner that renders the element unreadable: (a) the individual's Social Security number; (b) the individual's driver's license number or state identification number; (c) the number of the individual's financial account, including a credit or debit card account number, or any security code, access code, or password that would pennit access to the individual's financial account; (d) the individual's DNA profile; or (e) the individual's unique biometric data, including fingerprint, voice print, retina or iris image, or any other unique physical representation, and any other information protected by state or federal law. ProtectedHealthInformation(PHI):health information, including demographic information, created, received, maintained, or transmitted in any form or media by the Business Associate, on behalf of the Covered Entity, where such information relates to the past, present, or future physical or mental health or condition of an individual, the Page 3 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534A71C6-8D1F-8C91-8309-82798CE9E0EB provision of health care to an individual, or the payment for the provision of health care to an individual, that identifies the individual or provides a reasonable basis to believe that it can be used to identify an individual. PubliclyAvailableInformation:any information that an entity reasonably believes is one of the following: a) lawfully made widely available through any media; b) lawfully made available to the general public from federal, state, or local government records or disclosures to the general public that are required to be made by federal, state, or local law. 2. ORDEROFPRECEDENCE This Agreement and the following documents incorporated by reference into the Agreement constitute the entire agreement of the parties and supersedes all prior communications, representations or agreements between the parties, whether oral or written. Any conflict or inconsistency will be resolved by giving precedence in the following descending order: 1. The Business Associate Agreement (BAA) if applicable. 2. The terms of this Agreement. 3. Any and all exhibits or appendices to this Agreement. 3. PARTIES This is a grant agreement between the state agency responsible for overseeing the coordination and integration of social service programs and the Grantee listed below. A. The Wisconsin State Agency is: The State of Wisconsin Depart ment of Health Services (DHS). DHS' principal business address is: 201 E. Washington Ave., P.O. Box 7850, Madison, Wisconsin 53707-7850. B. The Grantee is: Franklin Health Department The Grantee's principal business address is: 9229 W Loomis Rd, Franklin, WI, 53132 4. PURPOSEANDSCOPE This Grant Agreement (Agreement) and Exhibit(s) describe the terms and conditions under which the Grantee receives an award from DHS to carry out part of a state and/or federal program. The Grantee agrees to provide goods and/or care and services consistent with the purposes and conditions of the objectives that it has agreed to attain within the Agreement period as referred to in the attached exhibit(s). Section 4.1 of this Agreement allows the user to provide a list of additional Exhibits to the Agreement. Please provide the scope of work for the work being conducted by the Grantee as Exhibit 1. 4.1 ListofExhibits Exhibit 1: Contract Letter 2027 Exhibit 2: Attachment A- Covered Services by Patient Type Exhibit 3: Attachment B- Clinical Services Plan Exhibit 4: Attachment C - CPT Service Codes Exhibit 5: Attachment D- Video Office visits Exhibit 6: Attachment E- Pharmacy Services Plan Exhibit 7: Attachment F- Medication Reimbursement rates Exhibit 8: Attachment G- TB Dispensary Policy Procedures Exhibit 9: Attachment H - Payment Details 5. CONTACTINFORMATION DHS Grant Administrator Grant Administrator Name: PatriciaHeger Telephone: 608-266-9692 Email: patricia.heger@dhs.wisconsin.gov Page 4 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB Grantee Grant Administrator Grant Administrator Name: EllenHenry Telephone: Email: ehenry@franklinwi.gov OHS will mail legal notices to the Grantee's Grant Administrator at the address identified in Section 3, unless otherwise notified by the Grantee. 6. PAYMENTFORGRANTAWARD Invoices presented for payment must be submitted in accordance with instructions contained on the purchase order including reference to purchase order number and submittal to the correct address for processing. A. Prompt Payment Law:OHS shall pay properly submitted Supplier invoices within thirty (30) days of receipt, providing that the services to be provided to OHS have been delivered, rendered, or installed (as the case may be), and accepted as specified in this Agreement and all documents incorporated herein by reference. A good faith dispute in regard to an invoice creates an exception to prompt payment pursuant to Wis. Stat. § 16.528 B. State Tax Exemption:DHS is exempt from payment of Wisconsin sales or use tax on all purchases. C. Payment Offsetsf or Grantee's Delinquency:The State of Wisconsin may offset payments made to the Grantee under this Agreement in an amount necessary to satisfy a certified or verifiable delinquent payment owed to the State or any state or local unit of government. DHS reserves the right to cancel this Agreement as provided in Agreement Cancellation, if the delinquency is not satisfied by the offset or other means during the Agreement term. D. Refund of Credits:DHS may request a refund of credits owed at any time. Grantee agrees to refund credits owed within sixty (60) days of DHS's request. 7. REPORTING A. The Grantee shall comply with DHS' program reporting requirements as specified in the Scope of Work. B. The required reports shall be forwarded to DHS Grant Administrator according to the schedule established by DHS. 8. FEDERALANDSTATERULESANDREGULATIONS A. The Grantee agrees to meet state and federal laws, rules, regulations, and program policies applicable to this Agreement. B. The Grantee will act solely in its independent capacity and not as an employee of DHS. The Grantee shall not be deemed or construed to be an employee of DHS for any purpose. C. The Grantee agrees to comply with Public Law 103-227, also known as the Pro-Children Act of 2001, which prohibits tobacco smoke in any portion of a facility owned, leased, or granted for or by an entity that receives federal funds, either directly or through the state, for the purpose of providing services to children under the age of 18. D. Pursuant to 2021 Wisconsin Executive Order 122, use of state funds for conversion therapy is expressly disallowed. 'Conversion therapy' does not include: any practice or treatment that provides acceptance, support, or understanding to an individual, or any practice or treatment that facilitates an individual's coping, social support, or identity exploration and development, so long as such practices or treatments do not seek to change sexual orientation or gender identity; any practice or treatment that is neutral with regard to sexual orientation or gender identity and that seeks to prevent or address unlawful conduct or unsafe practices, or any practice or treatment that assists an individual seeking to undergo a gender transition or who is in the process of undergoing a gender transition. E. Pursuant to 2023 Executive Order 184, grantee agrees it does not sell any products prohibited in the Order. In addition, grantee agrees that in fulfillment of its responsibilities under the Contract that no subcontractor relationship exists that would violate the prohibitions outlined in the Order. F. If federally funded, pursuant to 2 C.F.R. §200.322, the requirements of 2 C.F.R. §200.322 must be included in this award. The following clauses are hereby incorporated into this Contract and are enforceable as if restated herein in their entirety by reference to the following link: https://www.ecfr.gov/current/title-2/subtitle-A/chapter­ Il/part-200/subpart-D/subject-group-ECFR45ddd4419ad436d/section-200.322 Page 5of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB 9. AFFIRMATIVEACTION Pursuant to 2019 Wisconsin Executive Order 1, contractor agrees it will hire only on the basis of merit and will not discriminate against any persons performing a contract, subcontract or grant because of military or veteran status, gender identity or expression, marital or familial status, genetic information or political affiliation. 10.CIVILRIGHTSCOMPLIANCE As required by Wis. Stat. § 16.765, in connection with the perfonnance of work under this Agreement, the Grantee agrees not to discriminate against any employee or applicant for employment because of age, race, religion, color, handicap, sex, physical condition, developmental disability as defined in Wis. Stat. § 51.01(5), sexual orientation or national origin. This provision shall include, but not be limited to, the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Except with respect to sexual orientation, the Grantee further agrees to take affirmative action to ensure equal employment opportunities. The Grantee agrees to post in conspicuous places, available for employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of the nondiscrimination clause. The Grantee must file a Civil Rights Compliance Letter of Assurance (CRC LOA) for the current compliance period, within fifteen (15) working days of the effective date of the Agreement. If the Grantee employs fifty (50) or more employees and receives at least $50,000 in funding, the Grantee must complete a Civil Rights Compliance Plan (CRC Plan) unless the grantee meets one of the limited exceptions. The current Civil Rights Compliance Requirements and all appendices are hereby incorporated by reference into this Agreement and are enforceable as if restated herein in their entirety. The Civil Rights Compliance Requirements, including the CRC LOA fonn and the template and instructions for the CRC Plan can be found at https://www.dhs.wisconsin.gov/civil-rights/requirements.htm or by contacting: Department of Health Services Civil Rights Compliance Attn: Civil Rights Compliance Officer 201 E. Washington Ave., Room E200B P.O. Box 7850 Madison, WI 53707-7850 Telephone: (608) 267-4955 (Voice) 711 or 1-800-947-3529 (TTY) Fax: (608) 267-1434 Email: DHSCRC@dhs.wisconsin.gov The CRC Plan must be kept on file by the Grantee and made available upon request to any representative of DHS. Civil Rights Compliance Letters of Assurances should be sent to: Department of Health Services Division of Enterprise Services Bureau of Procurement and Contracting Affinnative Action Plan/CRC Coordinator 201 E. Washington Ave., Room A200 P.O. Box 7850 Madison, WI 53707-7850 dhscontractcompliance@dhs.wisconsin.gov The Grantee agrees to cooperate with DHS in any complaint investigations, monitoring or enforcement related to civil rights compliance of the Grantee or its Subgrantee(s) under this Agreement. DHS agrees to coordinate with the Grantee in its efforts to comply with the Grantee's responsibilities under these nondiscrimination provisions. 11. WEBCONTENTACCESSIBILITYGUIDELINES Page 6 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusgnEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB As required by the Americans with Disabilities Act of 1990 (42 U.S.C. $ 12101 et seq.) and the Rehabilitation Act of 1973 (29 U.S.C. § 791 et. seq.), specifically Sections 504 and 508, Section 1557 of the Affordable Care Act (42 U.S.C. $18116 et. seq.), and the Nondiscrimination in Healthcare Programs and Activities Rule (89 F.R. 37522) published on April 24, 2024, the State of Wisconsin and those receiving federal funding must adhere to the specific Federal requirements therein, ensuring that all web content and mobile applications (apps) created by or for the State of Wisconsin are accessible to people with disabilities. To meet those regulations, the Grantee must adhere to the Web Content Accessibility Guidelines required by the Department of Health Sercies (DHS)'s advanced (as of September l, 2026) adoption of regulations for Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act (i.e., WCAG 2.1 AA) in the fulfillment of the Contract. Contractor shall comply with the Americans with Disabilities Act (ADA) in a manner consistent with the W3C Web Content Accessibility Guidelines (WCAG), version 2.1 ("WCAG 2.1 ) , at conformance levels A and AA for all Products and Services provided under the Master Contract. If during the Term of the Master Contract, the Contractor fails to maintain compliance with WCAG 2.1 A and AA, or the State of Wisconsin identifies an accessibility barrier in the product or service that renders it inaccessible or unusable to people with disabilities, the State of Wisconsin shall notify the Contractor of non-compliance. If conformance is not reached within 30 days of the Contractor receiving the notification of non-compliance ("Notice"), the Contractor and the State of Wisconsin shall meet and mutually agree upon an appropriate timeline for resolution of the accessibility barrier(s). Should Contractor: (i) fail to acknowledge receipt of the notice within 30 days ofr eceipt of the Notice, or (ii) fail to materially resolve the accessibility barrier(s) within the agreed-upon timeline, Contractor agrees to indemnify and hold harmless the State of Wisconsin from any claims arising out of its failure to comply with the aforesaid requirements. Failure to comply with these requirements throughout the Contract tenn may be grounds for cancellation of the Master Contract by the State of Wisconsin. The State of Wisconsin may also require the Contractor to provide an Accessibility Confonnance Report (ACR) or Voluntary Product Accessibility Template (VPAT) upon request to demonstrate compliance with this requirement. 12. CONFIDENTIAL,PROPRIETARY,ANDPERSONALLYIDENTIFIABLEINFORMATION In connection with the performance of the work prescribed in this Agreement, it may be necessary for DHS to disclose to the Grantee certain infonnation that is considered to be confidential, proprietary, or containing Personally Identifiable Information (Confidential Information). The Grantee shall not use such Confidential Infonnation for any purpose other than the limited purposes set forth in this Agreement, and all related and necessary actions taken in fulfillment of the obligations herein. The Grantee shall hold all Confidential Information in confidence, and shall not disclose such Confidential Information to any persons other than those directors, officers, employees, and agents who have a business-related need to have access to such Confidential Information in furtherance of the limited purposes of this Agreement and who have been apprised of, and agree to maintain, the confidential nature of such information in accordance with the tenns of this Agreement. The Grantee shall institute and maintain such security procedures as are commercially reasonable to maintain the confidentiality of the Confidential Infonnation while in its possession or control including transportation, whether physically or electronically. OHS may conduct a compliance review of the Grantee's security procedures to protect Confidential Infonnation under Section 20 (Audits) of this Agreement. The Grantee shall ensure that all indications of confidentiality contained on or included in any item of Confidential Infonnation shall be reproduced by the Grantee on any reproduction, modification, or translation of such Confidential Infonnation. Ifr equested by OHS, the Grantee shall make a reasonable effort to add a proprietary notice or indication of confidentiality to any tangible materials within its possession that contain Confidential Infonnation of OHS, as directed. The Grantee or its employees and Subgrantees will not reuse, sell, make available, or make use in any fonn at the data researched or compiled for this Agreement for any venture, profitable or not, outside this Agreement. The restrictions herein shall survive the tennination of this Agreement for any reason and shall continue in full force and effect and shall be binding upon the Grantee or its agents, employees, successors, assigns, Subgrantee, or any Page 7 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534A471C6-8D1F-8C91-83C9-82798CE9E0EB party claiming an interest in this Agreement on behalf of or under the rights of Grantee following any tennination. Grantee shall advise all of their agents, employees, successors, assigns and Subgrantee which are engaged by the State of the restrictions, present and continuing, set forth herein. Grantee shall defend and incur all costs, if any, for actions that arise as a result of noncompliance by Grantee, its agents, employees, successors, assigns and Subgrantee regarding the restrictions herein. A. Reporting to DHS:Grantee shall immediately report within five (5) business days or less to DHS any use or disclosure of Confidential Information not provided for by this Agreement, of which it becomes aware, per state and federal requirements, as stated in any and all exhibits or appendices to this Agreement. Grantee shall cooperate with DHS' investigation, analysis, notification and mitigation activities, and shall be responsible for all costs incurred by DHS for those activities. B Indemnification. In the event of a breach of this section by Grantee, Grantee shall indemnify and hold hannless DHS and any of its officers, employees, or agents from any claims arising from the acts or omissions of the Grantee, and its Subgrantee, employees and agents, in violation of this section, including but not limited to, costs of credit monitoring and identity theft restoration coverage for one (I) year of coverage from the date the individual enrolls, of all persons whose Confidential Information was disclosed, disallowances or penalties from federal oversight agencies, and any court costs, expenses, and reasonable attorney fees, incurred by DHS in the enforcement of this section. C. Equitable Relief The Grantee-acknowledges and agrees that the unauthorized use, disclosure, or loss of Confidential Information may cause immediate and irreparable injury to the individuals whose infonn ation is disclosed and to DHS, which injury will not be compensable by money damages and for which there is not an adequate remedy available by law. Accordingly, the parties specifically agree that DHS, in its own behalf or on behalfo f the affected individuals, may seek injunctive or other equitable relief to prevent or curtail any such breach, threatened or actual, without posting security and without prejudice to such other rights as may be available under this Agreement or applicable law. D. Liquidated Damages: The Grantee agrees that an unauthorized use or disclosure of Confidential