114510-O4.pdf

EVENT SPEAKER CONTRACT

STATE OF NEBRASKA – DEPARTMENT OF HEALTH AND HUMAN SERVICES

DHHS –Event Speaker Contract Page 1 of 5 Ver. 01/2024

This contract, including any attachments (collectively, “Contract”), is entered into by and between the Nebraska Department of Health and Human Services, Public Health, Office of Emergency Health Systems (“DHHS”), and Leslie Scofield, MPH (“Event Speaker”) (collectively, “the parties”).

AGREEMENT DETAILS

Purpose of Agreement To provide pediatric training on pediatric care.

Unilateral Termination Required Notice DHHS For Event Speaker

Thirty (30) Days Thirty (30) Days

SPEAKING ENGAGEMENT

The Event Speaker agrees to present on the subject of Pediatric Considerations in Triage at the following event, date, time, and location (“speaking engagement” or “speaking engagements”).

Event Name Event Location(s)

Pediatric Disaster Awareness Simulation UNMC Davis Global Center 4111 Emile Street, Omaha, NE 68105

Event Date(s) Event Start Time(s) December 6th, 2025 8:15 a.m. and 12:45 p.m.

Content The presentation covers pediatric considerations in SALT triage, including key differences from adult triage and strategies for effective team communication during mass casualty incidents.

1. Assist DHHS and iEXCEL team with planning the Pediatric Disaster Awareness simulation for the

Little Lives Big Impacts Pediatric Readiness workshop for both sessions to be held on December 6, 2025.

2. Present on the topic of Pediatric Considerations in Triage at both sessions of the Little Lives Big Impacts Pediatric Readiness workshop to be held on December 6, 2025.

The Event Speaker warrants that all content of the speaking engagement is original; available for use without permission; used with permission from the originator or owner of the content; or covered by the fair use exemption under copyright law.

If this Contract involves federal funds, and as required by 45 C.F.R. §§ 87.1-87.2, Event Speaker may not include overtly religious content, such as worship, religious instruction, or proselytization, in the speaking engagement.

114510-O4 Docusign Envelope ID: E0BDA5C5-8845-4BC2-A61F-51E3460C53F5

DHHS –Event Speaker Contract Page 2 of 5 Ver. 01/2024

Event Speaker Expectations

Event Speaker shall speak and present in a courteous, professional manner. Event Speaker will treat all event attendees respectfully and abstain from any derogatory comments, gestures, or actions.

Equipment Needed

The parties agree to supply the following equipment for the speaking engagement(s):

DHHS will supply: Event Speaker will supply:

None. Venue will be providing AV equipment. Speaker will provide her own laptop.

Usage of Materials and Permission to Record By execution of this Contract, Event Speaker permits DHHS to use the Event Speaker’s name, photograph and likeness in, and in connection with, all forms of: advertising, information programs, promotional material and any and all other materials, including audio or video recordings, to promote the speaking engagement(s). Furthermore, by execution of this Contract, Event Speaker permits DHHS to make paper or electronic copies of any presentation materials for the purpose of the speaking engagement(s).

FINANCIAL/BUDGETARY

Speaking Fee DHHS shall pay Event Speaker a speaking fee of $5,000.00 (Five thousand dollars).

Total Amount of Contract Type of Funding $5,000.00 (Five thousand dollars) Federal Total Amount Type Payment Structure Type Capped at Designated Amount Time and Material

Funding Conditions

If this Agreement involves the provision of federal funding from DHHS to Agency, Agency agrees to use the funding only as permitted by the federal funding agency and applicable law, regulation, and policy.

Requirements may include, but are not limited to, 2 CFR Part 200; 45 CFR Part 75; 45 CFR Part 96; the restrictions on lobbying set forth in 45 CFR Part 93 or in the applicable Notice of Award; and Nebraska procurement statutes, including the requirements of Neb. Rev. Stat. § 73-501 et seq., as applicable.

Invoicing

Upon completion of all speaking engagements, Event Speaker shall invoice DHHS for all speaking fees.

DHHS shall pay consistent with the terms provided herein.

DHHS –Event Speaker Contract Page 3 of 5

Prompt Payment

Payment shall be made in compliance with the Nebraska Prompt Payment Act, Neb. Rev. Stat. §§ 81- 2401 et seq. DHHS shall make payment in full for services provided on or before the forty-fifth (45th) calendar day after (a) the date of the speaking engagement or final speaking engagement, if multiple or

(b) the date of receipt by DHHS of the invoice for the speaking engagement(s), whichever is later.

