250000000825.pdf

STATE OF MICHIGAN PROCUREMENT

Department Technology, Management and Budget Central Procurement Services 320 S Walnut Street Lansing, MI 48933 P.O. Box 30026, Lansing, MI 48909

CONTRACT CHANGE NOTICE

CONTRACT SUMMARY

Surveying tools and corresponding analytics services

INITIAL EFFECTIVE DATE INITIAL EXPIRATION DATE INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

June 1, 2025 May 31, 2030 5 - 1 Year May 31, 2030

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

MINIMUM DELIVERY REQUIREMENTS

P-Card Direct Voucher (PRC) Other Yes No

333 River Park Dr.

Provo UT 84604

Trey Hansen

5417888008 treyh@qualtrics.com

VS0012573

Qualtrics, LLC

C O

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A C

TO

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Angela Wright

517-899-4646

DTMB

Various Various

WrightA33@michigan.gov

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A dm inistrator Program M anagerSTA

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Change Notice Number 3

Contract Number MA250000000825 to

DESCRIPTION OF CHANGE NOTICE

OPTION EXTENSIONLENGTH OF OPTION LENGTH OF EXTENSION REVISED EXP. DATE

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$1,259,519.41 $1,281,058.00 $2,540,577.41

DESCRIPTION

Effective September 12, 2025 the parties add $1,281,058.00 per the attached Statement of Work.

The federal provisions that are applicable to this Change Notice are included as Attachment 1 to the attached Statement of Work. The existing Schedule H Federal Provisions Addendum remains unchanged.

Please note the State Agency Program Manager for MDHHS has been changed to Veronica Maxson.

All other terms, conditions, specifications, and pricing remain the same. Per contractor and agency agreement, DTMB Central Procurement Services approval, and State Administrative Board approval on September 11, 2025.

AGENCY NAME PHONE EMAIL

DTMB Duane Kerkstra 248-660-0132 kerkstrad@michigan.gov

MDHHS Veronica Maxson 517-243-8981 MaxsonV@michigan.gov

DTMB Dan Klodt 517 930-6368 KlodtD@michigan.gov

MDE Kelli Brozanski 517-648-4015 BrozanskiK@michigan.gov

MDOS Shawn Starkey 517-512-3204 StarkeyS@michigan.gov

Program Managers for

Multi-Agency and Statewide Contracts

CHANGE NOTICE NO. 3 TO CONTRACT NO. MA250000000825

CHANGE NOTICE NO. 3 TO CONTRACT NO. MA250000000825

Michigan.gov/MiProcurement

Version 2021-1 1 of 3

STATEMENT OF WORK -

IT CHANGE NOTICE

Project Title:

Michigan Department of Health and Human Services

(MDHHS)

Survey Implementation for MI Bridges

Period of Coverage:

September 12, 2025-May 31, Requesting Department:

Michigan Department of Technology Management and Budget (DTMB) in support of MDHHS

Date:

July 9, 2025

Agency Program Manager:

Veronica Maxson

Phone:

517-243-8981

DTMB Program Manager:

Duane Kerkstra

Phone:

248-660-0132

BACKGROUND:

Michigan Department of Health and Human Services (MDHHS) implemented an online, web-based system called MI Bridges in 2012 to provide online access to Health and Human service benefits information for MI residents. The website has continued to grow and evolve, encompassing a wider range of MDHHS benefit programs while also providing access to an array of community resources and services. MI Bridges serves more than 1,000,000 Michigan residents, and more than 5,000 community partner users. Over 82% of all applications for MDHHS services and benefits come through MI Bridges.

PROJECT OBJECTIVE:

The Contractor agrees to provide MDHHS with XM for Customer Frontlines – Digital software license (unlimited users), implementation services, and Support Services, which will allow MDHHS the ability to track, measure, understand and improve the use of the MI Bridges system by the public.

No Work Product is being created pursuant to this Statement of Work. The State is not acquiring ownership to the Deliverables provided by Contractor under this Statement of Work.

SCOPE OF WORK:

The XM for Customer Frontlines – Digital license will provide the following tools to further the SOM understanding of how the residents of Michigan interact with the MI Bridges system.

- Track trends and enhancements to the system and their impact

- Provide insights into the utilization of the system by the users

- Track digital behaviors of users including the time spent on various pages and “angry clicks” to the pages that cause the most issues for users

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- Provide feedback opportunities for users through survey function upon completed use of the system

- Improve engagement and communication opportunities between SOM and its residents using MI Bridges system

Pricing Per Schedule B:

Service Cost

XM for Customer Frontlines – Digital

$50,000 Annual

Minimum for Newly Branded

Licenses

N/A - Comes with Unlimited Users

This license comes with unlimited users.

Pricing is based on the number of annual responses. Minimum response count for this license is 10,000 at $5/response.

Additional responses are sold in batches of 1,000. Pricing shall not exceed $5,000 per 1,000 additional responses. Final pricing to be determined by available discounts at the time.*

MDHHS Pricing with Discounts:

60,000 Responses at $5/response 60,000 Responses at Discounted

Rate for MDHHS September 12, 2025-May 31, 2026**

$195000.00 $179,010.00

June 1, 2026-May 31, 2027 $300,000.00 $275,512.00

June 1, 2027-May 31, 2028 $300,000.00 $275,512.00

June 1, 2028-May 31, 2029 $300,000.00 $275,512.00

June 1, 2029-May 31, 2030 $300,000.00 $275,512.00

Total: $1,281,058.00

*Additional services provided to MDHHS with this license:

• 75,000,000 Digital Experience Analytics Sessions

• Guided Success Package

**Pro-rated to co-term with MA.

For License fees, payment will be made in advance, and within terms in the Contract.