Information may result in damage to the State's reputation and ability to serve the public interest in its administration of programs affected by this Agreement. Such amounts of damages which will be sustained are not calculable with any degree of certainty and thus shall be set forth herein. Assessment under this provision is in addition to other remedies under this Agreement and as provided in law or equity. DHS shall assess reasonable damages as appropriate and notify the Grantee in writing of the assessment. The Grantee shall automatically deduct any assessed damages from the next appropriate monthly invoice, itemizing the assessment deductions on the invoice. Liquidated Damages shall not exceed the following: 1. $1,000 for each individual whose Confidential Infonn ation was used or disclosed; 2. $2,500 per day for each day that the Grantee fails to substantially comply with the Corrective Action Plan under this Section E. HIPAA The Grantee ISNOTa "Business Associate" pursuant to the definition under the Health Insurance Portability and Accountability Act (HIPAA) and the regulations promulgated thereunder specifically 45 C.F.R. § 160.103. If the parties are Business Associates, then the parties shall comply with DHS' Business Associate Agreement. If the Grantee is a Business Associate, the Grantee agrees to comply with the Health Insurance Portability and Accountability Act, Public Law 104-191 and with the Standards for Privacy and Security of Individually Identifiable Health Infonn ation, 45 C.F.R. Parts 160 and 164 applicable to Business Associates. As defined herein, "Business Associate" shall mean the Grantee and Subgrantee and agents of the Grantee that receive, use or have access to protected health information under this Agreement and "Covered Entity" shall mean the State of Wisconsin, Department of Health Services. In agreements for the provision of services, activities, or functions covered by the Health Insurance Portability and Accountability act of 1996 (HIPAA), the Grantee as a Business Associate must complete a Business Associate Agreement (BAA) F-00759. This document must be fully executed before Agreement performance begins. This Section shall survive the termination of the Agreement. Page 8 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB 13. SECURITYOFPREMISES,EQUIPMENT,DATAANDPERSONNEL During the performance of Services under this Contract, the Contractor may have access to the personnel, premises, equipment, and other property, including data files, information, or materials (collectively referred to as "data") belonging to the State. The Contractor shall preserve the safety, security, and the integrity of the personnel, premises, equipment, data and other property of the State, in accordance with the instruction of the State. Contractor shall ensure personnel with access to the State's IT Resources comply with the State's Acceptable Technology Use, Access and Security Policy. The Contractor shall be responsible for damage to the State's equipment, workplace, and its contents, or for the loss of data, when such damage or loss is caused by the Contractor, Contracted Personnel, or Subcontractors, and shall reimburse the State accordingly upon demand. This remedy shall be in addition to any other remedies available to the State by law or in equity. 14.HIGH-RISKITREVIEW Pursuant to Wis. Stat. 16.973(13), Contractor is required to submit, via the contracting agency, to the Department of Administration for approval any order or amendment that would change the scope of the contract and have the effect of increasing the contract price. The Department of Administration shall be authorized to review the original contract and the order or amendment to determine whether the work proposed in the order or amendment is within the scope of the original contract and whether the work proposed in the order or amendment is necessary. The Department of Administration may assist the contracting agency in negotiations regarding any change to the original contract price. 15. SUBGRANTorSUBCONTRACT A. OHS reserves the right of approval of any Grantee's further contracts, grants, contractors, or grantees under this Agreement, and the Grantee shall report information relating to any further contract, grants, contractors, or grantees to OHS. A change in any further contractor or grantee or a change from a direct service provision to a further contractor or grantee may only be executed with the prior written approval of DHS. In addition, OHS approval may be required regarding the terms and conditions of any further contracts or grants and the further contractor or grantee selected. Approval of any further contracts, grants, contractors, or grantees will be withheld if OHS reasonably believes that the intended further contractor or grantee will not be a responsible contractor or grantee in terms of services provided and costs billed. B. The Grantee retains responsibility for fulfillment of all terms and conditions of this Agreement when it enters into any further contract or grant and will be subject to enforcement of all the tenns and conditions of this Agreement. 16. GENERALPROVISIONS A. Any payments of monies to the Grantee by DHS for goods and/or services provided under this Agreement shall be deposited in a Federal Deposit Insurance Corporation (the "FDIC") insured bank. Any balance exceeding FDIC coverage must be collaterally secured. B. The Grantee shall conduct all procurement transactions in a manner that provides maximum open and free competition. C. If a state public official (see Wis. Stat. § 19.42), a member of a state public official's immediate family, or any organization in which a state public official or a member of the official's immediate family owns or controls at least a 10 percent (10%) interest is a party to this Agreement and if this Agreement involves payment of more than $3,000 within a 12-month period, this Agreement is void unless appropriate written disclosure is made, according to Wis. Stat. § 19.45(6), before signing the Agreement. Written disclosure, if required, must be made to the State of Wisconsin Ethics Commission at: Wisconsin Ethics Commission PO Box 7125 Madison, WI 53707-7125 Fax: (608) 264-9319 D. Ifthe Grantee or Subgrantee is a corporation other than a Wisconsin corporation, it must demonstrate, prior to providing services under this Agreement, that it possesses a Certificate of Authority from the State of Wisconsin Page 9 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB Department of Financial Institutions, and must have and continuously maintain a registered agent, and otherwise conform to all requirements of Wis. Stat. chs. 180 and 181 relating to foreign corporations. E. The Grantee agrees that funds provided under this Agreement shall be used to supplement or expand the Grantee's efforts, not to replace or allow for the release of available Grantee funds for alternative uses. 17.ACCOUNTINGREQUIREMENTS A. The Grantee's accounting system shall allow for accounting for individual grants, permit timely preparation of reports required by this Agreement, and support expenditure reports or invoices submitted to OHS. B. The Grantee shall reconcile costs reported to OHS for reimbursement or as match to expenses recorded in the Grantee's accounting or simplified bookkeeping system on an ongoing and periodic basis. The Grantee agrees to complete and document reconciliation at least quarterly and to provide a copy to OHS upon request. The Grantee shall retain the reconciliation documentation according to approved records retention requirements. C. Expenditures of funds from this Agreement must meet the Department' s allowable cost definitions as defined in the Department's Allowable Cost Policy Manual (https://www.dhs.wisconsin.gov/business/allow-cost­ manual.htm). 18. CHANGESINACCOUNTINGPERIOD A. The Grantee shall notify OHS of any change in its accounting period and provide proof of Internal Revenue Service (IRS) approval for the change. B. Proof ofI RS approval shall be considered verification that the Grantee has a substantial business reason for changing its accounting period. C. A change in accounting period shall not relieve the Grantee of the reporting or audit requirements of this Agreement. An audit meeting the requirements of this Agreement shall be submitted within ninety (90) days after the first day of the start of the new accounting period for the short accounting period and within one hundred and eighty (180) days of the close of the new accounting period for the new period. For purposes of determining audit requirements, expenses and revenues incurred during the short accounting period shall be annualized. 19.PROPERTYMANAGEMENTREQUIREMENTS A. Propert y insurance coverage will be provided by the Grantee for fire and extended coverage of any equipment funded under this Agreement which OHS retains ownership of and which is in the care, custody, and control of the Grantee. B. OHS shall have all ownership rights in any computer hardware supplied by OHS as a result of this Agreement. OHS shall have all ownership rights in any software or modifications thereof and associated documentation that is designed and installed or developed and installed under this Agreement. The Grantee shall have all ownership rights in any computer hardware funded under this Agreement and will have a nonexclusive, nontransferable license to use for its purposes of the software or modifications and associated documentation that is designed and/or installed under this Agreement. C. The Grantee agrees that if any materials are developed under this Agreement, DHS shall have a royalty-free, nonexclusive, and irrevocable right to reproduce, publish, or otherwise use and to authorize others to use such materials. Any discovery or invention arising out of, or developed in the course of, work aided by this Agreement shall be promptly and fully reported to OHS. 20.AUDITS A. Requirement toHave anAudit:The Grantee shall submit an annual audit to OHS if the total amount of annual funding provided by OHS (from any and all of its Divisions or subunits taken collectively) through this and other Grants is $100,000 or more. B. Audit Requirements:The audit shall be performed in accordance with generally accepted auditing standards, Wis. Stat. § 46.036, Government Auditing Standards as issued by the U.S. Government Accountability Office, and other provisions specified in this agreement. In addition, the Grantee is responsible for ensuring that the audit complies with other standards and guidelines that may be applicable depending on the type of services provided and the amount of pass-through dollars received. Please reference the following audit documents for complete audit requirements: Page 10 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelope ID:534471C6-8D1F-8C91-83C9-82798CE9E0EB • 2 Code of Federal Regulations (C.F.R .), Part 200 - Uniform Adm inistrative Requirements, Cost Principles, and Audit Requirements for Federal Aw ards, Subpart F - Audit Requirements. The guidance also in cludes an Annual Compliance Supplement that details specific federal agency rules for accepting federal subawards. • The State Single Audit Guidelines (SSAG) expand on the requirements of 2 C.F.R. Part 200 Subpart F by identifyin g additional conditions that require a state single audit. Section 1.4 of the SSAG lists the required conditions. • OH S Audit Guide is an appendix to the SSA G and contains additional OHS-specific audit guidance for those entities who meet the SSAG requ irements. It also provides guidance for those entities that are not required to have a Single Audit but need to comply with OHS subrecipient/contractor audit requirements. An audit report is due to OHS if a subrecipient/contractor receives more than $10 0,000 in pass-thro ugh money from OHS as determined by Wis. Stat. §46.036. C. Source of Funding: OHS shall provide funding inform ation to all subrecipient/contractors for audit purposes, including the name of the program , the federal agency where the pro gram orig inated, the A ssistan ce Listin g number and the percentages of federal, state and local funds constituting the agreement. D. Reporting Package:The subrecipient/contractor that is required to have a Sin gle Audit based on 2 C.F.R . Part 200 Subpart F and the State Single Audit Guide is required to submit to DHS a reporting package which includes all of the follow ing: 1. Genera l-purpose financial statements of the overall agency and a schedule of expenditures of federal and state awards, including the independent auditor's opinion on the statements and schedule. 2. Schedule of findings and questioned costs, schedule of prior audit findings, corrective action plan and the man agement letter (if issued). 3. Report on complian ce and on internal control over financial reporting based on an audit performed in accordance with government auditing standards. 4. Report on compliance for each major program and a report on internal control over compliance. 5. Report on compliance with requirements applicable to the federa l and state program and on intern al control over compliance in accordan ce with the program -specific audit option. 6. DHS Cost Reimbursement Aw ard Schedule. This schedule is required by OHS if the subrecipient/contractor is a non-profit, for-profit, a governmental unit other than a tribe, county , Chapter 51 board or school district; if the subrecipient/contractor receiv es fundin g directly from OHS; if paym ent is based on or limited to an actual allowable cost basis; and if the auditee reported expenses or other activity resulting in paym ents totaling $10 0,000 or more for all of its grant(s) or contract(s) with OHS. 7. *R eserve Schedule is only required if the subrecipient/contractor is a non -profit and paid on a pro spectively set rate. 8. *Allow able Profit Schedule is only required if the subrecipient/contractor is a for-profit entity. 9. *Additional Supplemental Schedule(s) required by funding agency may be required. Check with the funding agency. *N OTE: These schedules are only required for certain types of entities or specific fin ancial conditions. For subrecip ient/contractors that do not meet the federa l audit requirements of 2 C F .R. Part 200 and SSAG, the audit reportin g package to OH S shall include all of the above items except items 4 and 5. E. Audit Due Date:Audits that must comply with 2 C.F.R. Part 200 and the State Single Audit Guidelines are due to the granting agencies nine months from the end of the fiscal period or thirty (30) days from completion of the audit, whichever is sooner. For all other audits, the due date is six months from the end of the fiscal period unless a diff erent date is specified within the contract or grant agreement. F. Sending the Reporting Package:Audit reports shall be sent by the auditor via email to DH SA uditors@ Wisconsin.gov with "cc" to the subrecipient/auditee. The audit reports shall be electronically created pdf files that are text searchable, unlocked, and unencrypted. (Note: To ensure that pdf files are unlocked and text-searchable, do not scan a physical copy of the audit report and do not change the default secur ity settings in your pdf creator.) G. Access to Subrecipient Records:The auditee must provide the auditor with access to personnel, accounts, books, records, supporting documentation, and other inform ation as needed for the auditor to perform the required audit. The auditee sh all permit appropriate representatives of OHS to have access to the auditee's records and finan cial statements as necessary to review the auditee' s com pliance with federa l and state requirements for the use of the funding. Having an independent audit does not lim it the authority of OHS to conduct or arrange for other audits or review of federa l or state programs. OHS shall use information from the audit to conduct their own reviews without duplication of the independent auditor's work. Page 11 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB H. Access toAuditor's Work Papers:The auditor shall make audit work papers available upon request to the auditee, OHS or their designee as part of performing a quality review, resolving audit findings, or carrying out oversight responsibilities. Access to working papers includes the right to obtain copies of working papers. I. Failure to Comply with the Audit Requirements:OHS may impose sanctions when needed to ensure that auditees have complied with the requirements to provide OHS with an audit that meets the applicable standards and to administer state and federal programs in accordance with the applicable requirements. Examples of situations when sanctions may be warranted include: 1. The auditee did not have an audit. 2. The auditee did not send the audit to OHS or another granting agency within the original or extended audit deadline. 3. The auditor did not perfonn the audit in accordance with applicable standards, including the standards described in the SSAG. 4. The audit reporting package is not complete; for example, the reporting package is missing the corrective action plan or other required elements. 5. The auditee does not cooperate with DRS or another granting agency's audit resolution efforts; for example, the auditee does not take corrective action or does not repay disallowed costs to the granting agency. J. Sanctions· OHS will choose sanctions that suit the particular circumstances and also promote compliance and/or corrective action. Possible sanctions may include: 1. Requiring modified monitoring and/or reporting provisions; 2. Delaying payments, withholding a percentage of payments, withholding or disallowing overhead costs, or suspending the award until the auditee is in compliance; 3. Disallowing the cost of audits that do not meet these standards; 4. Conducting an audit or arranging for an independent audit of the auditee and charging the cost of completing the audit to the auditee; 5. Charging the auditee for all loss of federal or state aid or for penalties assessed to OHS because the auditee did not comply with audit requirements; 6. Assessing financial sanctions or penalties; 7. Discontinuing contracting with the auditee; and/or 8. Taking other action that OHS determines is necessary to protect federal or state pass-through funding. K. CloseoutAudits:An agreement specific audit of an accounting period ofl ess than 12 months is required when an agreement is terminated for cause, when the auditee ceases operations or changes its accounting period (fiscal year). The purpose of the audit is to close-out the short accounting period. The required close-out agreement specific audit may be waived by OHS upon written request from the subrecipient/contractor, except when the agreement is terminated for cause. The required close-out audit may not be waived when an agreement is tenninated for cause. The auditee shall ensure that its auditor contacts OHS prior to beginn ing the audit. OHS, or its representative, shall have the opportunity to review the planned audit program, request additional compliance or internal control testing and attend any conference between the auditee and the auditor. Payment of increased audit costs, as a result of the additional testing requested by OHS, is the responsibility of the auditee. OHS may require a close-out audit that meets the audit requirements specified in 2 C.F.R. Part 200 Subpart F. In addition, OHS may require that the auditor annualize revenues and expenditures for the purposes of applying 2 C.F.R. Part 200 Subpart F and determining major federal financial assistance programs. This infonnation shall be disclosed in a note within the schedule of federal awards. All other provisions in 2 C.F.R. Part 200 Subpart F­ Audit Requirements apply to close-out audits unless in conflict with the specific close-out audit requirements. 