DHHS Service Contract (Short Form) Page 1 of 5 Rev. 07/2021

SERVICE CONTRACT (SHORT FORM)

BETWEEN

THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES

AND

This contract, including any attachments (collectively, “Contract”) is entered into by and between the Nebraska

Department of Health and Human Services, ______________________________________________

(hereinafter “DHHS”), and _____________________________________________________________

(hereinafter “Contractor”).

PURPOSE: The purpose of this Contract is ________________________________________________

FUNDING: This Contract involves _______________________________

1. DURATION

1.1. TERM. This agreement begins on the later of ______________________ or the date this agreement is signed by the parties. This agreement ends on _______________________.

2. PAYMENT TERMS AND STRUCTURE

2.1. TOTAL PAYMENT. DHHS shall pay Contractor a total amount not to exceed

$__________________________ (_________________________________dollars) for the services specified herein.

2.2. INVOICING. Upon completion of all services and provision of all deliverables, Contractor shall invoice DHHS for the total amount set forth in 2.1, above. DHHS shall pay consistent with the terms provided herein.

2.2.1. Any term included in Contractor’s invoice shall be deemed to be solely for the convenience of the parties and is not binding on the parties. No payment shall be made for any deliverable or cost unless specifically authorized in the terms of the Contract.

2.3. 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 completion of the service(s) or (b) the date of receipt by DHHS of the invoice for the service(s), whichever is later. Payment shall be

Docusign Envelope ID: 32341ADA-409D-4547-84CB-1B1F89668038

2850.00 two thousand eight hundred and fifty

August

To secure a venue and live streaming services for the August 5, 2026, Elder Justice

Training, held at the Nebraska Public Media facility

Nebraksa Public Media Foundation federal funds

Nebraksa Public Media Foundation

September

Division of Developmental Disabilities

DHHS Service Contract (Short Form) Page 2 of 5 made by electronic means. The Contractor 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

3. SERVICES PROVIDED

3.1. DESCRIPTION OF SERVICES. The Contractor shall ____________________________________

3.2. DELIVERABLES. Contractor shall provide the following deliverables:________________________

4. GENERAL TERMS

4.1. ACCESS TO RECORDS. All Contractor books, records, and documents, regardless of physical form, including data maintained in computer files or on magnetic, optical or other media, relating to work performed or monies received under this Contract, shall be subject to audit by DHHS or its authorized representative at any reasonable time and upon the provision of reasonable notice. Contractor shall maintain all records for five (5) years from the date of final payment.

4.2. AMENDMENT. This Contract may only be modified by written amendment, executed by both parties.

No alteration or variation of the terms of this Contract shall be valid unless made in writing and signed by the parties.

4.3. CIVIL RIGHTS AND EQUAL OPPORTUNITY EMPLOYMENT. The Parties shall comply with all applicable local, state and federal law regarding civil rights, including but not limited to the Nebraska Fair Employment Practice Act, Neb. Rev. Stat. §§ 48-1101 to 48-1125.

4.4. COMPLIANCE WITH LAW. The Parties shall comply with all other applicable federal, state, county and municipal laws, ordinances, and rules and regulations in the performance of this Contract.

4.5. CONFIDENTIALITY. Any and all information gathered in the performance of this Contract, either independently or through DHHS, shall be held in the strictest confidence and shall be released to no one other than DHHS without the prior written authorization of DHHS. Contrary provisions set forth in the Contract shall be deemed to be authorized exceptions to this general confidentiality provision.

4.6. DRUG-FREE WORKPLACE. Contractor certifies that it maintains a drug-free workplace environment to ensure worker safety and workplace integrity. Contractor shall provide a copy of its drug-free workplace policy at any time upon request by DHHS.

4.7. FORCE MAJEURE. Neither party shall be liable for any costs or damages resulting from its inability to perform any of its obligations under this Contract due to a natural disaster, or other similar event outside the control and not the fault of the affected party.

4.8. INDEMNIFICATION. Contractor shall defend, indemnify, hold, and save harmless DHHS and its employees, volunteers, agents, and its elected and appointed officials (“the indemnified parties”)

Docusign Envelope ID: 32341ADA-409D-4547-84CB-1B1F89668038

3.2.1 Provide DHHS full-resolution closed-captioned digital files of the taped training. DHHS will be provided full rights to host the files on websites, social media, or video-specific web platforms no later than September 5, 2026

3.1.1. Provide access to the Board room and meeting/events room for the full day of August 5, 2026.

3.1.2. Provide the necessary audio and visual equipment, live streaming link to record and live stream the training with closed captioning in English and Spanish, for the training scheduled for

August 5, 2026, 8:30 a.m.-4:30 p.m.

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

DHHS Service Contract (Short Form) Page 3 of 5 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 Contractor, except to the extent such Contractor liability is attenuated by any action of the DHHS that directly and proximately contributed to the claims. DHHS’s liability is limited to the extent provided by the Nebraska Tort Claims Act, the Nebraska Contract Claims Act, the Nebraska Miscellaneous Claims Act, and any other applicable provisions of law. DHHS does not assume liability for the action of its contractors.

4.9. INDEPENDENT CONTRACTOR. It is mutually understood and agreed by the Parties that the Contractor is an independent contractor. Contractor will be responsible for the payment of any taxes or fees due because of payment for the service(s).

4.10. 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.

4.11. NEBRASKA NONRESIDENT INCOME TAX WITHHOLDING. Contractor 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.

4.11.1. 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

4.12. NEW EMPLOYEE WORK ELGIBILITY STATUS. Contractor shall use a federal immigration verification system to determine the work eligibility status of new employees physically performing services within the State of Nebraska. A federal immigration verification system means the electronic verification of the work authorization program authorized by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 8 U.S.C. § 1324a, known as the E-Verify Program, or an equivalent federal program designated by the United States Department of Homeland Security or other federal agency authorized to verify the work eligibility status of a newly hired employee.