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PROJECT CONTACTS:

The designated Agency Program Manager is:

Name: Veronica Maxson Department: Michigan Department of Health and Human Services Area: ESA Technology Division Building/Floor: Grand Tower, 14th Floor Address: 235 S. Grand Ave City/State/Zip: Lansing, MI 48933 Phone Number: 517-243-8981 Email Address: MaxsonV@michigan.gov

The designated DTMB Program Manager is:

Name: Duane Kerkstra Department: DTMB Area: Agency of Departmental Services Building/Floor: Grand Tower, 9th Floor Address: 235 S. Grand Ave City/State/Zip: Lansing, MI 48933 Phone Number: (248) 660-0132 Email Address: KerkstraD@Michigan.Gov mailto:MaxsonV@michigan.gov mailto:KerkstraD@Michigan.Gov

Mi c hi gan. gov/ Mi Proc ure m e nt

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ATTACHMENT 1 TO STATEMENT OF WORK for

MDHHS Survey Implementation for MI Bridges

FEDERAL PROVISIONS ADDENDUM

This addendum applies to purchases that will be pai for in whole or in part with funds obtained from the federal government. The provisions below are required, and the language is not negotiable. Contractor agrees to comply with all obligations under federal rules or regulations for such funding, including but not limited to the provisions contained in this addendum. If any provision below conflicts with the State’s terms and conditions, including any attachments, schedules, or exhibits to this Contract, the provisions below take priority to the extent a provision is required by federal law; otherwise, the order of precedence set forth in the Contract applies.

Further, Contractor agrees to, through a Contract Change Notice, append or modify specific federal provisions to this Contract, if reasonably necessary to keep the State and Contractor in compliance with federal funding requirements, and comply with the terms set forth therein.

Hyperlinks are provided for convenience only; broken hyperlinks will not relieve Contractor from compliance with the law.

A. Equal Employment Opportunity

This Contract is not a “federally assisted construction contract” as defined in 41 CFR Part 60-1.3.

B. Davis-Bacon Act (Prevailing Wage)

This Contract is not a “federally assisted construction contract” as defined in 41 CFR Part 60- 1.3, nor is it a prime construction contract in excess of $2,000.

C. Copeland “Anti-Kickback” Act

This Contract is not a “federally assisted construction contract” as defined in 41 CFR Part 60- 1.3, nor is it a prime construction contract in excess of $2,000 where the Davis-Bacon Act applies.

D. Contract Work Hours and Safety Standards Act

The Contract does not involve the employment of mechanics or laborers.

E. Rights to Inventions Made Under a Contract or Agreement

If this Contract is funded by a federal “funding agreement” as defined under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that “funding agreement,” the recipient or subrecipient must comply with 37 CFR Part 401, “Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,” and any implementing regulations issued by the awarding agency.

F. Clean Air Act and the Federal Water Pollution Control Act https://www.govinfo.gov/content/pkg/CFR-2019-title41-vol1/pdf/CFR-2019-title41-vol1-part60.pdf https://www.govinfo.gov/content/pkg/CFR-2019-title41-vol1/pdf/CFR-2019-title41-vol1-part60.pdf https://www.govinfo.gov/content/pkg/CFR-2019-title41-vol1/pdf/CFR-2019-title41-vol1-part60.pdf https://www.govinfo.gov/content/pkg/CFR-2019-title41-vol1/pdf/CFR-2019-title41-vol1-part60.pdf https://www.govinfo.gov/content/pkg/CFR-2019-title41-vol1/pdf/CFR-2019-title41-vol1-part60.pdf https://www.govinfo.gov/content/pkg/CFR-2019-title41-vol1/pdf/CFR-2019-title41-vol1-part60.pdf https://www.govinfo.gov/content/pkg/CFR-2019-title37-vol1/pdf/CFR-2019-title37-vol1-sec401-2.pdf https://www.govinfo.gov/app/details/CFR-2019-title37-vol1/CFR-2019-title37-vol1-part401

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If this Contract is in excess of $150,000, the Contractor must comply with all applicable standards, orders, and regulations issued under the Clean Air Act (42 USC 7401-7671q) and the Federal Water Pollution Control Act (33 USC 1251-1387), and during performance of this Contract the Contractor agrees as follows:

(1) Clean Air Act https://www.govinfo.gov/app/details/USCODE-2018-title42/USCODE-2018-title42-chap85 https://www.govinfo.gov/app/details/USCODE-2018-title33/USCODE-2018-title33-chap26

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(i) The Contractor agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act, as amended, 42 U.S.C. § 7401 et seq.

(ii) The Contractor agrees to report each violation to the State and understands and agrees that the State will, in turn, report each violation as required to assure notification to the Federal Emergency Management Agency or the applicable federal awarding agency, and the appropriate Environmental Protection Agency Regional Office.

(iii) The Contractor agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or in part with Federal assistance provided by FEMA or the applicable federal awarding agency.

(2) Federal Water Pollution Control Act

(i) The Contractor agrees to comply with all applicablestandards, orders, or regulations issued pursuant to the Federal Water Pollution Control Act, as amended, 33 U.S.C. 1251 et seq.

(ii) The Contractor agrees to report each violation to the State and understands and agrees that the State will, in turn, report each violation as required to assure notification to the Federal Emergency Management Agency or the applicable federal awarding agency, and the appropriate Environmental Protection Agency Regional Office.