21. OTHERASSURANCES A. The Grantee shall notify DHS in writing, within thirty (30) days of the date payment was due, of any past due liabilities to the federal government, state government, or their agents for income tax withholding, Federal Insurance Contributions Act (FICA) tax, worker's compensation, unemployment compensation, garnishments or other employee related liabilities, sales tax, income tax of the Grantee, or other monies owed. The written notice shall include the amount owed, the reason the monies are owed, the due date, the amount of any penalties or interest (known or estimated), the unit of government to which the monies are owed, the expected payment date, and other related information. B. The Grantee shall notify DHS in writing, within thirty (30) days of the date payment was due, of any past due payment in excess of $500 or when total past due liabilities to any one or more vendors exceed $1,000 related to the operation of this Agreement for which DHS has reimbursed or will reimburse the Grantee. The written notice Page 12 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534A471C6-8D1F-8C91-83C9-82798CE9E0EB shall include the amount owed, the reason the monies are owed, the due date, the amount of any penalties or interest (known or estimated), the vendor to which the monies are owed, the expected payment date, and other related infonnation. If the liability is in dispute, the written notice shall contain a discussion of facts related to the dispute and the information on steps being taken by the Grantee to resolve the dispute. C. DHS may require written assurance at the time of entering into this Agreement that the Grantee has in force, and will maintain for the course of this Agreement, employee dishonesty bonding in a reasonable amount to be detenn ined by DHS up to $500,000. 22.RECORDS A. The Grantee shall maintain written and electronic records as required by state and federal law and required by program policies. B. The Grantee and its Subgrantee(s) or Subcontractor(s) shall comply with all state and federal confidentiality laws concerning the information in both the records it maintains and in any of DHS' records that the Grantee accesses to provide services under this Agreement. C. The Grantee and its Subgrantee(s) or Subcontractor(s) will allow inspection of records and programs, insofar as is permitted by state and federal law, by representatives of DHS, its authorized agents, and federal agencies, in order to confirm the Grantee's compliance with the specifications of this Agreement. D. The Grantee agrees to retain and make available to DHS all program and fiscal records for six (6) years after the end of the Agreement period. E. The use or disclosure by any party of any information concerning eligible individuals who receive services from the Grantee for any purpose not connected with the administration of the Grantee's or DHS' responsibilities under this Agreement is prohibited except with the informed, written consent of the eligible individual or the individual's legal guardian. 23. CONTRACTREVISIONSAND/ORTERMINATION A. The Grantee agrees to renegotiate with DHS the tenns and conditions of this Agreement or any part thereof in such circumstances as: 1. Increased or decreased volume of services. 2. Changes required by state and federal law or regulations or court action. 3. Increase or reduction in the monies available affecting the substance of this Agreement. B. Failure to agree to a renegotiated Agreement under these circumstances is cause for DHS to terminate this Agreement. C. Non-Appropriation:DHS reserves the right to cancel any Agreement in whole or in part without prior notice, any penalty, or liability whatsoever due to non-appropriation of funds or receipt of funds by the Legislature or federal government or for failure of the Grantee to comply with tenn s, conditions, and specifications of this Agreement. D. Terminationfor Cause:DHS may tenn inate this Agreement after providing the Grantee with thirty (30) calendar days written notice of the Grantee's right to cure a failure of the Grantee to perform under the tenn s of this Agreement, if the Grantee fails to so cure or commence to cure. The Grantee may terminate the Agreement after providing DHS a written notice, within one hundred and twenty (120) calendar days, of DHS' right to cure a failure to perform under the terms of this Agreement. Upon the termination of this Agreement for any reason, or upon Agreement expiration, each party shall be released from all obligations to the other party arising after the date of tenn ination or expiration, except for those that by their terms survive such termination or expiration. Upon termination for cause, the Grantee shall be entitled to receive compensation for any deliverables' payments owed under the Agreement only for deliverables that have been approved and accepted by DHS. E. Terminationfor Convenience:Either party may terminate this Agreement at any time, without cause, by providing a written notice. DHS must notify the Grantee at least forty-five (45) calendar days prior to the desired date of termination for convenience. The Grantee must notify DHS at least one hundred and twenty (120) calendar days prior to the desired date of termination for convenience- during this notification period, the Grantee will continue providing services in accordance with the Agreement requirements. In the event of tennination for convenience, the Grantee shall be entitled to receive compensation for any fees owed under the Agreement and shall also be compensated for partially completed services. In this event, compensation for such partially completed services shall be no more than the percentage of completion of the services requested, at the sole discretion of DHS, multiplied by the corresponding payment for completion of such services as set forth in the Agreement. Alternatively, at the sole discretion of DHS, the Grantee may be Page 13ofl 7 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB compensated for the actual service hours provided. DHS shall be entitled to a refund for goods or services paid for but not received or implemented, such refund to be paid within thirty (30) days of written notice to the Grantee requesting the refund. F. Cancellation:DHS reserves the right to immediately cancel this Agreement, in whole or in part, without penalty and without an opportunity for Grantee to cure if the Grantee: I. Files a petition in bankruptcy, becomes insolvent, or otherwise takes action to dissolve as a legal entity; 2. Allows any final judgment not to be satisfied or a lien not to be disputed after a legally-imposed, thirty (30)-day notice; 3. Makes an assignment for the benefit of creditors; 4. Fails to follow the sales and use tax certification requirements of Wis. Stat. § 77.66; 5. Incurs a delinquent Wisconsin tax liability; 6. Fails to submit a non-discrimination or affirmative action plan as required herein; 7. Fails to follow the non-discrimination or affirmative action requirements of subch. II, Chapter 111 of the Wisconsin Statutes (Wisconsin's Fair Employment Law); 8. Becomes a federally debarred Grantee; 9. Is excluded from federal procurement and non-procurement Agreements; I0. Fails to maintain and keep in force all required insurance, permits and licenses as provided in this Agreement; 11. Fails to maintain the confidentiality of DHS' information that is considered to be Confidential Information, proprietary, or containing Personally Identifiable Information; or 12. Grantee performance threatens the health or safety of a state employee or state customer. 24.NONCOMPLIANCEANDREMEDIALMEASURES A. Failure to comply with any part of this Agreement may be considered cause for revision, suspension, or termination of this Agreement. Suspension includes withholding part or all of the payments that otherwise would be paid to the Grantee under this Agreement, temporarily having others perform and receive reimbursement for the services to be provided under this Agreement, and any other measure DHS determines is necessary to protect the interests of the State. B. The Grantee shall provide written notice to DHS of all instances of noncompliance with the terms of this Agreement by the Grantee or any of its Subgrantees or Subcontractors, including noncompliance with allowable cost provisions. Notice shall be given as soon as practicable but in no case later than thirty (30) days after the Grantee became aware of the noncompliance. The written notice shall include information on the reason for and effect of the noncompliance. The Grantee shall provide DHS with a plan to correct the noncompliance. C. If DHS determines that noncompliance with this Agreement has occurred or continues to occur, it shall demand immediate correction of continuing noncompliance and seek remedial measures it deems necessary to protect the interests of the State up to and including termination of the Agreement, the imposing of additional reporting requirements and monitoring of Subgrantee or Subcontractors, and any other measures it deems appropriate and necessary. D. If required statistical data, reports, and other required information are not submitted when due, DHS may withhold all payments that otherwise would be paid the Grantee under this Agreement until such time as the reports and inform ation are submitted. 25.DISPUTERESOLUTION If any dispute arises between DHS and Grantee under this Agreement, including DHS' finding of noncompliance and imposition of remedial measures, the following process will be the exclusive administrative review: A. Informal Review:DHS' and Grantee's Grant Administrators will attempt to resolve the dispute. If a dispute is not resolved at this step, then a written statement to this effect must be signed and dated by both Grant Administrators. The written statement must include all of the following: I. A brief statement of the issue. 2. The steps that have been taken to resolve the dispute. 3. Any suggested resolution by either party. B. DivisionAdministrator's Review:If the dispute cannot be resolved by the Grant Administrators, the Grantee may request a review by the Administrator of the division in which DHS Grant Administrator is employed, or if the Grant Administrator is the Administrator of the division, by the Deputy Secretary of DHS. The Division Page 14 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusgnEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB Administrator (or Deputy Secretary) must receive a request under this step within fourteen (14) days after the date of the signed unresolved dispute letter in Step A. The Division Administrator or Deputy Secretary will review the matter and issue a written determination within thirty (30) days after receiving the review request. C. Secretary's Review:If the dispute is unresolved at Step B, the Grantee may request a final review by the Secretary of OHS. The Office of the Secretary must receive a request under this step within fourt een (14) days after the date of the written determination under Step B. The Secretary will issue a final determination on the matter within thirty (30) days after receiving the Step B review request. 26. FINALREPORTDATE A. Expenses incurred during the Agreement period but reported later than 60daysafter the period ending date will not be recognized, allowed, or reimbursed under the terms of this Agreement unless determined as allowable by OHS. In the event this occurs, an alternate payment process as determined by OHS would occur. B. Expenses incurred outside of the Agreement period would be considered not allowable. 27. INDEMNITY To the extent authorized under state and federal laws, OHS and the Grantee agree they shall be responsible for any losses or expenses (including costs, damages, and attorney's fees) attributable to the acts or omissions of their employees, officers, or agents. 28. CONDITIONSOFTHEPARTIES'OBLIGATIONS A. This Agreement is contingent upon authority granted under the laws of the State of Wisconsin and the United States of America, and any material amendment or repeal of the same affecting relevant funding or authority of OHS shall serve to revise or terminate this Agreement, except as further agreed to by the parties. B. OHS and the Grantee understand and agree that no clause, term, or condition of this Agreement shall be construed to supersede the lawful powers or duties of either party. C. It is understood and agreed that the entire Agreement between the parties is contained herein, except for those matters incorporated herein by reference, and that this Agreement supersedes all oral agreements and negotiations between the parties relating to the subject matter thereof. 29. GOVERNINGLAW This Agreement shall be governed by the laws of the State of Wisconsin. The venue for any actions brought under this Agreement shall be the Circuit Court of Dane County, Wisconsin or the U.S. District Court for the Western District of Wisconsin, as applicable. 30. SEVERABILITY The invalidity, illegality, or unenforceability of any provision of this Agreement or the occurrence of any event rendering any portion or provision of this Agreement void shall in no way affect the validity or enforceability of any other portion or provision of this Agreement. Any void provision shall be deemed severed from this Agreement, and the balance of this Agreement shall be construed and enforced as if it did not contain the particular portion or provision held to be void. The parties further agree to amend this Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. The provisions of this Article shall not prevent this entire Agreement from being void should a provision, which is of the essence of this Agreement, be determined void. 31. ASSIGNMENT Neither party shall assign any rights or duties under this Agreement without the prior written consent of the other party. Page 15 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E EB 32.ANTI-LOBBYINGACT The Grantee shall certify to DHS that it will not and has not used federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any federal contract, grant or any other award covered by 31 U.S.C. 1352. The Grantee shall also disclose any lobbying with non­ federal funds that takes place in connection with obtaining any federal award. The Grantee shall use Standard Form LLL (SFLLL) for Disclosure of Lobbying Activities available at: https://www .gsa.gov/reference/forms/disclosure-of-lobbying-activities. A completed disclosure must be provided upon Depart ment request. 33.DEBARMENTORSUSPENSION The Grantee certifies that neither the Grantee organization nor any of its principals are debarred, suspended, or proposed for debarment for federal financial assistance (including, but not limited to, General Services Administration's list of parties excluded from federal procurement and non-procurement programs). The Grantee further certifies that potential Subgrantees or Subcontractors and any of their principals are not debarred, suspended, or proposed for debannent. 34. DRUGFREEWORKPLACE The Grantee, agents, employees, Subgrantees or Subcontractors under this Agreement shall follow the guidelines established by the Drug Free Workplace Act of 1988. 35.MULTIPLEORIGINALS This Agreement may be executed in multiple originals, each of which together shall constitute a single Agreement. 36. CAPTIONS The parties agree that in this Agreement, captions are used for convenience only and shall not be used in interpreting or construing this Agreement. 