Payment shall be made by electronic means. The Event Speaker shall complete and sign the State of Nebraska ACH Enrollment Form and obtain the necessary information and signatures from their financial institution. The completed form must be submitted before payments may be made. Download ACH Form:

http://das.nebraska.gov/accounting/nis/address_book_info.htm

GENERAL TERMS

Compliance with Law

Civil Rights and Equal Employment Opportunity Law. The parties shall comply with all applicable local, state, and federal laws regarding civil rights, including, but not limited to, 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. § 794; the Americans with Disabilities Act of 1990, 42 U.S.C. § 12101 et seq.; the Age Discrimination in Employment Act of 1967, 29 U.S.C. § 621 et seq.; the Age Discrimination Act of 1975, 42 U.S.C. § 6101 et seq.; and the Nebraska Fair Employment Practice Act, Neb. Rev. Stat. §§ 48-1101 to 48-1125.

The parties shall comply with all other applicable federal, state, county, and municipal laws, ordinances, rules and regulations in the performance of this Agreement. This may include, but is not limited to, confidentiality requirements for the particular information being accessed or the data being shared, as may be more fully set forth herein.

Force Majeure

Neither party shall be liable for any costs or damages resulting from its inability to perform any of its obligations under the Contract due to a natural disaster or other similar event outside the control and not the fault of the affected party (“Force Majeure Event”). A Force Majeure Event shall not constitute a breach of the Contract. The party so affected shall immediately give notice to the other party of the Force Majeure Event. Upon such notice, all obligations of the affected party under the Contract, which are reasonably related to the Force Majeure Event, shall be suspended, and the affected party shall do everything reasonably necessary to resume performance as soon as possible. Labor disputes with the impacted party’s own employees shall not be considered a Force Majeure Event, and shall not suspend performance requirements under the Contract.

Indemnification Event Speaker shall defend, indemnify, hold, and save harmless DHHS and its employees, volunteers, agents, and its elected and appointed officials (“the indemnified parties”) from and against any and all claims, liens, demands, damages, liability, actions, causes of action, losses, judgments, costs, and expenses of every nature, including investigation costs and expenses, settlement costs, and attorney fees and expenses (“the claims”), sustained or asserted against DHHS, arising out of, resulting from, or attributable to the willful misconduct, negligence, error, or omission of Event Speaker, except to the extent such Event Speaker liability is attenuated by any action of the DHHS that directly and proximately contributed to the claims.

http://das.nebraska.gov/accounting/nis/address_book_info.htm

DHHS –Event Speaker Contract Page 4 of 5

Independent Contractor It is mutually understood and agreed by the Parties that the Event Speaker is an independent contractor.

Event Speaker will be responsible for the payment of any taxes or fees due because of payment for speaking engagement(s).

Integration

This written Contract, along with any attachments, represents the entire agreement between the parties, and any prior or contemporaneous representations, promises, or statements by the parties, which are not incorporated herein, shall not serve to vary or contradict the terms set forth in this Contract.

Nebraska Nonresident Income Tax Withholding

Event Speaker acknowledges that Nebraska law requires DHHS to withhold Nebraska income tax if payments for personal services are made in excess of six hundred dollars ($600) to any contractor who is not domiciled in Nebraska or has not maintained a permanent place of business or residence in Nebraska for a period of at least six months. This provision applies to individuals; to a corporation if 80% or more of the voting stock of the corporation is held by the shareholders who are performing personal services; and to a partnership or limited liability company if 80% or more of the capital interest or profits interest of the partnership or limited liability company is held by the partners or members who are performing personal services.

The parties agree, when applicable, to properly complete the Nebraska Department of Revenue Nebraska Withholding Certificate for Nonresident Individuals Form W-4NA or its successor. The form is available at: http://www.revenue.nebraska.gov/tax/current/fill-in/f_w4na.pdf

Termination

Either DHHS or Event Speaker may terminate this Contract prior to the speaking engagement by providing written notification to the other party. If, less than thirty (30) days prior to the speaking engagement, DHHS terminates the speaking engagement(s) for any reason, except for breach or those reasons provided below, DHHS shall reimburse the Event Speaker for any reasonable and actual incurred travel expenses that Event Speaker is unable to cancel; or, if a penalty applies and is less than that of the incurred travel expenses, DHHS shall reimburse the Event Speaker the amount of the penalty.