(iii) The Contractor agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or inpart with Federal assistance provided byFEMA or the applicable federal awarding agency.

G. Debarment and Suspension

A “contract award” (see 2 CFR 180.220) must not be made to parties listed on the government-wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (51 FR 6370; February 21, 1986) and 12689 (54 FR 34131; August 18, 1989), “Debarment and Suspension.” SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549.

(1) This Contract is a covered transaction for purposes of 2 C.F.R. Part 180 and 2 C.F.R. Part 3000. As such, the Contractor is required to verify that none of the Contractor’s principals (defined at 2 C.F.R. § 180.995) or its affiliates (defined at 2 C.F.R. § 180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined at 2 C.F.R. § 180.935).

(2) The Contractor must comply with 2 C.F.R. Part 180, subpart C and 2 C.F.R. Part 3000, subpart C, and must include a requirement to comply with these regulations in any lower tier covered transaction it enters into.

(3) This certification is a material representation of fact relied upon by the State. If it is later determined that the contractor did not comply with 2 C.F.R. Part. 180, subpart C and 2 C.F.R. Part. 3000, subpart C, in addition to remedies available to the State, the Federal https://www.govinfo.gov/app/details/CFR-2019-title2-vol1/CFR-2019-title2-vol1-sec180-220 https://sam.gov/SAM/pages/public/index.jsf https://www.govinfo.gov/app/details/CFR-2019-title2-vol1/CFR-2019-title2-vol1-part180 https://www.archives.gov/federal-register/codification/executive-order/12549.html https://www.govinfo.gov/content/pkg/FR-1986-02-21/pdf/FR-1986-02-21.pdf https://www.govinfo.gov/content/pkg/FR-1989-08-18/pdf/FR-1989-08-18.pdf https://www.archives.gov/federal-register/codification/executive-order/12549.html https://www.archives.gov/federal-register/codification/executive-order/12549.html

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Government may pursue available remedies, including but not limited to suspension and/or debarment.

(4) The bidder or proposer agrees to comply with the requirements of 2 C.F.R. Part 180, subpart C and 2 C.F.R. Part 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The bidder or proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions.

H. Byrd Anti-Lobbying Amendment, 31 U.S.C. § 1352 (as amended)

Contractor has applied or bid for an award of more than $100,000 and shall file the required certification in Exhibit 1 – Byrd Anti-Lobbying Certification attached to the end of this Addendum.

Each tier certifies to the tier above that it will not and has not used federally 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. Each tier shall also disclose any lobbying with non-federal funds that takes place in connection with obtaining any federal award. Such disclosures are forwarded from tier to tier up to the recipient who in turn will forward the certification(s) to the federal awarding agency.

I. Procurement of Recovered Materials

If this Contract is a procurement to purchase products or items designated by the EPA under 40 C.F.R. part 247 during the course of a fiscal year, then under 2 CFR 200.323, Contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act.

(1) In the performance of this contract, the Contractor shall makemaximum use of products containing recovered materials that are EPA-designated items unless the product cannot be acquired:

(i) Competitively within a timeframe providing for compliance with the contract performance schedule;

(ii) Meeting contract performance requirements; or

(iii) At a reasonable price.

(2) Information about this requirement, along with the list of EPA- designated items, is available at EPA’s ComprehensiveProcurement Guidelines web site, https://www.epa.gov/smm/comprehensive- procurement-guideline-cpg-program.

(3) The Contractor also agrees to comply with all other applicable requirements of Section 6002 of the Solid Waste Disposal Act.

J. Prohibition on Contracting for Covered Telecommunications Equipment or Services

Contractor acknowledges and agrees that Section 889(b) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019, Pub. L. No. 115-232 (the “McCain Act”), and 2 C.F.R.

§200.216, prohibit the obligation or expending of federal award funds on certain telecommunication products or with certain entities for national security reasons on or after August 13, 2020.

During performance of this Contract, the Contractor agrees as follows:

https://www.ecfr.gov/current/title-40/chapter-I/subchapter-I/part-247 https://www.ecfr.gov/current/title-40/chapter-I/subchapter-I/part-247 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-D/subject-group-ECFR45ddd4419ad436d/section-200.323 https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg-program https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg-program https://www.congress.gov/115/plaws/publ232/PLAW-115publ232.pdf https://www.congress.gov/115/plaws/publ232/PLAW-115publ232.pdf https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216

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(a) Definitions. As used in this Section J. Prohibition on Contracting for Covered Telecommunications Equipment or Services (“Section J”):

(1) the terms “backhaul,” “critical technology,” “interconnection arrangements,” “reasonable inquiry,” “roaming,” and “substantial or essential component” have the meanings defined in 48 CFR § 4.2101;

(2) the term “covered foreign country” has the meanings defined in § 889(f)(2) of the McCain Act; and

(3) the term “covered telecommunications equipment or services” has the meaning defined in § 889(f)(3) of the McCain Act.

(b) Prohibitions.

(1) Unless an exception in paragraph (c) of this Section J applies, neither the Contractor nor any of its subcontractors may use funds received under this Contract to:

(i) Procure or obtain any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology of any system;

(ii) Enter into, extend, or renew a contract to procure or obtain any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology of any system;

(iii) Enter into, extend, or renew a contract with an entity that uses any covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system; or

(iv) Provide, as part of its performance of this contract, subcontract, or other contractual instrument, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system.

(c) Exceptions.

(1) This Section J does not prohibit Contractor from providing—

(i) A service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Telecommunications equipment that cannot route or redirect user data traffic or permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(d) Reporting requirement.