37. SPECIALPROVISIONS,IFAPPLICABLE The following special provisions are required: Match Requirements: Funding percentages: a. Federal: b. State: c. Local/Other: Page 16 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB 38.NULLANDVOID This Agreement becomes null and void if the time between the earlier dated signature and the later dated signature of DHS' and Grantee's Authorized Representatives on this Agreement exceeds sixty (60) days inclusive of the two signature dates. Page 17 of 17 Template Revision: 07/01/2026 (previous templates no longer usable) Docusgn Envelope ID:534471C6-8D1F-8C91-8309-82798CE9E0EB Tony Evers Governor DIVISION OF PUBLIC HEALTH 1WEST WILSON STREET PO BOX 2659 MADISON WI 53701-2659 Kirsten L Johnson Secretary To: Local Health Officers State ofWisconsin Department of HealthServices Telephone 608-266-1251 Fax:608-267-2832 TTY·711 or 800-947-3529 From: Pat Heger, Financial Specialist Advanced, Wisconsin Department of Health Services (DHS) Tuberculosis Program (WTBP) Date: July 1, 2026 Re: FY2027 Wisconsin Tuberculosis (TB) Dispensary Contracts It is time to establish Wisconsin TB Dispensary contracts for fiscal year 2027, which runs from July 1, 2026 through June 30, 2027. The contract is a standard purchase order interagency agreement between your health department and the State of Wisconsin. The accompanying documents (Wisconsin Tuberculosis Dispensary Policy and Procedures, with attachmentsA, B, C,D, E, Gand the TreatmentAssistance Program Policies and Procedures) provide the specifics of how the Wisconsin TB Dispensary works, who is eligible for coverage, what services and medications are allowed, service codes, National Drug Codes (NDC), and Medicaid reimbursement rates as of April 2025. Please follow emailed DocuSign instructions to electronically sign the contract and return to DPH through DocuSign. Attachment B (Clinical Services Plan) must be returned, or your contract will not be valid. AttachmentD (Pharmacy Services Plan) is optional, to be completed and returned for any jurisdiction that will be requesting reimbursement for pharmacy services not ordered through the default Wisconsin TB Dispensary pharmacy. As always, WTBP staff members are available to answer any questions you may have by phone (608-261-6319) or email (DHSWITBProgram@dhs.wisconsin.gov). Thank You, www.dhs.wisconsin.gov DocusIgnEnvelopeID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENT A Wisconsin TB Dispensary Program Covered Clinical Services by Patient Type - Fiscal Year 2027 NOTE: Any additional servicesthat exceed allowed number of services MUST have apre-authorization and areat the discretion of the WisconsinTB program (WTBP) for reimbursement. "Liverfunction"includesasingleALT,AST,ortotalblrubmn,1f morethanoneIverfunctiontestisperformed,pleaseusehepaticfunctionpanel [servicecode80076],whichincludesallthreetests Hepaticfunctionpanelcanbesubstitutedwiththecombinationofacompletemetabolic panelandtotalbilirubmtest **Wheneverpossible,usethefee-exempttesting(HIVandliverfunctiontest)performedbytheWisconsinStateLaboratoryofHygiene(WSLH) TestingperformedbylaboratoriesotherthanWSLHwillbecoveredattheMedicaid-allowablerate Whilethepatent isstillinisolation,onlyonesputumshouldbeobtainedweeklyuntilthesmearresultisnegative.Aftertheinitialnegativesputum twomoresputumsamplesshouldbecollectedtoverifythenegativeresult.Repeatthisuntilallthreesputumsamplesaresmearnegative After allthreehavebecomenegatve,continuetocollectasetofthreesputumsampleseachmonthuntilthepatientcompletestreatment,achieves cultureconversion,orcannolongerproducesputum. Type and amount of services covered bythe WTBP (for the duration of treatment): Service Active Tuberculosis (TB) Suspect or contact who Latent TB Infection Disease is eventually ruled out (LTBI) Diagnostic IGRA - 2 Diagnostic IGRA- 2 Diagnostic IGRA- 2 Liver function - 1to 2 (1at baseline, 1at 8-10 Liverfunction - 2 Laboratorytests** CBC w/automated weeks post-exposure) CBC w/automateddifferential (does not include blood platelets - 1 Liver function -1 differential collection) HIV- 1 HIV- 1 platelets - 1 HIV- 1 Serum creatinine - 1 Uric acid - 1 Blood specimen collection (venipuncture) :;;#oftests performed <$# oftests performed :;;# oftests performed Diagnostictuberculinskintest 2 (TST, includes placement & 1 (1at baseline, 1at 8-10 1 reading) weeks post-exposure) Chest Imaging & interpretation (CT or2-viewchestX-ray 3 2 1 recommendedfor diagnosis) 4total 2total 2total Medical evaluation by MD [1 new (diagnostic)] [1new (diagnostic)] [1 new (diagnostic)] [3established (follow-up)] [1established (follow-up)] [1established (follow-up)] Sputum collection Variouse l 3 3 ;t ..+5 5•DOTand NurseServicesCodes± % ±~ Targeted Case Management Servicecode T1017 (TCM) TCM includesDOTNDOT, patienteducation,andsymptomtreatmentandmonitoringforadverse druareactions Patient education/ Service code S9445 Anticipatory guidance (Without DOT) Travelfor DOT Service code T0001 45to60minutesperdav,roundtrip 4O s eos t o %,S D r one n«orno s ave» Divisionof PublicHealth (04/ 2026) Page1of2 Docusgn EnvelopeID:534A471C6-8 1F-8091-8309-82798CE9E0EB Use of Targeted Case Management (TCM) and Nurse Service Codes forthe WisconsinTB Dispensary Program The bullets below represent generalguidance. Exceptions can be made in unique situations using the preauthorization process. General • TCM and Nurse Service Codes:TCM intrinsically includes patient education, anticipatoryguidance, DOTNDOT, and symptom/treatment monitoring.Additionally, as inprevious years,servicecodesfor"Patient Education/Anticipatory Guidance (S9445)" and "Targeted Case Management (T1017-15 toT1017-60)" should not be billedtogetheronthe same day. Therefore,the "Targeted Case Management (T1017)"servicecodeshould not be billed onthe same day as"Patient education/Anticipatory guidance". Use only one TCM or nurse service code per patient perday. • Video DOT: Please usethe"Targeted Case Management (T1017)" servicecodeforvideo DOT (VTCM). VTCM should be billedfor no longerthan 15 minutes perappointment. • TCM in Officeor Clinic: Please bill no morethan 30 minutesfor DOT performed inyourclinic oroffice(i.e., patients cometoyourofficeorclinicto receiveTB/LTBI medications by DOT). • Services in the Home: Forhomevisits,only 60 minutesof services (i.e., DOT, symptom/treatment monitoring, patient education/anticipatory guidance) may be billed per patient perday. The60-minutecapdoes not include traveltime,see belowfortravelcode (T-0001) information. • Venipuncture:ServicecodesT1017 and S9445 should not be usedforvenipunctureservices. Please use servicecode: 36415 (Blood collection,venous by venipuncture). LTHO Travel for TCM • A new service code 'TravelforTCM (T0001)" has been createdfortraveltime >45 minutes (e.g.,time inyour car)associatedwith DOT and nurse services. This code is meant to be used in combinationwiththe TCM and Patient education/Anticipatory guidancecodes. Reimbursed rates areshown below: ServiceCode Amount oftraveltime Reimbursement rate (round trip) T0001-45 45 $28.20 T0001-60 60 $37.60 o The travelservicecode (T0001) isintendedfortraveltime (e.g., driving) of;;::45 minutes, roundtrip. Traveltime of lessthan45 minutes is not reimbursable. o Billfortime spent onTCM and Patient education/Anticipatory guidance separatefromtime spentfor travel Wisconsin Department of Health Services Divisionof PublicHealth (04/2026) Page2 of 2 DocusignEnvelopeID:534A471C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENTB WisconsinTBDispensaryProgram Tuberculosis(TB)ClinicalServicesPlan(CSP) FY2026-2027 Purpose The purpose of the Clinical Services Plan is to provide a framework for local health departments to describe and document clinical services that will be provided through the Wisconsin Tuberculosis (TB) Dispensary Program. To participate in the Wisconsin TB Dispensary Program, the local health department must agree to provide a financial assessment for each patient, identify populations that are at risk for tuberculosis within their jurisdiction, provide documentation of services provided or arranged and patient results, and provide or assure clinical assessments, diagnostic and follow-up testing and patient management as described in Table 1. Please note that patients treated for active TB disease should receive medications through the Wisconsin TB Dispensary Program or the locally contracted pharmacy, to better coordinate outpatient TB treatment. The Financial Assessment below should still be completed and other payors identified, if available. FinancialAssessment All clients and patients referred or presenting themselves for TB services will be assessed for their ability to provide private insurance or Medicare/Medicaid coverage. Eligibility or presumptive eligibility for Medicaid and/or for Tuberculosis-related Medicaid (known as TB only-MA) should be pursued. Upon submission to the Wisconsin TB Program (WTBP), the services billed to the health department will be reimbursed at the Medicaid (MA) rate. Yes No Hardshipfor patient to pay deductible & co-pay (i.e., either is high enough to beadeterrent toseek medical careor adheretotreatment) Yes LHDcan decideTBservice costswill becovered by WTBPDispensary Patient will be seen by MD/medicalfacility listed on LHD'sdispensaryCSP. Patient agrees NOT seekTBservicesfrom their primary care physician (PCP),therefore, patient will not incur any expensesforTBservices. Or If the LHDobtainsagreement from the patient's PCPto perform stipulatedTB servicesthat get billed only totheLHD and accept reimbursement at the MA rate,the patient can gototheir PCP. TBservicescove Patient eligiblefor MA orTBonly-MA, but not enrolled Yes LHDwill facilitate enrollment into MA orTBonIv-MA Yes TBservicescovered by MA orTBonly-MA Page1of 4 Docusign Envelope ID' 534471C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENTB WisconsinTBDispensaryProgram NotCoveredbytheWisconsinTBDispensaryProgram o PersonswithPrivateorPublicInsurance All clients and patients referred or presenting themselves for TB services will be assessed for their ability to provide private insurance or Medicare/Medicaid coverage. Eligibility or presumptive eligibility for Medicaid and/or for Tuberculosis-related Medicaid (known as TB only-MA) should be pursued. o Hospitalizations The TB Dispensary cannotpay for any hospitalizations. This includes emergency room and urgent care visits. If the patient is eligible for TB dispensary services, coverage will begin afterdischarge from hospital. Hospital costs are billed to the patient, the patient's insurance, or the facility absorbs the cost. If considering the patient for dispensary covered services, assess the patient for health insurance and dispensary eligibility, as outlined above, before patient is discharged. o Employee,AdmissionorIncarcerationTesting Dispensary funds are notapplicablefor TB screening or testing done for employment, school, residential admittance, or incarceration. Facilities or persons requiring TB tests are obligated to bear the cost of those screenings. o TB ClassBStatusRefugees Refugees receive short-term health insurance called Refugee Medical Assistance (RMA) for the first eight months in the US. These individuals are not eligible for the Wisconsin TB Dispensary Program. At-riskPersons TB services are covered by the WTBP Dispensary for persons atriskof having TB infection or disease and insufficient, or no health insurance. Risk factors for TB infection in Wisconsin include the following: o Birth, travel or residence in a country with high TB prevalence (includes any country other than the United States, Canada, Australia, New Zealand, or a country in western or northern Europe). o Close contact to someone with infectious TB disease during lifetime, with priority to immune compromised individuals and children under the age of 5 years. o Individuals with recent TB symptoms: persistent cough lasting three or more weeks and one or more of the following symptoms: coughing up blood, fever, chills, night sweats, unexplained weight loss or fatigue. o Current or planned immunosuppression including receipt of an organ transplant, treatment with a TNF-alpha antagonist (e.g., infliximab, etanercept, or other), chronic steroids (equivalent of prednisone >15 mg/day for <1 month), or other immunosuppressive medication in combination with a risk for infection o Individuals who are likely to be infected and HIV-positive. o Those who have been referred to the LHD after a positive TST or IGRA test, abnormal chest imaging consistent with TB disease or other medical condition(s) suggestive of active TB. In addition to those listed above, individuals considered at "high risk" for TB within this jurisdiction include: D No additional high risk groups. Page2of 4 Docusign Envelope ID: 534471C6-8D1F-8C91-8309-82798CE9E0EB ATTACHMENTB WisconsinTBDispensaryProgram Documentation Records of all TB services provided or arranged for will be kept according to health department record policies and procedures and on forms/in formats that are efficient and useful in the health department. The WTBP, as authorized by Wis. Admin. Code § DHS 145.12(4)(a) may audit the records of the health department dispensary. For reimbursement for TB-related medical services, local and Tribal health departments (LTHDs) shall use the TB Ordering and Billing Interface (TOBI). The LTHD mustuse the Wisconsin Electronic Disease Surveillance System (WEDSS) for patient record management. All patients covered by the dispensary must have a TB-related disease incident number in WEDSS associated with one of the following services: o Tuberculosis (resolution status= suspect or confirmed) o AFB Smear o Tuberculosis, Class A or B o Tuberculosis, Latent Infection o Contact Investigations FormsforDocumentationof Treatment The final results of TB or LTBI treatment must be documented so the patient and future health care providers have a permanent record of this treatment. If the LTHD does not have access to WEDSS, or a doctor completed the treatment, the following forms can be used to document treatment completion: • Active TB Disease Follow-up Report form (E-02474) • Latent Tuberculosis Infection (LTBI) Follow-up Report (F-44125) InstructionsforDocumentingLTBIinWEDSS Instructions for documenting LTBI in WEDSS can be found here: P-02426: Documenting LTBI in WEDSS ClinicalAssessments All clients and patients referred or presenting themselves for TB services will be assessed according to LTHD policies, procedures and practices. Care provided, or arranged for, will be performed according to statutes, rules, guidelines and CDC protocols with emphasis on public health protection and TB prevention and care. Agreements The LTHD must have established agreements with providers for clinical services to ensure that proper MA billing practices are in place. Services provided or arranged by the LTHO should be documented in Table 1, below. Written agreements or a memorandum of understanding (MOU) are encouraged and should include the following: o Providers understand and agree to provide services in a timely manner to patients with infectious TB, or those being evaluated for infectious TB using proper respiratory precautions. o Providers understand and have agreed that they will be reimbursed at the MA rate. o Providers understand and agree that services not listed on the service grid (Attachment A) must be pre-authorized by the WTBP Director or Nurse Consultant. o Services provided without pre-authorization will not be reimbursed. o A simple form identifying the patient as a Health Department referral identifying the Health Department as responsible for payment at Medicaid rates. Include Attachments A and C for the Medical Professionals reference. Page3of4 DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENTB WisconsinTBDispensaryProgram db h L lH lhDd d Ap1 STable ervces rov1e or rrange IV t e oca eat epartment Typeofservices Provider Verbalor ! i IGRA (interferon gamma release assay) testing or Tuberculin skin testing (TST) Risk assessment and medical evaluation by physician or nurse Provider will prescribe drugs for treatment of TB and LTBI Chest Imaging: Chest X-ray (CXR) or computerized tomography (CT) scan Sputum collection or induction for acid-fast bacilli smear and culture Venipunctures for IGRA or other laboratory testing Health care setting(s) that allow for evaluation and care of patients with potentially infectious TB, including airborne infection isolation rooms and respiratory precautions (for inpatient and outpatient settings). Directly Observed Therapy (DOT) for active tuberculosis disease and the isoniazid and rifapentine (3HP) regimen for latent TB infection. DOT includes patient education and symptom check for adverse drug reactions. TB contact investigations Optional - Other service (describe): Optional - Other service (describe): Optional - Other service (describe): Oo, s s co st %. O p r ee n or Ht s r e c» Division of Public Health (04/ 2026) Page4of4 Docus1gnEnvelopeID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENT C WisconsinTuberculosisDispensary Program CPTCodesand Reimbursement RatesforAllowable Clinical Services, Targeted Case Management (TCM) and Nurse Service Codes, Fiscalyear 2027 NOTE: Pleasesee Attachment Afor allowed number of services; any additional servicesrequire pre-authorization and are at the discretion of theWITBProgramfor reimbursement. TBProgram ratesmay change subject to Medicaid ratesthroughout theyear. Service Service Dispensarydefinitionsforbilling Chargecode (May notapply to MAbilling/ 36415 Blood collection,venousbyvenipuncture For IGRA, LFT, HIV, HA1C,serum creatInine,and uncacid $7.06 X-Ray Exam, Chest,2Views(usecodeseries Imagingand interpretation;theCDCandWITBprogram recommend a 71046 71045for oneview X-Ray) two-vew X-Ray (ratherthan aone-vew X-Ray)for proper diagnostic $23.52 purposes 71046-PC X-Ray Exam,Chest,2Views-interpretatton only Professional interpretation only $8.53 71046-TC X-Ray Exam,Chest,2Views-technicalonly Imagingonly $14.98 71270 CTThorax DxC-/C+ Includeswithand w/o dye(71270-TC& 71270-PCalsoavailable) $366.10 76497 CTScan CADadd on Allowablemn conjunctionwith CTscan only $24.63 85025 CompleteCBCwithautomated d1fferent1al Doesnot include blood draw $7.77 80076 Hepaticfunction panel Usethiscode1f requestingany amount morethan oneliverfunctiontest $8.17 84450** AST Part of "Liver Function" test -doesnot include blooddraw $5.18 84460 ALT Part of "Liver Function" test -doesnot include blood draw $5.30 82247 Total bilirubin Part of "Liver Function" test -doesnot include blooddraw $5.02 82565 Assay of creatmme Doesnot include blood draw $5.12 84550 Assay of Blood/Uricacid Doesnot include blood draw $4.52 83036 HA1C(GlycosylatedHemoglobinTest) Doesnot include blood draw $9.71 86480 IGRA·Quant1feron'" Doesnot include blood draw $61.98 86481 IGRA:T-Spot" (throughQuest DiagnosticsLab) Doesnot include blood draw $87.22 86580 TBskmtest Placement and reading= oneservice $6.13 86703 HIV-1AND HIV-2 1result antibodyassay Doesnot include blood draw $13.71 89220 Sputum induction,withaerosol $14.40 TB101 Sputum obtained mhome orclinic bystaff Weekday drop-off/pick-up =oneservice $10.82Drop-off Friday/puck-up Monday=oneservice 43755* Gastrcaspirate Forchildren, pre-authonzat1on Isrequiredforadults $41.44 98004 Aud1o-Video MedicalVisit-Established Videovis1t wt h MD Straightforward (SF) 10 mm $29 33 98005 Audio-Video Medical Visit-Established Video visitwith MD Low 20 min $5132 99202 Officevisit with MD, NEW PATIENT Office0/PNew SF15-29 mm $48.35 99203 Officevsit with MD, NEW PATIENT OfficeO/PNew Low 30-44 min $74.38 99204 Officevsit with MD, NEW PATIENT Office0/PNew Mod45-59 mm $110.94 99205 Officevisit wIth MD, NEW PATIENT Office0/PNew HI60+Mm $146.41 99212 Officevisit with MD, ESTABLISHEDpatient Office0/PESTSF10-19 mm $37.79 99213 OfficeVISlt With MD, ESTABLISHEDpatient Office0/PESTLOW 20-29 min $60.42 99214 Officevisit wIth MD, ESTABLISHEDpatient Office0/PESTMod 30-39 mm $85.58 99215 Officevisit with MD, ESABLISHEDpatient Office0/PESTHI40+mm $119.97 84311 Spectrophotometry(Adenosmedeammase) Pre-authorization tsrequired unlesspleuralTBsdiagnosed $8.10 62270* DXLMBRSPI PNXR(CSF) Pre-authorization isrequired unless TBmeningitistssuspected $154.36 Continued on page 2. Page 1of 2 DocusIgn Envelope ID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB Publich e a l t h nurses e rv ic e s limitedt o 6 m i n u t e s p e r dayc u m u l a t i v e a Targeted casemanagement --T1017-15 (usefor Targeted Case Management hasreplaced directlyobservedtherapy $11.98VDOTalso-15 min only) (DOT)andvideo DOT(15 mm only): T1017 Targeted casemanagement -T1017-30 TCM/VTCM mncludesobserving pat ent whiletheyaretakmngtheir $23.96 