4.12.1. If Contractor is an individual or sole proprietorship, the following applies:

Contractor must complete the United States Citizenship Attestation Form, available on the Department of Administrative Services website at https://das.nebraska.gov.

If Contractor indicates on such attestation form that he or she is a qualified alien, Contractor agrees to provide the US Citizenship and Immigration Services documentation required to verify Contractor’s lawful presence in the United States using the Systematic Alien Verification for Entitlements Program.

Contractor understands and agrees that lawful presence in the United States is required and Contractor may be disqualified or the Contract terminated if such lawful presence cannot be verified as required by Neb. Rev. Stat. § 4-108.

4.13. SEVERABILITY. If any term or condition of this Contract is declared by a court of competent jurisdiction to be illegal or in conflict with any law, the validity of the remaining terms shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if this Contract did not contain the particular provision held to be invalid.

4.14. TERMINATION. DHHS and Contractor reserve the right to terminate this Contract at any time. Either party may terminate this Contract for convenience upon 10 (ten) days prior written notice to the other party. DHHS may terminate the Contract, in whole or in part, if Contractor fails to perform its obligations under the Contract in a timely and proper manner.

Docusign Envelope ID: 32341ADA-409D-4547-84CB-1B1F89668038 http://www.revenue.nebraska.gov/tax/current/fill-in/f_w4na.pdf https://das.nebraska.gov/

DHHS Service Contract (Short Form) Page 4 of 5

5. CONTACT INFORMATION

DHHS Contract Manager Contractor

Name

Address Line 1

Address Line 2

City, State Zip

Phone

Email

Name

Address Line 1

Address Line 2

City, State Zip

Phone

Email

6. ACKNOWLEDGEMENT

If Contractor is an individual or sole proprietorship, then the Acknowledgement below is applicable.

Otherwise, disregard this section.

By signing below, Contractor certifies, acknowledges and agrees with the following statement:

I acknowledge and agree that I am an independent contractor. I further certify that I am 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 me as a temporary, part-time, or permanent employee. I hereby waive 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.

anita.wisecup@nebraska.gov

4023147339

Anita Wisecup

Columbus, NE 68601

3727 25th St

Lincoln, NE 68503

402-472-9333

1800 North 33rd St rhansen@nebraskapublicmedia.org

Randal P Hansen

DHHS Service Contract (Short Form) Page 5 of 5

IN WITNESS THEREOF, the parties have duly executed this Contract hereto, and that the individual signing below has authority to legally bind the party to this Contract.

FOR DHHS: FOR CONTRACTOR:

Name Name

Title Title

Department of Health and Human Services Company

Division

DATE: ________________________ DATE: _________________________

Randal P Hansen

Nebraska Public Media

2/13/2026 | 11:50:52 CST

CFO

Tony Green

2/13/2026 | 12:04:41 CST

Director

Developmental Disabilities

Certificate Of Completion Envelope Id: 32341ADA-409D-4547-84CB-1B1F89668038 Status: Completed

Subject: Please DocuSign: Services Contract - Short Form.docx

Envelope Type:

Envelope Name:

Divison:

DHHS Sender:

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.ServicesProcurement@nebraska.gov

IP Address: 164.119.5.138

Record Tracking Status: Original

2/13/2026 11:28:16 AM

Holder: Procurement Shared

DHHS.ServicesProcurement@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 Anita Wisecup anita.wisecup@nebraska.gov

Nebraksa Public Media Foundation

Security Level:

DocuSign.email

ID: 1

2/13/2026 11:28:17 AM

Completed

Using IP Address: 164.119.5.138

Sent: 2/13/2026 11:28:17 AM

Viewed: 2/13/2026 11:28:23 AM

Signed: 2/13/2026 11:33:50 AM

Electronic Record and Signature Disclosure:

Accepted: 2/10/2026 9:18:23 AM ID: e2281321-6160-4d39-a515-a9f67ad351a2

Randal P Hansen

Rhansen@nebraskapublicmedia.org

Chief Financial Officer

Nebraska Public Media

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 129.93.103.122

Sent: 2/13/2026 11:33:53 AM

Viewed: 2/13/2026 11:49:53 AM

Signed: 2/13/2026 11:50:52 AM

Electronic Record and Signature Disclosure:

Accepted: 2/13/2026 11:49:53 AM ID: 90b96635-8140-4cfa-b88d-dfe2855af178

Tony Green

Tony.green@nebraska.gov

Director

DHHs

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 164.119.5.179

Sent: 2/13/2026 11:50:53 AM

Viewed: 2/13/2026 12:04:06 PM

Signed: 2/13/2026 12:04:41 PM

Electronic Record and Signature Disclosure:

Accepted: 2/13/2026 12:04:06 PM ID: 43d49103-8ee5-4634-b6c0-b7936381f977

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 Anita Wisecup anita.wisecup@nebraska.gov

Security Level: Email, Account Authentication (None)

Sent: 2/13/2026 11:33:51 AM

Electronic Record and Signature Disclosure:

Accepted: 10/19/2023 8:21:32 AM ID: 97a1353d-5029-461e-b050-ee3f0545eb91

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 2/13/2026 11:28:17 AM

Certified Delivered Security Checked 2/13/2026 12:04:06 PM

Signing Complete Security Checked 2/13/2026 12:04:41 PM

Completed Security Checked 2/13/2026 12:04:41 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: Anita Wisecup, Randal P Hansen, Tony Green, Anita Wisecup

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..

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(Mac only)

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** 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.