(1) In the event the Contractor identifies covered telecommunications equipment or services used as a substantial or essential component of any system, or as critical technology as part of any system, during contract performance, or the contractor is notified of such by a subcontractor at any tier or by any other source, the Contractor shall report the information in paragraph (d)(2) of this Section J to the recipient or

Version 2025-1 Page 6 subrecipient, unless elsewhere in this contract are established procedures for reporting the information.

(2) The Contractor shall report the following information pursuant to paragraph (d)(1) of this Section J:

(i) Within one business day from the date of such identification or notification: The contract number; the order number(s), if applicable;

supplier name; supplier unique entity identifier (if known); supplier Commercial and Government Entity (CAGE) code (if known); brand; model number (original equipment manufacturer number, manufacturer part number, or wholesaler number); item description; and any readily available information about mitigation actions undertaken or recommended.

(ii) Within 10 business days of submitting the information in paragraph (d)(2)(i) of this Section J: Any further available information about mitigation actions undertaken or recommended. In addition, the contractor shall describe the efforts it undertook to prevent use or submission of covered telecommunications equipment or services, and any additional efforts that will be incorporated to prevent future use or submission of covered telecommunications equipment or services.

(e) Subcontracts. The Contractor shall insert the substance of this Section J, including this paragraph (e), in all subcontracts and other contractual instruments.

K. Domestic Preferences for Procurements

(a) As appropriate, and to the extent consistent with law, the Contractor should, to the greatest extent practicable, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States. This includes, but is not limited to iron, aluminum, steel, cement, and other manufactured products.

(b) For purposes of this Section K – Domestic Preferences for Procurements:

(1) “Produced in the United States” means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States.

(2) “Manufactured products” mean items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer-based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber.

(c) Build America, Buy America Act (BABAA).

This Contract does not involve purchases for an infrastructure project that is subject to the domestic preference requirement in the Build America, Buy America Act.

L. Affirmative Socioeconomic Steps

For all contracts utilizing federal funding sources subject to Title 2 of the Code of Federal Regulations (C.F.R.) Part 200 issued on or after November 12, 2020, if subcontracts are to be let, the prime contractor is required to take all necessary steps identified in 2 C.F.R. § 200.321(b)(1)-(5)

Version 2025-1 Page 7 to ensure that small and minority businesses, women’s business enterprises, and labor surplus area firms are used when possible.

M. Copyright and Data Rights

Pursuant to 2 CFR § 200.315(b), the State may copyright any work which is subject to copyright and was developed, or for which ownership was acquired, under a Federal award. The Federal awarding agency reserves a royalty-free, nonexclusive and irrevocable right to reproduce, publish, or otherwise use the work for Federal purposes, and to authorize others to do so.

N. Additional FEMA Contract Provisions

This Contract does not involve purchases that will be paid for in whole or in part with funds obtained from the Federal Emergency Management Agency (FEMA).

O. Other Federal Contract Provisions

No additional federal provisions currently apply to this Contract.

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EXHIBIT 1

BYRD ANTI-LOBBYING CERTIFICATION

Contractor must complete this certification if the purchase will be paid for in whole or in part with funds obtained from the federal government and the purchase is greater than $100,000.

APPENDIX A, 44 C.F.R. PART 18 – CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

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 an 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 oremployee 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 Form to Report Lobbying,” in accordance with its instructions.

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 discloseaccordingly.

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. C. 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.

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The Contractor, Qualtrics, LLC, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C.Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any.

Signature of Contractor’s Authorized Official

Name and Title of Contractor’s Authorized Official

Date

Central Procurement Services 320 S Walnut Street Lansing, MI 48933 P.O. Box 30026, Lansing, MI 48909

CONTRACT CHANGE NOTICE

CONTRACT SUMMARY

Surveying tools and corresponding analytics services

INITIAL EFFECTIVE DATE INITIAL EXPIRATION DATE INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

June 1, 2025 May 31, 2030 5 - 1 Year May 31, 2030

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

MINIMUM DELIVERY REQUIREMENTS

P-Card Direct Voucher (PRC) Other Yes No

333 River Park Dr.

Provo UT 84604

Trey Hansen

5417888008 treyh@qualtrics.com

VS0012573

Qualtrics, LLC

C O

N

TR

A C

TO

R

Angela Wright

517-899-4646

DTMB

Various Various

WrightA33@michigan.gov

C ontract

A dm inistrator Program M anagerSTA

TE

net 45

Change Notice Number 2

Contract Number MA250000000825 to

DESCRIPTION OF CHANGE NOTICE

OPTION EXTENSIONLENGTH OF OPTION LENGTH OF EXTENSION REVISED EXP. DATE

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$1,171,930.00 $87,589.41 $1,259,519.41

DESCRIPTION

Effective September 5, 2025, this Contract is increased by $87,589.41 for MiLEAP and MSP per the attached 2 SOW's.