Targeted casemanagement -T1017-45 medication(s), patient education and symptom checkfor adverse $35.94drugreactions. Must beperformed byRNortrained TCM worker Targeted casemanagement -T1017-60 who ishealthdepartment employee. $47.92 Patient education/anticipatory guidance-S9445-15 VIsItstoencourageadherence,talkabout TBdiseaseorLTBI, $9.48 S9445 ++ Patient education/anticipatory guidance-S9445-30 diagnostictesting,treatment options, benefitsof adherenceto $18.97 Patient education/anticipatoryguidance-S9445-45 treatment and/orfollow-upcare. May not becombinedwIthTCM $28.46 Pat ent education/anticipatory guidance-S9445-60 code. $37.95 T-0001 TravelforTCM 45mm-T000l-45 Traveltime(roundtnp)~45 minutesforthe purposeof TCM $28 20 TravelforTCM 60 mm-T000l-60 $37.60 *Pre-authorization must be obtained from the Wisconsin TBProgram for any servicesto be reimbursed, unless otherwise noted. **Wheneverpossible,usethefee-exempt testingdonebytheWisconsinStateLaboratoryof Hygiene(W5LH) Testingdoneotherthanat theWSLHwill be coveredat theMA-allowablerate ***PleaseseeAttachment Aforfurtherguidanceonuseof TCM (T1017)Patient education/anticipatoryguidance(S9445),andTravelfor TCM (T-0001)codes Use of Targeted Case Management (TCM} and NurseService Codesforthe WisconsinTBDispensary Program The bulletsbelow represent general guidance. Exceptionscan be made in unique situationsusingthe preauthorizat1on process. General • TCM servicesintnns1cally include patient education, anticipatory guidance and symptom/treatment monitoring, aswell asdirectly observed therapy {DOT)services.Therefore, the "Targeted Case Management (T1017)" ser ce codeshould not be billed concurrently with the "Patient education/AntIcIpatoryguidance(59445)" code. • Video DOT: Please use the "Targeted Case Management {T1017)" service code forvideo DOT{VDOT). VDOTshould be billed for no longerthan 15 minutesper appointment. • Please bill no morethan 30 minutesforTCM performed in your clinic or office {i.e., patientscometoyour office or clinicto receive TB/LTBI medicationsbyTCM). • For home vsits, only 60 minutesof services(1.e., TCM, patient education/anticipatoryguidance)may be billed per patient per day. The 60-mmute cap doesnot includetraveltime, see below for travel code {T-0001) information. • Asin previousyears,service codesfor "Targeted Case Management" and "Patient education/AntIcIpatory guidance (59445)" should not be billedtogether on the same day. • Service codesT1017 and S9445 should not be billed for venipuncture services. Please use service code.36415 (Blood collection,venous by venipuncture). LHD Travel forTCM • A new service code "Travelfor TCM (T000l)" has been createdfortraveltime 245 minutes(e.g.,time in your car)associated with TCM and nurse services. Thiscode Ismeant to be used in combinationwiththe TCM, and Patient education/Anticipatory guidancecodes. Reimbursed ratesareshown below: ServiceCode Amount of traveltime (round Reimbursement rate trip) DOTT0001-45 45 $28.20 DOTT0001-60 60 $37.60 o Billfor timespent on TCM and Patient educat1on/Ant1c1patoryguidanceseparatefrom time spent for travel. o The travelservice code (T0001)Isintended fortraveltime (e.g., driving) of 245 minutes, round trip. Traveltime of lessthan 45 minutesIsnot reimbursable. o, waseonsin •J Department of Health Services D1v1S1on of Public Health / (04/ 2026) Page 2of2 DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB SynchronousAudio-Video MedicalVisits CPTCode Rate($) Description 98000 38.00 SynchronousAudio-Video MedicalVisit NEW Straightforward(SF)15 minutes 98001 62.44 SynchronousAudio-VideoMedicalVisit NEW Low 30 minutes 98002 99.59 SynchronousAudio-Video MedicalVisit NEW Moderate (Mod)45 minutes 98003 132.12 SynchronousAudio-Video MedicalVisit NEW High60 minutes 98004 29.33 SynchronousAudio-Video MedicalVisit ESTABLISHED (EST)Straightforward (SF)1Ominutes 98005 51.32 SynchronousAudio-Video MedicalVisit ESTABLISHED (EST)Low20 minutes 98006 75.31 SynchronousAudio-Video MedicalVisit ESTABLISHED (EST)Moderate(Mod)30minutes 98007 100.08 SynchronousAudio-Video MedicalVisit ESTABLISHED (EST)High40 minutes 98008 36.16 SynchronousAudioonly MedicalVisit NEWStraightforward (SF)15 minutes 98009 59.76 SynchronousAudioonlyMedicalVisit NEW LOW30 minutes 98010 92.52 SynchronousAudioonlyMedicalVisit NEW Moderate (Mod)45 minutes 98011 120.75 SynchronousAudioonlyMedicalVisit NEW High60 minutes 98012 26.82 SynchronousAudioonlyMedicalVisit ESTABLISHED(EST) Straightforward(SF)1Ominutes 98013 46.95 SynchronousAudio only MedicalVisit ESTABLISHED(EST) Low 20 minutes 98014 68.17 SynchronousAudioonly MedicalVisit ESTABLISHED(EST) Moderate(Mod)30 minutes 98015 99.34 SynchronousAudio onlyMedicalVisit ESTABLISHED(EST) High40 minutes DocusignEnvelopeID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENTD WisconsinTBDispensaryProgram Tuberculosis(TB)PharmacyServicesPlan FY2027 Purpose If theLHDisnotusingtheWisconsinTBDispensarydefaultpharmacy,theLHDwillpayforpharmacyservices upfront. TheLHDmustcompletethisPharmacyServicesPlanannuallytobereimbursedforTB-related medications.To participate in the Wisconsin TB Dispensary Program, the local health department (LHD) must agree to provide a financial assessment for each patient. LHDs must make agreements with pharmacies for provision of medications for treatment of TB and latent tuberculosis infection (LTBI) described in Table 1. FinancialAssessment All clients and patients referred or presenting themselves for TB services will be assessed for their ability to provide private insurance or Medicare/Medicaid coverage. Eligibility or presumptive eligibility for Medicaid and/or for Tuberculosis-related Medicaid (known as TB only-MA) should be pursued. Upon submission to the Wisconsin TB Program (WTBP), the medications billed to the health department will be reimbursed at the Medicaid (MA) rate. No Yes Hardshipfor patient to pay deductible and co-pay (i.e., erther is high enough to be adeterrent toseek medical careor adhereto treatment) Yes Yes Patient'sinsurance oversTBmedications LHDwill contact the WTBPto assess whether deductibleand co-pay can be covered by WITBDispensary. LHDisreimbursed by WITBDispensary at MA ratefor TB-related medications, deductible or co-pay,whichever isleast Patient eligiblefor MA orTBonly-MA, but not enrolled 0 WisconsmnTB Dispensary Program Yes Yes qa rcr.zvsesp9en,a:se e3rap31a4 LHDwillfacilitate enrollment into MA orTBonIv-MA Yes TBmedication medicationscovered byTBonly-MA TBmedicationscovered by MAorTBonly-MA Page1of4 DocusignEnvelopeID:534A471C6-8D1F-8C91-83C9-82798CE9E0E ATTACHMENTD WisconsinTBDispensaryProgram CoveredMedications The Wisconsin TB Dispensary covers the following antituberculosis medications: • Isoniazid • Rifampin (Rifadin, Rimactane) • Rifapentine (Priftin®) • Pyrazinamide • Ethambutol (Myambutol) • Rifater and Rifamate® (combination) The following second line antituberculosis drugs for drug-resistant tuberculosis are also covered: • Amikacin • Capreomycin (Capastat®) • Ciprofloxacin (Cipro®) • Clofazimine (Lamprene) • Cycloserine (Seromycin®) • Ethionamide (trecator-sc) • Gatifloxacin (Tequin®) • Kanamycin (Kantrex®) • Levofloxacin (Levaquin®) • Linezolid (Zyvox®) • Moxifloxacin (Avelox®) • Ofloxacin (Floxin®) • Paraminosalicylic Acid • Rifabutin • Streptomycin • Bedaquiline (Sirt uro@) • Pretomanid Custom compound prescription drugs, including pediatric formulations, are also covered. Dispensing and shipping fees are also covered. Under special circumstances, payment authorization is occasionally given for medications not listed above. Such authorization must be obtained in advance from the WTBP. The following medications may also be covered withpriorauthorizationfrom the WTBP: • Anti-nausea prescription medications while taking TB medications. • Vitamin B6 (pyridoxine) when INH is also prescribed, for pregnant women; breastfeeding infants; those with poor nutrition, diabetes, uremia, alcoholism, malnutrition, HIV, or seizure disorders; OR those with multidrug resistant (MDR) TB. • A multivitamin that contains vitamin D 400 IU (10 mcg) for infants 0-12 months, 600 IU (15 mcg) for children and adults. • Nutritional supplements such as Ensure®. Ordering,ReceivingandBillingforMedications • Requests for medication may be placed using the Tuberculosis Disease Initial Request for Medication (F-44000), Tuberculosis Infection Initial Request for Medication (F-00905) or Medication Refill Request (F-44126) forms. These forms are available on the WTBP website. Upload the completed form to WEDSS or fax the form to WTBP. Please note the Tuberculosis Disease Initial Request for Medication (F-44000) form should be used to document medication orders for all clients treated for active disease, regardless of whether the Wisconsin TB Dispensary Program is providing financial support for medications or treatment. Page 2of4 DocusgnEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENTD WisconsinTBDispensaryProgram • Instructions for ordering medications for active TB disease or LTBI can be found here: o Ordering Active Tuberculosis Medications through the Wisconsin TB Dispensary Program (P­ 02404A) o Ordering Latent Tuberculosis Infection Medications through the Wisconsin TB Dispensary Program (P-02404) • The pharmacy must fill with generic medications if available. o The exception is if the brand-name medication is less expensive than the generic. o If the least expensive medication option is not currently available, the pharmacy may fill a maximum 30-day supply using the more expensive option. • The pharmacy must deliver medications to the LHDs or health care provider, not directly to the patient. • The pharmacy must bill any prescription insurance first. The WI TB Dispensary Program will then cover any out-of- pocket costs, up to the Medicaid rate for that drug. • The pharmacy must bill the LHDs for TB-related drugs at the Medicaid rate. InformationaboutMedications(forpatients) Drug information and instructions for patients will accompany any medications from Aurora Pharmacy. This information is available in English (default), Spanish and other languages. Please inquire at WTBP if your patient needs drug infonnation in a language other than English. Documentation Records of all TB medications provided or arranged for will be kept according to health department record policies and procedures and on forms/in formats that are efficient and useful in the health department. The WTBP, as authorized by Wis. Admin. Code § DHS 145.12(4)(a) may audit the records of the health department. For reimbursement for TB-related medications, LHDs shall use the TB Ordering and Billing Interface (TOBI). All patients covered by the WI TB Dispensary Program must have a TB-related incident number in WEDSS associated with one of the following services: • Tuberculosis (resolution status= suspect or confirmed) • AFB Smear • Tuberculosis, Class A or B • Tuberculosis, Latent Infection • Contact Investigations FormsforDocumentationofTreatment The final results of TB or LTBI treatment should be documented so the patient and future health care providers have a permanent record of this treatment. Both WEDSS and the following forms can be used for documentation: • Active TB Disease Follow-up Report form (F-02474) • Latent Tuberculosis Infection (LTBI) Follow-up Report (F-44125) InstructionsforDocumentingLTBIinWEDSS Instructions for documenting LTBI in WEDSS can be found here: P-02426: Documenting LTBI in WEDSS ProvisionofMedicationsforthetreatmentofactiveTBorlatentTBinfection(LTBI) The pharmacy will dispense TB-related medications to clinics or local health departments (LHDs) as authorized by the WTBP. Treatment regimens and administration of drugs will follow guidelines and CDC protocols with emphasis on public health protection and TB prevention and care. AgreementswithPharmaciesotherthanthedefaultWisconsinTBDispensaryProgramPharmacy The LHD understands that they will pay for pharmacy services up front. The LHD must have established agreements with pharmacies to ensure that proper MA billing practices are in place. Written agreements or a memorandum of Page 3 o f4 DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENTD WisconsinTBDispensaryProgram understanding (MOU) are encouraged and should include the following: • Pharmacies understand and have agreed that they will bill the LHD and be reimbursed at the MA rate. • Pharmacies and providers understand and agree that all medications that will ultimately be paid for by the WI TB Dispensary Program (see Attachment E) must be approved by WTBP. • Medications provided without approval from WTBP will not be reimbursed. ActivemedicationsnotfilledthroughtheWisconsinTBDispensaryProgramDispensaryshouldstillbe documentedontheTBDiseaseInitialRequestforMedication,F-44000andreviewedbytheWisconsin TuberculosisProgramatthetimeofthefirstfill. Table1. Typeofservices Provider Verbalorwritten agreement Provision, dispensing, and delivery of medications for the treatment of active TB disease Provision, dispensing, and delivery of medications for the treatment ofl atent TB infection (LTBI) Oh s scoasin %,O De »rm ent o r Heat sr ccs DIv1ston of Public Health (06/ 2026) Page 4of 4 DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENT E Wisconsin Tuberculosis Dispensary Program NDC Numbers and reimbursement rates for TB medications for Fiscal year 2027 Maximum Package Reimbursement NDC Number Description Quantity Rate 0059 1554301 Allopurinol 100 mg tablet 100 $3.48 42806010201 Ethambutol HCL 400 mg tablet 100 $45.00 00555006602 Isoniazid 100 mg tablet 100 $163.21 00555007101 Isoniazid 300 mg tablet 30 $96.88 00555007102 Isoniazid 300 mg tablet 100 $322.95 55111028050 Levofloxacin 500 mg tablet 50 $7.09 65862053820 Levofloxacin 750 mg tablet 20 $5.51 67877041920 Linezolid 600 mg tablet 20 $27.35 24979004113 Megestrol 625 MG/5 ML suspension 150 $173.94 00093220401 Metoclopramide 5 mg tablet 100 $4.07 00093220301 Metoclopramide 10 mg tablet 100 $4.81 65862060330 Moxifloxacin HCL 400 mg tablet 30 $49.03 60505006500 Omeprazole DR 20 mg capsule 30 $0.86 68462015713 Ondansetron ODT 4 mg tablet 30 $4.00 00054474225 Prednisone 2.5 mg tablet 100 $6.71 00088210224 Priftin (rifapentine) 150 mg tablet 24 $115.99 70954048410 Pyrazinamide 500 mg tablet 60 $89.40 59762135001 Rifabutin 150 mg capsule 100 $960.09 00068059701 Rifadin IV 600 mg vial 1 $178.56 42806080130 Rifampin 150 mg capsule 30 $18.05 42806079960 Rifampin 300 mg capsule 60 $41.53 68180065906 Rifampin 300 mg capsule 30 $20.76 00904053061 Tab-A-Vite tablet 100 $3.79 *Thislistisnotcomprehensive. Multiplemanufacturersmakeeachofthesedrugs. Onlyoneexampleis listedforeachdosage. Medicationratesaresubjecttochange;pleaseverifyontheForwardHealth websitepriortobilling. The Wisconsin TB Dispensary Program's first line of anti-tuberculosis medications are as follows: • Ethambutol (Myambutol) • Isoniazid • Pyrazinamide • Rifampin (Rifadin, Rimactane) • Rifapentine (Priftin®) • Rifater and Rifamate® (combination) The following are second-line anti-tuberculosis dr ugs: • Amikacin • Allopurinol • Bedaquiline (Sirturo®) • Ciprofloxacin (Cipro®) • Clofazimine (Lamprene) • Cycloserine (Seromycin®) • Ethionamide (trecator-sc) O, s coa sia %,9 p- r a nt or e t s -rt » Dr1 s1on of Public Health (04/ 2026) Page1of2 DocusignEnvelopeID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENT E Wisconsin Tuberculosis Drug Reimbursement Program • Gatifloxacin (Tequin) • Kanamycin (Kantrex®) • Levofloxacin (Levaquin®) • Linezolid (Zyvox®) • Moxifloxacin (Avelox ) • Ofloxacin (Floxin@) • Paraminosalicylic Acid • Pretomanid • Streptomycin Also covered by the Wisconsin TB Dispensary Program: • Custom compound prescription drugs, including pediatric formulations • Dispensing fees MedicationsRequiringPre-Authorization Under special circumstances, payment authorization may be given for medications not listed above. Such authorization must be obtained in advance from the Wisconsin TB Program. The following medications may be covered with prior authorization from the Wisconsin TB Program: • Anti-nausea prescription medications (while taking active TB medications). • Vitamin B6 (pyridoxine), when INH is also prescribed, for pregnant women; breastfeeding infants; those with poor nutrition, diabetes, uremia, alcoholism, malnutrition, HIV, or seizure disorders; OR those with multidrug resistant (MOR) TB. • A multivitamin that contains vitamin D 400 JU (10 mcg) for infants 0-12 months or 600 IU (15 mcg) for children and adults; onlyupon recommendation from the TB Program • Nutritional supplement such as Ensure®; onlyupon recommendation from the TB Program. Os s ee s%, 9Der r er cot t eat srec » D I ston of Public Health (04/ 2026) Page2of2 DocusgnEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB aWisconsin A' I epartment of Health Services Drv1s1on of Public Health P-00670 (06/ 2026) ATTACHMENTF WisconsinTuberculosisDispensaryProgram PolicyandProcedures Introduction The primary purpose of the Wisconsin Tuberculosis (TB) Dispensary is to ensure that all persons in Wisconsin with suspected or confirmed tuberculosis infection or disease can receive appropriate evaluation, treatment, and monitoring, regardless of insurance availability. Wisconsin's TB Dispensary uses state tax revenue funds to reimburse local and Tribal health departments (LTHDs) for medical management of patients with active TB, patients being evaluated for TB, patients with latent TB infection (LTBI), and patients exposed to TB. The word "dispensary," as it is used here, is a legislative term referring to the mechanism by which LTHDs are reimbursed for the management of TB patients. The traditional use of the word (i.e., the pharmaceutical dispensing of medicines or medical supplies) does not apply. Wisconsin's TB Dispensary includes reimbursement for clinical services and medications necessary for the diagnosis, treatment, and prevention of TB. Wisconsin's TB Dispensary must be the LAST payer after all other potential sources have been billed. The payer order is: • Private insurance • Public insurance: Medicare, Medicaid (MA), Refugee MA, and Tuberculosis Related Medicaid (known as TB Only MA) • Wisconsin TB Dispensary Policy LTHDs or combinations of two or more health departments that are "in good standing," as determined by their overall health department review process under Wis. Admin. Code $ OHS 140, may request certification as a dispensary for TB clinical services and/or TB pharmacy services. This will enable the LTHD to submit bills and to be reimbursed for specific procedures and/or medications for eligible persons with TB disease, LTBI, or persons being evaluated for TB disease or LTBI. The Wisconsin Tuberculosis Program (WTBP) will provide consultation, guidance, and