DHHS may terminate this Contract immediately and without liability or penalty if the Event Speaker, prior to the speaking engagement, is charged with or commits a crime or act of moral turpitude such that DHHS, in its sole discretion, would be exposed to public embarrassment or ridicule for hosting the Event Speaker. DHHS may also terminate this Contract without liability or penalty if the Event Speaker is not ready to speak at the speaking engagement(s) or if the Event Speaker arrives in a condition for the speaking engagement(s) as to appear to a reasonable person to be incapable of speaking in a reasonably acceptable manner.

http://www.revenue.nebraska.gov/tax/current/fill-in/f_w4na.pdf

DHHS –Event Speaker Contract Page 5 of 5

NOTICES

Notices shall be in writing and shall be effective upon mailing or emailing. Either party may change the individual to be noticed under this section via letter sent by U.S. Mail, postage prepaid, or via email.

All written notices shall be sent to the following addresses:

FOR DHHS FOR EVENT SPEAKER

Regan Blackwell Nebraska Department of Health and Human Services 301 Centennial Mall South Lincoln, NE 68509-5026 402-326-0173 Regan.Blackwell@nebraska.gov

Leslie Scofield, MPH 3074 330th St Logan, IA 51546 402-677-4124 Leslie.scofield@outlook.com

ACKNOWLEDGEMENTS

Event Speaker acknowledges and agrees that it is an independent contractor and is not a current employee of the State of Nebraska. With this Contract, the State of Nebraska, Department of Health and Human Services, is not hiring Event Speaker as a temporary, part-time, or permanent employee. Event Speaker waives any current or future claim to employment, employee protections under contract, rule or regulation, healthcare benefits, retirement, or other benefits offered now or in the future by the State of Nebraska.

Event Speaker acknowledges and represents that, under the Nebraska Political Accountability and Disclosure Act, Event Speaker is not a public employee or public official, nor is an immediate family member of, and represented by, a public employee or public official.

SIGNATURES

IN WITNESS HEREOF, the parties hereto have duly executed this Contract, and each individual signing below certifies that he or she has the authority to legally bind the party to this Contract.

FOR DHHS FOR EVENT SPEAKER

Sara Morgan Deputy Director of Health Promotion and Prevention Nebraska Department of Health and Human Services

Leslie Scofield, MPH

DATE: DATE:

10/6/2025 | 11:39:10 CDT10/6/2025 | 13:21:42 CDT

Certificate Of Completion Envelope Id: E0BDA5C5-8845-4BC2-A61F-51E3460C53F5 Status: Completed

Subject: Complete with Docusign: 114510-O4 Leslie Scofield Agreement CLMS 7029.pdf

Envelope Type: Contract

Envelope Name: 114510-O4 Leslie Scofield Agreement CLMS 7029

Divison: Child & Family Services

DHHS Sender: dhhs.procurement@nebraska.gov

DHHS Sharepoint ID:

FFATA Reporting Required:

Source Envelope:

Document Pages: 5 Signatures: 2 Envelope Originator:

Certificate Pages: 5 Initials: 0 Procurement Shared

AutoNav: Enabled

EnvelopeId Stamping: Enabled

Time Zone: (UTC-06:00) Central Time (US & Canada)

301 Centennial Mall S

Lincoln, NE 68508-2529 dhhs.procurement@nebraska.gov

IP Address: 164.119.5.173

Record Tracking Status: Original

10/6/2025 9:43:41 AM

Holder: Procurement Shared dhhs.procurement@nebraska.gov

Location: DocuSign

Security Appliance Status: Connected Pool: StateLocal

Storage Appliance Status: Connected Pool: Nebraska Department of Health & Human

Services

Location: Docusign

Signer Events Signature Timestamp Leslie Scofield leslie.scofield@outlook.com

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address:

2605:59c8:51e5:5610:4182:f9e2:ef08:3b18

Sent: 10/6/2025 9:46:27 AM

Viewed: 10/6/2025 11:38:16 AM

Signed: 10/6/2025 11:39:10 AM

Electronic Record and Signature Disclosure:

Accepted: 10/6/2025 11:38:16 AM ID: 3c74e1bc-fe95-424e-9edc-027031061fb6

Sara Morgan

Sara.Morgan@nebraska.gov

Deputy Director, Promotion and Prevention

NDHHS, Division of Public Health

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 164.119.5.36

Sent: 10/6/2025 11:39:11 AM

Viewed: 10/6/2025 1:20:47 PM

Signed: 10/6/2025 1:21:42 PM

Electronic Record and Signature Disclosure:

Accepted: 10/6/2025 1:20:47 PM ID: 7fea69bd-d11f-420b-a3dd-bd28a60cfdbb

In Person Signer Events Signature Timestamp

Editor Delivery Events Status Timestamp

Agent Delivery Events Status Timestamp

Intermediary Delivery Events Status Timestamp

Certified Delivery Events Status Timestamp

Carbon Copy Events Status Timestamp Regan Blackwell

Regan.Blackwell@nebraska.gov

Security Level: Email, Account Authentication (None)

Sent: 10/6/2025 9:46:26 AM

Viewed: 10/6/2025 9:47:29 AM

Electronic Record and Signature Disclosure:

Not Offered via Docusign

Tim Wilson

Tim.Wilson@nebraska.gov

Program Manager

ABC Company

Security Level: Email, Account Authentication (None)

Sent: 10/6/2025 9:46:26 AM

Electronic Record and Signature Disclosure:

Accepted: 8/7/2025 10:13:20 AM ID: 7d8cd9b4-5968-4f80-8c72-04be0f934fe3

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 10/6/2025 9:46:26 AM

Certified Delivered Security Checked 10/6/2025 1:20:47 PM

Signing Complete Security Checked 10/6/2025 1:21:42 PM

Completed Security Checked 10/6/2025 1:21:42 PM

Payment Events Status Timestamps

Electronic Record and Signature Disclosure

CONSUMER DISCLOSURE

From time to time, Nebraska Department of Health & Human 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, Inc. (DocuSign) electronic signing system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the ‘I agree’ button at the bottom of this document.

Getting paper copies 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 signing session and, if you elect to create a DocuSign signer account, you may access them for a limited period of time

(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.

Withdrawing your consent 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.

Consequences of changing your mind 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. To indicate to us that you are changing your mind, you must withdraw your consent using the DocuSign ‘Withdraw Consent’ form on the signing page of a

DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn your consent to receive required notices and disclosures electronically from us and 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.

All notices and disclosures will be sent to you electronically 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.

Electronic Record and Signature Disclosure created on: 2/11/2018 10:43:44 PM Parties agreed to: Leslie Scofield, Sara Morgan, Tim Wilson

How to contact Nebraska Department of Health & Human Services:

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: john.canfield@nebraska.gov

To advise Nebraska Department of Health & Human Services of your new e-mail address

To let us know of a change in your e-mail address where we should send notices and disclosures electronically to you, you must send an email message to us at john.canfield@nebraska.gov and in the body of such request you must state: your previous e-mail address, your new e-mail address. We do not require any other information from you to change your email address..

In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected in your DocuSign account by following the process for changing e-mail in the DocuSign system.

To request paper copies from Nebraska Department of Health & Human Services To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an e-mail to john.canfield@nebraska.gov and in the body of such request you must state your e-mail address, full name, US Postal address, and telephone number. We will bill you for any fees at that time, if any.

To withdraw your consent with Nebraska Department of Health & Human Services

To inform us that you no longer want to receive future notices and disclosures in electronic format you may:

i. decline to sign a document from within your DocuSign session, and on the subsequent page, select the check-box indicating you wish to withdraw your consent, or you may;

ii. send us an e-mail to john.canfield@nebraska.gov and in the body of such request you must state your e-mail, full name, US Postal Address, and telephone number. We do not need any other information from you to withdraw consent.. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process..

Required hardware and software

Operating

Systems:

Windows® 2000, Windows® XP, Windows Vista®; Mac OS® X

Browsers:

Final release versions of Internet Explorer® 6.0 or above (Windows only);

Mozilla Firefox 2.0 or above (Windows and Mac); Safari™ 3.0 or above

(Mac only)

PDF Reader: Acrobat® or similar software may be required to view and print PDF files

Screen

Resolution:

800 x 600 minimum

Enabled Security

Settings:

Allow per session cookies

** These minimum requirements are subject to change. If these requirements change, you will be asked to re-accept the disclosure. Pre-release (e.g. beta) versions of operating systems and browsers are not supported.

Acknowledging your access and consent to receive materials electronically To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please verify that you were able to read this electronic disclosure and that you also were able to print on paper or electronically save this page for your future reference and access or that you were able to e-mail this disclosure and consent to an address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receiving notices and disclosures exclusively in electronic format on the terms and conditions described above, please let us know by clicking the ‘I agree’ button below.

By checking the ‘I agree’ box, I confirm that:

I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF

ELECTRONIC CONSUMER DISCLOSURES document; and

I can print on paper the disclosure or save or send the disclosure to a place where I can print it, for future reference and access; and

Until or unless I notify Nebraska Department of Health & Human Services as described above, I consent to receive from exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to me by Nebraska Department of Health & Human

Services during the course of my relationship with you.