All other terms, conditions, specifications, and pricing remain the same. Per contractor and agency agreement, DTMB Central Procurement Services approval

DTMB Dan Klodt 517 930-6368 KlodtD@michigan.gov

MDE Kelli Brozanski 517-648-4015 BrozanskiK@michigan.gov

MDOS Shawn Starkey 517-512-3204 StarkeyS@michigan.gov

DTMB Jim Coggin 517-243-5265 CogginJ@michigan.gov

MSP Chelsea Deckler 517-388-4066 DecklerC@michigan.gov

MiLEAP Brandon Colby 517-898-5428 ColbyB@michigan.gov

Program Managers for

Multi-Agency and Statewide Contracts

CHANGE NOTICE NO. 2 TO CONTRACT NO. MA250000000825

CHANGE NOTICE NO. 2 TO CONTRACT NO. MA250000000825

STATEMENT OF WORK -

IT CHANGE NOTICE

Project Title:

Qualtrics for Early Childhood and The Office Student Success and Strategic Initiatives

Period of Coverage:

September 5, 2025 through April 21, 2026

Requesting Department:

MiLEAP

Date:

July 29, 2025

Agency Program Manager: Brandon Colby

Phone: 517-898-5428

DTMB Program Manager: Scott Wager

Phone:

(517)243-2329

BACKGROUND:

Currently The Office Student Success and Strategic Initiatives, formally The Office of Sixty by 30, that falls under Higher Education in MiLEAP currently uses Qualtrics.

PROJECT OBJECTIVE:

This SOW is to add the area of Early Childhood to the current MiLEAP Qualtrics brand and to provide option years for future license renewals.

SCOPE OF WORK:

• Contractor will add licenses to the existing MiLEAP branded license

• The new licenses end date is coterminous with the current MiLEAP License .

• All future MiLEAP licenses have the option to renew

• All future MiLEAP licenses will renew under the MA.

• Pro-rates the costs to coincide with the new timelines.

The Term of this SOW is September 5, 2025 through April 21, 2026 with the option to renew for 4 periods.

PRICING:

MiLEAP Brand for Early Childhood

DesignXM License Quantit y

Rate per User Per Schedule

B

Total License Fees

Rate Per Schedule B

Additional 1000 responses

Discounted rate Additional 1000 responses @ Total

September 5, 2025-April 21, 2026* 4 $1,572* $6,288 $1,680 $50 $6,338

MiLEAP Brand for Early Childhood

Option Years

April 22, 2026-May 31, 2027*

4* $2,777 $11,106 $1,680 $50 $11,156

Year 3 June 1, 2027-May 31, 2028

4 $2,500 $10,000 $1,680 $50 $10,050

Year 4 June 1, 2028-May 31, 2029

4 $2,500 $10,000 $1,680 $50 $10,050

Year 5 June 1, 2029-May 31, 2030

4 $2,500 $10,000 $1,680 $50 $10,050

MiLeap Brand for the Office Student Success and Strategic Initiatives Pricing with Discounts

Option Years

DesignXM License Quantity

Rate per User Per

Schedule B

Total License Fees

Rate Per Schedule B

Additional 2000 responses

Discounted rate Additional 2000 responses @ Total

April 22, 2026-May 31, 2027*

5* $2,777* $13,885** $3,200 $100 $13,985

June 1, 2027-May 31, 2028

5 $2,500 $12,500 $3,200 $100 $12,600

June 1, 2028-May 31, 2029

5 $2,500 $12,500 $3,200 $100 $12,600

June 1, 2029-May 31, 2030

5 $2,500 $12,500 $3,200 $100 $12,600

*Amounts are prorated to co-term dates with the existing licenses in the MiLEAP brand and with the MA.

**Calculations are rounded

PROJECT CONTACTS:

The designated Agency Program Manager is:

Name: Brandon Colby Department: MiLEAP Phone: 517-898-5428 Email: ColbyB@michigan.gov

The designated DTMB Program Manager is:

Name: Scott Wager Department: DTMB Phone: 517-243-2329 Email: wagers1@michigan.gov

STATEMENT OF WORK -

IT CHANGE NOTICE

Project Title: Qualtrics

Period of Coverage:

September 5, 2025 -May 31, Requesting Department: Michigan State Police

Date: August 27, 2025

Agency Program Manager: Chelsea Deckler

Phone: 517-388-4066

DTMB Program Manager: Jim Coggin

Phone: 517-243-5265

Brief description of services to be provided:

BACKGROUND: The department requires a secure, centralized solution for survey creation, distribution, and data storage to support strategic planning, performance measurement, and stakeholder engagement. Qualtrics is a cloud-based platform that meets this need by offering advanced survey and form management capabilities while maintaining the highest standards of data security. Without departmentwide access, members face significant challenges in collecting and analyzing feedback from internal and external stakeholders, creating barriers to progress on organizational goals.

PROJECT OBJECTIVE: The objective of this project is to maintain departmentwide access to Qualtrics to continue to provide a consistent, secure, and efficient platform for survey and form management. This will enhance the department’s ability to collect actionable feedback, measure performance, and support decision-making aligned with strategic priorities.

SCOPE OF WORK: Renewal of Licenses and to co-term the renewal dates with the MA.

PRICING:

Michigan State Police Line-Item Pricing with Discounts

XM for Customer Frontlines – Digital Interactions

Annual License Cost per Schedule B for 80,000* responses:

Discount Received Total

9/5/2025-5/31/2026* $295,155.00 -$220,185.63 $74,969.37 XM for Employee Experience - People Lifecycle Employees

Annual License Cost per Schedule B for 3000* Licenses @ $34.20 per License:

Discount Received Total

9/5/2025-5/31/2026* $75,708.52 -$69,426.48 $6,282.04

Total $370,863.52 -$289,612.11 $81,251.41 *Amounts are prorated to co-term renewal dates with MA.