review of LTHO TB programs, policies, procedures, and clinical practices to ensure that they are in compliance with Wisconsin statutes, administrative codes and established standards of practice, particularly those outlined in Wis. Stat. $ 252.10: http://docs.legis.wi.gov/statutes/statutes/252/10/1. To participate in the Wisconsin TB Dispensary, LTHDs must ensure that all services provided, or arranged for, are consistent with the Centers for Disease Control and Prevention (CDC) and WTBP guidelines and clinical standards of practice for TB control and elimination. LTHDs must ensure these services are provided in keeping with goals for the elimination of TB in Wisconsin. If suchguidelinesorstandardsofpracticearenot followed,dispensaryfundsmaybewithheld,suspended,orrevokedperWis.Admin.Code§ DHS145.12 (1): https://docs.legis.wisconsin.gov/code/admin code/dhs/110/145/II/l 2. One service for which the Wisconsin TB Dispensary was particularly developed is to ensure that directly observed therapy (DOT) is provided as appropriate for all persons with active TB disease or LTBI, as recommended by the WTBP and national guidelines. The availability of reimbursement to LTHDs for DOT is meant to ensure that this service will be provided as recommended. DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB To participate in the Wisconsin TB Dispensary, the LTHO must create and submit clinical and/or pharmacy services plan(s), as well as sign the annual contract. The contract with WTBP enables the LTHO to bill the WTBP for covered TB-related clinical services and TB-related medications. TB clinical services and medications are specific and limited by Wis. Admin. Code $ OHS 145.12 (1): https://docs.Iegis.wisconsin.gov/code/admin code/dhs/110/145/II/12. As determined by Wisconsin Administrative Code, services and medications are reimbursed at the MA rate; however, the Wisconsin TB Dispensary is not an MA program. Reimbursable services and medications are listed in AttachmentsA, C, and E. Procedure InitialRequest LTHDs are encouraged to participate in the Wisconsin TB Dispensary. LTHDs have the option of participating in the Wisconsin TB Dispensary by providing clinical services, pharmacy services, or both. The following conditions must be met to participate: • The LTHO must be "in good standing" in relation to the latest public health department review. • The LTHO must have established agreements with providers (for clinical services) and/or pharmacies (for pharmacy services) to ensure that there are proper MA billing practices in place. • It is the responsibility of the LTHO to evaluate patients' health insurance status to determine if they have private insurance or qualify for MA or TB Only MA , as well as to assist a qualifying TB patient in applying for MA services. Local economic assistance agencies are most knowledgeable about qualification for and enrollment in state and federal health care programs. TheWTBPisnotabletocheck eligibilityorenrollpatients. • The LTHO mustuse the Wisconsin Electronic Disease Surveillance System (WEDSS) for patient record management. • For reimbursement to LTHDs for TB-related medical services and/or medications, LTHDs shall use the TB Ordering and Billing Interface (TOBI). Information The WTBP will provide information to LTHDs interested in participating in the Wisconsin TB Dispensary. Information provided shall include: • Wis. Admin. Code § § OHS 145.12 and 145.13: https://docs.legis.wisconsin.gov/code/admin code/dhs/110/145/Il/ • Allowable clinical services and medications • Clinical and/or pharmacy services plans • Department of Health Services (OHS) general contract • Billing instructions for reimbursement ConsultationandReview LTHDs that participate in the Wisconsin TB Dispensary will coordinate services with local providers, educate the community on the prevention of tuberculosis, and consult with the WTBP on all persons being evaluated for TB, patients with active TB disease, and, as warranted, on people with LTBI or who are contacts to an active case. WTBP review will ensure that the health department has up-to-date resources readily available for staff's access, and that policy, procedures, and clinical practices are consistent with: • State and federal regulatory requirements • CDC standards and protocols for treatment • Official statements from the American Thoracic Society and the American Academy of Pediatrics • Directives from the State of Wisconsin epidemiologist • WTBP Guidelines, Division of Public Health Directives, and current established clinical standards of practice, especially those identified by DHS 145.12 https://docs.legis.wisconsin.gov/code/admin code/dhs/110/145/Il/12 Page2of5 DocusgnEnvelopeID:534A47106-8D1F-8C91-83C9-82798CE9E0EB RequiredforParticipationintheWisconsinTBDispensary To participate in the Wisconsin TB Dispensary, Wis. Admin. Code § OHS 145.12 requires that the LTHD be able to provide or ensure provision of clinical services (see Attachment B) and pharmacy services (see Attachment D). All provisions will be reviewed and the delivery of TB services will be monitored by WTBP staff. ClinicalServicesPlan(CSP) A CSP ensures the provision for tuberculosis prevention and control at the local level. The LTHO should focus on identification of active TB disease in high-risk groups and early identification and treatment of LTBI, particularly close and high-risk contacts, children, and any person who is immunosuppressed. The plan consists of five elements: 1. Financial assessment (see CSP template, Attachment B for eligibility determination guidance) • Private insurance • Medicaid or Medicare • TB Only MA 2. Identification of high-risk persons • Population or medical risk factors • Risk specific to Wisconsin • Risk specific to the LTHD jurisdiction 3. Documentation of patient management in WEDSS • Services provided by LTI-ID • Services provided by health care provider 4. Clinical Assessments and Services • IGRA (preferred) or TST • Risk assessment and medical evaluation • Prescription of drugs for treatment of TB and LTBI • Chest imaging: chest X-ray (CXR) or computed tomography (CT) • Sputum collection or induction for acid-fast bacilli smear and culture • Venipuncture for IGRA or other laboratory testing • Health care setting with airborne infection isolation and respiratory precautions • Directly observed therapy • Contact investigations 5. Provider Agreements • Written (preferred) or verbal agreement(s) with local provider(s) • Types of services that the provider will offer • Provider acceptance of MA rate for reimbursement A CSP should be submitted annually with the contract. A CSP does not need to change from year to year, but anything done differently from the previous year should be highlighted in the updated plan. Because the contract consists largely of general contract language, the CSP must specifically identify the providers with whom the LTHO has agreements for the patient services to be provided. A template oft he CSP can be found in Attachment B and may be customized for an individual LTHD. PharmacyServicesPlan(PSP) A PSP ensures treatment of active TB disease and LTBI. The plan consists of four elements: 1. Provision of medications for the treatment of active TB disease or LTBI (see PSP template, Attachment D). 2. Financial assessment (see PSP template, Attachment D) for eligibility determination guidance • Private insurance • Medicaid or Medicare • TB Only MA 3. Documentation of patient management in WEDSS • Date therapy started • Initial drug regimen Page3of 5 DocusignEnvelopeID:534471C6-8D1F-8C91-8309-82798CE9E0EB • Changes in drug regimen • Date therapy stopped • Reason therapy stopped • DOT 4. Provider Agreements • Written agreement(s) with pharmacy • Types of services that the pharmacy will offer • Pharmacy acceptance of MA rate for reimbursement A PSP should be submitted annually with the contract. A PSP does not need to change from year to year, but anything done differently from the previous year should be highlighted in the updated plan. Because the contract consists largely of general contract language, the PSP must specifically identify the pharmacies with whom the LTHD has agreements for the patient services to be provided. A template of the PSP can be found in Attachment D and may be customized for individual LTHDs. Budget WTBP will provide a sum sufficient to cover expenses for identification, treatment and management of active TB disease and LTBI. Each fiscal year begins on July 1 and ends on June 30. All reimbursements from the Wisconsin TB Dispensary are based on the availability of state tax revenue funds. Contract State contracts are sent electronically through the DocuSign platform. Upon receipt and review of the contract by the appropriate LTHD authorities, the contract should be signed electronically and returned via DocuSign. Attachment B must be completed and returned within DocuSign, completion of Attachment D is optional. The contract will be signed by the State of Wisconsin Division of Public Health Administrator. An electronic copy of the signed contract will be sent to the LTHD and the WI TB Program. The contract is effective from July 1 through June 30 for the given fiscal year and governs the provision and reimbursement of dispensary services. The TB Dispensary will send a renewal contract to the LTHD each spring through DocuSign. Questions about the contract or CSP should be directed to: Wisconsin TB Program 201 East Washington Avenue, Room Gl OO Madison, Wisconsin 53703 608-261-6319 (Main Office) 608-266-9692 (Billing) 608-266-0049 (Fax) DHSWITBProgram@dhs.wisconsin.gov (Email) CertificationReview Certifications will be reviewed at least every five years and will be achieved through evidence from continuing Wis. Admin. Code § DHS 140 reviews and continued monitoring of care delivered to all TB patients. Communication between the health department and the WTBP will be ongoing regarding clinical care. Reimbursement All patients covered by the Wisconsin TB Dispensary must have a TB-related disease incident number in WEDSS. Invoices must be submitted within 60 days of the end of the state fiscal year (June 30) to assure reimbursement. Reimbursement is at the MA rate. A grid outlining the frequency of services allowed by type of Page4of 5 DocusgnEnvelopeID'534A471C6-8D1F-8C91-83C9-82798CE9E0EB patient can be found in Attachment A. A list of CPT codes and reimbursement rates for services and medications can be found in Attachments C and E, pleasenotethattheseratesaresubjecttochangeatanytime. Certain non-routine services may be reimbursable at the MA rate, but, mustbepreauthorizedby the Wisconsin TB Program and documented in the patient's WEDSS file. InvoicingUsingtheTBOrderingandBillingInterface(TOBI) The following are needed to enter invoicing information into TOBI: • Patient name • Patient WEDSS Incident ID For medical services: • Date of service • Service code and description • Amount billed For medications: • Date prescription filled • National Drug Code (NDC) and description • Quantity and prescription Number • Amount billed Services and medications not listed on Attachment C or E are considered non-routine and must be preauthorized. A fillable form to request preauthorization for clinical services is provided electronically in TOBI. All Initial Requests for Medication are reviewed and authorized by a TB Nurse Consultant prior to submittal to the pharmacy. Unauthorized medication will not be reimbursed. For questions regarding the billing process, contact: Wisconsin TB Program 201 East Washington Avenue, Room G 100 Madison, Wisconsin 53703 608-261-6319 (Main Office) 608-266-9692 (Billing) 608-266-0049 (Fax) DHSWITBProgram@dhs.wisconsin.gov (Email) Page5of5 DocusignEnvelopeID:534471C6-8D1F-8C91-83C9-82798CE9E0EB ATTACHMENT G Wisconsin TB Dispensary Program Payment Details FY2027 Invoicing Invoices presentedfor payment must besubmitted inaccordancewithinstructions contained inAttachments A-F and submittedthroughthe Tuberculosis Ordering and Billing Interface (TOBI). Sum Sufficient OHS will payfor services providedby Grantee inaccordancewiththeterms and conditions ofthisAgreement andAttachments in asum sufficienttocoverapprovedexpensesbasedoncase loadandavailablefunding. The amount offunding available is anticipatedto besimilartothe amount awarded in FY2025. This amount is contingent upon receipt of sufficientfunds by OHS. O s eonsio •J Department of Health Services DIvIston of Public H ealth (05/ 2024) Page l o f l Docusign Envelope ID:534A71C6-8D1F-8C91-83C9-82798CE9E0EB CERTIFICATIONREGARDINGLOBBYING The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal Contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal Contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal Contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. Disclosure of Lobbying Activities (Standard Form-LLL) (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including Subcontracts, subgrants, and Contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. (Signature of Official Authorized to Sign Application) Ellen Henry (Print Name) (Agency/ Contractor Name) (Date) Interim Health Officer (Title) (Title of Program) DocusignEnvelopeID:534471C6-8D1F-8C91-8309-82798CE9E0EB DEPARTMENT OF HEALTH SERVICES DivisionofEnterpnseServices F-01788 (03/2022) STATE OF WISCONSIN CERTIFICATION REGARDING DEBARMENT AND SUSPENSION Federal Executive Order(E.O.) 12549 "Debarment"requiresthat allcontractors receiving individual awards, using Federalfunds,and allsubrecipientscertify thatthe organizationand its principals arenot debarred,suspended, proposedfordebarment, declared ineligible,orvoluntarily excluded by any Federaldepartment oragencyfromdoing businesswiththe Federal Government. By signing this document you certify that yourorganizationand its principals are not debarred. Failuretocomplyorattemptstoedit this language may disqualifyyour bid. Informationondebarment is available at the followingwebsites:www.sam.gov. Your signaturecertifiesthat neitheryounoryourprincipal is presently debarred,suspended, proposedfordebarment, declared ineligible,orvoluntarily excludedfrom participation inthistransaction by any Federal department oragency. SIGNATURE--OfficialAuthorizedto SignApplication For (Name of Vendor) Date Signed Unique Entity Identifier (UEI), if applicable Certificate Of Completion Envelope Id. 534A71C6-8O1F-8C91-83C9-82798CE9E0EB Subject DHS - Franklin HD -Tuberculosis (TB) Dispensary Program -435100-G27-TBDISPENSE-25 Source Envelope. Document Pages·43 Certificate Pages. 5 AutoNav. Enabled Envelopeld Stamping Enabled TimeZone·(UTC-06.00) CentralTime (US &Canada) Odocusign_ Status Sent Envelope Originator. Yvette Smith 201 East WashingtonAvenue Madison,WI 53703 yvettea.smith@dhswisconsin gov IP Address 165 225.60 55 Signatures Initials: 0 Record Tracking Status·Original 8/12/2026 853 52 AM SecurityAppliance Status. Connected Signer Events Amanda Ross amandal.ross@dhs wsconsmn.gov Paralegal Department of Health Services Security Level. Emal,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered va Docusign Ellen Henry EHenry@frankl1nwi.gov Interim Health Officer Security Level Emal,AccountAuthentication (None) Electronic Record and Signature Disclosure: Accepted. 8/14/2026 4.22.24 PM ID 5c98e9c6-aa92-4f41-8551-f9a10498f8aa Anna Benton anna benton@dhs.wisconsin.gov Security Level Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign In Person Signer Events Editor Delivery Events Agent Delivery Events Intermediary Delivery Events Certified Delivery Events Carbon Copy Events Pat Heger patncia heger@dhs wsconsmn.gov Security Level Emal,Account Authentication (None) Holder:Yvette Smith yvettea smith@dhswsconsmn gov Pool. StateLocal Signature s onar ±=­Signature Adoption. Pre-selected Style Using IP Address 136 226 84.184 Signature Status Status Status Status Status COPIED Location DocuSign Timestamp Sent 8/12/2026 85553 AM Viewed·8/14/2026 346:25 PM Signed 8/14/2026 347-27 PM Sent: 8/14/2026 347.32 PM Viewed. 8/14/2026 4:22 24 PM Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp Sent 8/12/2026 8 5551AM Carbon Copy Events Electronic Record and Signature Disclosure: Accepted 4/5/2023 2:53.27 PM ID 43fbd7de-b2ed-4b35-a320-54190dd784b7 DHS DPH Contract Routing dhsdphcontractrouting@dhswisconsin gov Security Level Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign DPH Contracts DHSDPHContracts@dhs.wisconsin gov DPH Contracts Shared Account Wisconsmn Department of Health Services Security Level Email,AccountAuthentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Manivanh Patheuangsinh mnanrvanh patheuangsinh1@dhs.wsconsin.gov Security Level Email,AccountAuthentication (None) Electronic Record and Signature Disclosure: Not Offered via Docusign Witness Events Notary Events Envelope Summary Events Envelope Sent Payment Events Status COPIED COPIED Signature Signature Status Hashed/Encrypted Status Timestamp Sent. 8/12/2026 8 55.52 AM Sent·8/12/2026 8·55:52 AM Timestamp Timestamp Timestamps 8/12/2026 8.55.53 AM Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on. 12/19/2018 8:24.51AM Partiesagreed to: Ellen Henry, Pat Heger ELECTRONICRECORDANDSIGNATUREDISCLOSURE From time to time, Wisconsin Department of Health Services (we, us or Company) may be required by law toprovide to you cert ain written notices or disclosures. 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APPROVAL REQUESTFOR MEETINGDATE COUNCILACTION 09/01/26 REPORTS& PopulationEstimateasofJanuary1,2026 ITEMNUMBER RECOMMENDATIONS G. .() Franklin has received the preliminary population estimate of 37,195 as of January 1, 2026. If the Council wishes to challenge this estimate, such challenge must be submitted before September 15, 2026. For your review, Franklin's prior population was as follow: 1960 10,006 2016 35,741 1970 12,247 2017 36,046 1980 16,469 2018 35,779 1990 21,732 2019 35,996 2000 28,804 2020 36,514 411100 Census 29,494 4/ 1/20 Census 36,816 2001 30,199 2021 36,646 2002 30,749 2022 36,259 2003 31,467 2023 35,785 2004 31,804 2024 36,417 2005 32,548 2025 36,882 2006 33,000 2026 37,195 2007 33,380 2008 33,550 2009 33,700 2010 33,900 4/1/10 Census 35,451 2011 35,504 2012 35,520 2013 35,810 2014 35,702 2015 35,655 COUNCILACTIONREQUESTED Motion to place on file the Wis. Dept. of Administration January 1, 2026 population estimate of 37,195. OR Motion to direct Director of Clerk Services to submit challenge, based on information provided by staff, to State of Wisconsin 2026 population estimate no later than September 15, 2026. CITY CLERK -sjr Shirley Roberts From: Sent: To: Subject: Dan Barroilhet - DOA <Dan.Barroilhet@wisconsin.gov> Monday,August 10,2026 3:07 PM Shirley Roberts Preliminary Population Estimatefor theCity of Franklin in MilwaukeeCounty DearMunicipalClerk: TheDemographicServicesCenter'spreliminaryestimateoftheJanuary1, 2026 populationfortheCityof FranklininMilwaukeeCountyis37,19 5. This representsachangeof 1,079 persons(2.99%) sincethe 2020 Census. Wisconsin'stotalpopulationisestimatedat 6,064,500 whichisachangeof 17 0,782 personsand2.90%. Inresponsetothehousingsurveythatwesentyouearlierthisyear,yourmunicipalityreportedanet changeof70 housingunitsforcalendaryear2025. (Ifwedidnot receiveasurveyfromyou,weestimated yourchangeinhousingstockorusedothersources.) Ifyourmunicipalitybelievesthattheaboveestimateisnotareasonableapproximationofitspopulation, pleaseseethechallengeformat https://d0a.wi.gov/DIR/Challenge Form MUNI.pdf Approximately29,722 oftheestimated populationfortheCityof Franklinareofvotingage.Thiscourtesy estimatehelpsyoutocomplywithWisconsinStatute5.66, whichrequiresmunicipalclerksto approximatethenumberofelectorspriortoelections.Thevotingagepopulationwascalculatedby applyingthecensusproportionof personsover18 tothepreliminaryJanuary1estimate,andthen multiplyingtheresult byastate-widefactortoaccountforthegeneral agingofthepopulation.Please notethat,ifyouhaveanadultcorrectionalfacilityinyourmunicipality,itspopulationisincludedinthis voting-ageestimate. DemographicServicesCenter Divisionof Intergovernmental Relations WIDept.ofAdministration https://doa.wi.gov/demographics 1 CHANGEOFADDRESS/OFFICEHOLDERNOTIFICATION (Thisside of formisfor Change of Addressof Office Holder only.) Sendto: DIR_Demo@wi.gov Pleasenotename/addresschange below for: D Town □ City D Villageof: _ inthe County of: NAME: TITLE: OFFICIALMAILINGADDRESS: EMAILADDRESS DAYTIMETELEPHONE: (_ } _ SIGNATUREOFRESPONDENT: _ [pTE; MUNICIPALPOPULATION ESTIMATECHALLENGEFORM If your municipalitybelievesthat theestimateisnot areasonableapproximationof your population,completethisformandsubmit it withadministrativedatathat can beused toevaluatethechallenge.Submit thechallengeon or beforeSeptember 15, 2026. Sendchallengesto: dan.barroilhet@wisconsin.gov TheCouncil/Boardof the □ Town □ City Villageof: _ intheCountyof: hasauthorized metosubmit achallengetothecorrectnessof theannualpreliminary populationestimatepreparedfor our municipality.Themunicipalitycontendsthe estimateisinaccuratebecauseit isbaseduponinadequateinformation. Evidence based uponadministrativerecordsor other informationispresented in support of thiscontention, asrequiredby §16.96 of the WisconsinStatutes. The statutesdo not permit the Department of Administrationtoaccept the resultsof apopulationenumerationconductedbyanygroup, agency, or unit of government other thanthe U.S. CensusBureau. NAME: TITLE: MAILINGADDRESS: EMAIL: DAYTIMETELEPHONE: SIGNATURE: DATE: APPROVAL Reports & Recommendations REQUESTFOR COUNCILACTION AResolutionAuthorizingtheInstallationofaRetainingWallWithin the20'DrainageEasementUponLot2oftheWhisperingWoods subdivisionlocatedinapartoftheWest 1/2ofSection15,Township5 North,Range21East,intheCity ofFranklin,MilwaukeeCounty, Wisconsin (6860WWildFlowerCt.)(TKN 8370213000) (DerekandNellieFoster,Applicant) MTG.DATE September 1, 2026 ITEMNO. Ald. Dist. 4 BACKGROUND Staff received a request to install a retaining wall within the 20' Drainage Easement at 6860 W Wild Flower Ct. The retaining wall will be installed roughly 7' into the 20' Drainage Easement south of the north property line. The proposed retaining wall will be encroaching the said drainage easement on the property located at 6860 W Wild Flower Ct: See Exhibit C. ANALYSIS Staff are agreeable to allow the retaining wall to be installed within the easement if the property owner is fully responsible for repair and/or replacement if the said drainage easement should need to be accessed for improvement or maintenance purposes. The resolution provides that: 1. The subject wall will be installed in the drainage easement 2. The property owners, and their successors and assigns, shall keep the wall in good repair. 3. The property owners, and their successors and assigns, shall be responsible for the replacement and/or repair of the wall should the wall need to be removed or damage due to access for improvement or maintenance to the said drainage easement. 4. The City is not responsible for any damage that may occur during or as a result of maintenance purposes, needs and/or activities. 5. The property owner(s) and any mortgage with an interest in the property shall agree to and execute the Acceptance set forth on Exhibit A annexed hereto, and the Mortgage Holder Consent set forth on Exhibit B attached, respectively. OPTIONS Approve or Deny FISCALNOTE None RECOMMENDATION Resolution 2026- a resolution to authorize the installation of a retaining wall within the 20' Drainage Easement, upon Lot 2 of the Whispering Woods subdivision (6860 W Wild Flower Ct.) (Tax Key No. 837 0213 000) (Derek and Nellie Foster, applicant). Engineering: KAB STATE OF WISCONSIN : CITY OF FRANKLIN : MILWAUKEE COUNTY RESOLUTION NO. 2026 ­ A RESOLUTION AUTHORIZING THE INSTALLATION OF A RETAINING WALL WITHIN THE 20' PUBLIC DRAINAGE EASEMENT UPON LOT 2 OF WHISPERING WOODS SUBDIVISION. (6860 W WILD FLOWER CT) (TKN: 837 0213 000) (DEREK & NELLIE FOSTER, APPLICANT) ------------------------------------------------------------------------------------------------------------------ WHEREAS, the Whispering Woods Subdivision Plat prohibits the building of structures within a public drainage easement, described thereon; and WHEREAS, Derek & Nellie Foster, property owner, having applied for an installation of a retaining wall, located at 6860 W Wild Flower Ct., zoned R-SE, bearing Tax Key No. 837 0213 000, more particularly described as follows: LOT 2 OF WHISPERING WOODS, BEING A PARCEL OF PARTS OF THEW 1/2 OF SECTION 15, TOWNSHIP 5 NORTH, RANGE 21 EAST, IN THE CITY OF FRANKLIN, MILWAUKEE COUNTY, WISCONSIN; and WHEREAS, the retaining wall would encroach on the "Public Drainage Easement" (Exhibit C) located on the north of the property; and WHEREAS, the "Public Drainage Easement" restrictions upon the Final Plat of Whispering Woods Subdivision and the City of Franklin its accompanying restriction of the building of structures is a restriction which was imposed by the Franklin Common Council in its approval of the Final Plat; and WHEREAS, Wis. Stats. § 236.293 provides in part that any restriction placed on platted land by covenant, grant of easement or in any other manner, which was required by a public body vests in the public body the right to enforce the restriction at law or in equity and that the restriction may be released or waived in writing by the public body having the right of enforcement; and WHEREAS, the Common Council having considered the owner's request, for the encroachment at the public drainage easement restriction only so as to allow for the subject retaining wall installation; and WHEREAS, the Common Council having considered the proposed location of and type of retaining wall to be installed upon the subject property and potential interference with the drainage easement. NOW, THEREFORE, BE IT RESOLVED, by the Mayor and Common Council of the City of Franklin, Wisconsin, that the installation of the proposed retaining wall as described and only upon the location as set forth within the plans accompanying the application of Derek & Nellie Foster, on August 26, 2026 be and the same is hereby authorized and approved and that the "Public RESOLUTIONNO.2026­ Page2 Drainage Easement" restrictions as they would apply to such installation upon the subject property only, are hereby waived and released, subject to the following conditions: 1. The subject retaining wall shall be installed in the drainage easement. 2. The property own ers, and their successors and assigns, shall keep the retaining wall in good repair. 3. The property owners, and their successors and assigns, shall be responsible for the replacement and/or repair of the retaining wall should the retaining wall need to be removed or damage due to access for improvement or maintenance to the said drainage easement. 4. The City is not responsible for any damage that may occur during or as a result of maintenance purposes needs and/or activities. 5. The property owner(s) and any mortgage with an interest in the property shall agree to and execute the Acceptance set forth on Exhibit A annexed hereto, and the Mortgage Holder Consent set forth on Exhibit B annexed hereto, respectively. BE IT FURTHER RESOLVED, that the applicant shall further obtain all required permit(s) for the installation of the subject retaining wall and that the subject retaining wall shall be installed pursuant to such permit(s) within one year of the date hereof, or all approvals granted hereunder shall be null and void. BE ITFINALLY RESOLVED, that the City Clerk be and the same is hereby directed to obtain the recording of this Resolution with the Office of the Register of Deeds for Milwaukee County. Introduced at a regular meeting of the Comm on Council of the City of Franklin the day of ° 2026, by Alderman _ PASSED AND ADOPTED by the Common Council of the City of Franklin on the day of 2026. APPROVED: John R. Nelson, Mayor ATTEST: Shirley JRoberts, City Clerk AYES NOES ABSENT Exhibit A Acceptance The undersigned, Derek and Nellie Foster, applicants of the property located at 6860 W Wild Flower Ct, Franklin, Wisconsin 53132, Tax Key No. 8370213000, does hereby agree to, consent to and accepts the terms and provisions of the City of Franklin Resolution No. and that in consideration of the making of such grant to allow the installation of a fence within the public drainage easement by the City of Franklin, the undersigned agrees that this acceptance shall be binding upon the undersigned and the undersigned's successors and assigns and that the terms and provisions of the City of Franklin Resolution No. , shall run with the land, subject to any amendments thereto and/or any other actions thereto approved by the Common Council of the City of Franklin in the future. In witness whereof, the undersigned has executed and delivered this acceptance on the/.~ day of Acer ,2026. Property owner '/ a ) Pl. Z mnm e e a 2 1 3 ExhibitB MORTGAGEHOLDERCONSENT The undersigned, Associated Bank, N.A, a Wisconsin banking corporation ("M ort gagee") , as Mort gagee under that certain Mort gage encumbering the Propert y and recorded in the Office of the Register of Deeds for Milwaukee County, Wisconsin, on September, 11 2015, as Document No. 10498326_hereby consents to the execution of the foregoing Resolution No. 2026­ authorizing the installation of the fence within the public drainage easement. IN WITNESS WHEREOF, Mortgagee has caused these presents to be signed by its duly authorized officers and its corporate seal to be hereunto affixed, as of the day and year first above written. AssociatedBank,N.A ~ By: 'li-LLM- Jenna Klein, AVP STATE OF WISCONSIN ) S.S. COUNTY OF MILWAUKEE) On this, the 24" day of August 2026, before me, the undersigned personally appeared Jenna Klein, Assistant Vice President of Associated Bank, N.A., a Wisconsin banking corporation, and acknowledged that (s)he executed the foregoing instrument on behalf of said corporation, by its authority and or the purposes therein contained. Nam ipuuuu"<K'tLI"iutu!'Lr1 Notary Public State of U [ S t County of .....fo=r~~---=t'-'t.~ - - - - - - - - - - - - ­ My comm ission expires on:_0l·)-202f EX?!-f\13\T C I J 1. 1 1 l I J I I '.l ± Q" APPROVAL Reports & Recommendations REQUESTFOR COUNCILACTION AResolutionAuthorizingtheInstallationofaFenceWithinthe20' Sanitary SewerEasementUponLot 16oftheCapeCrossingsubdivision locatedinapartofthe Southwest¼ofSection19,Township5North, Range21East,intheCity ofFranklin,MilwaukeeCounty,Wisconsin (9378SParksideLn.)(TKN 8901016000) (LukasButtke,Applicant) MTG.DATE September 1, 2026 ITEMNO. Ald. Dist. 6 BACKGROUND Staff received a request to install a 4-foot black aluminum fence within the 20' Sanitary Sewer Easement at 9378 S Parkside Ln. The fence will be installed roughly 5' west of the east property line. The proposed fence will be encroaching the said sanitary sewer easement on 9378 S Parkside Ln: See Exhibit C. ANALYSIS Staff is agreeable to allow the fence to be installed within the easement if the property owner is fully responsible for repair and/or replacement if the said sanitary easement should need to be accessed for improvement or maintenance purposes. The resolution provides that: 1. The subject fence will be installed in the sanitary sewer easement 2. The property owners, and their successors and assigns, shall keep the fence in good repar . 3. The property owners, and their successors and assigns, shall be responsible for the replacement and/or repair of the fence should the fence need to be removed or damage due to access for improvement or maintenance to the said drainage easement. 4. The City is not responsible for any damage that may occur during or as a result of maintenance purposes, needs and/or activities. 5. The property owner(s) and any mortgage with an interest in the property shall agree to and execute the Acceptance set forth on Exhibit A annexed hereto, and the Mortgage Holder Consent set forth on Exhibit B attached, respectively. OPTIONS Approve or Deny FISCALNOTE None RECOMMENDATION Resolution 2026- a resolution to authorize the installation of a fence within the 20' Sanitary Sewer Easement, upon Lot 16 of the Cape Crossing subdivision (9378 S Parkside Ln.) (Tax Key No. 890 1016 000) (Lukas Buttke, applicant). Engineering: KAB STATE OF WISCONSIN : CITY OF FRANKLIN : MILWAUKEE COUNTY RESOLUTION NO. 2026 - - - - - A RESOLUTION AUTHORIZING THE INSTALLATION OF A FENCE WITHIN THE 20° SANITAR Y SEWER EASEMENT UPON LOT 16 OF CAPE CROSSING SUBDIVISION. (9378 S PARKSIDE LN) (TKN: 890 1016 000) (LUKAS BUTTKE, APPLICANT) ------------------------------------------------------------------------------------------------------------------ WHEREAS, the Cape Crossing Subdivision Plat prohibits the building of structures within a sanitary sewer easement, described thereon; and WHEREAS, Lukas Buttke, property owner, having applied for an installation of a 4' black aluminum fence, located at 9378 S Parkside Ln., zoned PDL-40, bearing Tax Key No. 890 10 16 000, more particularly described as follows: LOT 16 OF CAPE CROSSING, BEING A PARCEL OF PAR TS OF THE SW 1/4 OF SECTION 19, TOWN SHIP 5 NORTH, RANGE 21 EAST, IN THE CITY OF FRANKLIN, MILWAUKEE COUNTY, WISCONSIN; and WHEREAS, the fence would encroach on the "Sanitary Sewer Easement" (Exhibit C) located on the east of the property; and WHEREAS, the "Sanitary Sewer Easement" restrictions upon the Final Plat of Cape Crossing Subdivision and the City of Franklin its accompanying restriction of the building of structures is a restriction which was imposed by the Franklin Common Council in its approval of the Final Plat; and WHEREAS, Wis. Stats. § 236.293 provides in part that any restriction placed on platted land by covenant, grant of easement or in any other manner, which was required by a public body vests in the public body the right to enforce the restriction at law or in equity and that the restriction may be released or waived in writing by the public body having the right of enforcement; and WHEREAS, the Common Council having considered the owner's request, for the encroachm ent at the sanitary sewer easement restriction only so as to allow for the subject fence installation; and WHEREAS, the Comm on Council having considered the proposed location of and type of fence to be installed upon the subject property and potential interference with the sanitary easement. NOW, THEREFORE, BE IT RE SOLVED, by the Mayor and Common Council of the City of Franklin, Wisconsin, that the installation of the proposed fence of the type and specifications as described and only upon the location as set forth within the plans accompanying the application of Lukas Buttke, on August 26, 2026 be and the same is hereby authorized and approved and that the "Sanitary RESOLUTIONNO.2026- Page2 Sewer Easement" restrictions as they would apply to such installation upon the subject property only, are hereby waived and released, subject to the following conditions: 1. The subject fence shall be installed in the sanitary easement. 2. The property owners, and their successors and assigns, shall keep the fence in good repair. 3. The property owners, and their successors and assigns, shall be responsible for the replacement and/or repair of the fence should the fence need to be removed or damage due to access for improvement or maintenance to the said sanitary easement. 4. The City is not responsible for any damage that may occur during or as a result of maintenance purposes needs and/or activities. 5. The property owner(s) and any mortgage with an interest in the property shall agree to and execute the Acceptance set forth on Exhibit A annexed hereto, and the Mortgage Holder Consent set forth on Exhibit B annexed hereto, respectively. BE IT FURTHER RESOLVED, that the applicant shall further obtain all required permit(s) for the installation of the subject fence and that the subject fence shall be installed pursuant to such permit(s) within one year of the date hereof, or all approvals granted hereunder shall be null and void. BE IT FINALLY RESOLVED, that the City Clerk be and the same is hereby directed to obtain the recording of this Resolution with the Office of the Register of Deeds for Milwaukee County. Introduced at a regular meeting of the Common Council of the City of Franklin the day of , 2026, by Alderman _ PASSED AND ADOPTED by the Common Council of the City of Franklin on the day of , 2026. APPROVED: John R. Nelson, Mayor ATTEST: Shirley J Roberts, City Clerk AYES NOES ABSENT Exhibit A Acceptance The undersigned, L ~s \1 0 11:ile....-- , applicants of the property located at 633 S ( ck2& La _,Franklin, Wisconsin 53132, Tax Key No. 8j 0 - Joi ou2 ·does hereby agree to, consent to and accepts the terms and provisions of the City of Franklin Resolution No. 2026-_ _ , and that in consideration of the making of such grant to allow the installation of a lee within the publieSA 11 24 SivJ~ -tk-ttfflageeasement by the City of Franklin, the undersigned agrees that this acceptance shall be binding upon the undersigned and the undersigned's successors and assigns and that the terms and provisions of the City of Franklin Resolution No. 2026-_ _ , shall run with the land, subject to any amendments thereto and/or any other actions thereto approved by the Common Council of the City of Franklin in the future. witness whereof, the undersigned has executed and delivered this acceptance on the m ay of U •2026. Property owner By: .. lR' o Mu . e• ExhibitB MORTGAGEHOLDERCONSENT The undersigned, Londmo:rLCte~1tUn,\Y:\ , a Wisconsin banking corporation ("Mortgagee"), as Mortgagee under that certain Mortgage encumbering the Property and recorded in the Office of the Register of Deeds for Milwaukee County, WiscoRsi1tson _ _ 2 5 .20 , as Document No. )LO OI ] here y consents to the execution of the foregoing Resolution No. 2026- , authorizing the installation of the fence within the public drainage easement. IN WITNESS WHEREOF, Mortgagee has caused these presents to be signed by its duly authorized officers and its corporate seal to be hereunto affixed, as of the day and year first above written. a Wisconsin Banking Corporation Lidw t ['mad+tu,Name of Wisconsin Bank ing Cor oration typed or printed By: · t L AN?