Optional renewal Terms

XM for Customer Frontlines – Digital Interactions

Annual License Cost per Schedule B for 80,000* responses:

June 1, 2026-May 31, 2027 $400,000.00 -$298,394.65 $101,605.35 June 1, 2027-May 31, 2028 $400,000.00 -$298,394.65 $101,605.35 June 1, 2028-May 31, 2029 $400,000.00 -$298,394.65 $101,605.35 June 1, 2029-May 31, 2030 $400,000.00 -$298,394.65 $101,605.35 XM for Employee Experience - People Lifecycle Employees

Annual License Cost per Schedule B for 3000* Licenses @ $34.20 per License:

June 1, 2026-May 31, 2027 $102,600.00 -$94,086.60 $8,513.40 June 1, 2027-May 31, 2028 $102,600.00 -$94,086.60 $8,513.40 June 1, 2028-May 31, 2029 $102,600.00 -$94,086.60 $8,513.40 June 1, 2029-May 31, 2030 $102,600.00 -$94,086.60 $8,513.40

PROJECT CONTACTS:

The designated Agency Program Manager is:

Name: Chelsea Deckler Department: Michigan State Police Phone: 517-388-4066 Email: Decklerc@michigan.gov

The designated DTMB Program Manager is:

Name: Jim Coggin Department: DTMB Phone: 517-243-5265 Email: cogginj@michigan.gov

STATE OF MICHIGAN

ENTERPRISE PROCUREMENT

Department of Technology, Management, and Budget 320 S. Walnut Street 2nd Floor Lansing, MI 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

CONTRACT SUMMARY

Surveying tools and corresponding analytics services

INITIAL EFFECTIVE DATE INITIAL EXPIRATION DATE INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

June 1, 2025 May 31, 2030 5 - 12 Months May 31, 2030

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

MINIMUM DELIVERY REQUIREMENTS

P-Card Direct Voucher (PRC) Other Yes No

333 River Park Dr.

Provo 44 84604

Trey Hansen

5417888008 treyh@qualtrics.com

VS0012573

Qualtrics, LLC

C O

N

TR

A C

TO

R

Angela Wright

517-899-4646

DTMB

Various Various wrighta33@michigan.gov

C ontract

A dm inistrator Program M anagerSTA

TE

net 45

Change Notice Number 1

Contract Number MA250000000825 to

DESCRIPTION OF CHANGE NOTICE

OPTION EXTENSIONLENGTH OF OPTION LENGTH OF EXTENSION REVISED EXP. DATE

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$200,000.00 $971,930.00 $1,171,930.00

DESCRIPTION

Effective June 25, 2025 the parties add $971,930.00 per the attached statement of work.

All other terms, conditions, specifications, and pricing remain the same. Per contractor and agency agreement, DTMB Central Procurement Services approval, and State Administrative Board approval on June 24, 2025.

MDE Kelli Brozanski 517-648-4015 BrozanskiK@michigan.gov

MDOS Shawn Starkey 517-512-3204 StarkeyS@michigan.gov

DTMB Dan Klodt 517 930-6368 KlodtD@michigan.gov

Program Managers for

Multi-Agency and Statewide Contracts

CHANGE NOTICE NO. 1 TO CONTRACT NO. MA250000000825

Version 2021-1 1 of 5

STATEMENT OF WORK -

IT CHANGE NOTICE

Project Title:

MDOS Qualtrics Implementation

Period of Coverage:

7/1/2025 through 5/31/2030

Requesting Department:

MDOS

Date:

6/4/25

Agency Project Manager:

Shawn Starkey

Phone:

517-512-3204

DTMB Project Manager:

Dan Klodt

Phone:

517 930-6368

PROJECT OBJECTIVE:

MDOS wishes to procure an agency-wide, user-friendly system to establish surveys, reporting, and data analysis. The system will permit users with no coding or programming experience to create, test, modify, and publish surveys. This system will also permit saving, exporting, and analysis of the response data. The system will control access to survey responses based upon role, business area, or other requirements.

SCOPE OF WORK:

Qualtrics to provide:

• Platform implementation o MDOS will be provided with 50 user DesignXM accounts that allow the user to perform any or all tasks listed below within the Qualtrics platform.

o The one-time cost of $45,250 covers the setup of the platform by Qualtrics, training of MDOS staff on the platform and assistance in implementations/integrations identified to this point Customer and Automotive Records System (CARS).

• Survey creation o The platform will allow users to create, test, modify and publish surveys within the system.

o Surveys will be contained within the user profile and permissions can be set to limit who from MDOS can see a given survey.

o There is to be no Qualtrics enforced limit to the number of surveys that can be created.

• Survey distribution

Version 2021-1 2 of 5 o The platform will allow the distribution of personalized surveys via text and email.

o MDOS Interactive Voice Response (IVR) survey responses will be pulled into the Qualtrics platform for analysis.

o QR codes can also be posted in branches for real-time, anonymous feedback, if desired.

o Links to surveys can be posted on websites, if desired.

o Surveys are to be distributed between 20 minutes and 24 hours after interactions depending on the type of integration.

o MDOS will be provided with 700,000 SMS credits annually.

o MDOS will be allowed to receive 400,000 responses annually. MDOS won’t be charged for any overage in responses for the first year of the contract.

Future increases in this number will be negotiated within the terms of the contract (not to exceed $1,680 per 1,000 responses per Schedule B - Pricing).

• Survey response analysis o All survey responses will be housed on the Qualtrics platform and responses will be returned in real-time.

o Survey responses will include the ability to filter by location, channel, date/time and customer service agent, as well as by any other data element/field shared with Qualtrics.

o Each user will be able to create custom dashboards within Qualtrics for the key metrics they’d like to see.

o The platform will allow customized workflows to notify MDOS individuals when a certain response score is achieved (or other conditions that come standard with the platform).

o The platform will provide machine learning tools to help group specific feedback and do basic analysis for staff.

o All data can be exported from the Qualtrics system for further analysis, if required.

ADDITIONAL SECURITY REQUIREMENTS:

o Qualtrics will provide its GovRAMP package to the State within two weeks of the State’s request. The State won’t request this package prior to July 1, 2025.

o For Hosted Services, Qualtrics will provide the Complementary User Entity Controls within two weeks of the State’s request.

o Qualtrics will maintain an annual, contiguous SOC 2 Type 2 report (separate from the Hosting Provider’s SOC report) that includes the American Institute of Certified Public Accountants (AICPA) five trust principles: security, availability, processing integrity, confidentiality, and privacy. Contractor will provide a copy of this report to the State within two weeks of the State’s request.

Version 2021-1 3 of 5

PRICING

Usage was determined by the following MDOS statistics:

o Completed appointments in branch offices (these are individual customers)

– 4,785,848 o Calls handled by agents (these are individual customers) – 859,059 o Completed transactions online (these are transactions, not customers;

some customers might complete multiple transactions) – 3,983,710 o Website visits – 44,857,181 (total users were 14,389,888, so each person in 2024 visited almost 3 times on average) o 4,785,848 In-person - Surveys will be facilitated via direct email and

SMS engagements within 20 minutes to 24 hours (depending on what is uncovered via project scoping - it is integrations dependent).

Non-response follow up messages result in higher engagement rates and can also be leveraged for this programming. Additionally, QR codes will be posted in branch locations for real-time feedback on site.

a. SMS Outreach Estimated Response Rate = ~12-20%

b. Email Outreach Estimated Response Rate = ~12-15%

c. QR Code Signage Estimated Response Rate = ~2-5% o 859,059 Calls - IVR Survey responses will be pulled into the Qualtrics platform for analysis.

a. Assuming ~3% response rate o 3,983,710 Online Transactions - Targeted site intercepts and standing feedback mechanisms will engage throughout site visits and upon completion of online transactions. Email and SMS triggers can be leveraged to distribute direct surveys to service recipients as well (provided contact information is collected in the process or already on file in an integrated system).

a. Site Links Estimated Response Rate = ~1% Anticipated Annual Responses for a Mature DesignXM Program is 450,000

Version 2021-1 4 of 5

Per Schedule B - Pricing

Subscription Based

- Product Name

Annual License Subscription Fee

(Minimum Requirements)*

Annual Tiered Pricing

(Cost by User)

Annual Enterprise Licensing – Unlimited Number of Users (Cost by Annual Interactions)

DesignXM $30,000 Annual Minimum for Newly Branded Licenses

$2,500/User Each User comes with 1,000 annual responses automatically (to be used across the license). Additional responses are sold in batches of 1,000. Pricing shall not exceed $1,680 per 1,000 additional responses. Final pricing to be determined by available discounts at the time.

MDOS Line-Item Pricing with Discounts

One Time Implementation Cost

Ongoing Annual Costs:

Users: 50

350,000 Additional Annual Responses (@$1.68/response)*

350,000 Additional Annual Responses (Discounted Rate)*

$45,250 $45,250 Year 1 $125,000.00 $588,000.00 $60,336.00 $185,336 Year 2 $125,000.00 $588,000.00 $60,336.00 $185,336 Year 3 $125,000.00 $588,000.00 $60,336.00 $185,336 Year 4 $125,000.00 $588,000.00 $60,336.00 $185,336 Year 5 $125,000.00 $588,000.00 $60,336.00 $185,336 Total: $971,930

• Users: 50

• Annual Responses: 400,000

• *Pricing included 700,000 annual SMS Credits: The conversion rate for 1 credit is 1.2 to

1.3 SMS messages. Additional SMS credits can be purchased in groups of 50,000 for $500. Any unused SMS credits roll over from one year to the next.

DELIVERABLES:

Deliverables won’t be considered complete until the Agency Program Manager and DTMB Program Manager has formally accepted them.

Version 2021-1 5 of 5

PROJECT CONTROL AND REPORTS:

A bi-weekly progress report must be submitted to the Agency Program Manager and the DTMB Program Manager throughout the life of this project. This report may be submitted with the billing invoice. Each bi-weekly progress report must contain the following:

1. Accomplishments: Indicate what was worked on and what was completed during the current reporting period.

2. Funds: Indicate the amount of funds expended during the current reporting period, and the cumulative total to date for the project.

PROJECT CONTACTS:

The designated Agency Program Manager is:

Shawn Starkey MDOS- Office of Continuous Improvement and Transformation (OCIT) Secondary Complex/Third Floor 7964 Crowner Drive Lansing, MI 48918 517-512-3204 StarkeyS@Michigan.gov

The designated DTMB Program Manager is:

Dan Klodt DTMB- Agency Services Austin Building/3rd Floor 430 West Allegan Street Lansing, MI 48918 517 930-6368 klodtd@michigan.gov

EXPECTED CONTRACTOR WORK HOURS AND CONDITIONS:

Work hours are not to exceed eight (8) hours a day, forty (40) hours a week. Normal working hours of 8:00 am to 5:00 pm are to be observed unless otherwise agreed to in writing.