+ o dt a/ STATE OF WISCONSIN ) S.S. COUNTY OF MILWAUKEE) On this, o p ex p}af$ z 2g o s me, the undersigned personally a ge@red D a@ ¥, _.e [ y yUj Lua9, g'l.flrdM.tifL (e,l). , a Wisconsin banking corporation, and acknowledged that (s)he execute he foregoing instrument on behalf of said corporation, by its authority and for the purposes therein contained. a reLr ,..... Not au blic JulieE.Zaffke State of X Do o County of "NQl.:l~ 5'\°"- My commission expires on:(g1.11 t-)(11 \i I1 (__ HOLLAND & THOMAS, L.L.C. - LAND SURVEYORS 202 West Street Johnson Creek. WI 53038 (920) 699-3305 A J) f. G II PLAT OF SURVEYFORLOT 16 OF CAPECROSSING, ,6,NOBEING A PARTOF l1iESW 1/ 4 OF lHE SOUTHWESTQUARTEROF SECTION19, TOWN 5 NOR'lll, RANGE21 EAST, CITYOF FIWll<UN, MILWAUKEECOUNTY, WISCONSIN. <<::, s<::, ,o I::....~ " s.- <Jlf ll O l h....£ -_--,._ .= ~ z a3 1\ ¢ .....'; s~ "'"3 ~ 7 I I I I I wr11 I.OT 15 ,..._,_♦_.2_•·_ ,._ --,,,.._5•- - - - --t"1 L umNG 6l! JLD1/IG T.OF • IOU 5'offpnpe•() v,th , pelt 40.M ' 1.45" LOT16 9.000 SQ, FT. 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L.P.L.S.. do here by ccniJ)' th.at I ha._.c m~ this !Ur.'C) and 11\1.1the information asshown on 1b.:uho\oCPhil of Survey isu true:md t:off'Ctl reprcst!ntnlion thereof and lh11this ,u.n.c) complie,.v.-ith Wisconsin Admini!ltati\-eCodc A-h 7. l.ois.orcdrawn from subdivisionplats' €.S.M.s; unplou.:d lands from recorded d.:cJs/surveys. Boundary survey pha~ reflect fictd-loClllcJ Jnfonnmion; con:rult a title attorney t otli,;covcr nll the legal enc:-umbt.-nncnlSottachc.:d W any prop¢rt ) . IO II 12 A [l (" n ('. G II LEGEND:lheN stand°"' -,mbol, marbe found in IN drolft\G. • Lal Comer (Found) • / "-' - - - 0 1&" X 3/ 4" Dlo.. ... , (S, t) - Un..H Hottd othintl .. 0 Dee. Trani . Box EoNITMlf'lt BoundOI')' 8ulldirt9 Setback Line, PROJECT: 123-016 BUILDER:Harbor Homes N27 W24025 Paul ct.Pewaukff, WI!53072 Ph: (262) 232-8!520 @ Men Hal• -0- UWHy ,,._ tal 'tf Rre Hyd,ant s::&'#at.,- Volve a Catch Ba,ln (" H allaml 'Th am,as24/ 7134H+h e t u n Rv! t 'heel 4 Re· / PK I · H+.nx - €1 .nu." APPROVAL REQUESTFOR COUNCILACTION MEETING DATE 9/1/2026 REPORTSAND RequestCouncilApprovaltoaccepta$300.00 public RECOMMENDATIONS donationfrom theFranklinLionessFoundationand applythistotheAutomatedExternalDefibrillators (AED's)intheCity ofFranklinParksProgram. Background: ITEM NUMBER The fire department has received a $300.00 donation from the Franklin Lioness Club as part of a City-wide initiative to place Automated External Defibrillators (AEDs), with secure boxes, in City of Franklin Parks. This is the second donation made this year by the Lioness Club toward the AEDs in the Parks Program, and we are extremely grateful for their support . The fire department is requesting Council approval to accept the donation and to spend the funding on AEDs, secure boxes, installation, and maintenance of the equipment and AEDs in the Parks Program. FinancialNote: With approval, funds will go into the designated budget lines for incoming (28-0000-4734) and outgoing (28- 0221-5329.7079) funds of the AEDs in the Parks Program. COUNCILACTIONREQUESTED Request Council Approval to accept a $300.00 public donation from the Franklin Lioness Foundation and apply this to the Automated External Defibrillators (AED's) in the City of Franklin Parks Program. Fire/JCM BLANKPAGE APPROVAL REPORTSAND RECOMMENDATIONS BACKGROUND REQUESTFORCOUNCILACTION DirectiononW.PuetzRoadPathwayProject MEETINGDATE 9/1/2026 ITEMNUMBER Ga.Z.Aid.Dist.#1 The W. Puetz Road Pathway project involves constructing a 10-foot-wide asphalt pathway adjacentto W.PuetzRd.from W.St. MartinsRoad (HWY 100)to S.76" Street (CTHU).This projecthasbeenongoingsince2023.Therefore,below isatimelinewithdatesandcouncilaction notedforthisprojecttoprovidebackgroundinformation. August15,2023: • W. Puetz Road reconstruction was discussed for the 2024 Local Street Improvement Program project with accommodations of a pathway for the safety of pedestrians and bicycles. • Transportation AlternativeProgram (TAP) grant wasmentioned asan option forfunding thispathway,alongwiththeuseofparkimpactfees. • TheCommonCouncilwasgiventheoptiontoeitherdirectstafftocontacttheneighboring property ownersandhaveaneighborhoodmeetingorproceedwiththe2024LocalStreet ImprovementProgramwithoutconsiderationofafuturepathway. • Alderman Holpfer moved to direct staff to proceed with contacting neighborsto the W. Puetz Road Corridor. Seconded by Alderwoman Eichmann. All voted Aye; motion carried. August29,2023: • AneighborhoodmeetingwasheldwiththeassistanceofAldermanEdHolpfer(District 1) andAlderwomanMichelleEichmann(District2). • Themeetingwaswellattended,with50peopleinattendanceestimated. • As of August 30, 2023, forty-three comments were received either at the meeting or throughemail. September5,2023: • The Engineering Department provided an update to the Common Council from the neighborhoodmeetingheldon 8/29/23. • Of the43 responses, 65% believed the pathway was agood idea, and 28% believed the pathwaywasabadidea.Seethecouncilactionsheetfrom 9/5/23forallwrittenresponses received. • Propertyownersalsohadthechancetolisttheirpreferenceofeitherthenorthorthesouth sideoftheroadway.37%preferredthesouthside,30%preferredthenorthside,and 10% hadnopreference. • Also includedinthecouncilaction sheetfrom 9/5/23wastheproposedpathwaywidth,if Statefunded,would be8-10 feetwide. • Alderman Holpfer moved to direct staff to start with project development for Grant applications (80% Transportation Alternative Program due on October 31, 2023). SecondedbyAlderwomanEichmann. AllvotedAye;motioncarried. November7,2023: • The Engineering Department submitted a Transportation Alternative Program grant applicationonOctober27,2023. • Enclosedinthecouncilactionsheetisacopyoftheapplication. • Listedinthegrantapplicationisthedescriptionofthepathwaybeing10-feetwide. • Theproposedpathwayestimatewaslistedas$2,070,000.00.80%wouldbegrantfunded and$256,680.00couldbefundedthroughparkimpactfees,leavingthetotalCitycostto be$157,320.00. • AldermanHolpfermovedtoadoptResolutionNo.2023-8061,ARESOLUTION SUPPORTINGWISCONSINDEPARTMENTOFTRANSPORTATION­ TRANSPORTATIONALTERNATIVESPROGRAM(TAP)2024-2028AWARD CYCLEFORTHEW.PUETZROADPATHWAY. SecondedbyAldermanCraig. All votedAye;motioncarried. March19,2024: • TheFinanceDirectorprovidedanupdatetotheCommonCouncil(ItemG.27)onthe impactfeesandreportedthat"IftheCitymadethedecisiontonotspendanotherparkfee dollaronanyprojects,theCitywouldhavetostartreturningparkimpactfeesbackto residentsinApril2025." April3,2024: • Staff informed Common Council that the project has been recommended for funding throughtheTAP2027-28fundingcycle. • Staff requested permission to start the process of selecting a consultant to design the pathway. • AlderwomanEichmannmovedtodirectstafftoproceedwiththesolicitationandselection ofadesignconsultantforthePuetzPathwayandreturnwithacontractafterallagreements necessaryforfundingthedesignaresecure. SecondedbyAldermanHolpfer. Allvoted Aye;motioncarried. May21,2024: • Resolution to Execute a State/Municipal Agreement (SMA) for an Infrastructure TransportationAlternativesProgram(TAP)ProjectforWestPuetzRoadPathwayinthe Amountof$440,000. • TheSMAallowstheprojecttoproceedthroughtheprocessoffindingaconsultingfirm fordesignandpermitting,completingtheplans,andfindingacontractor. • Solicitationofadesignconsultantisunderway. • IntheSMAitisstatedthattheproposedpathwaywouldbe10-feetwide. • The updated project estimate is a total of $2,200,000.00. Therefore, the City cost is increasedto$167,200.00. • AlderwomanEichmannmovedtoadoptResolutionNo.2024-8158,ARESOLUTION TOEXECUTEASTATE/MUNICIPALAGREEMENTFORANINFRASTRUCTURE TRANSPORTATIONALTERNATIVESPROGRAM(TAP)PROJECTFORW. PUETZRD.PATHWAYINTHEAMOUNTOF$440,000. SecondedbyAlderman Hasan. AllvotedAye;motioncarried. June14,2024: • Statementofqualificationsfromdesignconsultantsdueforreviewandconsideration. July2,2024: • A Resolution to "Certify aNon-Traditional Project Administration and Delivery for the PuetzPathway (WisconsinDepartmentofTransportationProjectID 2976-04-01/71)"for aPathwayProjectalongWestPuetzRoadfromWestSt.MartinsRoadtoSouth76thStreet. • DuetothisprojectbeingsponsoredbytheCity ofFranklin,theCitymustcertifythatthis projectwillberuntofollowallapplicableguidelines. • Designconsultantshavebeensolicited. • AlderwomanEichmannmovedtoadoptResolutionNo.2024-8176,ARESOLUTION TO"CERTIFYANON-TRADITIONALPROJECTADMINISTRATIONAND DELIVERYFORTHEPUETZPATHWAY(WISCONSIN DEPARTMENTOF TRANSPORTATION PROJECTID2976-04-01/71")FORAPATHWAYPROJECT ALONGW.PUETZRD.FROM W.ST.MARTINSROADTOS.76TH ST. Seconded byAldermanHasan.AllvotedAye;motioncarried. May6,2025: • ARESOLUTION TOAUTHORIZEAPROFESSIONAL SERVICESCONTRACT WITH CIVILTECHENGINEERING,INC.TOPROVIDEENGINEERINGSERVICES FORPUETZROADPATHWAYINTHEAMOUNTOF$268,611.56. • AlderwomanEichmannandAldermanPeccarelliwerebothinvolvedinthereviewand selectionofthedesignconsultant. • AlderwomanEichmann movedtoadoptResolutionNo.2025-8312,ARESOLUTION TOAUTHORIZEAPROFESSIONAL SERVICESCONTRACTWITHCIVILTECH ENGINEERING,INC.TOPROVIDE ENGINEERINGSERVICESFORPUETZROAD PATHWAYIN THEAMOUNTOF $268,611.56. SecondedbyAlderman Salous. All votedAye;motioncarried. June3,2025: • A Resolution to Supersede a State/Municipal Financial Agreement for an Infrastructure Transportation Alternatives Program (TAP)Project for West PuetzRoadPathway in the Amountof$440,000. • Thestatemunicipalagreementstatestheproposedpathwidthof 10-feetwide. • TheupdatetotheSMAistoupdatetheprojectdatesstated.Theprojectmustbecompleted byJune30,2033. • AlderwomanEichmannmovedtoadoptResolutionNo.2025-8329,ARESOLUTION TO SUPERSEDEASTATE/MUNICIPALFINANCIALAGREEMENTFORAN INFRASTRUCTURE TRANSPORTATIONALTERNATIVESPROGRAM (TAP) PROJECTFORWESTPUETZROADPATHWAYINTHEAMOUNTOF$440,000, subjecttotechnicalcorrectionsbytheCityAttorney. SecondedbyAlderwomanDay. AllvotedAye;motioncarried. October28,2025: • PublicInvolvementMeeting(PIM)#1 washeldattheFranklinPublicLibraryfrom4-6pm. • Thismeetingwasto discuss theproject andintroducethe4 different alternatives forthe pathway which are;AlternativeA (South Alignment),Alternative B (North Alignment), AlternativeC(HybridAlignment),AlternativeD(Nobuild). • Approximately61communitymembersattendedPIM#1 and34commentswerereceived. • Ofthe34 comments,59%weresupportiveoftheproject,41% werenotsupportiveofthe project. 21% preferAlternativeA,21% prefer AlternativeB, and 12% prefer alternative C. • ThePIM#1summarywassharedwiththeMayor,AlderwomanEichmann andAlderman Peccarelli.TheAlternativeA(SouthAlignment)wasselected. • CiviltechcontinueddesignontheproposedpathwayonthesouthsideofW.PuetzRd. May13,2026: • PublicInvolvement Meeting (PIM)#2washeld on May 13, 2026 atthe Franklin Public Libraryfrom 4-6pm. • Approximately49communitymembersattendedPIM#2and22commentswerereceived. • Ofthe22comments,36%weresupportiveoftheproject,55% werenotsupportiveofthe project,and9% expressedconditionalsupportfortheproject. • ThePIM#2summarywassharedwiththeMayor,AlderwomanEichmann,andAlderman Peccarelli. ANALYSIS AfterthePIM#2,Citystaff,Civiltech,theMayor,andAlderwomanEichmannmettodiscussthe resultsfromthePIM#2.ThedecisionwastobringthisitembacktoCouncilfordiscussionandto makeadecisiontoeithermoveforwardwiththisprojectorcancelit. City staffasked Civiltech toprovidecost estimates for four different options.Those optionsare describedbelow: 1. Selected 10-footwideasphaltpath • ThisoptionistocontinueasplannedandfollowsWisDOTTAPfundingrequirements. TheCity would receive 80% funding ($1,760,000.00) from the Stateifthis option is selected.TheCitycostwouldbeapproximately$167,200.00. 2. CurbandGutterwith 10-footwideasphaltpath • Thisoption would includemovingthepathway closertotheroadway,allowingfor a 5-foot wide grass terrace, then the 10-foot wide asphalt pathway. The existing stormwaterditch adjacenttotheroadwaywouldneedtobe filled in and storm sewer wouldbeaddedtoconveythestormwater.TheCitywouldstillreceivethe80%funding ($1,760,000.00),butthecostfortheCitywouldbeapproximately$650,000.00. 3. 6-footwideConcreteSidewalk • This option would reducethepathwaywidth.Reducingthepathway widthwould go against the WisDOT TAP fundingrequirements,therefore,the City wouldbe giving upthefunding.ThetotalcosttotheCitywouldbeapproximately$1,155,000.00 4. Cancelproject • This option would meanthat all coststhe city hasincurred upto this datewouldbe 100%theCitycost.TheWisDOTTAPfundingwouldnotbeabletobeused.Thecost tocanceltheprojectisapproximately$147,500.00.Iftheprojectiscanceled,theCity would be paying approximately $20,000 less than having an asphalt pathway and wouldbegettingnothing.TheCitywould alsonotbeabletousetheparkimpactfees andwouldneedtostartpayingthoseback. Staffis seekingaresolution from Common CouncilaswehaveatimelinefortheWisDOTTAP fundingandadecisionneedstobemade. FISCALNOTE TheCity budgetonly accountsfor $167,200.00.Ifanotheroption isselectedthatwouldresultin additionalfundingbeingrequired,abudgetamendmentwouldneedtobebroughttoCouncil. STAFFRECOMMENDATION lanned. Engineering- MNP;DOA- KH; APPROVAL Reports& commendations BACKGROUND REQUESTFORCOUNCILACTION DiscussionofaW.PuetzRoadPathwayfrom S.76 StreettoW.St.MartinsRoad MTG.DATE Agt 15,2023 f At the August 9, 2023 Board of Public Works (BOPW) meeting, the 2024 Local Street Improvement Program (LSIP) was discussed. Much of the discussion centered around the conditionofW.PutezRoadfrom S.76" StreettoW.St.MartinsRoad. Thissectionofroadhas been submitted multipletimesfor thetransportation improvementprogram, butthis segment of roaddoesnotcompetewellwiththeotherroadprojectswithintheMilwaukeeurbanizedarea. The BOPWrecommendedtodoafullpulverizationandrepavingofthissectionofroadwayfor2024, butalsopursueapathwayforthesafetyofpedestriansandbicycles. ANALYSIS This 1.3+/-milesegmentofroadwayhassignificantobstaclestowideningoraddingaseparated pathway. Thoseobstaclesincludepropertylines,utilities,vegetation,andwetlandsthatcrowdthe roadwayinmanylocations. Staffisproposingtohaveaneighborhoodmeetingandmeetwithpropertyownerswithproperties adjacenttotheright-of-waytodiscussvoluntarypurchaseofadditionalright-of-way.Asaresult ofthesemeetingsanddiscussions,aconceptplancouldbeputtogetherforapathwayproject.This pathway project could be locally funded or submitted for pathway grants, such as the TransportationAlternativeProgram(nextrounddueOctober27,2023). Thereare 42parcelsalongthesouthsideofthisroadsegmentandateglance,thereappeartobe 11parcelsthatmightneedtoselladditionalright-of-wayifthepathwayweretobelocatedonthe southside. Similarforthenorthside,thereare43parcelswith 13parcelsthatmightneedtosell additionalright-of-wayifthepathwaywerelocatedonthenorthside. Again,utilitiesaretight,includingpowerpoles,andwetlandfeaturesarein closeproximitythat wouldrequireextensivepermitting. Iftheneighborhoodmeetingsandinduvialmeetingswiththemostaffectedpropertyownersappear promising, Staffwouldcontactaconsultantandprepareacontractfor thisworkto bepresented beforetheParksCommissionandtheCommonCouncil. OPTIONS A. DirectStafftoproceedwithcontactingneighborstotheW.PuetzRoadCorridor. B. DirectStafftoproceedwithplanningforthe2024LSIPprogramwithoutconsiderationof afuturepathway. C. OtherdirectiontoStaff FISCALNOTE This PuetzPathway trail project,with a yet unknown budget,would be eligible for 62% park impactfees. RECOMMENDATION AtthewilloftheCommonCouncil. Engineering:GEM 217 APPROVAL Reports& Recommendations REQUESTFOR COUNCILACTION ContinuedDiscussionofaW.PuetzRoadPathwayfrom S,76S treettoW.St.MartinsRoad \ MTG. DATE seembr5,2023 IDKMNO. Ald.Dist.1&2 /c.iABACKGROUND I AtthesuggestionfromtheBoardofPublicWorks,theCommonCouncildirectedStafftoproceed with contacting neighborstotheW.PuetzRoad corridor (from S.76" Streetto W. St Martins Road)and solicitinputconcerningapossiblePuetzRoadPathway.Aneighborhoodmeetingwas heldonTuesday,August29,2023withtheassistanceofAldermanEdHolpferandAlderwoman MichelleEichmannthatshareanaldermanicboundaryalongthissection(District1southsideand District2northside). Anypropertyadjoiningthissection ofroadwaywasmailedaninvitation andanoticewasdistributedforsocialmediapurposestoanyandallothersthatmightbeinterested. Themeetingwaswell attended(estimatedover 50attendees)andotherinputhasbeenreceived viaemailinresponsetopublicationofthemeetingonvarioussocialmedia. SomeexpressedfrustrationthattheCitycannotprovideplansforthisproject. Atthistime,thisis notaprojectandpublicinputwassolicitedtohelpguidethedecision-makingprocess. Although thedefinitions of theword's "pathway°, "trail and "sidewalk" are addressed in thefollowing writeup,thesetermsaremostlyusedinterchangeablythroughoutthisCouncilActionbyStaffand commentswithoutdifferentiationorpresumptionofafinaldesign. ANALYSIS Althoughitisestimatedthatthereweremorethan50inattendancetotheAugust29neighborhood meeting,only31peoplesignedin.Themessagetoallwasthatthereisnopre-conceivedproject underway. Themeetingandsolicitationofcommentsweretogatherinput. As ofAugust 30,2023, forty three commentshavebeen received from forms submitted at the neighborhoodmeetingorviaemail. Theformsaskedforthefollowing: • Name&Address • MypropertybordersW.PuetzRoad:YES/ NO (chooseone). Ifso,pleaseprovide yourtelephonenumber andemailaddresssothatwecancontactyouinthefuture,if needed. • Iftherewereapathwayforthiscorridor,Iwoulduseitfor:BICYCLING/ WALKING /WOULDN'TUSE IT(chooseone) • IthinkthatapathwayalongthiscorridorisaGOOD/BADidea(chooseone)because: • IF a Puetz Pathway Project is pursued, the best location for a pathway would be NORTHSIDE/ SOUTHSIDE/NOPREFERENCE (chooseone)because: • OtherComments: Ofthe43responses,28(65%)believethatapathwayalongthiscorridorisagoodidea,12 (28%) believeditisabadideaand3(7%)hadnoopinion.16responsessaidthattheywouldusethisfor bicycling, 24 saidthattheywoulduseitforwalking,and 10would notuse it. The comments, groupedaccordingtotheirvote,concerningthisquestionareasfollows: Good Idea • Since moving to Franklin in 2019, one of the only disappointments we've had w th our neig