No overtime will be permitted.

mailto:StarkeyS@Michigan.gov mailto:klodtd@michigan.gov

320 S Walnut Street Lansing, MI 48933

NOTICE OF CONTRACT

between

THE STATE OF MICHIGAN

and

333 River Park Dr.

Provo Utah 84604

Trey Hansen

5417888008 treyh@qualtrics.com

VS0012573

Qualtrics, LLC

C O

N

TR

A C

TO

R

517-648-4015

BrozanskiK@michigan.gov

Angela Wright

517-899-4646

DTMB

Kelli Brozanski MDE

WrightA33@michigan.gov

CONTRACT SUMMARY

DESCRIPTION: Surveying tools and corresponding analytics services

INITIAL EFFECTIVE DATE INITIAL EXPIRATION DATE EXPIRATION DATE BEFORE

CHANGE(S) NOTED BELOW

6/1/2025 5/31/2030 5 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

MINIMUM DELIVERY REQUIREMENTS

N/A

P-card Payment Request (PRC) Other Yes No

MISCELLANEOUS INFORMATION

THIS IS NOT AN ORDER. This Contract Agreement is awarded on the basis of the State’s inquiry bearing the Invitation to Negotiate #230000000014. Orders for Delivery will be issued directly by the Departments through the issuance of a Delivery Order (DOIT1).

ESTIMATED CONTRACT VALUE AT TIME OF EXECUTION $200,000.00

N/Anet 45

C on tra ct

Ad m in is tra to r Pr og ra m M an ag er

ST

A

TE

P.O. Box 30026, Lansing, MI 48909

NOTICE OF CONTRACT NO. 250000000825

INITIAL

AVAILABLE

OPTIONS

5/31/2030

FOR THE CONTRACTOR:

Company Name

Authorized Agent Signature

Authorized Agent (Print or Type)

Date

FOR THE STATE:

Signature

Name and Title

Agency

Date

CONTRACT NO. 250000000825

Revised 5/03/2016

SOFTWARE CONTRACT TERMS AND

CONDITIONS

These Terms and Conditions, together with all Schedules (including the Statement(s) of Work), Exhibits and any other applicable attachments or addenda (Collectively this “Contract”) are agreed to between the State of Michigan (the “State”) and Qualtrics LLC (“Contractor”), a Utah corporation. This Contract is effective on June 1, 2025 (“Effective Date”), and unless terminated, will expire on May 31, 2030 (the “Term”).

This Contract may be renewed for up to 5 additional 1-year period(s). Renewal is at the sole discretion of the State and will automatically extend the Term of this Contract. The State will document its exercise of renewal options via a Change Notice.]

1. Definitions. For the purposes of this Contract, the following terms have the following meanings:

“Acceptance” has the meaning set forth in Section 9.

“Acceptance Tests” means such tests as may be conducted in accordance with Section 9.1 and a Statement of Work to determine whether the Software meets the requirements of this Contract and the Documentation.

“Access” means (1) the ability and means to enter a restricted or locked area, room, or physical container containing State Data; or (2) the ability and means to communicate with or otherwise interact with a system, to use system resources to handle information, to gain the information or knowledge of the information the system contains, or to control system components and functions (including physical or technical controls, or having the ability to modify or bypass any or all security controls).

“Affiliate” of a Person means any other Person that directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with, such Person. For purposes of this definition, the term “control” (including the terms “controlled by” and “under common control with”) means the direct or indirect ownership of more than fifty percent (50%) of the voting securities of a Person.

“Allegedly Infringing Materials” has the meaning set forth in Section 17.2(b).

“Analyses” means the analyzation of information that may include Anonymized State Data.

“Anonymize” means the removal of all data, or combination of data, that could identify a user, a user device, or a user location in a manner such that the Anonymized data cannot be used to reidentify a user, a user device, or a user location through the inspection, correlation, analysis, or further processing of such data. Anonymized has a correlative meaning.

“Anonymized State Data” means State Data that has been Anonymized.

“Approved Third Party Components” means all third party components, including Open-Source Components, that are included in or used in connection with the Software and are specifically identified by Contractor in the Contractor’s Bid Response, in an applicable Statement of Work or elsewhere in this Contract, or as otherwise required by this Contract, including without limitation as part of the State’s Security Accreditation Process defined in Schedule E – Data Security Requirements.

“Authorized Users” means all Persons authorized by the State to access and use the Software under this Contract, subject to the maximum number of users specified in the applicable Statement of Work.

“Business Day” means a day other than a Saturday, Sunday or other day on which the State is authorized or required by law to be closed for business.

“Business Requirements Specification” means the initial specification setting forth the State’s business requirements regarding the features and functionality of the Software, as set forth in a Statement of Work.

“Change” has the meaning set forth in Section 2.2.

“Change Notice” has the meaning set forth in Section 2.2(b).

“Change Proposal” has the meaning set forth in Section 2.2(a).

“Change Request” has the meaning set forth in Section 2.2.

“Confidential Information” has the meaning set forth in Section 22.1.

“Configuration” means State-specific changes made to the Software without Source Code or structural data model changes occurring.

“Contract” has the meaning set forth in the preamble.

“Contract Administrator” is the individual appointed by each party to (a) administer the terms of this Contract, and (b) approve any Change Notices under this Contract.

Each party’s Contract Administrator will be identified in Schedule A or subsequent Change Notices.

“Contractor” has the meaning set forth in the preamble.

“Contractor’s Bid Response” means the Contractor’s proposal submitted in response to the invitation to negotiate.

“Contractor Hosted” means the Hosted Services are provided by Contractor or one or more of its Permitted Subcontractors.

“Contractor Personnel” means all employees of Contractor or any subcontractors or Permitted Subcontractors involved in the performance of Services hereunder.

“Contractor Project Manager” means the individual appointed by Contractor and identified in Schedule A or subsequent Change Notices to serve as the primary contact with regard to services, to monitor and coordinate the day-to-day activities of this Contract, and to perform other duties as may be further defined in this Contract, including an applicable…